Comparative effectiveness of laser, PRP, splinting, and ESWT versus corticosteroid injection in lateral epicondylitis: a randomized controlled trial.

BACKGROUND

Lateral epicondylitis is one of the most common musculoskeletal disorders of the upper extremity, characterized by lateral elbow pain and functional disability. Despite the wide range of available treatments, the comparative effectiveness of invasive and non-invasive interventions remains controversial.

OBJECTIVE

To compare the short-term clinical effectiveness of low-level laser therapy (LLLT), platelet-rich plasma (PRP) injection, splinting, and extracorporeal shock wave therapy (ESWT) with corticosteroid (CS) injection in patients with lateral epicondylitis.

METHODS

In this prospective, single-blind, randomized controlled trial, 98 patients with clinically diagnosed lateral epicondylitis were randomly assigned to five treatment groups: LLLT, PRP, splinting, ESWT, and CS injection. Clinical outcomes were assessed using the Numeric Rating Scale (NRS), Patient-Rated Tennis Elbow Evaluation (PRTEE), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and hand-grip strength (HGS). Assessments were performed at baseline, 1 month, and 3 months after treatment.

RESULTS

All treatment groups demonstrated significant improvements in pain and function at 1 and 3 months (p < 0.05). HGS improved in all groups except PRP, where no significant gain was observed. No statistically significant differences were found between the groups across outcome measures.

CONCLUSION

Conservative and injection-based modalities provided clinically meaningful short-term improvements in patients with lateral epicondylitis. While CS injection produced rapid analgesic effects, non-invasive interventions such as LLLT, splinting, and ESWT achieved comparable functional benefits without the risks of invasive therapy. Although PRP improved pain and functional scores, its limited effect on HGS suggests that it may be best considered as a supportive option in selected patients.