Lateral Epicondylitis Research Articles

Corticosteroid injections for the treatment of lateral epicondylitis are superior to platelet rich plasma at 1 month but platelet rich plasma is more effective at 6 months: An updated systematic review and meta-analysis of level 1 and 2 studies.

The purpose of this study was to perform a systematic review and meta-analysis of studies comparing local injections of either platelet-rich plasma (PRP) or corticosteroid for the treatment of lateral elbow epicondylitis. A systematic review of Medline, Embase, Scopus, and Google Scholar was performed, and all level 1 and 2 randomized studies from 2000 to 2022 were included. Clinical symptoms, patient perceived outcomes, and pain were assessed by the DASH (disabilities of the arm, shoulder and hand questionnaire) and pain by the VAS (visual analog scale). Publication bias and risk of bias were assessed using the Cochrane Collaboration's tools. The modified Coleman Methodology Score (CMS) and the GRADE system were used to assess the quality of the body of evidence. Heterogeneity was assessed using χ2 and I2 statistics. Thirteen studies were included in the analysis. Five studies had a high risk of bias, and the risk of bias across studies was assessed as unclear. There was no publication bias identified. Two of the four GRADE domains (inconsistency of results, imprecision of results) were downgraded to low quality, and the final GRADE assessment was downgraded to a low quality of evidence. The mean CMS score was 62.8, indicating fair quality. The pooled estimate for VAS at 1 month favored corticosteroids (p=0.75), but favored PRP at three (p=0.003) and six months (p=0.0001). The pooled estimate for the DASH score favored corticosteroids at 1 month (p=0.028), but favored PRP at three (p=0.01) and six months (p=0.107) CONCLUSION: The results of this meta-analysis suggest that PRP has no advantage over steroid injections within the first month of treatment, but that it is superior to steroids at both 3 and 6 months. These results also suggest that corticosteroids have a short-term beneficial effect during the early treatment period, although the quality of the available evidence is not very robust in support of this finding. However, these findings must all be viewed with caution as the high risk of bias and moderate to low quality of the included studies may not justify a recommendation of one treatment over another.

Interhemispheric Inhibition Between Primary Motor Cortices is Not Altered in Individuals With Chronic Lateral Epicondylalgia

Lateral epicondylalgia (LE), commonly referred to as tennis elbow, is a musculoskeletal condition characterized by pain and sensorimotor dysfunction. In some individuals with chronic unilateral LE, sensorimotor symptoms develop on the unaffected side despite no evidence of tissue damage. Altered interhemispheric inhibition (IHI) is one mechanism that could underpin this phenomenon. The aim of this cross-sectional study was to examine IHI between the primary motor cortices (M1) in individuals with chronic LE and healthy controls. In 20 individuals with chronic LE and 20 healthy participants, transcranial magnetic stimulation was used to assess 1) short and long-latency IHI from the affected (corresponding to the injured side) to the unaffected M1 and 2) corticomotor excitability of the affected and unaffected M1. Sensorimotor function was evaluated bilaterally at the extensor carpi radialis brevis muscle using pressure pain threshold, grip strength, 2-point discrimination, and temporal summation tests. Short- and long-latency IHI from the affected to the unaffected M1 and corticomotor excitability of the affected and unaffected M1 were not altered in individuals with LE compared with healthy participants. No differences in sensorimotor function were observed for the affected or unaffected extensor carpi radialis brevis muscles when individuals with LE were compared with healthy participants. IHI is not altered in individuals with chronic LE. Further studies are required to determine the mechanisms that underpin the development of bilateral sensorimotor symptoms in unilateral LE. PerspectiveIHI is unaltered from the affected M1 (corresponding to the painful muscle) to unaffected M1 in individuals with LE compared to healthy controls. The absence of bilateral sensorimotor dysfunction and low pain severity in this cohort of individuals with LE may explain this finding.

