Injection of dexamethasone versus placebo for lateral elbow pain: A prospective, double-blind, randomized clinical trial

被引:78
作者
Lindenhovius, Anneluuk
Henket, Marjolijn
Gilligan, Brendan P.
Lozano-Calderon, Santiago
Jupiter, Jesse B.
Ring, David [1 ]
机构
[1] Massachusetts Gen Hosp, Orthopaed Hand & Upper Extrem Serv, Boston, MA 02114 USA
来源
JOURNAL OF HAND SURGERY-AMERICAN VOLUME | 2008年 / 33A卷 / 06期
关键词
depression; dexamethasone; injection; lateral elbow pain; placebo;
D O I
10.1016/j.jhsa.2008.02.004
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Purpose We tested the hypthesis that there is no difference in disability, pain, and grip strength 1 and 6 months after corticosteroid and lidocaine injection compared with lidocaine injection alone (placebo) Methods Sixty-four patients were randomly assigned to dexamethasone (n = 3 1) or placebo (n = 33) injection. At enrollment, disability (Disabilities of the Arm, Shoulder, and Hand [DASH] questionnaire), pain on a visual analog scale, grip strength, depression (the Center for Epidemiologic Studies Depression Scale; CESD), and ineffective coping skills (the Pain Catastrophizing Scale; PCS) were comparable between treatment groups. At I and 6 months, DASH, pain, and grip strength measures were repeated. Univariate and multivariate analyses were used to determine predictors of disability. Analysis was by intention to treat. Results One month after injection, DASH scores averaged 24 versus 27 points (dexamethasone vs placebo), pain 3.7 versus 4.3 cm, and grip strength 83% versus 87%. At 6 months, DASH scores averaged 18 versus 13 points, pain 2.4 versus 1.7 cm, and grip strength 98% versus 97%. CESD and PCS scores correlated with disability as measured by the DASH questionnaire. The best multivariate models included CESD at I month and PCS scores at 6 months and explained the majority of variability in DASH scores. Conclusions Corticosteroid injection did not affect the apparently self-limited course of lateral elbow pain. In secondary analyses in a subset of patients, perceived disability associated with lateral elbow pain correlated with depression and ineffective coping skills.
引用
收藏
页码:909 / 919
页数:11
相关论文
共 50 条
[1]   In vivo investigation of ECRB tendons with microdialysis technique - no signs of inflammation but high amounts of glutamate in tennis elbow [J].
Alfredson, H ;
Ljung, BO ;
Thorsen, K ;
Lorentzon, R .
ACTA ORTHOPAEDICA SCANDINAVICA, 2000, 71 (05) :475-479
[2]  
Altay T, 2002, CLIN ORTHOP RELAT R, P127
[3]  
[Anonymous], 2002, COCHRANE DB SYST REV
[4]  
[Anonymous], CONSORT STAT
[5]   Evaluating and managing acute low back pain in the primary care setting [J].
Atlas, SJ ;
Deyo, RA .
JOURNAL OF GENERAL INTERNAL MEDICINE, 2001, 16 (02) :120-131
[6]   SOMATIZATION AND MEDICALIZATION IN THE ERA OF MANAGED CARE [J].
BARSKY, AJ ;
BORUS, JF .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1995, 274 (24) :1931-1934
[7]   Where tendons and ligaments meet bone: attachment sites ('entheses') in relation to exercise and/or mechanical load [J].
Benjamin, M ;
Toumi, H ;
Ralphs, JR ;
Bydder, G ;
Best, TM ;
Milz, S .
JOURNAL OF ANATOMY, 2006, 208 (04) :471-490
[8]   Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial [J].
Bisset, Leanne ;
Beller, Elaine ;
Jull, Gwendolen ;
Brooks, Peter ;
Darnell, Ross ;
Vicenzino, Bill .
BMJ-BRITISH MEDICAL JOURNAL, 2006, 333 (7575) :939-941
[9]  
BOYD JH, 1982, ARCH GEN PSYCHIAT, V39, P1195
[10]   Lateral tennis elbow: "Is there any science out there?" [J].
Boyer, MI ;
Hastings, H .
JOURNAL OF SHOULDER AND ELBOW SURGERY, 1999, 8 (05) :481-491