Lateral Epicondylitis Of Elbow Research Articles

Platelet-rich plasma vs corticosteroids for elbow epicondylitis: A systematic review and meta-analysis.

Objective:The aim of this meta-analysis was to compare the effectiveness of platelet-rich plasma (PRP) vs corticosteroids for treatment of patients with lateral elbow epicondylitis.Methods:A literature search was performed in EMBASE, Medline, the Cochrane Library and PubMed. Randomized controlled studies comparing PRP with corticosteroids for the treatment of epicondylitis were included. The Cochrane Collaboration's tool for assessing the risk of bias was used to evaluate the methodological quality of the included trials. The Cochrane Collaboration's Review Manager software was used to perform the meta-analyses. The overall effect size of each anesthetic was calculated as the weighted average of the inverse variance of the study-specific estimates.Results:Seven randomized controlled trials were included in this review. The data from 2 studies were unavailable for meta-analysis, and the systematic review criteria were just achieved. Local corticosteroid injection yielded a significantly superior Disabilities of the Arm, Shoulder and Hand (DASH) score at 4 weeks (WMD, 11.90; 95% CI: 7.72 to 16.08; P < .00001; heterogeneity, χ2 = 0, I2 = 0%, P = 1.00) and 8 weeks (WMD, 6.29; 95% CI: 2.98 to 9.60; P = .0002, χ2 = 0, I2 = 0%, P = 1.00). Otherwise, it was noteworthy that a significantly lower VAS score (WMD, −2.61; 95% CI: −5.18 to −0.04; P = .05; heterogeneity, χ2 = 29.85, I2 = 97%, P < .00001) and DASH score (WMD, −7.73; 95% CI: −9.99 to −5.46; P < .00001, χ2 = 0.20, I2 = 0%, P = .66) existed in the PRP regimen than in the steroid regimen at the 24-week follow-up. More effective treatments were achieved in the PRP-treated patients than in the patients treated with corticosteroids (WMD, 3.33; 95% CI: 1.81 to 6.14; P = .000; heterogeneity, χ2 = 0.43, I2 = 0%, P = .51).Conclusions:Local corticosteroid injections demonstrated favorable outcomes compared with those of local PRP treatments for lateral elbow epicondylitis during the short-term follow-up period (4 weeks and 8 weeks post-treatment). Otherwise, at the long-term follow-up (24 weeks post-treatment), PRP injections had improved pain and function more effectively than corticosteroid injections.

Effects of intralesional platelet-rich plasma in the patients with lateral epicondylitis of elbow

Lateral epicondylitis (tennis elbow) is a major cause of musculoskeletal pain involving common extensor origin of the forearm. This study was done to determine the effects of platelet-rich plasma on 15 patients with lateral epicondylitis. Selected patients were given intralesional platelet-rich plasma injection, activity of daily living instructions and paracetamol. Patients were assessed every 14 days interval by visual analogue scale, and the patient rated tennis elbow evaluation. Treatment response according to visual analogue scale and patient rated tennis elbow evaluation tool, the difference of improvement was found in respect to time, from pretreatment W1 (just before 1st Intervention) score to W11 score in every alternate week (p&lt;0.005). This indicates that intralesional platelet-rich plasma is effective in the patients with lateral epicondylitis of elbow.

Platelet Rich Plasma Therapy and Understanding the Risk Factors of Heel Pain Syndrome

