Chronic Lateral Epicondylitis Research Articles

Statistical Analysis of Percutaneous Tenotomy Outcomes in Chronic Lateral Epicondylitis

Background: Chronic lateral epicondylitis significantly impacts individuals' quality of life by causing persistent elbow pain and limited grip strength. Percutaneous tenotomy offers a promising approach to address this condition, yet its long-term efficacy remains underexplored.
 Methods: This retrospective study assessed 45 patients who underwent percutaneous tenotomy for chronic lateral epicondylitis. Pain and functional outcomes were evaluated using NRS, DASH, and Oxford scores over a 36-month follow-up period.
 Results: Significant improvements were observed in all outcome measures across the follow-up period, indicating sustained pain relief, functional recovery, and enhanced quality of life post-tenotomy.
 Conclusion: Percutaneous tenotomy proves to be an effective and durable treatment for chronic lateral epicondylitis, offering significant benefits in terms of pain reduction and functional improvement over time.
 Keywords: Chronic lateral epicondylitis, Percutaneous tenotomy, Long-term efficacy, Pain relief, Functional recovery.

Botulinum Toxin in Chronic Lateral Epicondylitis, from Tendon to Muscle Approach-A Review.

Chronic lateral epicondylitis challenges the therapeutical approach; underlying mechanisms are incompletely understood; neuropathic pain and central and peripheral sensitization may explain the fact that botulinum toxin has been found to play a role in pain and function management. We searched the literature for MeSH terms: lateral epicondylitis or synonyms and botulinum toxin. We found 14 papers containing trials on botulinum toxin injection into the tendon or into the extensor muscles (specifically, extensor carpi radialis brevis and extensor communis digitorum). We followed the administration pathways, doses, timing, and side effects. With a chronic course, the focus of the therapy shifts from the afflicted tendon to the inserting muscles, as muscle contracture may create a vicious loop to perpetuate and aggravate the disease. Doses, timing, and side effects are discussed.

Demographic Influence on Percutaneous Tenotomy Outcomes in Chronic Lateral Epicondylitis

Background: Chronic lateral epicondylitis, or tennis elbow, affects individuals irrespective of age, gender, or occupation, impacting their functional arm movement and quality of life. Percutaneous tenotomy presents a minimally invasive treatment option, yet its efficacy across different demographic groups remains underexplored.
 Methods: This retrospective study at the Department of Orthopaedics, Dr. RPGMC Kangra at Tanda, included 45 patients undergoing percutaneous tenotomy for chronic lateral epicondylitis. Patients were assessed pre-operatively and at intervals up to 36 months post-operation using NRS, DASH, and Oxford scores.
 Results: Significant improvements in pain and functional scores were observed across all demographic groups, with no single demographic factor significantly influencing treatment outcomes.
 Conclusion: Percutaneous tenotomy is universally effective in treating chronic lateral epicondylitis, offering significant pain relief and functional recovery across diverse demographic groups.
 Keywords: Chronic lateral epicondylitis, Percutaneous tenotomy, Demographic influence, Pain relief, Functional recovery..

Efficacy of Percutaneous Tenotomy in Chronic Lateral Epicondylitis Over Time

Background: Chronic lateral epicondylitis significantly impacts individuals' quality of life by causing persistent elbow pain and limited grip strength. Percutaneous tenotomy offers a promising approach to address this condition, yet its long-term efficacy remains underexplored.
 Methods: This retrospective study assessed 45 patients who underwent percutaneous tenotomy for chronic lateral epicondylitis. Pain and functional outcomes were evaluated using NRS, DASH, and Oxford scores over a 36-month follow-up period.
 Results: Significant improvements were observed in all outcome measures across the follow-up period, indicating sustained pain relief, functional recovery, and enhanced quality of life post-tenotomy.
 Conclusion: Percutaneous tenotomy proves to be an effective and durable treatment for chronic lateral epicondylitis, offering significant benefits in terms of pain reduction and functional improvement over time.
 Keywords: Chronic lateral epicondylitis, Percutaneous tenotomy, Long-term efficacy, Pain relief, Functional recovery.

