EVIDENCE-BASED REVIEWS & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: HYALURONIC ACID INFILTRATION FOR ELBOW EPICONDYLITIS IN ADULTS.

INTRODUCTION

Elbow epicondylitis is a common tendinopathy in adults, and infiltration is frequently used when initial conservative treatment fails. Hyaluronic acid and corticosteroids are among the most widely used injectable agents, but their comparative effectiveness remains uncertain.

METHODS

We performed an evidence-based review of randomized controlled trials and systematic reviews comparing hyaluronic acid with corticosteroid injections for adult elbow epicondylitis. PubMed, Embase, the Cochrane Library, and BVS were searched through August 2025. Main outcomes were pain and elbow function; risk of bias and certainty of evidence were assessed using Cochrane and GRADE approaches.

RESULTS

Of 94 records, three studies met the eligibility criteria (one systematic review and two randomized trials), all focused on lateral epicondylitis. Very low-quality evidence suggests that hyaluronic acid provides greater improvement in pain and function than corticosteroids from 8 weeks to 6 months in acute cases, whereas in chronic lateral epicondylitis, corticosteroid injections appear more effective than hyaluronic acid for pain relief and functional recovery up to 6 weeks.

CONCLUSIONS

Current evidence, though very limited and at high risk of bias, supports preferential use of corticosteroids for short-term symptom control and hyaluronic acid for medium- to long-term pain and functional improvement in adult lateral epicondylitis. Level of evidence II; Systematic review.