Category:Basic Sciences/Biologics, Hindfoot, SportsIntroduction/Purpose:Heel pain syndrome is a complex condition causing morbidity and decreases the quality of life in our adult population. It is known that individuals with a body mass index (BMI) of more than >30 kg/m2 have increased risk of plantar fasciitis. However, heel pain consists of larger entities not merely to plantar fasciitis alone. Limited study mentioned the association between hypertension and musculoskeletal pain. Platelet rich plasma (PRP) therapy is an emerging treatment option for its regenerative properties in the treatment of degenerative enthesopathic conditions as in plantar fasciitis and lateral elbow epicondylitis. We hypothesize that obesity (BMI>30 kg/m2) and hypertension do influence the poorer outcome after PRP injection in individuals with heel pain.Methods:We analysed 154 heel pain cases from orthopaedic outpatient clinic that were treated with PRP injection. BMI and BP were taken as preadmission measurements with at least three readings for blood pressure. PRP was harvested from the antecubital vein, and spun in a centrifuge machine. Follow-up was conducted with AOFAS Ankle Hindfoot system before injection, 6 weeks and up to 2 years after injection.Results:Mean age was 49.96 (range 20-81 years old) with 52.60% female and 47.4% male. Plantar fasciitis was the majority source of heel pain (71.43%) followed by achilles tendinopathy (26.62%), posterior tibial tendon disorder (1.3%), and peroneal tendinopathy (0.65%). One hundred and twenty-eight (83.1%) patients achieved resolution of heel pain and related symptoms after injection. Statistical analysis was performed using one sample student t-test. No statistical significant result was found in both overweight (p =0.29) and obesity grade 1 (p = 0.40). Statistical significant result found in the prehypertension group (p<0.04).Conclusion:Based on this preliminary data, we recommend weight loss with trials of lifestyle modification in individuals with obesity, and better control of our patients’ blood pressure in order to achieve comparable outcome with normal BMI population.

Functional outcome of platelet rich plasma on lateral epicondylitis of elbow

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The study was conducted with the aim to explore the efficacy of platelet rich plasma in sixty patients who presented to us with lateral epicondylitis of elbow where conservative management has failed&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Between 2013 and 2015, 60 patients (M: F- 20: 40) with lateral epicondylitis of elbow were included. All patients presented to us with lateral epicondylitis of elbow where conservative management has failed. All patients are treated with platelet rich plasma injection. Serial follow-up were done at 1, 6 and 12 month.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All sixty patients had significant improvement before and after platelet rich plasma injection. The mean VAS score and the Mayo score suggests significant improvement in pain and elbow function following platelet rich plasma treatment&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Platelet rich plasma improves pain and elbow function in patients suffering from lateral epicondylitis where conservative management has failed. Platelet rich plasma treatment may decrease the overall time for healing, and thereby decreasing the overall need for surgical intervention&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Arthroscopic surgical treatment of recalcitrant lateral epicondylitis – A series of 47 cases

ObjectiveTo evaluate the results of patients undergoing arthroscopic surgical treatment of refractory lateral epicondylitis, identifying poor prognosis factors. MethodsA retrospective study of 44 patients (47 elbows) who underwent arthroscopic debridement of the extensor carpi radialis brevis (ECRB) tendon to treat refractory lateral epicondylitis from February 2013 to February 2015, operated by a single surgeon at one center. Patients were assessed by DASH score, visual analog scale of pain (VAS), and ShortForm 36 (SF-36). The mean age at surgery was 44.4 years (32–60). The duration of symptoms prior to the surgery was approximately 2.02 years (range: 6 months to 10 years). Mean follow-up was 18.6 months (range of 6–31.9). ResultsThe mean postoperative DASH score was 25.9 points; mean VAS, 1.0 point at rest (all the patients with mild pain) and 3.0 points at activity, of which 31 (66%) cases presented mild pain, 10 (21%) moderate pain, and six (13%) severe pain; mean SF-36 score was 62.5. A moderate correlation was observed between duration of pain before surgery and the DASH score with the final functional outcome. No significant complications with the arthroscopic procedure were observed. ConclusionsArthroscopic surgical treatment for recalcitrant lateral elbow epicondylitis presented good results, being effective and safe. The shorter the time of pain before surgery and the lower the preoperative DASH score, the better the prognosis.

Musculoskeletal disorders among orthopedic pediatric surgeons: an overlooked entity.

