Management Of Lateral Epicondylitis Research Articles

Effectiveness of High-Power Laser Therapy via Shear Wave Speed Analysis on Pain and Functioning in Patients with Lateral Epicondylitis: A Proof-of-Concept Study.

Background: Lateral epicondylitis (LE) causes lateral elbow pain due to the overuse of the common extensor tendon. Several therapies have been proposed for pain relief and functional recovery, including physical therapy, minimally invasive injection approaches, and physical agent modalities such as laser therapy. Methods: Our study evaluates the impact of high-power laser therapy (HPLT) on pain and functioning. The HPLT protocol consists of 10 daily sessions using a LASERIX PRO device. The healthy elbow of each participant was also considered as a control group. The outcomes assessed were the Numerical Rating Scale (NRS) for pain, QuickDASH questionnaire for functionality, and shear wave velocity (SWS) through ultrasonography. Assessments were conducted at baseline (T0), post-treatment (T1), and 2-week follow-up (T2). Results: Sixteen participants (81.2% male, mean age 40.4 ± 5.53 years) completed the study. Post-treatment, pain significantly decreased (NRS: T0 6.13 ± 0.96; T1 2.75 ± 1.69; p < 0.001), functionality improved (QuickDASH: T0 69.88 ± 10.75; T1 41.20 ± 3.78; p < 0.001), and shear wave velocity increased (SWS (m/s): T0 1.69 ± 0.35; T1 2.56 ± 0.36; p < 0.001). Conclusions: At the 2-week follow-up, pain relief was maintained, and shear wave velocity showed no further significant change. Shear wave velocity assessments might be considered a useful diagnostic tool. However, further research is needed to support the role of HPLT and shear wave velocity in the rehabilitation management of LE.

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.

Efficacy of Therapeutic Ultrasound and Therapeutic Laser Along with Myofascial Release in Reducing Pain and Improving Hand Grip for People with Lateral Epicondylitis

Background: Lateral epicondylitis is a common overuse injury that affects the tendons on the outer side of theelbow. It results from repetitive gripping or wrist extension activities, leading to microtrauma and subsequentinflammation. The condition primarily manifests as pain and reduced grip strength, often affecting dailyactivities and occupational performance. However, limited research directly compares the effectiveness of theseinterventions for lateral epicondylitis.Purpose: The aim of this study is to compare the effectiveness of therapeutic ultrasound and therapeutic laser,in conjunction with myofascial trigger release, in reducing pain and improving handgrip strength in individualswith lateral epicondylitis.Methods: Patients willing to participate in the study were screened for inclusion and exclusion criteria taken fromGet well soon physio rehabilitation centre. The total number of subjects (40) are divided into 20 subjects for theexperimental group (Group A), they are given therapeutic ultrasound along with myofascial release . The controlgroup (Group B) consisting of 20 subjects, are low level therapeutic laser along with myofascial release, NPRS andHandheld dynamometer are used as outcomes measure. The entire process was conducted from November 2022to March 2023.Results: The results revealed significant pain reduction and greater improvements in handgrip strength for thetherapeutic laser group compared to the therapeutic ultrasound group. This study showed that the p value isstatistically significant &lt;0.0001.Conclusion: This study concluded that therapeutic laser, when combined with myofascial trigger release,demonstrated superior effectiveness compared to therapeutic ultrasound in the management of lateral epicondylitis.

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.

Google Search Analytics for Lateral Epicondylitis.

The use of online search engines for health information is becoming common practice. We analyzed Google search queries to identify the most frequently asked topics and questions related to lateral epicondylitis ("tennis elbow") and the Web sites provided to address these questions. Four search terms for lateral epicondylitis were entered into Google Web Search. A list of the most frequently asked questions along with their associated Web sites was extracted and categorized by 2 independent reviewers. A total of 400 questions were extracted with 168 associated Web sites. The most popular question topics were related to indications/management (39.0%), risks/complications (19.5%), and the ability to perform specific activities (18.8%). Frequently asked questions had to do with the duration of symptoms, self-management strategies (eg, brace use and self-massage), and the indications for surgery. The most common Web sites provided to address these questions were social media (27.5%), commercial (24.5%), academic (16.5%), and medical practice (16.3%). The most frequently asked questions about lateral epicondylitis on Google centered around symptom duration and management, with most information originating from social media and commercial Web sites. Our data can be used to anticipate patient concerns and set expectations regarding the prognosis and management of 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 &amp;lt; 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 Clinical Overview of the Natural Course and Management of Lateral Epicondylitis.