Ultrasound Percutaneous Tenotomy: An Intervention for Managing Lateral Epicondylitis: A Narrative Review

A growing emphasis is being focused on percutaneous ultrasonic tenotomy for expedited recovery from lateral epicondylitis (LE) and enhanced functionality. The TX1 tissue removal system, also known as the Tenex device from Tenex device (Tenex Health Inc., Lake Forest, CA, USA), notably excels in the management of chronic LE. Utilizing ultrasonic energy, this device offers three tips, namely, TX1, TX2, and TXBone-introducing novel avenues, for determining the previously inaccessible tendon pathology. The procedure disrupts degenerated segments, which creates fenestrations that induce local hemorrhage and the release of vasoactive substances. The overarching goal of Tenex is to boost vascularity through the initiation of tendon repair via the deposition of new collagen and elimination of necrotic tissues. This review assesses Tenex’s effectiveness though gathering information, aiming to understand how it helps doctors and other healthcare professionals in their work.

Evaluation of the efficiency of an ultrasound-supported infiltration technique in patients with tennis elbow applying the ITEC medical device: a multicenter study

BackgroundThe treatment of lateral epicondylitis (LE) remains unsatisfactory in certain cases. The aim of this study is to investigate the efficiency of an ultrasound-guided infiltration combined with fenestration of the extensor tendon postulating a 50% reduction in pain on exertion within 6 months. MethodsIn a prospective, non-randomized, multi - center study design, 68 patients with chronic LE and symptoms lasted of at least 6 weeks were included. Each hospital has been assigned either for Traumeel (A), autologous whole blood (B) or dextrose (C) in advance. Preinterventional, 6 weeks, 12 weeks, 6 and 12 months after infiltration, patient related outcome parameter and dorsal wrist extension strength were documented. Pre - interventional (obligate) and after 6 months (optional) radiological evaluation (MRI) was performed. ResultsThe Visual Analog Scale (VAS) showed a significant reduction after 6 months in all groups (A. from 4.8 to 2.5, B. 6.2 to 2.3, C. 5.8 to 2.4). Similar results could be observed with SEV, DASH, MEPS and PRTEE. The loss of strength could be completely compensated after about 6 months. MRI did not fully reflect clinical convalescence. Re-infiltrations were sometimes necessary for final reduction of symptoms (A=11, B=8, C=4). Switching to surgical intervention was most frequent observed in group C (A=2, B=1, C=5). In 14.5% of the cases, no improvement of the symptoms could be achieved with this method. ConclusionThe primary hypothesis of a significant long-term pain reduction of at least 50% could be achieved regardless of the medication chosen.

Assessment of clinical and functional outcomes after single dose injection of autologous platelet rich plasma in patients with chronic lateral epicondylitis: a prospective and brief follow up study

Background: Lateral epicondylitis is a chronic, painful, and debilitating elbow condition. The introduction of platelet-rich plasma as an adjunct to the conservative and operative treatment has revolutionized the research in this topic. PRP is considered to be the ideal autologous biological blood-derived product which helps in regenerating the degenerated tissue rather than just repairing it and helps in relieving pain and improving function. Methods: This is a prospective study where 40 patients diagnosed with tennis elbow, failing other conservative treatment modalities were enrolled; and treated with single dose injection of autologous PRP; and were evaluated for clinical and functional outcomes using the visual analogue scale and disabilities of arm, shoulder, and hand scores on the follow-ups. Results: Out of the 40 patients enrolled, there were 15 males and 25 females. The mean age of the population was 45.88±8.87 years. All the patients had improved statistically significant differences in mean VAS and DASH scores (p value<0.001) on each follow-up as compared to the baseline score with VAS score and DASH score improvement being more than 77% and 65% respectively at final follow up. Conclusion: Our study concludes that a single local injection of autologous PRP appears to be the promising and safe modality of treatment in lateral epicondylitis, helping to improve the pain as well as the clinical and functional outcomes.

