ORTHOPAEDIC SURGERY The effects of corticosteroid injection versus local anesthetic injection in the treatment of lateral epicondylitis: a randomized single-blinded clinical trial Mohsen Mardani-Kivi • Mahmoud Karimi-Mobarakeh • Ali Karimi • Niloofar Akhoondzadeh • Khashayar Saheb-Ekhtiari • Keyvan Hashemi-Motlagh • Farzaneh Bahrami Received: 12 January 2013 / Published online: 15 March 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract Introduction This study seeks to compare two treatment methods of lateral epicondylitis: corticosteroid injection (CSI) and a local anesthetic injection (LAI). Materials and methods In this single-blinded randomized clinical trial, 138 patients with the diagnosis of lateral epicondylitis were assigned either into CSI group receiving methylprednisolone 1 ml (49 patients) or LAI group (51 patients) receiving procaine 1 ml 2 % in a single dose at the maximal point tenderness site. The primary outcome measure was elbow disability using Quick DASH, and secondary outcome measures were pain intensity using Visual Analogue Scale (VAS) and recurrence rate at pre- treatment visit and at 3-, 6- and 12-week post-treatment visits. Results There were no significant differences between the patients in both groups for demographic factors including age, gender, dominant hand, involved hand, and work pressure. Before treatment, the patients in both groups were suffering from the same rates of elbow disability and pain as measured by Quick DASH and VAS, respectively, (p [ 0.05). In general, the recovery rate (comparison between pretreatment visit and last post-treatment visit) was significantly more effective and higher in CSI than LAI. CSI was dramatically more effective at 3-week visit, but less and less effective at 6- and 12-week visits. At 12-week visit the recurrence rate was 34.7 % (17 patients) in CSI group. Conclusion For lateral epicondylitis, CSI has the best short-term treatment results yet the highest recurrent rates. The combination of CSI with other treatment option or with a change in injection technique from single injection to peppering injection may be promising. Keywords Tennis elbow Á Lateral epicondylitis Á Intra- lesional injection Á Corticosteroids Á Local anesthetic Á Visual analogue scale Á Treatment outcome Introduction Lateral epicondylitis is a common disorder characterized by the lateral elbow pain and tenderness. Despite the general belief, relatively few proportions of patients (5 %) develop epicondylitis for playing with rackets such as tennis [1–3]. The incidence of epicondylitis is 1–4 % in general population and 15 % in high risk industrial workers [4, 5]. Epicondylitis generally occurs among adults over 40, with the pick incidence between 35 and 55 years of age, involving men and women equally. The patient’s M. Mardani-Kivi Á A. Karimi Á N. Akhoondzadeh (&) Á K. Saheb-Ekhtiari Á K. Hashemi-Motlagh Á F. Bahrami Orthopedic Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, P.O. Box: 4193713191, Rasht, Iran e-mail: orthop_md@yahoo.com M. Mardani-Kivi e-mail: dr_mohsen_mardani@yahoo.com K. Saheb-Ekhtiari e-mail: emprature@yahoo.com K. Hashemi-Motlagh e-mail: k1_1981@yahoo.com F. Bahrami e-mail: bahramy.f@gmail.com M. Karimi-Mobarakeh Orthopedic Department, Kerman University of Medical Sciences, Kerman, Iran e-mail: dr_mk.mobarakeh@yahoo.com 123 Arch Orthop Trauma Surg (2013) 133:757–763 DOI 10.1007/s00402-013-1721-x