Pairwise association of upper extremity musculoskeletal conditions: large population investigation from PERSIAN cohort study

BackgroundPeople with one area of upper extremity musculoskeletal conditions (UEMSCs) may have other. We aim to determine how frequent is the ipsilateral coexistence of common UEMSCs apparent on interview and examination.MethodsThis is a large population cross-sectional study conducted as part of the PERSIAN cohort study int Mashhad University of Medical Sciences (MUMS). The study aimed to evaluate individuals for symptoms and signs of the following conditions: carpal tunnel syndrome (CTS), lateral epicondylitis (LE), trapeziometacarpal osteoarthritis (TMC OA), DeQuervain’s tendinopathy, trigger digit (TD), ganglion cyst, and rotator cuff tendinopathy (RCT). The primary outcomes of the study are (1) to determine the side-specific relative risk of each UEMSC coexisting with the second condition, and (2) to identify predictive factors of each UEMSC using side-specific multivariate logistic regression analysis.ResultsWe conducted a study involving 4737 individuals from the staff of MUMS and found significant pairwise associations among UEMSCs on a side-specific basis. Women had more chance of having DeQuervain’s disease (β = 6.3), CTS (β = 3.5), ganglion cyst (β = 2.5), TMC OA (β = 2.3), and RCT (β = 2.0). Each condition (dependent variable) was associated with others (predictors) as follows: CTS: RCT (β = 5.9), TMC OA (β = 4.7), TD (β = 2.9), and LE (β = 2.5). TMC OA: LE (β = 6.4), TD (β = 5.4), RCT (β = 4.3), and CTS (β = 4.1). LE: RCT (β = 8.1), TMC OA (β = 6.4), and CTS (β = 2.5). DeQuervain’s disease: TD (β = 13.6), RCT (β = 4.5), and LE (β = 3.8). TD: CTS (β = 8.8), ganglion cyst (β = 7.6), DeQuervain’s disease (β = 5.7), and TMC OA (β = 4.3). RCT: LE (β = 5.8), TMC OA (β = 5.5), CTS (β = 5.2), and DeQuervain’s disease (β = 4.3). Ganglion cyst: TD (β = 4.8).ConclusionOur study reports significant increased frequency of the UEMSCs among patients who already have one of the diseases, in a large sample size study.Level of Evidence Level II (Differential Diagnosis/Symptom Prevalence Study).

Long-term effectiveness of conservative management for lateral epicondylitis: a meta-analysis.

To investigate the long-term (>12 months) effectiveness of conservative management for lateral epicondylitis. PubMed and Embase databases were searched for relevant studies from inception to March 2023. Only English-written randomized controlled trial (RCT) with data download as well as follow up ≥12 months were acceptable. Raw data were extracted into a predefined worksheet, and quality analysis was conducted based on the Cochrane risk-of-bias tool version 2 (RoB2). The standardized mean difference (SMD) with 95% confidence interval (CI) were calculated. Extracorporeal shock wave therapy (ESWT) could significantly relive pain for lateral epicondylitis patients in the long term (SMD: -0.19, 95% CI [-0.36, -0.02]); however, there was no significant difference between ESWT and control groups in long-term function outcome (SMD: 0.24, 95% CI [-0.02, -0.49]). No significant difference could be observed between (1) exercise and control groups in pain (SMD: -0.21, 95% CI [-0.60, 0.18]) or function (SMD: 0.06, 95% CI [-0.11, 0.23]), (2) corticosteroids and placebo groups in pain (SMD: 0.70, 95% CI [-0.43, 1.82]) or function (SMD: -0.02, 95% CI [-0.36, 0.31]), and (3) platelet-rich plasma (PRP) in pain (SMD: -0.30, 95% CI [-0.85, 0.25]) and function (SMD: -0.08, 95% CI [-0.78, 0.62]). The present conventional conservative management for lateral epicondylitis, with the exception of ESWT, a lack adequate evidence supporting their long-term effectiveness.

