***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background To determine the effectiveness of three different local injection modalities in the treatment of lateral epicondilitis . Methods In a prospect i ve r and omized study on lateral epicondilitis , 75 patients were divided into three equal groups A , B and C ( n = 25 ) and were treated using three different method of local injection . The patients in group A were treated with local injection of a steroid ( 1 mL triamcinolone ) combined with local anaesthetic ( 1 mL lidocaine ) , those in group B were treated with injection of local anaesthetic ( 1 mL lidocaine ) combined with peppering technique and those in group C with local injection of a steroid ( 1 mL triamcinolone ) combined with local anaesthetic ( 1 mL lidocaine ) and peppering technique . The outcome was defined by measuring the elbow pain during the activity using a 10-cm visual analogue scale ( VAS ) and satisfaction with the treatment using a scoring system based on the criteria of the Verhaar et al. at 3 weeks and 6 months after the injection and compared with the pre-treatment condition . Results There were significant ( P = 0.006 ) differences in the successful outcomes between the three groups at 6 months . In group C in which local steroid + peppering injection technique were used ; excellent results were obtained in 84 % of patients comparing to 36 % and 48 % for patients in groups A and B , respectively . The successful outcomes were statistically higher in group C comparing to group A ( P = 0.002 ) and group B ( P = 0.011 ) . In all groups , there was a significantly lower pain ( VAS ) at the 3-week and 6-month follow-ups comparing to the pre-treatment condition . VAS measured at 6-month follow-up were significantly lower in group C comparing to other groups ( P = 0.002 ) . Conclusion In the treatment of lateral epicondilitis , combination of corticosteroid injections with peppering is more effective than corticosteroid injections or peppering injections alone and produces better clinical results Background The aim of this prospect i ve r and omized clinical trial was to investigate the efficacy of a home-based program of isometric strengthening exercises for the treatment of the lateral epicondylitis ( LE ) of the distal humerus . We hypothesized that 1 ) use of isometric strengthening exercises would result in clinical benefits similar to those provided by medication and pain relief and 2 ) functional improvements after exercise would be time-dependent . Methods Patients were assigned to one of two groups : 1 ) an immediate physical therapy group ( group I ) , or 2 ) a delayed physical therapy group ( group D ) . Group I patients ( n = 16 ) were instructed how to do the exercises at their first clinic visit and immediately carried out the exercise program . Group D patients ( n = 15 ) learned and did the exercises after being on medications for 4 weeks . Results Outcomes at the 1-month clinic visit indicated that pain ( measured using a visual analogue scale [ VAS ] ) had been significantly reduced in group I compared to group D ( p < 0.01 ) . However , significant differences between groups were not found at 3- , 6- , and 12-month follow-up for either VAS scores or Mayo elbow performance scores . For modified Nirschl/Pettrone scores , a significant difference between groups was found only at the 1-month follow-up visit . By then , the number of participants who returned to all activities with no pain or occasional mild pain was six ( 37 % ) in Group I and two ( 13 % ) in Group D ( p = 0.031 ) . At the final follow-up visit , 88 % of all participants performed physical activities without pain . Conclusions Isometric strengthening exercises done early in the course of LE ( within 4 weeks ) provides a clinical ly significant improvement & NA ; Forty‐nine patients suffering from lateral humeral epicondylalgia were enrolled in a double‐blind study to observe the effects of Ga‐As laser applied to acupuncture points . The Mid 1500 IRRADIA laser machine was used , wavelength : 904 nm , mean power output : 12 mW , peak value : 8.3 W ; frequency : 70 Hz ( pulse train ) . Localization of points : LI 10 , 11 , 12 , Lu 5 and SJ 5 . Each point was treated for 30 sec result ing in a dose of treatment of 0.36 J/point . The patients were treated 2–3 times weekly with 10 treatments in all . Follow‐ups were done after 3 months and 1 year . No significant differences were observed between the laser and the placebo group in relation to the subjective or objective outcome after 10 treatments or at the follow‐ups Kazemi M , Azma K , Tavana B , Rezaiee Moghaddam F , Panahi A : Autologous blood versus corticosteroid local injection in the short-term treatment of lateral elbow tendinopathy : A r and omized clinical trial of efficacy . Objective : To compare local corticosteroid with autologous blood injections for the short-term treatment of lateral elbow tendinopathy . Design : A single blind , r and omized clinical trial was performed in an outpatient clinic at a university hospital . Sixty patients aged 27–64 yrs with a new episode of tennis elbow were recruited . Thirty patients were r and omized to methylprednisolone and 30 to autologous blood group over 1 yr .  