Trends in Corticosteroid Injections for Treatment of Lateral Epicondylitis: An Analysis of 80,169 Patients

Introduction: Corticosteroid (CS) injections are a frequently used treatment modality for lateral epicondylitis (LE) despite an increasing number of studies suggesting their lack of efficacy. The objective of this study was to review the annual utilization of CS injections for treatment of LE, as well as that of other nonsurgical treatments and surgical treatments, to understand how recent publications have affected the practice of physicians in treating LE. Methods: Patients with LE from 2010 to 2017 were identified within a national insurance database and grouped by treatment modalities of CS injections, physical therapy, bracing treatment, and surgery. Epidemiologic and demographic data were reported using descriptive statistics. The number of patients receiving each treatment and the number of CS injections per patient were quantified for each year, and annual trends were analyzed using logistic regression. Results: Among 80,169 qualifying patients, 16,476 received CS injections, 12,180 received physical therapy, 1,874 received bracing treatment, and 2,650 underwent surgery, with patients receiving multiple modalities being members of each respective group. We found a significant decrease in the proportion of patients with LE receiving CS injections from 23.3% in 2010 to 18.8% in 2017 (R-2 = 0.956, P < 0.001). Interestingly, the number of CS injections per patient increased during this period from 1.33 to 1.83 (R-2 = 0.843, P = 0.001). No notable changes in utilization trends for other modalities were found. Discussion: Overall, our data support a decline in the use of CS injection as a treatment modality for LE from 2010 to 2017. Although correlational, this trend may reflect the increasing body of published evidence demonstrating the ineffectiveness of CS injections for the treatment of LE. In addition, the increasing number of injections per patient among those who received injections contrasts with the overall decrease in steroid utilization among all patients. Further study is needed to fully understand the mechanisms behind these trends.