Open versus Arthroscopic in Management of Tennis Elbow. A Systematic Review

Background Treatment of resistant tennis elbow (lateral epicondylitis) still challenging, which may require surgery in order to gain pain relief and improve function. Aim of the Work The aim of this study is to systematic review and meta-analysis arthroscopic to open surgery for resistant TE regarding ROM, grip strength, DASH score, VAS, and complications. Methodology This study was approved by the Ethics Committee of Ain Shams University Faculty of Medicine. Written informed consent was not needed because of the study design (systematic review). We included randomized control trails (RCTs), controlled clinical trials, retrospective cohort studies, case series studies and we excluded case reports, cross sectional studies, non English study. Search results will be conducted to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion/exclusion criteria. Results Our systematic review found that the most relevant conclusion from the current study is that there is a significant difference between the 2 operative techniques when examining VAS score, Mayo elbow performance score, grip strength, DASH score and time to return to work in favor of arthroscopic technique. While the arthroscopic surgery had a longer surgical time than the open technique. Additionally, it was found that the complication rates, DASH score, range of motion and failure rates were similar between the arthroscopic and the open technique. Conclusion We found a similar effectiveness of both arthroscopic and open techniques in improving failure risk, complication rate and range of motion postoperative in the treatment of tennis elbow. There is significant difference between arthroscopic and open surgery with regards to self-reported function (DASH), pain intensity (VAS) at follow up, time to return to work and grip strength postoperative in favor of arthroscopic technique. The current meta-analysis found that arthroscopic surgery had a longer surgical time than the open surgery for lateral epicondylitis.

Effect of Platelet Rich Plasma Therapy for Shoulder Osteoarthritis: Double Blinded Randomized Controlled Study

Abstract Background Platelet-rich plasma (PRP) is widely used in musculoskeletal conditions and orthopaedic surgery ranging from clinic-based injections for tendinopathies to intra-operative application to augment soft-tissue healing. It has been used in knee osteoarthritis, rotator cuff tears, elbow epicondylitis, anterior cruciate ligament reconstruction, shoulder impingement syndrome and various tendinopathies to date, with an expanding list of indications. While available evidence supports the use of PRP in the management of lateral epicondylitis and knee osteoarthritis, there is limited clinically significant evidence for other indications Aim of the Work This study aims to evaluate the efficacy of platelet-rich plasma as a treatment for primary and secondary shoulder osteoarthritis pain. Patients and Methods A prospective, double-blinded randomized control study in Ain Shams University Hospitals from 3 to 6 months. The patients were divided into 2 groups using computerized generated randomization. The control group received 5 ml 0.9% saline injection in the intra-articular shoulder (between glenohumeral joint). The study group received 5 ml of PRP treatment. Results The study results showed: All demographic data (age, sex, weight and BMI) and chronic diseases were insignificantly different between both groups, all medical data (chronic diseases, type of osteoarthritis, severity of symptoms, time of symptoms, radiological finding and type of treatment) were insignificantly different between both groups, NRS was significantly lower in study group compared to control group at ―2nd evaluation post injection|| and was insignificantly different between both groups at ―1st evaluation post injection||. (P < 0.05), range of movement was insignificantly different between both groups at 2nd evaluation post injection and injection related complications (inflammation and infection) were insignificantly different between both groups. Conclusion In general, efficacy was observed in treatment with PRP alone in shoulder osteoarthritis. However, patients receiving PRP treatment are less likely to experience post-injection pain and are more likely to recover faster when compared to patients receiving saline alone.