IntroductionForceful and repetitive maneuvers constitute the majority of pediatric orthopedic surgical tasks, thus subjecting surgeons to the risk of musculoskeletal (MSK) injuries during their years in practice. The aim of this study was to assess the prevalence, characteristics and impact of MSK disorders among pediatric orthopedic surgeons.MethodsA modified version of the physical discomfort survey was sent to surgeons who were members of the Pediatric Orthopedic Society of North America (POSNA) via e-mail. The collected data were analyzed using descriptive statistics, one-way analysis of variance, and Fisher’s exact test. p values of <0.05 were considered statistically significant.ResultsOf the 402 respondents, 67 % reported that they had sustained a work-related MSK injury, of which the most common diagnoses were low back pain (28.6 %) and lateral elbow epicondylitis (15.4 %). Among those which reported an injury, 26 % required surgical treatment and 31 % needed time off work as a direct result of their injury. The number of work-related injuries incurred by a surgeon increased significantly with increasing age (p < 0.001), working in a non-academic institute (p < 0.05), working in more than one institute (p < 0.05), and being in active practice for >21 years (p < 0.05). The need to undergo treatment or take time off due to the injury was associated with increased number of injuries (p < 0.001). In addition, surgeons were more likely to require time off work when they were >56 years of age (p < 0.001), had been in practice for >21 years (p < 0.001), required surgical management of their disorder (p < 0.001), and had experienced an exacerbation of a previous disorder (p < 0.001).Discussion and conclusionThis study is the first of its kind to assess MSK injuries sustained by pediatric orthopedic surgeons. The high incidence of these disorders may place a financial and psychological burden on these surgeons and thus the healthcare system. These results should shed a light on awareness and the need for further studies to prevent and help decrease the incidence of these disorders not only in orthopedic surgeons but also in the surgical population in general.

Tratamento cirúrgico artroscópico da epicondilite lateral recalcitrante – Série de 47 casos

ObjectiveTo evaluate the results of patients undergoing arthroscopic surgical treatment of refractory lateral epicondylitis, identifying poor prognosis factors. MethodsA retrospective study of 44 patients (47 elbows) who underwent arthroscopic debridement of the extensor carpi radialis brevis (ECRB) tendon to treat refractory lateral epicondylitis from February 2013 to February 2015, operated by a single surgeon at one center. Patients were assessed by DASH score, visual analogue scale of pain (VAS), and ShortForm 36 (SF‐36). The mean age at surgery was 44.4 years (32‐60). The duration of symptoms prior to the surgery was approximately 2.02 years (range: 6 months to 10 years). Mean follow‐up was 18.6 months (range of 6 to 31.9). ResultsThe mean postoperative DASH score was 25.9 points; mean VAS, 1.0 point at rest (all the patients with mild pain) and 3.0 points at activity, of which 31 (66%) cases presented mild pain, 10 (21%) moderate pain, and six (13%) severe pain; mean SF‐36 score was 62.5. A moderate correlation was observed between duration of pain before surgery and the DASH score with the final functional outcome. No significant complications with the arthroscopic procedure were observed. ConclusionsArthroscopic surgical treatment for recalcitrant lateral elbow epicondylitis presented good results, being effective and safe. The shorter the time of pain before surgery and the lower the preoperative DASH score, the better the prognosis.

A Comparative Study on the Efficacy of Local Infiltration of Autologous Blood versus Local Corticosteroid Infiltration for the Treatment of Chronic Lateral Epicondylitis Elbow

A Comparative Study on the Efficacy of Local Infiltration of Autologous Blood versus Local Corticosteroid Infiltration for the Treatment of Chronic Lateral Epicondylitis Elbow

Lateral Epicondylitis: Impact on Demographic Variables

Background: Lateral epicondylitis is a repetitive trauma disorder which is caused due to over-use or over-stress of the wrist extensors of the forearm. The primarily complaint of the patient is that he suffers from pain and decreased function which affects the basic activities in daily life. The present study was conducted to assess the impact of Lateral epicondylitis on different demographic variables. Methods: A total of 52 diagnosed cases of Lateral epicondylitis of elbow who fulfilled the inclusion and exclusion criteria were taken and included in the study. A detailed assessment of the patients was done which included the demographic and examination variables measurement. Results: Unpaired t test was used to measure the difference in variable of two groups and Karl Pearson’s correlation coefficient was used to determine the correlation between two entities. All of the subjects were in fourth and fifth decade of life with 96.15% subjects had the dominant side affected. There were 31 females (59.6%) and 21 males (40.4%) in the study signifying females were more affected than males and majority of the sample had normal BMI. There was no significant correlation between age of patients and physical and mental component of QOL (p = 0.888, p = 0.507). Majority of the patients had their dominant side affected and only 3.85% had their nondominant side affected thereby making the 2 groups incomparable statistically. No statistically significant correlation was found between the BMI and physical and mental component of QOL of the patient. (p = 0.977, p = 0.991) There was no significant difference between the quality of life of males and females. (p = 0.591, p = 0.782) When comparing the quality of life of domestic population, working population and tennis player there was no statistical significant difference found between the groups. (p = 0.993, p = 0.786). Conclusion: No significant difference between the demographic factors of gender, age, BMI and side affected was seen suggesting LE equally affects all the demographic variables. But, on comparison of mean scores it was seen that women had lower scores than men. In addition, people with affection of dominant hand were seen to be affected more with lateral epicondylitis.