Lateral epicondylitis (LE), also often called tennis elbow, is a frequent cause of elbow pain. The most characteristic symptom of LE is pain and burning around the lateral epicondyle of the humerus that may radiate to the forearm or to the upper arm. Ultrasonography is a quick and noninvasive tool used to confirm (or exclude) the diagnosis of LE. Management of LE symptoms should be directed to the management of pain, protection of movement, and improvement of arm performance. Treatment of LE includes nonoperative techniques and surgery. [Orthopedics. 2023;46(4):e210-e218.].

A systematic review of the effectiveness of wrist manipulative therapy in patients with lateral epicondylitis

Study DesignSystematic review. IntroductionSeveral treatment methods treat lateral epicondylitis, but there is no consensus regarding the most effective method. Research has suggested that joint mobilizations may help recover patients with lateral epicondylitis. Purpose of the StudyTo determine if wrist joint manipulations effectively improve pain, grip strength, ROM, and functional outcome in adults with lateral epicondylitis. MethodsSearches were performed in 6 databases to identify relevant clinical trials. Three reviewers independently extracted data and assessed the methodological quality using the PEDro scale. Standard data were extracted and summarized. ResultsA total of 4 studies met the inclusion criteria. A best-evidence synthesis was used to summarize the results. The included studies found effectiveness in favor of wrist manipulations given for at least 3 weeks to reduce pain in lateral epicondylitis against comparison groups comprising ultrasound, laser, friction massage, and exercises. Functional outcomes varied considerably among studies. Grip strength showed varied results, and no effect was seen on wrist ROM. ConclusionThe evidence is convincing that wrist joint manipulations positively affect pain in the short term, compared to comparison groups in the management of lateral epicondylitis. Future high-quality studies are recommended.

Lateral Epicondylitis: Critical Analysis Review of Current Nonoperative Treatments.

Lateral epicondylitis (LE) or tennis elbow is a common cause of elbow pain in the general population, especially women in the fourth and fifth decades of life who participate in repetitive forceful movements involving the wrist and forearm. The pathogenesis of this overuse injury is believed to start from an overload event leading to a microtear in or near the origin of the extensor carpi radialis brevis that is subsequently prone to additional injury and structural weakness over time. Treatment of LE often begins with a wide variety of nonoperative modalities including rest, nonsteroidal anti-inflammatory drugs, bracing, and physical therapy. For recalcitrant symptoms, additional nonoperative therapies are implemented; however, there remains a lack of comparative efficacy between these adjunct treatments. In this article, we examine the available literature regarding nonoperative management of LE and provide supplementary insight into the effectiveness of current modalities.

A systematic review on the efficacy of different types of platelet-rich plasma in the management of lateral epicondylitis

