Lindenhovius Anneluuk, Henket Marjolijn, Gilligan Brendan P, Lozano-Calderon Santiago, Jupiter Jesse B, Ring David
Harvard Medical School, Boston, MA, USA.
J Hand Surg Am. 2008 Jul-Aug;33(6):909-19. doi: 10.1016/j.jhsa.2008.02.004.
We tested the hypothesis 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).
Sixty-four patients were randomly assigned to dexamethasone (n = 31) 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 1 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.
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 1 month and PCS scores at 6 months and explained the majority of variability in DASH scores.
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.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
我们检验了这样一个假设，即与单独注射利多卡因（安慰剂）相比，注射皮质类固醇和利多卡因1个月及6个月后，在残疾、疼痛和握力方面没有差异。
64例患者被随机分配接受地塞米松注射（n = 31）或安慰剂注射（n = 33）。在入组时，治疗组之间在残疾程度（手臂、肩部和手部残疾[DASH]问卷）、视觉模拟量表上的疼痛程度、握力、抑郁程度（流行病学研究中心抑郁量表；CESD）以及无效应对技巧（疼痛灾难化量表；PCS）方面具有可比性。在1个月和6个月时，重复进行DASH、疼痛和握力测量。采用单因素和多因素分析来确定残疾的预测因素。分析采用意向性治疗。
注射后1个月，DASH评分平均为24分对27分（地塞米松对安慰剂），疼痛为3.7厘米对4.3厘米，握力为83%对87%。在6个月时，DASH评分平均为18分对13分，疼痛为2.4厘米对1.7厘米，握力为98%对97%。CESD和PCS评分与DASH问卷测量的残疾程度相关。最佳多因素模型包括1个月时的CESD和6个月时的PCS评分，并解释了DASH评分中的大部分变异性。
皮质类固醇注射并未影响外侧肘部疼痛明显的自限病程。在一部分患者的二次分析中，与外侧肘部疼痛相关的感知残疾与抑郁和无效应对技巧相关。
研究类型/证据水平：治疗性I级。