Comparative Study of Efficacy Between Platelet-Rich Plasma vs Corticosteroid Injection in the Treatment of Lateral Epicondylitis

Background: Lateral epicondylitis, commonly known as "tennis elbow," is a painful condition affecting the tendons on the outer part of the elbow. Managing lateral epicondylitis is essential to relieve discomfort and improve the patient's quality of life. Various treatment options are available for lateral epicondylitis, including Platelet-Rich Plasma (PRP) therapy and corticosteroid injections. The technique if proved better in pain control would be later on preferred as it will contribute significantly to reduce indoor patient burden, earlier recovery of patients and to their overall satisfaction. Objective: To assess and comparative effectiveness of corticosteroid injections with platelet-rich plasma injections in the management of lateral epicondylitis. Study Design: Randomized controlled trial (RCT). Settings: Department of Orthopedic Surgery, PIMS, Islamabad Pakistan. Duration: From December 2019 to May 2020. Methods: Overall, 162 adult patients having clinical features of chronic lateral epicondylitis unilateral/bilateral not responding to conservative management of either gender with age between 18-60 years were included. Patients were randomly assigned into two intervention groups. Patients of Group A underwent local steroid injections, while Group B received platelet-rich plasma (PRP) injections. Patients of the PRP group, were administered 2 mL of PRP, derived from their own blood, at the most sensitive spot on the lateral epicondyle. Patients of the steroid group, were given 2 mL of methylprednisolone (40 mg/mL). Following the injections, patients were instructed to rest for 15 minutes and advised against massaging the treated area. VAS score was calculated at baseline before giving treatment in both groups and was subsequently assessed at 6th week, 3rd month and 6th month post therapy. VAS score was compared in both groups at different time intervals using student-t test for independent samples. Results: Mean age in group A was 47.4 ± 7.5 years and in group B was 48.1 ± 8.2 years. In group A, 56.8% of the participants were males, and 43.2% were females, whereas in group B, 54.3% were males, and 45.6% were females. Baseline average score of VAS was almost equal among both groups at baseline (7.69 ± 1.03 and 7.74 ± 1.06) in group A and B respectively. At 6th weeks, average score of VAS in steroid group was 3.7 ± 1.79 and in PRP group was 3.23 ± 2.05 (P=0.440). At 3 months, average score of VAS in steroid group was 2.73 ± 1.48 and it was 2.53 ± 1.82 SD in PRP group (P=0.451). At 6 months, VAS average score was noted significantly decreased 2.11±1.29 compared to steroid group was 4.83 ± 2.11 (P=0.001). Conclusion: The study revealed that PRP injections are more effective than local steroid injections for chronic lateral epicondylitis. Initial VAS scores were similar for both treatments up to three months, but PRP showed significantly better results at the 6-month follow-up, indicating its long-term effectiveness.

Deficits in neuromuscular control of increasing force in patients with chronic lateral epicondylitis.

Objective: This study investigated the neuromuscular control of increasing and releasing force in patients with chronic lateral epicondylitis (CLE). Methods: Fifteen patients with CLE (10 males, 5 females, 46.5 ± 6.3years) and fifteen healthy participants (9 males, 6 females, 45.3 ± 2.5years) participated in this study. In addition to power grip and maximal voluntary contraction (MVC) of wrist extension, force fluctuation dynamics and characteristics of inter-spike intervals (ISI) of motor units (MUs) with various recruitment thresholds in the extensor carpi radialis brevis (ECRB) and extensor carpi radialis longus (ECRL) during a designated force-tracking task with a trapezoidal target (0%-75%-0% MVC) were assessed. Results: Besides a smaller MVC of wrist extension, the patients exhibited significantly greater task errors (p = 0.007) and force fluctuations (p = 0.001) during force increment than the healthy counterparts. Nevertheless, no force variables significantly differed between groups during force release (p > 0.05). During force increment, the amplitudes of the motor unit action potential of the ECRB and ECRL muscles of the patients were smaller than those of the heathy counterparts (p < 0.001). The patient group also exhibited a higher percentage of motor units (MU) with lower recruitment threshold (<5% MVC) in the ECRL/ECRB muscles and a lower percentage of MU with higher recruitment threshold (>40% MVC) in the ECRB muscle, compared to the healthy group. During force increment, the patient group exhibited a higher rate of decrease in inter-spike intervals (ISIs) of motor units with lower recruitment thresholds (<10% MVC) in the ECRB and ECRL muscles, compared to the control group (p < 0.005). Conclusion: The patients with CLE exhibited more pronounced impairment in increasing force than in releasing force. This impairment in increasing force is attributed to deficits in tendon structure and degenerative changes in the larger motor units of the wrist extensors. To compensate for the neuromuscular deficits, the rate of progressive increase in discharge rate of the remaining smaller motor units (MUs) is enhanced to generate force. Significance: The deficits in neuromuscular control observed in CLE with degenerative changes cannot be fully explained by the experimental pain model, which predicts pain-related inhibition on low-threshold motor units.

