Therapeutic Corticosteroid Injection
Original Editor - Maëlle Cormond
Corticosteroids in the treatment of lateral epicondylitis
Expert opinion is already turning away from corticosteroids for tennis elbow in response to mounting evidence that the injections don’t work for long and encourage recurrences. 
In a study from Brooke K et al. corticosteroid injection resulted in lower complete recovery or much improvement at 1 year vs placebo injection and greater 1-year recurrence. Among patients with chronic unilateral lateral epicondylalgia, the use of corticosteroid injection vs placebo injection resulted in worse clinical outcomes after 1 year, and physiotherapy did not result in any significant differences. 
Krogh TP et al declare that neither injection of PRP nor glucocorticoid was superior to saline with regard to pain reduction in LE at the primary end point at 3 months. However, injection of glucocorticoid had a short-term pain-reducing effect at 1 month in contrast to the other therapies. Injection of glucocorticoid in LE reduces both color Doppler activity and tendon thickness compared with PRP and saline. 
Other articles refer to different kind of methods of injections.
Okçu G et al found that long-term clinical success in the treatment of lateral epicondylitis depends on the injection method. The peppering technique appears to be more effective than the single injection technique in the long-term. Group 1 received a single injection of 1 ml betamethasone and 1 ml prilocaine on the lateral epicondyle at the point of maximum tenderness. Group 2 patients received an injection of the same drug mixture. Following the initial injection, the needle tip was redirected and reinserted down the bone approximately 30 to 40 times without emerging from the skin, creating a hematoma. 
Stefanou A et al. compares corticosteroid injection to corticosteroid iontophoresis for lateral epicondylitis. It accurse that the corticosteroid iontophoresis is a better treatment for lateral epicondylitis that the corticosteroid injections. The iontophoresis patients had statistically significant improvement in grip strength at the conclusion of hand therapy compared with baseline. They were also more likely to get back to work without restriction. By 6-month follow-up, all groups had equivalent results for all measured outcomes. Dexamethasone via iontophoresis produced short-term benefits because for this group grip strength and unrestricted return to work were significantly better. This study suggests that this iontophoresis technique for delivery of corticosteroid may be considered a treatment option for patients with lateral epicondylitis. 
In a study from Nilsson P et al. the intervention group had less pain than patients treated with corticosteroid injections (p < 0.0001) or NSAIDs (p = 0.048) and experienced better function than those treated with corticosteroid injections (p = 0.002). The intervention group had a lower recurrence (p < 0.0001) and fewer sick leave days at the time of the visit to the health care centre (p = 0.005). 
We can decide that the most articles are not very promising about the corticoid injections. Other treatments may have better results. Most studies found good results in short term (pain release), however corticoid injections seem not to be effective in long term.
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- Coombes B.K. et al. Effect of Corticosteroid Injection, Physiotherapy, or Both on Clinical Outcomes in Patients With Unilateral Lateral Epicondylalgia, A Randomized Controlled Trial, 2013, JAMA. Level of evidence: 1b
- Krogh TP et al. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial,2013, Diagnostic Centre, Region Hospital Silkeborg, Silkeborg, Denmark. Level of evidence: 1b
- Okçu G et al. Evaluation of injection techniques in the treatment of lateral epicondylitis: a prospective randomized clinical trial, 2012, Department of Orthopedics and Traumatology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey. Level of evidence: 1b
- Stefanou A et al., A randomized study comparing corticosteroid injection to corticosteroid iontophoresis for lateral epicondylitis, 2012, Department of Surgery, Henry Ford Hospital, Detroit, MI 48202, USA. Level of evidence: 2b
- Nilsson Pet al., Lateral epicondylalgia: a structured programme better than corticosteroids and NSAID,2012 ,Tandemkliniken, Tvååker Primary Health Care Centre, Varberg, Sweden. Level of evidence: 1b