A meta-analysis of the risk factors for lateral epicondylitis

BackgroundVery few meta-analyses discussed risk factors for lateral epicondylitis (LE), and previous meta-analyses reached conflicting conclusions with each other on some specific risk factors. PurposeTo investigate the risk factors for LE through meta-analysis. Study DesignMeta-analysis. MethodsPubMed, Embase, and Web of Science databases were searched for relevant studies in January 2022. Raw data were extracted into a predefined worksheet, and quality analysis was conducted by the Quality in Prognosis Studies (QUIPS) tool. Pooled effect sizes and 95% confidence intervals were calculated. R package "meta" was used for statistical analysis. Results22 studies were included in the meta-analysis. Female sex (odds ratio [OR]=1.33 and p-value<0.05), smoking history (OR=1.46 and p-value<0.001), manual labor (OR=2.39 and p-value<0.001), and hypercholesterolemia (OR=1.67 and p-value<0.05) were significant risk factors for LE. ConclusionsFemale gender, smoking history, manual labor, and hypercholesterolemia could increase the risk of LE. According to an additional literature review, statin treatment for hypercholesterolemia is described as potentially related to the development of LE.

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.

Assessment of common extensor tendon vascularization using superb microvascular imaging: a potential tool in the evaluation of extracorporeal shock wave therapy and therapeutic ultrasound effectiveness in lateral epicondylitis.

Lateral epicondylitis, also known as tennis elbow, is the most common elbow pain in the adult age group. To evaluate common extensor tendon (CET) vascularity with superb microvascular imaging (SMI) before and after extracorporeal shock wave therapy (ESWT) and ultrasound (US) treatment in patients with lateral epycondylitis and to compare the effects of two different treatments on tendon vascularity. Patients with lateral epycondylitis were divided into two groups; 30 patients were treated with ESWT (group 1) and 30 patients were treated with therapeutic US (group 2). We performed a high-frequency (14-MHz) linear array transducer to evaluate tendon anatomy and vascularity before and after treatment in both groups. The decrease in Patient-Rated Tennis Elbow Evaluation (PRTEE) score after treatment was statistically significant compared to pre-treatment for both groups (P < 0.001). Likewise, the decrease in visual analog scale (VAS) score after treatment was statistically significant compared to pre-treatment for both groups (P < 0.001). A significant difference was found between the CET SMI values of group 1 and group 2 after treatment, according to the chi-square test (P < 0.001). In the post-treatment VAS and PRTEE comparison of both groups, the score reduction in group 1 was higher than in group 2, and this decrease was statistically significant (P < 0.001). We can evaluate CET vascularization with the SMI method as a new potential diagnostic tool in comparing the effectiveness of different treatments in cases of lateral epicondylitis.

Interactive game experience: a preliminary investigation of the impact of virtual reality on exercise rehabilitation behaviors

ABSTRACT Tennis elbow, known as lateral epicondylitis in medical terms, which affects the daily life function of most patients. Many patients are becoming less willing to practice traditional rehabilitation due to time and space constraints and the need to go to the hospital for rehabilitation. In this study, the concept of user experience, and the remote therapy model were used to design a virtual reality interactive game system which incorporated lateral epicondylitis exercise rehabilitation knowledge on user learning. The usability of this system was evaluated by a digital content instructor and a rehabilitation practitioner before being put into practice to test the user experience. The system could provide four rehabilitation modes for the user to choose from, with the guidance of a virtual physiotherapist or therapist, to achieve optimal results. This study found that virtual reality provided good interaction satisfaction for the users, but that a long operation time or too much information might bring users the feeling of troublesome. The integration of digital information content and control on the length of operation time were important factors when designing this kind of games.

Lived experience of people with lateral elbow tendinopathy: a qualitative study from the OPTimisE pilot and feasibility trial

ObjectivesTo explore the lived experience of people with lateral elbow tendinopathy (LET) and its impact on everyday life.DesignQualitative semi-structured interviews, analysed using thematic analysis.SettingConducted as part of the mixed-methods OPTimisE...

BESS patient care pathway: Tennis elbow.