Short- to mid-term follow-up effectiveness of US-guided focal extracorporeal shock wave therapy in the treatment of elbow lateral epicondylitis

Lateral epicondylitis of the elbow is a common and disabling overuse syndrome. Several treatment modalities are currently available for this condition, but the optimal treatment method remains undefined. Extracorporeal shock wave therapy (ESWT) has been widely used in the last 10 years, although conflicting results are present in the literature. In this study, we evaluated 36 patients (37 elbows), with a mean follow-up time of 24.8 months. Focal ESWT was administered by means of an electromagnetic generator equipped with in-line ultrasound guidance, during one or more cycles of 3-4 weekly sessions. In the setting of the study, patients were clinically evaluated and subjective satisfaction and rate of relapse were investigated. A positive response was described in 75.7 % of the patients after treatment. Mean quickDASH score and VAS attested at 5.5 and 1.1, respectively. Roles and Maudsley score was rated as I or II in 33 cases. Four patients resulted not responders to the therapy, while 5 patients complained one or more episodes of symptoms relapse. No influence on the final outcome was evident with respect to demographic features and previous therapies as well. Response rate to further ESWT cycles in patients refractory to the first cycle of ESWT was 33.3 %. Focal ESWT represents a valuable and safe solution in case of elbow lateral epicondylitis, both in newly diagnosed and previously treated cases, representing a definitive treatment in the majority of patients. Patients refractory to a 3- to 4-session ESWT cycle have lower chances of positive response after further ESWT cycles.

The effect of stretching exercise in the management of lateral epicondylitis

This comparative study was conducted on patients of lateral epicondylitis attending at Physical Medicine and Rehabilitation Department of BSMMU, Dhaka from June to November 2010 with an aim to assess the effect of stretching exercise in patients of lateral epicondylitis of elbow. Eighty consecutive patients of lateral epicondylitis were randomly assigned to two groups. In group A, patients were treated with stretching exercise, ultrasound therapy (UST), NSAID, advice regarding activities of daily living. In group B, patients were treated with ultrasound therapy (UST), NSAID and advice regarding activities of daily living. The outcome was evaluated at weekly interval for 6 weeks in terms of pain, tenderness and frequency of pain. At 2nd week, the pain in group-A came to satisfactory level, but in group-B, it became so at 4th week. The improvement of tenderness was observed at 2nd and 3rd week in group A and group B respectively, but the improvement in pain frequency achieved at 2nd and 4th week in group-A and group-B respectively. The study concludes that stretching exercise is helpful in the early recovery from lateral epicondylitis, majority of the cases experiencing improvement in pain (both in terms intensity and frequency) and tenderness. DOI: http://dx.doi.org/10.3329/bmj.v43i2.21384 Bangladesh Med J. 2014 May; 43 (2): 61-66

A case study of 20 patients with lateral epicondylitis of the elbow by using hwachim (burning acupuncture therapy) and sweet bee venom pharmacopuncture.

Objectives:This study was performed to estimate the effectiveness of burning acupuncture therapy (Hwachim) and sweet bee venom pharmacopuncture (S-BV pharmacopuncture) in treating lateral epicondylitis of elbow.Methods:We selected 33 patients at first, but 13 patients were excluded due to unclear medical records. Finally, a total of 20 patients who had received treatment from January 2012 to December 2013 were included in this study; all 20 patients had undergone Hwachim for the treatment of lateral epicondylitis of elbow, and 19 of the 20 had been treated with S-BV pharmacopuncture (Korea Pharmacopuncture Institute, KPI) and transcutaneous electrical nerve stimulation (TENS) as an ancillary treatment method. The degrees of pain of the 20 patients were evaluated by using the visual analogue scale (VAS) score at their first and final visits. The Wilcoxon signed rank test and the Kruskal-Wallis test were used to compare the VAS scores statistically.Results:The VAS score had decreased significantly from 10.00 ± 0.00 to 4.00 ± 2.47 (P = 0.000) by the end of the treatment. No significant changes were observed based on the number of treatments (P = 0.246), the age of the patients (P = 0.810), the duration of the illness (P = 0.705), and the location of the lesion (P = 0.076).Conclusion:This study suggests Hwachim and S-BV pharmacopuncture are very effective for treating lateral epicondylitis of the elbow.

