Several methods of treatment have been suggested to be effective in the treatment of lateral epicondylalgia (tennis elbow). In previous studies we have evaluated the pain alleviating effect of acupuncture, low energy laser and pulsed ultrasound in patients suffering from lateral epicondylalgia. In this study the pain-alleviating effect of elbow-band, splintage and local steroid injections, employed separately, was studied. Sixty-one patients were consecutively assigned at random to one off three groups. The patients in the elbow-band group and in the splintage group were instructed to use the support daily during activity for 3 months. In the steroid group the patients were given an injection of bupivacaine hydrochloride (Marcaine) 0.3 ml and triamcinolone acetonide, 10 mg/ml (Kenacort) 0.2 ml into the area of maximal tenderness at the lateral epicondyle. Follow-up, including subjective and objective outcome, was done at the clinic after 2 weeks, 3, 6 and 12 months. In subjective as well as objective outcome a significant difference between the groups, favouring the steroid injections, was observed after 2 weeks: p < 0.001 and p < 0.05, respectively. After 3 months there was no significant difference between the three treatment groups. Furthermore, after 6 months, 42 percent of the patients in the steroid group had a recurrence, and 36 percent in the elbow band group and 38 percent in the splint group withdrew because of persisting pain. In conclusion, despite the high incidence of recurrence and the clinical side-effects reported after local steroid injection (tendon atrophy and tendon dissolution), steroid injection might be the treatment of choice in very severe cases to achieve rapid relief of pain. However, steroid injection is no more effective than elbow-band or splintage in the long-term treatment of lateral epicondylalgia.

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