Platelet-rich plasma (PRP) is reported as an effective treatment for lateral epicondylitis (LE). Theoretically, different types of PRP have different therapeutic effects. However, there is controversy on the effects of different types of PRP in the treatment of LE. The purpose of this study was to systematically compare pain relief, functional improvement, and the success rate of treatment using 2 different types of PRP by reviewing and summarizing the data available in the current literature on LE after PRP injection. The PubMed, MEDLINE, Embase, Cochrane Library, and Web of Science databases were reviewed. A computerized literature search was performed for related studies published from database inception to August 2021 using the following terms: lateral epicondylitis, tennis elbow, tendinopathy, lateral elbow pain, PRP, and platelet-rich plasma. The PRP patients included in our study were divided into those receiving leukocyte-poor PRP (LP-PRP) and those receiving leukocyte-rich PRP (LR-PRP) according to the different preparation methods. Outcomes of interest included patient characteristics, types and preparations of PRP, clinical outcomes, success rates, and the safety of treatment at short- and long-term follow-up. A total of 33 studies were evaluated in our analysis, including 2420 LE patients. LP-PRP was used in 19 of these studies, LR-PRP was used in 13, and both LP-PRP and LR-PRP were used in 1. Patients in both PRP groups showed significantly improved clinical outcomes after treatment compared with before treatment. The mean visual analog scale scores ranged from 6.1 to 8.0 before treatment, ranged from 1.5 to 4.0 at short-term follow-up, and ranged from 0.6 to 3.3 at long-term follow-up in the LR-PRP group. The mean visual analog scale scores ranged from 4.2 to 8.4 before treatment, 1.6 to 5.9 at short-term follow-up, and 0.7 to 2.7 at long-term follow-up in the LP-PRP group. The Disabilities of the Arm, Shoulder and Hand scores in the LR-PRP and LP-PRP groups ranged from 47.0 to 54.3 and 30.0 to 67.7, respectively, before treatment and ranged from 20.0 to 22.0 and 5.5 to 19.0, respectively, at long-term follow-up. The success rates in the LR-PRP and LP-PRP groups ranged from 70% to 100% and 36% to 100%, respectively. The complication rate was lower in the LP-PRP group (3.9%) than in the LR-PRP group (6.4%, P=.029), with the main complication being temporary pain after PRP treatment. PRP treatment demonstrated significant improvements in terms of pain relief and functional improvement in LE patients regardless of the type of PRP. There were no significant differences in pain relief and functional improvement between LR-PRP and LP-PRP. The main complication was temporary pain after PRP injection, and the complication rate in the LP-PRP group was lower than that in the LR-PRP group.

A Study to Compare the Effectiveness of Active Release Technique Versus Deep Friction Massage on Pain, Grip Strength and Functional Performance in Patients with Chronic Lateral Epicondylitis

Background and Objectives: Lateral epicondylitis is a very common overuse syndrome in the elbow. It is an injury whichinvolves the extensor muscles of the forearm. The most frequent location of the involvement is in the musculotendinousjunction of the extensor carpi radialis brevis muscle. It leads to pain, reduced grip strength and functional impairmentsaffecting individual’s lifestyle. Active release technique and deep friction massage both are effective techniques in thetreatment of lateral epicondylitis. This study focuses on the comparative perspective of these soft tissue techniques alongwith the conventional treatment in terms of relief to the patients suffering from lateral epicondylitis.Study Design: Experimental design comparative in nature.Method: This study was done on 30 subjects who were divided equally into two groups. Group A received active releasetechnique along with the conventional treatment for lateral epicondylitis and group B received deep friction massagealong with the conventional treatment. Each patient was assessed on 1st, 11th and 21st day using Numeric Pain Rating Scale(NPRS), hand dynamometer and Patient Rated Tennis Elbow Evaluation (PRTEE) questionnaire.Result: Statistical analysis of the data revealed that both the therapies produced improvement in pain, grip strength andfunctional activity status among patients with chronic lateral epicondylitis but according to independent t-test there washighly significant difference between active release technique and deep friction massage groups. The study confirmedthat the effect of therapy in group B is more effective rather than group A by NPRS scores but on PRTEE and gripstrength effect of therapy in group A (ART) was more effective rather than group B (DFM). And by paired sample test therewas statistically significant difference between before and after program in group A and group B among chronic lateralepicondylitis patients.Conclusion: The study concluded that active release technique and deep friction massage both are effective treatments ifdone along with the conventional treatment. Active release technique demonstrated better improvement than the deepfriction massage in the management of lateral epicondylitis.