Platelet rich plasma versus laser therapy in lateral epicondylitis of elbow.

Background:Platelet rich plasma (PRP) extract has shown to be a general stimulation for repair and currently used widely in various sports injury. A prospective observational study was done to assess the efficacy of autologous PRP injection in lateral epicondylitis of elbow, and compare the result with low level laser therapy.Materials and Methods:The trial was conducted at a tertiary care center for a period of 2 years. Eighty-one patients with chronic lateral epicondylitis were divided into two groups. PRP group (n = 39) and laser therapy group (n = 42). The primary analysis included Nirschl pain score, local tenderness, pain on wrist extension, grip strength, elbow swelling were clinically assessed at different interval of followup (minimum followup: 52 weeks) and; clinical and functional outcome evaluated at final followup. The statistical analysis were done.Results:The mean Nirschl pain score decreased significantly from baseline in PRP when compared with low level laser therapy (P ≤ 0.05).Conclusions:Treatment of patients with chronic lateral epicondylitis with PRP extract reduced pain and significantly increased function, exceeding the effect of low level laser therapy on long term followup. Low-level laser therapy is better in the short term period, but on long term followup injection PRP therapy is better than laser therapy in lateral epicondylitis.

Platelet-rich plasma versus corticoid in the treatment of chronic lateral elbow epicondylitis

A total of 52 patients with chronic lateral epicondylitis were randomly assigned into platelet-rich plasma (PRP) (n=28) or corticosteroid (n=24) group. The visual analog pain scale (VAS) and Mayo elbow score had no significant difference between two groups within 1 week post-treatment. However, VAS and Mayo elbow score improved more significantly in PRP group versus corticosteroid group at Month 1 and 6 post-treatment (P<0.05). The PRP trigger point injection treatment of elbow lateral epicondylitis achieved clinical outcomes and it was superior to glucocorticoid treatment. Key words: Lateral elbow epicondylitis; Platelet-rich plasma

SHORT- AND LONG-TERM OUTCOMES OF ELECTROLYSIS PERCUTANEOUS INTRATISSUE (EPI) IN CHRONIC LATERAL ELBOW EPICONDYLITIS

IntroductionChronic lateral elbow epicondylitis is a tendinosis with angiofibroblastic degeneration of the wrist extensors' origin. Electrolysis Percutaneous Intratissue (EPI) is a minimally invasive technique that involves the application of a...

A Case Study of 13 Patients with Lateral Epicondylitis of Elbow Using Deep Thermo-conductive Acupuncture Therapy

Objectives : The Purpose of this study is to evaluate the effect of the deep thermo-conductive acupuncture therapy for the patients with lateral epicondylitis of the elbow. Methods : Thirteen patients with lateral epicondylitis were included from April 2011 to December 2012 and all the patients were treated with the deep thermo-conductive acupuncture therapy. Then we checked visual analog scale(VAS) scores of the patients at every hospital visit, and compared the differences for before and after treatment. We also divided them into 3 age groups(in 40s, 50s, 60s) and 4 groups of the duration of illness(~ 1 week, ~ 1month, ~ 6 months, 6 months ~), and compared the effects for 3 age groups as well as 4 groups of duration of illness. Results : 1. VAS scores had been changed significantly from 6.0769±1.5390 to 3.3077± 1.9207(p=0.005). 2. No significant differences were found between 3 age groups(p=0.968) as well as 4 groups of the duration of illness(p=0.724). Conclusions : This study suggests that deep thermo-conductive acupuncture therapy is effective for healing of the lateral epicondylitis of elbow. But the age and the duration of illness seem to have no influence on results.

Natural course in tennis elbow—lateral epicondylitis after all?

