Dr. (Col.) Vishal Marwaha, Dr. George Mathews John, Dr. Bindu. S, Dr. Anoop. R, Dr. Anuj Singhal, Dr. Abhishek Kumar, Dr. Koneru Prathyusha, Dr. Mithun Mathew Thomas, Ms. Joanna Jiji Varghese, Dr. Mithun C.B



Lateral epicondylitis (Tennis elbow) is a common cause of elbow pain, and originates in the lateral epicondyle of humerus. Conservative management in the form of rest, non-steroidal anti-inflammatory drugs, bracing and physiotherapy comprise the mainstay of therapy. There are not many studies evaluating efficacy of combined steroid and local anaesthetic injection for treating recalcitrant cases.

Aim: To evaluate effect of combined steroid and lignocaine injection at lateral epicondyle humerus in recalcitrant cases of lateral epicondylitis.


A prospective, multi-centre interventional study was conducted at tertiary care teaching hospitals at Kolkata, Mumbai and Kochi, respectively over 12 months. Patients with lateral epicondylitis refractory to conventional conservative treatment methods (physiotherapy, ultrasound therapy etc.) for more than 6 weeks and presenting with pain measuring 4 or more on the visual analogue scale (VAS) were enrolled. They were infiltrated with methyl prednisolone and lignocaine at the origin of extensor carpi radialis brevis muscle (lateral epicondyle humerus). Purpose of study was to observe change in VAS at day 7 and day 28 post-injection respectively. Improvement was classified as good, moderate or mild based on reduction in VAS score compared to the baseline by 3 or more, 2 and 1 respectively. Wilcoxon signed rank test was used for comparing data before and after injection.


Total of 49 patients with a mean age of 41.78 ± 1.73 years were enrolled. After week one, 40 out of 49 patients showed good improvement, while moderate and mild improvement was seen in 2 patients each. The progress was sustained for up to 28 days in all these patients. In five patients there was no improvement.

Conclusion: Combined steroid and lignocaine injection is a safe and effective modality of treatment for resistant cases of lateral epicondylitis when compared to steroid injection alone. This may prove to be a very promising modality, especially in limited resource regions where complex treatment options are not be available.


Lateral epicondylitis, Recalcitrant, Visual analogue scale.

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