Comparison of the Effects of Hyaluronate versus Corticosteroid Injections in the Treatment of Lateral Epicondylitis

Abstract

ateral epicondylitis (LE) is a non-inflammatory degenerative disease of the common extensor origin due to an overload repetitive microtrauma resulting in a process of immature reparative response and delayed tendon healing. Lateral epicondylitis is characterized by "angiofibroblastic hyperplasia" or non-inflammatory degeneration of Extensor Carpi Radialis Brevis (ECRB) or common extensor tendon together with cellular apoptosis, therefore the term "tendinosis" has been recently adopted instead of the term "tendinitis. Diagnosis of LE is mainly clinical. Clinical picture include lateral elbow pain that is aggravated by activities involving wrist extension and gripping. Examination reveals tenderness at the lateral epicondyle together with pain on resisted wrist extension. Provocative tests can be of value in diagnosing LE, The standard provocative tests for LE are: Cozen’s, Mill’s and Maudsley’s tests. It is very important to exclude conditions that may mimic LE before starting the plan of management such as cervical radiculopathy, osteochondritis dissecans and intra-articular foreign body. There is a wide spectrum of treatment modalities such as rest, activity modification, stretching exercises, using of counterforce brace, NSAID, steroid injections, botulinum