This article provides a guidance summary for the management of lateral elbow tendinopathy (LET) using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of the rating quality of the literature and grading the strength of available evidence. The process began by assembling a guideline development group of volunteers including orthopaedic surgeons, trainees, physiotherapists, rheumatologists, radiologists and patients. Virtual meetings were organised to set out explicit PICO questions, including specification of all important outcomes (including patient reported tennis elbow evaluation (PRTEE) as an important primary outcome) to determine the clinical effectiveness of common treatment options for LET compared with no treatment or placebo. Clinical librarian searched (date 31 April 2022) for available systematic reviews and randomised controlled trials reviewing the management of the LET January 2011 onwards and evidence was collected and summarized using explicit GRADE criteria for rating the quality of evidence that include study design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect. Recommendations were characterized as strong or weak (alternative terms conditional or discretionary) according to the quality of the supporting evidence and the balance between desirable and undesirable consequences of alternative management options. This informative summary provides the quality of available evidence for the management of LET.

Shoulder &amp; Elbow

The August 2023 Shoulder &amp; Elbow Roundup360 looks at: Motor control or strengthening exercises for rotator cuff-related shoulder pain? A multi-arm randomized controlled trial; Does the choice of antibiotic prophylaxis influence reoperation rate in primary shoulder arthroplasty?; Common shoulder injuries in sport: grading the evidence; The use of medial support screw was associated with axillary nerve injury after plate fixation of proximal humeral fracture using a minimally invasive deltoid-splitting approach; MRI predicts outcomes of conservative treatment in patients with lateral epicondylitis; Association between surgeon volume and patient outcomes after elective shoulder arthroplasty; Arthroscopic decompression of calcific tendinitis without cuff repair; Functional outcome after nonoperative management of minimally displaced greater tuberosity fractures and predictors of poorer patient experience.

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.

Pressure Pain Hypersensitivity and Ultrasound Changes in the Radial Nerve in Patients with Unilateral Lateral Epicondylalgia: A Case-Control Study.

Some authors have proposed the potential role of the radial nerve in lateral epicondylalgia. The aims of this study were to investigate the presence of pressure pain hyperalgesia and nerve swelling (increased cross-sectional area) assessed with ultrasound imaging on the radial nerve in people with lateral epicondylalgia, and to investigate if an association exists between pressure pain sensitivity and cross-sectional area. A total of 37 patients with lateral epicondylalgia (43% women, age: 45.5 ± 9.5 years) and 37 age- and sex-matched pain-free controls were recruited for participation. Pressure pain thresholds (PPTs) were assessed bilaterally on the radial nerve at the spiral groove, the arcade of Frohse, and the anatomic snuffbox in a blinded design. Further, the cross-sectional area of the radial nerve at the spiral groove and antecubital fossa was also assessed. The results demonstrated lower PPTs on the radial nerve of the affected side in individuals with lateral epicondylalgia as compared with the unaffected side (p < 0.01) and with both sides in healthy controls (p < 0.001). Additionally, the cross-sectional area of the radial nerve on the affected side in patients was higher compared with the unaffected side (p < 0.01) and both sides in healthy controls (p < 0.001). The cross-sectional area of the radial nerve at the spiral groove was negatively associated with PPTs over the radial nerve at the spiral groove (r = -0.496, p = 0.002) and positively associated with function (r = 0.325, p = 0.045). Our findings revealed generalized pressure pain hyperalgesia and also nerve swelling of the radial nerve in people with lateral epicondylalgia, suggesting the presence of a widespread sensitization of nerve tissues in this population. The radial nerve could represent a potential peripheral drive to initial and maintain altered pain processing in lateral epicondylalgia.