Retrospective comparison of the efficacy of corticosteroid and dry needling in lateral epicondylitis

Lateral epicondylitis (LE) commonly known as tennis elbow (as it affects 50% of tennis players) is also a general public health issue as it affects a high number of the general population.The preferred method of treatment most commonly is a local corticosteroid (CS) injection with or without the addition of a local anesthetic 6. Dry needling (DN) is another treatment modality which is commonly employed for the management of LE.The purpose of our study was to evaluate whether DN is as effective as CS injections in the management of LE. The number of patients included in our study was 146. Patients were divided into two groups. One that had been treated with corticosteroid injections (Group A) and one that had been treated with dry needling (Group B).Patient evaluation forms/records at 4 weeks and 12 weeks, were retrieved and analyzed. For this modified criteria of Verhaar et al was utilized.The study suggests that both the techniques, i.e dry needling as well as corticosteroid injections are reliable methods for treatment of lateral epicondylitis.

Extracorporeal shock wave therapy (ESWT) versus local corticosteroid injection in treatment of lateral epicondylitis (tennis elbow) in athletes: clinical and ultrasonographic evaluation

BackgroundLateral epicondylitis is one of the commonly noticed disorders of the arm described by agony focused over lateral epicondyle which is the site of wrist extensors origin. The purpose of this work was to compare the efficiency of extracorporeal shock wave therapy and local corticoid injection in management of lateral epicondylitis both clinically and ultrasonographically as well as to assess the role of ultrasound in diagnosis and follow-up of lateral epicondylitis. This study was performed on 30 athletes diagnosed as lateral epicondylitis.ResultsBoth corticosteroid injection and shock wave treatment showed a highly significant effectiveness on pain by visual analog scale (VAS). A highly significant difference between before treatment and after 2 as well as 4 weeks of treatment regarding the functional disability parameters as patient-rated tennis elbow evaluation (PRTEE) and quick disabilities of the arm, shoulder, and hand (DASH) was found. Likewise, a statistically significant improvement in favor of shock wave therapy group after 2 weeks was found, inversely insignificant difference after 8 and 12 weeks regarding to VAS occurred. Both PRTEE and Quick DASH test showed a statistically significant difference among groups through all follow-up period.There was a statistically insignificant difference among the studied groups according to ultrasound (US) changes in the form of focal areas of hypo-echogenicity through follow-up periods. A significant improvement in favor of ESWT group is detected among the studied groups regarding tendon thickening in ultrasonography before treatment and after 2 and 4 weeks. However, the difference was insignificant after 8 and 12 weeks.ConclusionsBoth corticosteroid local injection and shock wave therapy are helpful and effective for lateral epicondylitis treatment. However, a shock wave therapy revealed better improvement on long-term clinical and ultrasonogrphic follow-up than corticosteroid injection. Musculoskeletal ultrasound represents a helpful diagnostic and follow-up tool for lateral epicondylitis.

Efficacy of wrist manipulation in the management of lateral epicondylitis

Background: Lateral epicondylitis is the most common clinical condition characterized by pain generally localized around the lateral epicondyle but sometimes radiating distally to the forearm. Objectives: The study's primary objective was to find out the efficacy of multiple therapeutic interventions consisting of wrist manipulation, ultrasound therapy, and stretching exercise on lateral epicondylitis patients. Subjects and methods: A pre-test, post-test experimental study design was used. A criterion-based simple random sampling was used to recruit patients (N=30) diagnosed with lateral epicondylitis, and they were randomized into two treatment groups. The experimental group-1 was exposed to ultrasound therapy and stretching exercises, whereas those assigned to experimental group-II were given ultrasound therapy, stretching exercise, and wrist manipulation for the period of 2 weeks. The efficacy of treatment was measured through visual analogue scale (VAS), manual hand dynamometer, and DASH Scale. Both paired and unpaired ‘t’ test was employed to study the treatment effectiveness. A p-value &lt;0.05 was considered ‘significant’. Result: The group, which was exposed to the treatment combinations of wrist manipulation, ultrasound therapy, and stretching exercise showed a better reduction in pain intensity (mean difference 1.4) &amp; self-reported upper extremity disability score (mean difference 8.06) and a notable improvement in grip strength (mean difference 4.73) than the other group, that was exposed to the treatment combinations of ultrasound therapy and stretching exercise at 0.05 levels of significance. Conclusion: There is a significant reduction in pain intensity, improvement in pain-free grip strength, and the overall function of the arm following the application of 2 weeks of wrist manipulation technique along with conventional treatment in Lateral Epicondylitis patients. Clinical Implications: Manipulation of the wrist is found to produce a significant effect when combined with conventional methods like ultrasound stretching and strengthening to manage lateral epicondylitis patients. KEY WORDS: Lateral epicondylitis, Ultrasound, Passive stretching, Wrist manipulation.