Severity of pain within last 24 hrs ; limb function ; pain and strength in maximum grip ; disabilities of the arm , shoulder , and h and quick question naire ( Quick DASH ) scores ; modified Nirschl scores ; and pressure pain threshold were evaluated before injection and at 4 and 8 wks after injection . We analyzed our data with the & khgr;2 and t test . Results : Within-group analyses showed better results for autologous blood ( all P values < 0.001 except for grip strength , P = 0.005 ) . In the corticosteroid group , differences in severity of pain ( P = 0.008 ) and grip strength ( P = 0.001 ) were significant . At 4 wks , between-group analyses showed superiority of autologous blood for severity of pain ( P = 0.001 ) , pain in grip ( P = 0.002 ) , pressure pain threshold ( P = 0.031 ) , and Quick DASH question naire score ( P = 0.004 ) . There were no significant differences in modified Nirschl score , grip strength , and limb function . At 8 wks , autologous blood was more effective in all the outcomes ( all P values < 0.001 ) . Conclusions : Autologous blood was more effective in short term than the corticosteroid injection Background There is conflicting evidence regarding extracorporeal shock wave treatment for chronic tennis elbow . Hypothesis Treatment with repetitive low-energy extracorporeal shock wave treatment is superior to repetitive placebo extracorporeal shock wave treatment . Methods Seventy-eight patients enrolled in a placebo-controlled trial . All patients were tennis players with recalcitrant MRIconfirmed tennis elbow of at least 12 months ’ duration . Patients were r and omly assigned to receive either active low-energy extracorporeal shock wave treatment given weekly for 3 weeks ( treatment group 1 ) or an identical placebo extracorporeal shock wave treatment ( sham group 2 ) . Main outcome measure was pain during resisted wrist extension at 3 months ; secondary measures were > 50 % reduction of pain and the Upper Extremity Function Scale . Results At 3 months , there was a significantly higher improvement in pain during resisted wrist extension in group 1 than in group 2 ( mean [ SD ] improvement , 3.5 [ 2.0 ] and 2.0 [ 1.9 ] ; P= .001 for between-group difference of improvement ) and in the Upper Extremity Function Scale ( mean [ SD ] improvement , 23.4 [ 14.8 ] and 10.9 [ 14.9 ] ; P < .001 for between-group difference of improvement ) . In the treatment group , 65 % of patients achieved at least a 50 % reduction of pain , compared with 28 % of patients in the sham group ( P= .001 for between-group difference ) . Conclusion Low-energy extracorporeal shock wave treatment as applied is superior to sham treatment for tennis elbow Abstract Objective To investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow . Design Single blind r and omised controlled trial . Setting Community setting , Brisbane , Australia . Participants 198 participants aged 18 to 65 years with a clinical diagnosis of tennis elbow of a minimum six weeks ' duration , who had not received any other active treatment by a health practitioner in the previous six months . Interventions Eight sessions of physiotherapy ; corticosteroid injections ; or wait and see . Main outcome measures Global improvement , grip force , and assessor 's rating of severity measured at baseline , six weeks , and 52 weeks . Results Corticosteroid injection showed significantly better effects at six weeks but with high recurrence rates thereafter ( 47/65 of successes subsequently regressed ) and significantly poorer outcomes in the long term compared with physiotherapy . Physiotherapy was superior to wait and see in the short term ; no difference was seen at 52 weeks , when most participants in both groups reported a successful outcome . Participants who had physiotherapy sought less additional treatment , such as non-steroidal anti-inflammatory drugs , than did participants who had wait and see or injections . Conclusion Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks , providing a reasonable alternative to injections in the mid to long term . The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks , with high recurrence rates , implying that this treatment should be used with caution in the management of tennis elbow OBJECTIVE The aim of this study was to evaluate the effectiveness of 904-nm low-level laser therapy ( LLLT ) in the management of lateral epicondylitis . BACKGROUND DATA Lateral epicondylitis is characterized by pain and tenderness over the lateral elbow , which may also result in reduction in grip strength and impairment in physical function .  