This 2×2 factorial RCT (n=165) from JAMA tests whether corticosteroid injection, multimodal physiotherapy, or their combination improves outcomes in chronic lateral epicondylalgia compared with placebo injection over 1 year — directly addressing whether the common clinical practice of combining these treatments is justified.
When a patient with lateral epicondylalgia requests a cortisone shot, counsel them that the injection will likely provide meaningful short-term relief but carries a greater than 50% chance of recurrence and worse 1-year outcomes than no injection — physiotherapy or watchful waiting with activity modification is the better long-term strategy.
Combining the injection with physiotherapy does not rescue the poor long-term trajectory of corticosteroid.
This 2×2 factorial RCT (n=165) from JAMA tests whether corticosteroid injection, multimodal physiotherapy, or their combination improves outcomes in chronic lateral epicondylalgia compared with placebo injection over 1 year — directly addressing whether the common clinical practice of combining these treatments is justified.
When a patient with lateral epicondylalgia requests a cortisone shot, counsel them that the injection will likely provide meaningful short-term relief but carries a greater than 50% chance of recurrence and worse 1-year outcomes than no injection — physiotherapy or watchful waiting with activity modification is the better long-term strategy.
Combining the injection with physiotherapy does not rescue the poor long-term trajectory of corticosteroid.