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Ketorolac injection offers pain relief and functional improvement comparable to triamcinolone in lateral epicondylitis, serving as a safe and effective steroid-sparing alternative, especially in those with shorter symptom duration or contraindications to corticosteroids.
In a high-quality randomized controlled trial of 200 patients with lateral epicondylitis (LE), ketorolac injection offered comparable analgesic and functional benefits as triamcinolone injection at 24 weeks.
LE, also known as tennis elbow, is a prevalent cause of chronic elbow pain. Corticosteroid injections such as triamcinolone are frequently used but may carry concerns regarding tendon degeneration and recurrence. Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), has emerged as a safer injectable alternative. Hence, this non-inferiority trial compared ketorolac vs. triamcinolone injections in 200 LE-affected patients. Subjects were randomized to get:
Injections were administered using either a peppering technique or single-injection technique, with or without ultrasound guidance. The key outcome was the change in visual analog scale (VAS) pain at rest at 24 weeks, with a predefined non-inferiority margin of 1 cm. Secondary outcomes included:
Statistical analysis used linear mixed-effects models, one-sided 95% confidence intervals (CIs), and subgroup analyses. At 24 weeks, ketorolac met the predefined criteria for non-inferiority compared with triamcinolone (Table 1).
The upper bound of the 95% CI (0.681) remained below the 1 cm non-inferiority threshold, confirming that ketorolac is non-inferior to triamcinolone for pain alleviation at 24 weeks. Both groups illustrated comparable improvements in functional outcomes, including PRTEE and DASH scores, as well as strength measures.
Subgroup Analysis: Symptom Duration Matters
This suggests that early-stage LE may respond equally well to ketorolac, while chronic cases may benefit more from corticosteroid therapy.
Safety and Adverse Events
Adverse events were mild and comparable:
Most events included mild injection-site pain or swelling. Transient post-injection pain occurred more frequently in the ketorolac group, but no serious adverse events were reported.
Clinical Implications
The findings suggest that ketorolac injection yields pain relief and functional improvement comparable to triamcinolone at 24 weeks in LE. Ketorolac may be particularly valuable for:
Journal of Shoulder and Elbow Surgery
The KINDLE trial: ketorolac vs. triamcinolone injections for lateral epicondylitis- a non-inferiority randomized controlled multicentric trial
Kavin Khatri et al.
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