Activation of middle and lower trapezius and strengthening of serratus anterior muscle for the rehabilitation of a patient with chronic lateral epicondylalgia: A case report

Introduction: The most quintessential elbow condition among athletes, especially tennis players, is lateral epicondylalgia, familiar as lateral epicondylitis. Individuals employed in professions that involve frequent physical exertion or repetitive movements are also susceptible to potential risk. This case report intents to present a brief overview of the patient’s treatment and rehabilitation for lateral epicondylalgia by using specific problem-oriented treatments. Case Report: In this case report, we report a case of a 35-year-old female patient who had chronic lateral epicondylitis on right elbow for three months. On physical examination, Numeric Pain Rating Scale (NPRS), Quick DASH, and Patient-rated Tennis Elbow Evaluation score and activities were evaluated on the initial visit to physical therapy and after discharge. By the time she attended three times a week for four weeks, she received conventional therapy lateral epicondylitis. Additionally, she also received a wide range of physiotherapy to stabilize the scapula, more specifically the middle and lower trapezius and strengthening of serratus anterior muscle. This helped to correct deformities, reduce pain, and restore elbow function. The patient reported NPRS = 8/10, Quick DASH = 72.7, and PR-TEE = 89 on the initial visit. At discharge the patient reported a 3 on NPRS, Quick DASH = 15.9, and PR-TEE = 34 with ability to return to full work and no associated symptoms or complaints. Conclusion: The combination of conventional physiotherapy intervention with scapular muscle activation and strengthening was comparatively effective in relieving the patient’s lateral epicondylalgia and push the patient to a higher level of functional activity within only four weeks.

Comparison of the Clinical Results of Platelet-Rich Plasma, Steroid and Autologous Blood Injections in the Treatment of Chronic Lateral Epicondylitis

The aim of our study is to compare the efficacy of PRP, steroids, and autologous blood injection in patients with chronic lateral epicondylitis. A total of 120 patients comprised our study. Three groups of 40 patients each received only one of the following: PRP, steroids, or autologous blood injections. Thereafter, VAS (visual analog scale), DASH (Disabilities of the Arm, Shoulder, and Hand), and Nirschl scores of those treated were evaluated in the second week, the fourth week, the third month, and the sixth month. The baseline evaluation revealed no significant change in VAS, DASH, and Nirschl scores among the three groups (p > 0.050). At the second week evaluation, patients treated with steroids showed significant improvement compared to patients treated with PRP and autologous blood (p < 0.001). The fourth-week evaluation revealed the VAS, DASH, and Nirschl scores of the patients treated with steroids to have improved more significantly than those of patients treated with PRP and autologous blood (p < 0.001). The third month, when the results of all three groups were compared, revealed similar results (p > 0.050). The sixth-month evaluation, when the results of all three groups were compared, revealed the autologous blood and PRP applications provided significantly better results than the group treated with steroids (p < 0.001). We concluded that steroid administration is effective in the short term, while PRP and autologous blood applications are more effective than steroid administration in the long term.

