Patient-Rated Tennis Elbow Evaluation Score Research Articles

Comparison between Ultrasound-guided Percutaneous Needle Tenotomy and Extracorporeal Shockwave Therapy in Reducing Pain and Functional Disability in the Management of Recalcitrant Lateral Epicondylosis: A Randomized Controlled Study

Abstract Background: Tendinopathies like lateral epicondylosis (LE) are a difficult problem requiring lengthy management with patients often responding poorly to treatment. Although it is known as a tendonitis, histopathologic studies in recalcitrant LE have shown that it is associated with few inflammatory cells and more of fibroblasts. Emerging regenerative therapies such as autologous blood, platelet-rich plasma, extracorporeal shockwave therapy, and tenotomy have a significant role in the management of recalcitrant cases. The present study aimed to compare ultrasound-guided percutaneous needle tenotomy and extracorporeal shockwave therapy in reducing pain and functional disability in the management of recalcitrant LE. Materials and Methods: A randomized controlled study was conducted for 2 years on 82 patients recruited from the outpatient department, and they were randomly assigned to two groups – Group A (41 patients) received extracorporeal shockwave therapy, while Group B (41 patients) underwent ultrasound-guided tenotomy of the common extensor tendon. The outcome was measured by the Visual Analog Scale (VAS), grip strength, and Patient-Rated Tennis Elbow Evaluation (PRTEE) and was assessed at baseline, 4, 12, and 24 weeks. Results: At the end of 24 weeks, the VAS score was 1.34 ± 0.48 in Group B, while it was still 3.44 ± 0.59 in Group A. The PRTEE score reduced to 24 ± 1.74 in Group B compared to 40.91 ± 2.94 in Group A. Conclusion: Percutaneous tenotomy provides significant improvement in pain and elbow activities as measured by VAS and PRTEE at 24 weeks, and thus, a single percutaneous tenotomy may be considered as a cheap and easy novel alternative in resistant cases of LE.

Clinical and Ultrasonographic Effectiveness of Two Different Splints Used for the Treatment of Lateral Epicondylitis: A Prospective Randomized Controlled Study

ObjectiveThis study compares the clinical and ultrasonographic efficacy of 2 splint types, the lateral epicondylitis band (LEB) and the wrist extensor splint (WES), for treatment of lateral epicondylitis (LE). DesignRandomized controlled single-blind trial. SettingOutpatient clinic. Participants159 participants diagnosed with unilateral LE based on clinical and ultrasonographic findings, and 2-12 weeks from symptom onset, were included (N=159). InterventionsOne group received joint-protection education-only (wait-and-see), while the other 2 groups were fit with splints: one the LEB and the other the WES. Both splint groups received joint-protection education. Main Outcome MeasuresThe primary outcome measure was the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire. Secondary outcome measures were the Visual Analog Scale (VAS) for pain, hand grip strength by dynamometry, algometric measurements, patient satisfaction, and selected ultrasonographic parameters (maximum tendon thickness measurements (MTTM) in the capitellar-radiocapitellar region and total ultrasonography scale score [TUSS]). All outcomes were assessed at baseline, 3-weeks, and 6-weeks post intervention initiation. ResultsParticipants’ mean age was 46.85±8.63 years. Of the participants, 40.88% (n=65) were male and 59.12% (n=94) were female. The baseline median (1Q-3Q) values of PRTEE-total scores were 58.5 (51-68) for the LEB, 63.5 (56.25-70.25) for the WES and 57 (48-68) for the education-only groups. At 6-weeks, the PRTEE-total scores had decreased by 44 points for those randomized to the LEB, 46 points to the WES and 7 points in the education-only groups(P<.001). While the LEB and WES approaches were superior to the wait-and-see approach in algometric measurements, VAS, and PRTEE scores (P<.05), no significant changes were found in MTTM and TUSS values. The LEB group was superior to the WES group in hand grip strength and patient satisfaction (P<.05). ConclusionUsing either splint for 6 weeks can be considered effective for the relief of pain and increased functionality in persons with subacute LE, although the LEB had a more positive effect on grip strength and patient satisfaction than the WES.

