Occupational Load, Orthobiologics, and Corticosteroid in Lateral Epicondylitis: A Stratified Randomized Study

Background: Occupation may modify treatment response in lateral epicondylitis because manual work imposes a higher repetitive mechanical load that impairs tendon repair. We tested whether occupational exposure (manual vs. desk labor) alters the comparative effectiveness of intralesional corticosteroid versus platelet-rich plasma. Materials and Methods: A prospective, stratified randomized study was conducted at a tertiary center (February 2023–February 2025). Three hundred and eighty-four patients (18–50 years) with refractory lateral epicondylitis were stratified by occupation into desk ( n = 132) and manual labor ( n = 252), then randomized to intralesional corticosteroid ( n = 192) or autologous platelet-rich plasma (PRP) ( n = 192). An occupational exposure score (0–8) was recorded. The primary outcome was assessed using Oxford Elbow Score at 1, 3, 6, and 12 months. Results: Baseline characteristics were comparable across groups, with significantly lower occupational exposure in desk workers than manual workers (mean ≈ 1.5 vs. 6.2; P < 0.001). All patients improved over time. PRP yielded consistently superior functional outcomes versus corticosteroid (all P < 0.001). Occupational differences were small and inconsistent, and the treatment × occupation interaction was nonsignificant ( P > 0.20). Conclusion: In this large, stratified randomized cohort, PRP provided superior and durable functional improvement over corticosteroid injection for lateral epicondylitis, including among manual laborers. Occupational load increased baseline exposure but did not materially modify the comparative treatment effect. Clinical decisions should prioritize PRP for sustained functional gain, while workplace ergonomics and rehabilitation remain important for prevention and return-to-work planning.