Functional outcome of autologus platelet rich plasma injection as treatment for patients with lateral epicondylitis

Background: Lateral epicondylitis is the most common chronic disabling painful condition affecting 1% to 3% of the population predominantly those between 35 and 55 years of age. Elbow pain with tenderness and restricted wrist extension is its common manifestations. Although a few conservative methods of treatment are available, recent studies have suggested platelet-rich plasma (PRP) to be a safe and effective therapy in relieving pain and improving function for tennis elbow. Aim: This study aims to study the efficacy of autologous PRP in tennis elbow. Materials and Methods: A prospective observational study was conducted in our hospital. Fifty patients with chronic lateral epicondylitis aged above 18 years were included in the study. All the patients had a minimum of 3 months of symptoms, were selected based on the inclusion and exclusion criteria and underwent the same method of treatment. All patients had a baseline assessment of numerical pain score and were repeated at 2 weeks, 4 weeks, 8 weeks, 3 months, and 6 months posttreatment. The PRP was prepared from venous whole blood. All patients had a single-dose injection of autologous PRP in their extensor tendons at the elbow through a peppering needling technique. Results: The patients were more often successfully treated. When baseline numerical pain scores were compared with those at 8 weeks, 12 weeks, and 24 weeks follow-up, they showed improvement over time. There were no complications observed related to the use of PRP. The difference between 1-, 2-, 4-, and 6-month pain reduction was tested for significance by Friedman's test and found that there was no significant difference in pain reduction between 2 months and 3 months, 2 months and 6 months, and 3 months and 6 months scores. However, there was a statistically significant difference in pain score in 1 and 2 months. Duration of symptoms suggests the chronic nature of disease. In this study, analysis was done based on the duration of symptoms. Thirty-two out of the 50 patients had pain for <6 months, 16 out of 50 patients between 6 and 12 months, and 2 out of 50 had symptoms of >1 year. In our study, it was found that mean pain score at the end of 6 months for patients with symptoms <6 months was 0.59, whereas the mean pain score of patients with symptoms from 6 to 12 months was 1.81. This indicates that duration of symptoms had a significant correlation with the clinical outcome after injection. Conclusion: Autologous PRP injection is a safe and useful modality of treatment in the treatment of tennis elbow. Maximum benefit after PRP injection was observed at 2 months and had sustained for at least 6 months. More trials are required to optimize the technique for separating PRP. These improvements were maintained over in our follow-up period without any significant complications. Long-term follow-up with more number of patients is needed to evaluate the lasting benefits of pain relief and functional improvement in lateral epicondylitis.

Platelet-Rich Plasma Injections Decrease the Need for Any Surgical Procedure for Chronic Epicondylitis versus Conservative Treatment-A Comparative Study with Long-Term Follow-Up.

Background: Platelet-rich plasma (PRP) injections may alleviate symptoms of chronic medial or lateral epicondylitis. Methods: We retrospectively analyzed a total of 55 patients with chronic ME or LE who had undergone at least 6 months of any conservative treatment before intervention. The patients were divided into two groups: the PRP group (n = 25), who received a single injection of autologous PRP to the medial or lateral epicondyle, and the PT group (n = 30), who continued with PT and pain medication. The primary outcome measures were pain and functional outcomes measured in terms of the following: Patient Related Tennis Elbow Evaluation (PRTEE), Visual Analogue Scale (VAS), and Disabilities of the Arm, Shoulder, and Hand (DASH), which were detected at preintervention, 6-, 12-, 24-, and 36-month follow-up. Secondary outcomes included complications and the need for any surgery at follow-up. Results: Primary outcome measurements showed significantly better results favoring the PRP group (6-month PRTEE total 43.2 ± 19.2 vs. 62.8 ± 24.0, p < 0.001; 12-month PRTEE total 6.9 ± 15.0 vs. 28.1 ± 24.4, p < 0.001; 24-month PRTEE total 4.8 ± 9.8 vs. 12.7 ± 14.5, p = 0.029), and significantly better results in VAS and DASH sub-scores. The PRP group required significantly fewer surgical procedures (n = 0/0% vs. n = 6/20%, p = 0.027) at follow-up (mean 38.3 ± 12.3 months), and one case of prolonged pain after injection was detected. Conclusions: Patients who underwent PRP injections for epicondylitis resulted in better pain and functional outcomes compared to physiotherapy, and this improvement lasted at least 24 months. They required fewer surgical procedures and achieved faster recovery than the PT group. We recommend PRP for chronic epicondylitis of the elbow before considering surgery when other treatments have failed.