Efficacy of extension wrist hand orthosis on pain, grip strength and electromyographic activities in lateral epicondylitis: A randomized single-blind clinical trial

BackgroundLateral epicondylitis (LE) is one of the most common work-related complications characterized by pain, decreased grip strength and dysfunction of upper limb. Although conservative management such as physiotherapy and orthosis is reported as first line of treatment, sufficient evidence to decide their effectiveness is lacking and remains controversial. PurposeThe current study evaluated and compared the efficacy of a custom-made extension wrist hand orthosis adjunct to usual physiotherapy and therapeutics alone for subjects with LE. Study DesignProspective randomized single-blinded clinical trial. Methods62 subjects with LE were selected as samples using convenience method in this experimental study. They were randomly divided into two groups: usual physiotherapy only and its combination with orthosis. Pain and grip strength were measured using Visual Analog Scale and Jamar hydraulic digital hand dynamometer. Muscle activity of extensor carpi radialis brevis during hand gripping was measured using surface electro-myographic by PowerLab electromyography (AD Instruments, Castle Hill, Australia). Data analysis and comparison were performed for baseline and post-intervention (12weeks). ResultsAfter 12weeks of treatment, there were significant differences in mean scores of pain (1.22 ± 0.51, p = 0.001), maximum voluntary grip strength (5.82 ± 7.84, p = 0.04), and extensor carpi radialis brevis muscle activation (0.082 ± 0.094, p = 0.02) between the therapeutics alone group and the therapeutics plus orthosis group. Compared to therapeutics alone, those getting a combination of physiotherapy and orthosis had greater treatment efficacy (p < 0.05). ConclusionsBoth postintervention (12-week) treatments could affect pain scores, grip strength, and extensor muscle activation. Custom-made extension wrist hand orthosis adjunct to usual physiotherapy is more effective than therapeutics alone in subjects with LE. Therefore, the use of wrist orthosis adjunct to physiotherapy should be recommended in rehabilitation settings for LE.

Bracing or kinesio taping in the management of lateral elbow tendinopathy: A prospective, randomized single-blinded trial

ObjectiveThe aim of the study was to compare the effects of forearm counter force brace (FCB) and kinesio taping (KT) on pain severity, grip strength and functionality of patients with lateral elbow tendinopathy (LET). MethodsThe study was planned as a prospective, randomized and assessor-blinded study with 1-month follow-up period. Seventy-two patients, diagnosed as LET were randomly assigned to FCB (n = 41) or KT (n = 31) groups. In the FCB group, the patients were informed and instructed to wear the brace for three weeks continuously. In the KT group, tape was applied once a week for four weeks with muscle inhibition and fascia correction techniques. The outcome measures were pain pressure threshold (PPT), maximal pain-free hand grip strength measurement and patient-rated tennis elbow evaluation questionnaire (PRTEE). The assessments were performed at the baseline, immediately after treatment and one month later after treatment. ResultsPPT and grip strength were significantly increased over time in both groups. Pain, function and total scores of PRTEE were significantly decreased in both FCB and KT groups. The effect size of the improvement in PRTEE function score was within acceptable clinical significance in the KT group. However, there was no significant difference between groups. ConclusionsPain severity, grip strength and functionality of patients with LET improved over time in both FCB and KT groups. However, neither was superior in the management of LET.

Clinical efficacy of Platelet-Rich Plasma versus local Methylprednisolone Injection in Lateral Epicondylitis.

To compare the results of local administration of platelet-rich plasma (PRP) with methylprednisolone in the treatment of tennis elbow. This retrospective cohort was conducted at Jinnah Postgraduate Medical Center (JPMC) during January 2017 to April 2018. Patients conservatively managed for lateral epicondylitis with local methylprednisolone injection or PRP injection were approached for possible inclusion in the study at 12 months of treatment. The primary outcome of the study was to determine the Numerical Pain Rating Score (NPRS) on resisted wrist extension. Whereas, the secondary outcomes were quick disability arm, shoulder, and hand score (qDASH), the grip strength and VAS for satisfaction. The baseline, six weeks and three month data on Grip strength, NPRS, and qDASH were extracted from the patients' medical records maintained at the hospital. The data were analyzed by using SPSS software. A total of 91 patients were approached, of them 81 (89.01%) agreed to participate. There were 46 (56.79%) who received local methylprednisolone injection and 35 (43.20%) received PRP. At 12 months follow up, there was no difference in NPRS pain scores between the two groups (p=0.691); pain decreased in both groups at six weeks and at 12 months. There was no significant difference in the functional outcome (qDASH score) in both groups. Both groups were equally satisfied with the treatment they had received. The study concluded that there is no difference between outcome and efficacy of both treatment modalities used for the treatment of tennis elbow in alleviating pain at 12 months.