LLLT has been shown effective in its therapeutic effects in tissue healing and pain control . METHODS Thirty-nine patients with lateral epicondylitis were r and omly assigned to receive either active laser with an energy dose of 0.275 J per tender point ( laser group ) or sham irradiation ( placebo group ) for a total of nine sessions . The outcome measures were mechanical pain threshold , maximum grip strength , level of pain at maximum grip strength as measured by the Visual Analogue Scale ( VAS ) and the subjective rating of physical function with Disabilities of the Arm , Shoulder and H and ( DASH ) question naire . RESULTS Significantly greater improvements were shown in all outcome measures with the laser group than with the placebo group ( p < 0.0125 ) , except in the two subsections of DASH . CONCLUSION This study revealed that LLLT in addition to exercise is effective in relieving pain , and in improving the grip strength and subjective rating of physical function of patients with lateral epicondylitis Background : Chronic lateral elbow epicondylitis is a tendinosis with angiofibrolastic degeneration of the wrist extensors ’ origin . Healing of this lesion is reported with the use of autologous blood as well as with platelet-rich plasma ( PRP ) . Purpose : A comparative study of these 2 treatments was conducted in an effort to investigate the possible advantages of PRP . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Twenty-eight patients were divided equally into 2 groups , after blocked r and omization . Group A was treated with a single injection of 3 mL of autologous blood and group B with 3 mL of PRP under ultrasound guidance . A st and ardized program of eccentric muscle strengthening was followed by all patients in both groups . Evaluation using a pain visual analog scale ( VAS ) and Liverpool elbow score was performed at 6 weeks , 3 months , and 6 months . Results : The VAS score improvement was larger in group B at every follow-up interval but the difference was statistically significant only at 6 weeks , when mean improvement was 3.8 points ( 95 % confidence interval [ CI ] , 3.1 - 4.5 ) in group B ( 61.47 % improvement ) and 2.5 points ( 95 % CI , 1.9 - 3.1 ) in group A ( 41.6 % improvement ) ( P < .05 ) . No statistically significant difference was noted between groups regarding Liverpool elbow score . Conclusion : Regarding pain reduction ,  PRP treatment seems to be an effective treatment for chronic lateral elbow epicondylitis and superior to autologous blood in the short term . Defining details of indications , best PRP concentration , number and time of injections , as well as rehabilitation protocol might increase the method ’s effectiveness . Additionally , the possibility of cost reduction of the method might justify the use of PRP over autologous whole blood for chronic or refractory tennis elbow Abstract Background . Chronic tennis elbow ( lateral epicondylosis ) is a common disorder . Like other chronic soft-tissue pain conditions it is often difficult to treat successfully . The effects of exercise have been discussed , but no convincing evidence has been put forward so far , and a simple protocol for exercise is lacking . Aims of the study . This study is a r and omized , controlled , clinical trial of the effect of exercise versus expectation ( wait-list ) on pain , muscle strength , function , and quality of life in patients with long-st and ing lateral epicondylosis . Methods . Eighty-one subjects with tennis elbow lasting for more than 3 months were r and omly allocated to an exercise group ( n = 40 ) or a reference group ( n 
    Output:
    
There may be a short-term pain relief advantage found with the application of corticosteroids , but no demonstrable long-term pain relief .
Injection of botulinum toxin A and prolotherapy are superior to placebo but not to corticosteroids , and botulinum toxin A is likely to produce concomitant extensor weakness .
Platelet-rich plasma or autologous blood injections have been found to be both more and less effective than corticosteroid injections .
Non-invasive treatment methods such as bracing , physical therapy , and extracorporeal shockwave therapy do not appear to provide definitive benefit regarding pain relief .
Some studies of low-level laser therapy show superiority to placebo whereas others do not .
Conclusions There are multiple r and omized controlled trials for non-surgical management of lateral epicondylitis , but the existing literature does not provide conclusive evidence that there is one preferred method of non-surgical treatment for this condition .