MRI and Ultrasound Analysis of Corticosteroid Injection Combined with Extracorporeal Shockwave Therapy in Lateral Epicondylitis-A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial.

The knowledge about the effective implementation of corticosteroid injection and extracorporeal shockwave therapy on radiological changes in chronic lateral epicondylitis is lacking. Therefore, the objective of this study is to find and compare the effects of corticosteroid injection and extracorporeal shockwave therapy on radiological changes in chronic lateral epicondylitis. A randomized, double-blinded controlled study was conducted on 60 LE participants at a university hospital. The active extracorporeal shockwave therapy group (n = 30) received a corticosteroid injection with active extracorporeal shockwave therapy one session a week for 4 weeks, and the placebo extracorporeal shockwave therapy group received a corticosteroid injection with placebo extracorporeal shockwave therapy. The primary outcome was pain intensity, measured with the visual analog scale. The other outcome measures were the percentage of injury measured by magnetic resonance imaging and ultrasound, functional disability, handgrip strength, patient perception, kinesiophobia, depression status, and quality of life. The between-group difference in pain intensity at 4 weeks was 1.4 (CI 95% 0.77 to 2.02), which shows more improvement in the active group than in the placebo group. Improvements in the effects were noted after 8 weeks and at 6 months (1.8; CI 95% 1.50 to 2.09) follow-up. Similar improvements were also found in the percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status, and quality of life. Extracorporeal shockwave therapy has added effects on corticosteroid injection for improving pain, percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life in people with chronic lateral epicondylitis.

Ultrasound-guided versus palpation-guided platelet-rich plasma injection for the treatment of chronic lateral epicondylitis: A prospective, randomized study.

This study aims to compare the effectiveness of palpation-guided and ultrasound (US)-guided platelet-rich plasma (PRP) injections in patients with chronic lateral epicondylitis (LE). Between January 2021 and August 2021, a total of 60 patients (34 males, 26 females; mean age: 40.5±10.9 years; range, 22 to 64 years) diagnosed with chronic LE were included. The patients were randomly allocated to either the palpation-guided (n=30) or the US-guided injection group (n=30) before they received PRP injection. All patients were assessed using the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) scale, and grip strength at baseline and at one, three, and six months after injection. Baseline sociodemographic and clinical variables were statistically similar between two groups (p>0.05). The VAS and DASH scores improved significantly after the injection at each control, as well as grip strength in both groups (p<0.001). No statistically significant difference was found between the groups regarding VAS and DASH scores, and grip strength at one, three, and six months post-injection (p>0.05). No significant complication related to the injection was observed in any of the groups. This study demonstrates that both palpation-guided and US-guided PRP injection protocols can improve clinical symptoms and functional parameters of patients with chronic LE.

Is Low-Dose Dextrose Prolotherapy as Effective as High-Dose Dextrose Prolotherapy in the Treatment of Lateral Epicondylitis? A Double-Blind, Ultrasound Guided, Randomized Controlled Study

