O-2 Evaluation of local injection of platelet rich plasma and corticosteroids in the treatment of lateral epicondylitis: a retrospective study

Abstract

<h3>Introduction</h3> Lateral epicondylitis is one of the most common causes of musculoskeletal pain involving common extensor origin of the forearm. Although the diagnosis of lateral epicondylitis is clear, there has been no consensus on the optimal management strategy.¹ Local steroid injection has been proven to provide consistent and predictable short term pain relief¹ .Platelet rich plasma (PRP) is a concentrate of platelets derived from the patient’s own blood. The action of PRP therapy in chronic tendinopathies is varied and hypothesised to include angiogenesis, increase in growth factor expression and cell proliferation, increase the recruitment of repair cells and tensile strength. The aim of our study was to compare the efficacy of local injection of platelet rich plasma versus corticosteroids in terms of pain relief, grip strength and functional improvement. <h3>Material/methods</h3> A retrospective study on the clinical efficacy of local injection of PRP versus corticosteroids in cases of lateral epicondylitis was carried out between June 2015 to December 2015. 55 patients of both genders between 23–50 years of age suffering from lateral epicondylitis were recruited.The diagnosis was made on the basis of clinical signs and symptoms. The duration of the symptoms ranged from two months to one year. Group A patients received a single injection of PRP (2 ml), with absolute platelet count of 1 million platelets/mm3 as confirmed by manual counting. For PRP preparation, the Autologous Conditioned Plasma system was used.A 9001:2000 ISO certified R-23 centrifuge was used for the purpose of platelet concentration with 1500 rpm (3500 g) for five minutes.Group B patients received a single injection of corticosteroid (methyl-prednisolone(depomedrol), 40 mg in 1ml).Pain, grip strength and functional improvements were assessed using visual analogue scale, jamar hydrolic dynamometer and quick disabilities of the Arm, Shoulder and Hand scale respectively at baseline, 15 days and 3 months. <h3>Results</h3> <h3>Pain </h3> Pain was assessed using the Visual Analogue Scale (VAS). The subjective pain report or the VAS score improved more with corticosteroid injection after 15 days (p &lt; 0.0001), however, at the end of three months improvement in pain was significantly better in PRP injection group (p &lt; 0.0001) (Table 1). <h3>Grip strength </h3> Similar pattern of improvement in grip strength was observed. Grip strength in Group A patients showed significantly better outcome as compared to Group B patients at three months follow-up (p &lt; 0.001) (Table 2). <h3>Functional outcome</h3> Functional outcome was measured using q-DASH scale. Gradual improvement of q-DASH score was observed in both the groups. This improvement was statistically significant in all the follow up visits in the both the groups. As in case of the other two parameters functional outcome measure (qDASH) also showed better improvement (p &lt; 0.001) in Group A patients at the end of three months. Statistically significant improvement (p &lt; 0.05) was noted in each parameter at 15 days, 3 month follow up from baseline values in both the groups. When the groups were compared with each other, group B had statistically significant (p &lt; 0.05) and better improvement than Group A at 15 days follow up period while at 3 month follow up group A had better improvement on each parameter over Group B (p &lt; 0.05) (Table 3). <h3>Conclusion</h3> The results revealed that the long term efficacy of PRP treatment is better. Therefore, we concluded that PRP as a superior treatment option in cases of tennis elbow. However, keeping in view the limited period of follow up in the present study we recommend longer follow up studies to further consolidate our findings and establish the long term efficacy of PRP in cases of lateral epicondylitis. <h3>Reference</h3> Labelle H, Guibert R, Joncas J, Newman N, Fallaha M, Rivard CH. Lack of scientific [2] evidence for the treatment of lateral epicondylitis of the elbow. An attempted metaanalysis. <i>J Bone Joint Surg [Br]</i> 1992;<b>74(B)</b>:646–51.