This RCT enrolled 185 primary-care patients with lateral epicondylitis of at least 6 weeks' duration. It compared 6 weeks of corticosteroid injection, structured physiotherapy, or a wait-and-see policy. Outcomes were tracked at 3, 6, 12, 26, and 52 weeks to determine which approach works best and over what timeframe.
Corticosteroid injection was the reflex first-line treatment for lateral epicondylitis for years — it works fast, patients leave satisfied, and the visit looks productive. This trial established that fast is not the same as durable.
When a patient wants quick relief, injection is defensible. Counsel them explicitly: recurrence is likely, 63% will need additional treatment within a year, and long-term outcomes are worse than with physiotherapy or even watchful waiting.
If the patient can tolerate a slower recovery, physiotherapy achieves the best one-year outcome at 91% success. For patients who cannot access physiotherapy or prefer to avoid active treatment, structured ergonomic advice plus analgesics as needed is evidence-supported and yields 83% success at one year.
The narrow, non-significant gap between physiotherapy and wait-and-see (5-10%) means patient preference and resource availability should drive that choice. Not an assumption that physiotherapy is always worth the cost.
This RCT enrolled 185 primary-care patients with lateral epicondylitis of at least 6 weeks' duration. It compared 6 weeks of corticosteroid injection, structured physiotherapy, or a wait-and-see policy. Outcomes were tracked at 3, 6, 12, 26, and 52 weeks to determine which approach works best and over what timeframe.
Corticosteroid injection was the reflex first-line treatment for lateral epicondylitis for years — it works fast, patients leave satisfied, and the visit looks productive. This trial established that fast is not the same as durable.
When a patient wants quick relief, injection is defensible. Counsel them explicitly: recurrence is likely, 63% will need additional treatment within a year, and long-term outcomes are worse than with physiotherapy or even watchful waiting.
If the patient can tolerate a slower recovery, physiotherapy achieves the best one-year outcome at 91% success. For patients who cannot access physiotherapy or prefer to avoid active treatment, structured ergonomic advice plus analgesics as needed is evidence-supported and yields 83% success at one year.
The narrow, non-significant gap between physiotherapy and wait-and-see (5-10%) means patient preference and resource availability should drive that choice. Not an assumption that physiotherapy is always worth the cost.