ObjectivesTo investigate the effects of prolotherapy (PrT) on pain, functionality, clinical improvement and to compare the 5% low and 15% high dose dextrose PrT in chronic lateral epicondylitis. DesignA double-blind, parallel groups, randomized controlled study. SettingsOutpatient Clinic. ParticipantsSixty patients (N=60), aged 44.30±10.31 years old, with chronic lateral epicondylitis were allocated randomly into 3 groups. InterventionsTo Group 1 5% dextrose PrT, to Group 2 15% dextrose PrT, to Group 3 0.9% saline injections were done at 3 times (weeks 0, 3, 6), to the entheses of forearm extensors and annular ligament. Main Outcome MeasuresThe primary outcomes were handgrip strength, visual analog scale-rest (VAS-R), visual analog scale-activity (VAS-A), pressure-pain threshold, and Quick Disability of the Arm, Shoulder and Hand (Q-DASH). The secondary outcomes were clinical improvement (Disease Global Assessment Questionnaire), side effects, and complications. Primary outcomes were collected at baseline week 0, week 3, and 12. Secondary outcomes were collected at weeks 3 and 12. ResultsIn Group 2, VAS-A and VAS-R (at week 3), handgrip strength and pressure-pain threshold (at week 12) were significantly different than other groups (P<.05). In Groups 1 and 2, there was a difference in primary outcomes at week 12 than baseline (P<.05). In Group 3, there was no difference in VAS-R, VAS-A, and handgrip strength at weeks 3 and 12 than baseline (P>.05). ConclusionIn chronic lateral epicondylitis, 5% and 15% dextrose PrT is more effective in pain, handgrip strength, functionality, and clinical improvement than %0.9 saline. There was no difference in functionality, clinical improvement, side effects, and complications between the PrT groups. 15% dextrose PrT was more effective in handgrip strength and pressure-pain threshold at week 12 and pain at week 3. We recommend 15% dextrose PrT based on this study.

COMPARISON BETWEEN PLATELET RICH PLASMA INJECTION AND EXTRACORPOREAL SHOCK WAVE THERAPY IN THE IMPROVEMENT OF PAIN AND FUNCTION IN CHRONIC LATERAL EPICONDYLITIS: A RANDOMIZED CONTROLLED TRIAL

Introduction: Lateral epicondylitis (LE) is a painful condition of the elbow, resulting from non-inammatory tendinopathy along the extensor origin of the lateral epicondyle. PRP and ESWT are commonly used therapies for the treatment of chronic lateral epicondylitis. But the superiority of treatment over one another is not known. This study is conducted to compare between platelet rich plasma injection and ESWT therapy in the improvement of pain and function in chronic lateral epicondylitis. Materials and Methods: A randomized controlled study was conducted in Department of Sports Medicine, Imphal on patients with chronic lateral epicondylitis comparing the effectiveness of PRP (Study group) and ESWT(control group). Data were collected from a sample size of 84 patients fullling the inclusion criteria. Analysis was done by using mean, SD, chi square test and independent t-test. Results: VAS and DASH score were used as outcome measures which was measured at baseline, 4 weeks,12 weeks and 24 weeks. VAS score improved from 7.13 ± 0.48 to 3.25 ± 1.20 and DASH score improved from 88± 0.9 to 34.16± 0.6 in the study group at 24 weeks follow up. Conclusion:There was signicant improvement in all outcome measures with p-value of &lt;0.05 in study group. Hence, PRP is a promising technique for the treatment of chronic lateral epicondylitis.

Autologous and Allogenic Utilization of Stromal Vascular Fraction and Decellularized Extracellular Matrices in Orthopedic Surgery: A Scoping Review.

This narrative review of the literature aims to analyze the utilization of stromal vascular fraction (SVF) and decellularized extracellular matrices (dECMs) in various pathologies related to orthopedic surgery. A literature search was carried out in PubMed on February 15, 2022, using "Stroma Vascular Fraction and Orthopedic Surgery" and "Decellularized Extracellular Matrices and Orthopedic Surgery" as keywords. A total of 278 articles were found, of which 28 papers were selected because they seemed to be the most appropriate concerning the title of the article. The reported results have shown that intra-articular injection of SVF seems to be a safe and efficacious method for managing knee osteoarthritis (OA). Platelet-rich plasma (PRP) and SVF are safe and effective management for intractable Achilles tendinopathy in humans, although subjects treated with SVF recover earlier. There are promising results in utilizing adipose-derived mesenchymal stromal cells in chronic lateral epicondylitis of the elbow in athletes. Ready-to-use ECM/SVF gel seems to be a good therapeutic option promoting the regeneration of the articular cartilage in subjects with injuries of the cartilage. The SVF can safely be used to treat diabetic subjects suffering from chronic foot ulcers. There are scarce high-quality data for utilizing cell-based approach in soft tissue injuries of the knee in athletes. Experimental studies indicate that SVF could be a new option to osseous regeneration. Other experimental studies support the utilization of dECMs as a scaffold for the regeneration of large osseous defects, cell-derived dECMs scaffolds to repair articular cartilage injuries, and utilization of xenogeneic acellular muscles to manage volumetric muscle loss where there is a lack of donor site.Intra-articular injections of SVF seems to be a safe and efficacious method for managing OA of the knee joint. Platelet-rich plasma (PRP) and SVF are safe and efficacious methods for the management of intractable Achilles tendinopathy in humans, although subjects treated with SVF recover earlier.