Comparison of the efficacy of corticosteroid, dry needling, and PRP application in lateral epicondylitis.

The aim of this study was to compare the short-term efficacy of dry needling, corticosteroids, and platelet-rich plasma application (PRP) in the management of lateral epicondylitis. The study included 72 patients diagnosed with lateral epicondylitis divided into three groups of 24 individuals using the sealed envelope method. Group 1 underwent dry needling, Group 2 received 40mg methylprednisolone acetate, and Group 3 received PRP treatment. Patients were assessed using the visual analog scale (VAS) and the Disabilities of the Shoulder, Arm, and Hand (DASH) score, and Jamar grip strength before treatment and 3rdweek and 3rdmonth. At the 3rdmonth, the mean VAS score was 1.16 ± 0.56 in dry needling group and 0.75 ± 0.60 in corticosteroids group, showing a statistically significant difference between dry needling and corticosteroids group, and between corticosteroids and PRP group (p = 0.015 and p = 0.000, respectively). At the 3rdweek and 3rd month, VAS scores decreased in each treatment modality group, showing a statistically significant difference between the groups (p <0.01). Jamar grip strength increased over time in all groups. There were no significant differences between the DASH scores of all groups at the 3rdweek (p >0.05). DASH scores decreased significantly from the 3rdweek to the 3rdmonth in dry needling and corticosteroids group (p <0.01), while it increased slightly in PRP group during the same period with a statistically insignificant change (p >0.05). DASH scores decreased significantly at the 3rd month for all groups (p = 0.014). Dry needling is an effective and safe application for the short-term treatment of lateral epicondylitis.

Short term effect of local steroid injection in lateral epicondylitis

Introduction: Lateral epicondylitis is a common cause of pain in the lateral side of elbow. It affects 1% to 3% of adults in general population per year.' it is common in dominant arm, tennis players and in workers who are involved in repetitive gripping and heavy lifting tasks because of repeated micro trauma to extensor tendons origin from lateral epicondyle. Objective: To compare the outcome of local steroid injection and local anesthetic injection after 2 weeks in management of lateral epicondylitis. Setting: Department of orthopedics, Hayatabad Medical Complex, Peshawar. Study design: Randomized clinical trial. Study Duration: 21st September 2020 to 21st March 2021. Methodology: A total of 60 patients were included in study (30 in each group). All patients were observed to compare the outcome of local steroid injection and local anesthetic injection after 2 weeks in management of lateral epicondylitis. Results: Distribution of Age among groups of 60 (30 in each group) were analyzed. Most of the patients between the age category (31-40 years) group A (steroid injection) was 9(42.9%) and group B 12(57.1%). Mean age was 41.56 ±3.357. There were 16(50.0%) male &amp; 14(50%) female in group A. In group B, there were 16 (50.0%) male &amp;14(50% female.

Survey of clinical practice after publication of the Clinical Practice Guidelines on the Management of Lateral Epicondylitis（2nd edition）

Survey of clinical practice after publication of the Clinical Practice Guidelines on the Management of Lateral Epicondylitis（2nd edition）

Tennis elbow, study protocol for a randomized clinical trial: needling with and without platelet-rich plasma after failure of up-to-date rehabilitation

