Resarch lateral elbow pain: dexamethasone versus placebo

The injection of dexamethasone versus placebo for lateral elbow pain: a prospective, double-blind, randomized clinical trial.

PURPOSE: We tested the hypothesis that there is no difference in disability, pain, grip strength, and 1 and 6 months after injection of corticosteroids and lidocaine compared with lidocaine injection alone (placebo).

METHODS: Sixty-four patients were randomized to dexamethasone (n = 31) or placebo (n = 33) injection. At enrollment, disability (disability of arm, shoulder and hand [DASH] questionnaire), pain on a visual analogue scale, grip strength, depression (the Center for Epidemiologic Studies Depression Scale; CESD), and the ineffectiveness of skills (Pain Catastrophizing Scale; PCS) were comparable between treatment groups. At 1 and 6 months, DASH, pain, grip strength and repeated measures. Univariate and multivariate analysis were used to determine predictors of disability. Analysis was by intention to treat.

RESULTS: One month after injection, an average DASH score of 24 versus 27 points (dexamethasone versus placebo), pain 3.7 versus 4.3 cm, and the grip strength of 83% compared with 87 %. At 6 months, an average DASH score of 18 points versus 13, pain 1.7 versus 2.4 cm, and the grip strength of 98% compared to 97%. PCS CESD and results correlated with disability, as measured by the DASH questionnaire. The best multivariate model including CESD PCS at 1 month and 6 months for the results and explained that most of the variability in DASH scores.

CONCLUSIONS: Injection of corticosteroids did not affect the apparently self-limited course of lateral elbow pain. In the secondary analysis in a subgroup of patients, the perception of disability associated with lateral elbow pain correlated with depression and ineffectiveness of skills.