Efficacy of Osteopathic Manipulative Treatment (OMT) Vs Physiotherapy in Chronic Lateral Epicondylitis

Background: Several rehabilitative treatments have been proposed for Lateral Elbow Tendinopathy (LET). Therapeutic exercise showed the greatest beneficial effects together with patient education, and multimodal treatment subject specific. In recent years, osteopathic manipulative treatment (OMT) has been proposed as treatment for LET. The aim of the study was to focus on this emerging approach by comparing it to more traditional physiotherapy. Methods: Thirty-two patients with a diagnosis of LET were enrolled and randomly assigned to two groups: the OMT group and the physiotherapy group. In the former, patients underwent OMT according to the common techniques. In the latter, patients underwent a physiotherapy protocol consisting in stretching and strengthening exercises, and laser therapy. Outcome measures included the Patient-Rated Tennis Elbow Evaluation (PRTEE), the Mayo Elbow Performance, and VAS for pain. Assessment was carried out at baseline (T0), after 1 (T1) and 3 (T2) months. In addition, an ultrasound assessment of the elbow common extensor tendon was performed at T0 and T2. Results: Both the OMT and the Physiotherapy group showed a statistically significant improvement along the follow-up for VAS for pain and PRTEE score. No significant difference was found for the Mayo Score in the Physiotherapy group. Ultrasound assessment confirmed the presence of abnormalities of vascularization, echogenicity, and thickness of the tendon at T0, partially reduced at T2. Conclusion: OMT and physiotherapy resulted both effective in the treatment of LET, offering a significant clinical improvement which helped patients recovering their functional activities in the short-term follow-up.

Comparison of Hyaluronate & Steroid Injection in the Treatment of Chronic Lateral Epicondylitis and Evaluation of Treatment Efficacy With MRI: A Single-Blind, Prospective, Randomized Controlled Clinical Study.

Introduction: Injection therapy in refractory cases of lateral epicondylitis might relieve symptoms, although no consensus exists on which material to use. Corticosteroids are widely used but recent literature indicated possible tenotoxic effects and inefficacy in mid- and long-term follow-up (FU). Hyaluronate/hyaluronic acid (HA) might be of better clinical efficacy. Magnetic resonance imaging (MRI) might reflect the clinical changes in the short-term FU.Methods: A single-blind, prospective, randomized controlled study was designed. A total of 80 patients were included. A total of 40 patients received a single triamcinolone injection and 40 received a hyaluronic acid (HA) injection. Follow-up was repeated at six and 12 weeks. The shortened disabilities of the arm, shoulder, and hand questionnaire (Q-DASH) score; visual analog scale (VAS) for pain at rest, and hand grip strength were collected. Dynamometer measurements were done at baseline and FU examinations. The MRI images at baseline and 12 weeks FU were evaluated.Results: There were significant differences between the groups favoring the triamcinolone group at six weeks. At 12 weeks, no differences existed between the groups in any of the parameters. The MRI grades were nonsignificantly different between baseline and at 12 weeks.Conclusion: Both triamcinolone and HA were shown to relieve pain and increase functional outcomes. However, the effects were short-lived. The MRI did not show significant differences at 12 weeks, although clinical improvements were substantial.