Perceived Pain Severity and Disability After the Recurrence of Tennis Elbow Following a Local Corticosteroid Injection

Document Type : RESEARCH PAPER

Authors

1 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 1 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 2 Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran

3 Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran

4 Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, USA

Abstract

Background: We hypothesized that there is no difference in the perceived pain and disability when the tennis elbow 
symptoms recur after a CSI. Consequently, we secondarily aimed to assess the approximate time from CSI until 
symptom recurrence. Moreover, we aimed to evaluate factors associated with the time to recurrence.
Methods: This cross-sectional study was performed during 2018-2019. We enrolled 50 consecutive patients who 
presented with the recurrence of tennis elbow symptoms and had a history of a single CSI for this condition. We asked 
the patients to rate the perceived pain and disability by filling the QuickDASH twice, including one by recalling pain and 
function before the CSI and one for the recent recurrent symptoms to assess the patient’s perceived pain and disability 
at the two-time points. 
Results: There was a significant difference in perceived pain VAS and disability QuickDASH between pre-injection and 
recurrence, showing that the patient’s perceived pain and disability were greater when recurred (P<0.001). The mean 
time between CSI and recurrence of symptoms was 6 (4-7) months, which is shorter than the expected spontaneous 
resolution of tennis elbow (> 1 year) to offer other invasive treatments. Time to recurrence had no significant association 
with sex, age, side, education, occupation, pre-injection VAS score, pre-injection QuickDASH, or symptom duration 
using a linear regression model.
Conclusion: Although CSI seems to relieve or mask the pain in the short term, there is a considerable chance of 
recurrence, and patients may perceive more significant pain and disability that may lead to subsequent injection or 
precocious surgery. Time is an effective treatment for this illness. Shared decision-making is paramount, and patients 
have to be counseled regarding the natural history and expected prognosis of different treatments. 
Level of evidence: IV

Keywords

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The Archives of Bone and Joint Surgery
Volume 10, Issue 9
September 2022
Pages 760-765

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History

  • Receive Date: 20 April 2021
  • Revise Date: 05 June 2021
  • Accept Date: 08 June 2021

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