91 Malaysian Orthopaedic Journal 2022 Vol 16 No 1 Prakash YR, et al ABSTRACT Introduction: Lateral epicondylitis is a common condition causing severe incapacitating pain. Several methods of treatment have been approached for its management. In our study we aim to compare the results of injecting steroid and lignocaine mixture via single injection and peppered injection technique and analyse the outcome in each category. Materials and methods: A prospective randomised study comprising of 25 patients in each group (single vs peppered group) were included in the study after satisfying inclusion and exclusion criteria. Outcome of the treatment was measured in the form of Patient Related Tennis Elbow Evaluation (PRTEE) Questionnaire, Visual analogue score (VAS) and tenderness grading at two weeks, six weeks and six months after injection. Results: Results of our study showed that the mean PRTEE score was 22.36, 18.40 and 14.16 at 2 weeks, 6 weeks and 6 months following peppered injection as compared to 28.96, 21.84 and 25.32 in the single injection group (p value <0.05). VAS score at 2 weeks, 6 weeks and 6 months after the peppered injection was found to be 2.72, 1.72 and 1.36 and in the single injection group was 2.96, 1.92 and 2.72 at 2weeks, 6 weeks and 6 months, respectively (p value <0.05). On comparison of the 2 groups, there was a significant reduction of VAS scores at 6 months post-injection (p value <0.05) and PRTEE score at 6 weeks, 6 months in peppered injection group. Conclusion: The effects of peppered injection technique is seen to be advantageous over the single injection technique in the management of chronic lateral epicondylitis. Keywords: single injection technique, peppered injection technique, PRTEE, lateral epicondylitis INTRODUCTION Lateral epicondylitis is a chronic condition characterised by pain at the common extensor origin over the lateral aspect of the elbow region. It was first described by Runge in the year 1873 1 , as commonly affecting women in their 5th and 6th decade. Although it may not necessarily be associated with playing tennis, it is seen in persons who perform repetitious movements involving the forearm, with elbow in extension 2 ; like carpenters, musicians, or computer programmers. Prevalence of this condition is approximately 1-3% in general population 3-5 . Tennis elbow is usually regarded as a minor ailment, but it causes a nagging pain in the elbow region interfering with the day-to-day activities of the affected individuals, and in some instances, may flare up severely needing immediate intervention. Mechanical overload and repetitive stress leads to tendinosis and microtrauma at the extensor carpi radialis brevis muscle origin. This gradually progresses to a partial injury, which may lead to a full thickness tendon tear in untreated individuals 6 . There are several treatment options available for lateral epicondylitis, conservative treatment in the form of oral analgesics and anti-inflammatory drugs, physiotherapy, application of tennis elbow braces and interventional procedures like intralesional injection of steroids, platelet rich plasma injection and arthroscopic or open surgery 7-8 . Intralesional injection of steroids have been in use in the treatment of tennis elbow since 1950 9 . Steroid injections relieve pain, reduce inflammation and improve mobility 10 . The significant reduction in pain provided by local steroid injection is however short lived and is seen to last for only about six weeks, but they have been found to be superior to oral analgesics and inflammatory drugs 11 . In a systematic review of randomised controlled trials conducted by Smidt et Peppering versus Single Injection Technique in Tennis Elbow - A Prospective Comparative Study Prakash YR 1 , MS Orth, Dhanda A 1 , MS Orth, Yallapur KL 2 , MS Orth, Inamdar SS 1 , MS Orth, Darshan GT 1 , MS Orth, Ramakrishna M 1 , MS Orth 1 Department of Orthopaedics, Bangalore Medical College and Research Institute, Bangalore, India 2 Department of Orthopaedics, Vijayanagar Institute of Medical Sciences, Ballari, India This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited Date of submission: 21st May 2021 Date of acceptance: 14th December 2021 Corresponding Author: Sohail Saifuddin Inamdar, Department of Orthopaedics, Bangalore Medical College and Research Institute (formerly Bangalore Medical College), Fort, Krishna Rajendra Rd, Bengaluru, Karnataka 560002, India Email: sohailinamdar02@gmail.com doi: https://doi.org/10.5704/MOJ.2203.013