Comparative Analysis of Platelet Rich Plasma and Corticosteroid Injection in Lateral Epicondylitis

Comparative Analysis of Platelet Rich Plasma and Corticosteroid Injection in Lateral Epicondylitis

Poster 361: Prolotherapy in the Treatment of Sports-Related Tendinopathies: A Systematic Review

Objectives: Prolotherapy (PrT) involves the injection of a proliferant in order to irritate a microenvironment and promote healing via the inflammatory cascade. PrT has become an increasingly popular nonoperative treatment in orthopedics. However, numerous prolotherapy solutions exist and varying applications and results have been described. The purpose of this study is to review high-quality randomized controlled trials (RCTs) that analyzed efficacy and safety profiles of prolotherapy (PrT) treatments for the most common sports-related tendinopathies. Methods: All RCTs published in English between January 1st 1980 and July 30th 2021, reported in Embase, Medline, and Web of Science databases, were queried with search terms including sclerotherapy, prolotherapy, sports medicine, sports injuries, tendinopathies, and musculoskeletal pain/injuries. PRISMA guidelines were used. Studies analyzing tendinopathies using a RCT design were included, while case controls, reviews, and observational studies were excluded. Duplicates were eliminated through Endnote. The remaining articles were screened by titles, followed by abstract and then by full text analysis. The Cochrane collaboration tool was used to assess for risk of bias. Two researchers independently performed the screening and conflicts were resolved using Rayyan © software (Rayyan Systems Inc., Cambridge, MA, USA). Graphical representations were created using SPSS version 28.00. Results: Application of the inclusion and exclusion criteria yielded 20 RCTs (fig. 1): 6 studies on lateral epicondylitis (LE); 6 on rotator cuff tendinopathy (RC); 5 on plantar fasciitis (PF); 2 on Osgood-Schlatter disease (OSD); 1 on Achilles tendinosis. Most of the trials used dextrose injections over P2G or hypertonic glucose (fig. 2), and the most common studied conditions were LE and RC (fig.3). The average follow-up period was 12 weeks. No significant adverse effects were reported, and the most common outcome measures were visual analog scale (VAS), patient rated tennis elbow evaluation (PRTEE), quick- disabilities of the arm, shoulder, and hand (Q-DASH), and symptoms relief. For the treatment of LE, dextrose PrT was associated with significant improvement in VAS pain score at rest and PRTEE compared to normal saline (p&lt;0.041, p&lt;0.013 respectively). Additionally, compared to hyaluronic acid and lifestyle modifications, PrT showed significant improvement in VAS pain score with activity, Q-DASH, and PRTEE scores (p&lt;0.04, p&lt;0.04, p&lt;0.05 respectively). For the treatment of RC, dextrose PrT was found superior to physiotherapy in the shoulder disability index (p&lt;0.001). Finally, dextrose PrT demonstrated significant improvements in foot function index (p&lt;0.001) for the treatment of PF, and reduction of symptoms in OSD (p&lt;0.024) compared to physical therapy and lidocaine controls. Patients with AT had a more rapid improvement in symptoms in the combined PrT/eccentric loading exercises protocols compared to dextrose PrT alone (p&lt;0.007). A graphical representation of the results is reported in figure 4. Conclusions: This systematic review summarized high quality RCTs and found PrT injections to be overall safe and effective in the treatment of sports-related tendinopathies. Further RCTs with larger sample sizes and comparisons to orthobiologics would add to the literature. Based on the current findings, sports medicine professionals may safely pursue PrT as an additional component of conservative treatment before surgery.