Tennis elbow is a common and difficult-to-treat condition largely because of lack of evidence. The natural history is unknown, but the condition is described as self-limiting. The objective of this case report is to describe the natural course of two control participants (pain free), who later developed tennis elbow, patient history, clinical findings, and ultrasound and colour Doppler examination before, during and after a period of tennis elbow.

Platelet-Rich Plasma

Several injectable substances have been studied for the treatment of tendinitis of the hand, wrist, and elbow, including corticosteroids, botulinum toxin, autologous blood, and platelet-rich plasma (PRP). 1 Faro F. Wolf J.M. Lateral epicondylitis: review and current concepts. J Hand Surg. 2007; 32A: 1271-1279 Google Scholar , 2 Mishra A. Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006; 34: 1774-1778 Crossref PubMed Scopus (628) Google Scholar , 3 Peerbooms J.C. Sluimer J. Bruijn D.J. Gosens T. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med. 2010; 38: 255-262 Crossref PubMed Scopus (523) Google Scholar , 4 Szabo R.M. Steroid injection for lateral epicondylitis. J Hand Surg. 2009; 34A: 326-330 Google Scholar , 5 Creaney L. Wallace A. Curtis M. Connell D. Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med. 2011; 45: 966-971 Crossref PubMed Scopus (212) Google Scholar , 6 Thanasas C. Papadimitriou G. Charalambidis C. Paraskevopoulos I. Papanikolaou A. Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. Am J Sports Med. 2011; 39: 2130-2134 Crossref PubMed Scopus (262) Google Scholar , 7 Wolf J.M. Ozer K. Scott F. Gordon M.J. Williams A.E. Comparison of autologous blood, corticosteroid, and saline injection in the treatment of lateral epicondylitis: a prospective, randomized, controlled multicenter study. J Hand Surg. 2011; 36A: 1269-1272 Google Scholar , 8 Gosens T. Peerbooms J.C. van Laar W. den Oudsten B.L. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2011; 39: 1200-1208 Crossref PubMed Scopus (387) Google Scholar Whereas empiric data suggest a beneficial effect of many treatments for tendinitis, defined roles for these various injections remain unclear. For several years, orthopedic surgeons have used PRP to treat conditions such as tendinitis about the knee, hip, and shoulder 9 Hall M.P. Band P.A. Meislin R.J. Jazrawi L.M. Cardone D.A. Platelet-rich plasma: current concepts and application in sports medicine. J Am Acad Orthop Surg. 2009; 17: 602-608 Crossref PubMed Scopus (273) Google Scholar , 10 Sampson S. Gerhardt M. Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008; 1: 165-174 Crossref PubMed Scopus (4) Google Scholar , 11 Mishra A. Harmon K. Woodall J. Vieira A. Sports medicine applications of platelet rich plasma. Curr Pharm Biotechnol. 2011 July 8; (Epub ahead of print) Google Scholar ; however, data are inconclusive as to its precise mechanism of action as well as whether it demonstrates lasting benefit. We review the composition and preparation of PRP and list several of the available kits for its preparation. Journal CME QuestionsJournal of Hand SurgeryVol. 37Issue 3Preview Full-Text PDF

Platelet-Rich Plasma Versus Autologous Whole Blood for the Treatment of Chronic Lateral Elbow 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: Randomized controlled trial; Level of evidence, 1. Methods: Twenty-eight patients were divided equally into 2 groups, after blocked randomization. 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 standardized 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.

Common extensor origin release in recalcitrant lateral epicondylitis - role justified?

The aim of our study was to analyse the efficacy of operative management in recalcitrant lateral epicondylitis of elbow. Forty patients included in this study were referred by general practitioners with a diagnosis of tennis elbow to the orthopaedic department at a district general hospital over a five year period. All had two or more steroid injections at the tender spot, without permanent relief of pain. All subsequently underwent simple fasciotomy of the extensor origin. Of forty patients thirty five had improvement in pain and function, two had persistent symptoms and three did not perceive any improvement. Twenty five had excellent, ten had well, two had fair and three had poor outcomes (recurrent problem; pain at rest and night). Two patients underwent revision surgery. Majority of the patients had improvement in pain and function following operative treatment. In this study, an extensor fasciotomy was demonstrated to be an effective treatment for refractory chronic lateral epicondylitis; however, further studies are warranted.