BackgroundThe conservative management of lateral epicondylitis is known to be a difficult-to-treat annoying condition. A treatment with platelet-rich plasma (PRP) is often performed, but its efficacy remains controversial.MethodsThis study is a single-center, randomized double-blind controlled trial, preceded by a case series. All the 232 planned patients of the case series will undergo an up-to-date comprehensive rehabilitation program, including focused extracorporeal shock waves therapy. This rehabilitation program is expected to have a maximum success rate 75%. It is therefore aimed to allocate a minimum of 58 patients with rehabilitation failure into the 1:1 randomized trial. Stratification is planned on age and lesion pattern. The masking will be quadruple (Participant, Care Provider, Investigator & Outcome Assessor). The patients will undergo an ultrasound (US)-guided needling combined with either PRP (intervention group) or saline (control group). The primary endpoint will be the pain improvement from baseline (month 0) at 3 months on a 0–10 visual analog scale (VAS) during a maximal strength isometric contraction of the extensor carpialis brevis muscle. The main secondary endpoints will include the rehabilitation success rate and improvements from baseline at 3, 6, and 12 months of the following outcomes: (i) Single Assessment Numeric Evaluation (SANE) score, (ii) Patient-Rated Tennis Elbow Evaluation (PRTEE) score, (iii) maximal grip strength on Jamar test, and (iv) the ultrasonographic evaluation of the US of the epicondylar tendons.DiscussionThe study results will provide insight into the effect of PRP as adjuvant therapy to tendon fenestration, and may contribute to identify the best preceding and concomitant rehabilitation protocol.Trial registrationClinicalTrials.gov NCT03987256. Registered on 20 August 2019.

Management of lateral epicondylitis (tennis elbow) by local infiltration of platelet rich plasma an outcome study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Platelet-rich plasma (PRP) has been recently the emerging biological therapy in which a large pool of signals released from platelets producing a biological microenvironment for local and migrating cells for tissue regeneration. A prospective randomized observational study was done to assess the efficacy of autologous PRP injection in lateral epicondylitis of elbow.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total 100 patients of lateral epicondylitis were selected and treated from December 2015 to November 2017. VAS (visual analogue scale) and PRTEE (patient rated tennis elbow evaluation) scoring were used for clinical and functional assessment at pre-injection, 2&lt;sup&gt;nd&lt;/sup&gt; week, 4&lt;sup&gt;th &lt;/sup&gt;week, 3&lt;sup&gt;rd&lt;/sup&gt; month and 6&lt;sup&gt;th&lt;/sup&gt; month.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; At the end of 6 months follow-up 61% patients were completely relieved of pain. 34% patients had mild pain that was significantly decreased (p value &amp;lt;0.0001) from mean VAS (75) and mean PRTEE (78.62) to mean VAS (6.05) and mean PRTEE (5.63). 5 patients were lost their 6 months follow-up. There was a significant increase in post intervention pain for few days in 70% patients. Recurrence rate of 0% was noted at the end of 6 months follow-up.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; An injection of PRP improves pain and function in patients suffering from lateral epicondylitis.&lt;/p&gt;

Efficacy of local corticosteroid injections and autologous blood injections in management of lateral epicondylitis

Background: The commonly used medical term for tennis elbow is lateral epicondylitis or common extensor tendinitis. The present study was conducted to compare the efficacy of local corticosteroid injections and autologous blood injections in management of lateral epicondylitis. Materials and methods: The present study was conducted in the department of Orthopaedics. It comprised of 60 adult patients of lateral epicondylitis (Tennis elbow) of both genders. Patients were divided into 2 groups of 30 each. Group I was given autologous blood injections and group II received methylprednisolone. In all patients pain was assessed as per VAS scale. The results were assessed as excellent, good, fair and poor depending upon the point on VAS scale. Results: Right side was involved in 18 in group I and 16 in group II, left side was involved in 12 in group I and 14 in group II. Excellent results was seen in 1 in group I and 5 in group II, good 7 in group I and 15 in group II, fair 12 in group I and 10 in group II and poor 10 in group I. The difference was significant (P< 0.05). Common complication was white discoloration of skin was seen 1 patients each in both groups and transient pain 4 in group I and 2 in group II. Conclusion: Authors found that corticosteroid injection was more effective than autologous blood injection in improving pain and function.