Role of vitamin D in lateral epicondylitis among Egyptians

BackgroundLateral elbow pain is a prevalent musculoskeletal disorder affecting the elbow’s epicondyle region. One form of lateral elbow pain is lateral epicondylitis, which is a degenerative disorder of the musculotendinous system. Adequate levels of vitamin D are essential for maintaining musculoskeletal health. Our study aimed to assess the role of vitamin D in lateral epicondylitis among Egyptians.ResultsOur research revealed that there is a significant correlation between vitamin D deficiency and lateral epicondylitis. Patients with vitamin D deficiency displayed worse patient-rated tennis elbow evaluation score (PTREE), visual analog scale score (VAS), and grip strength. These findings indicate a statistically significant association between lateral epicondylitis patients with deficient vitamin D and each of the PTREE scores (p < 0.001), VAS score (p < 0.001), and hand grip strength (p < 0.001).ConclusionThe etiology of lateral epicondylitis is not yet fully understood. However, our study provides evidence supporting the notion that low levels of vitamin D may be one of the risk factors in the etiology of lateral epicondylitis among Egyptians.

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.

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.

The "Selfie Test": A Novel Test for the Diagnosis of Lateral Epicondylitis.

Background: Lateral epicondylitis (LE) is one of the most diagnosed elbow pathologies. The purpose of this study was to determine the diagnostic test accuracy of a new test (selfie test) for the diagnosis of LE. Methods: Medical data were collected from adult patients who presented with LE symptoms and ultrasound findings that supported the diagnosis. Patients underwent a physical examination, including provocative tests for diagnosis as well as the selfie test, and were asked to fill out the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire and subjectively rate the activity of their affected elbow. Results: Thirty patients were included in this study (seventeen females, 57%). The mean age was 50.1 years old (range of 35 to 68 years). The average duration of symptoms was 7 ± 3.1 months (range of 2 to 14 months). The mean PRTEE score was 61.5 ± 16.1 (range of 35 to 98), and the mean subjective elbow score was 63 ± 14.2 (range of 30 to 80). Mill's, Maudsley's, Cozen's, and the selfie tests had sensitivities of 0.867, 0.833, 0.967, and 0.933, respectively, with corresponding positive predictive values of 0.867, 0.833, 0.967, and 0.933. Conclusions: The selfie test's active nature, which allows patients to perform the assessment themselves, could be a valuable addition to the diagnostic process, potentially improving the accuracy of the diagnosis of LE (levels of evidence: IV).

Comparing the effectiveness of prolotherapy and percutaneous dry needling in the treatment of lateral epicondylitis: a retrospective cohort study.

Lateral epicondylitis (LE) can result in a functional loss in patients because of pain and has recently become more prevalent. This study compared the effects of minimally invasive prolotherapy (PRO) and percutaneous dry needling (PDN) on LE treatment. Patients were divided into three groups; Group 1 included patients undergoing PDN, Group 2 included those undergoing PRO, and Group 3 included those undergoing PDN+PRO. All these treatments were administered three times and at a 3-week interval in each patient. Data on the visual analog scale (VAS) and patient-rated tennis elbow evaluation (PRTEE) scale scores of the patients were collected at weeks 0, 3, and 6 and month 6 and retrospectively analyzed. The VAS and PRTEE scores decreased in all groups. The decrease in Group 3 was higher than that in the other groups (p<0.001). Upon evaluating within-group differences in VAS and PRTEE scores, the scores at week 3, week 6, and month 6 gradually decreased compared with the baseline in all groups (p<0.001). PDN and PRO are minimally invasive and can successfully treat LE. A combination of PDN+PRO provides better results than PDN or PRO alone. As the materials we used in these treatments are relatively inexpensive and readily available, we believe our study will help reduce the national healthcare costs allocated for the treatment of LE.

Comparative Effects of Focused and Radial Extracorporeal Shock Wave Therapies on Lateral Epicondylitis: A Randomised Sham-controlled Trial.

To evaluate and compare the effects of radial and focused types of extracorporeal shock wave therapy (ESWT) on lateral epicondylitis. A randomised sham-controlled trial. Place and Duration of the Study: Department of Sports Medicine, Yuzuncu Yil University Hospital, Van, Turkiye, from August 2019 to April 2020. Patients with acute lateral epicondylitis were randomised into focused, radial, and sham ESWT groups. The ESWT was applied for three sessions at 2-4 days intervals. All the subjects were evaluated at baseline (week 0), week 5, and 13. Patient-rated tennis elbow evaluation (PRTEE) scores were used as outcome measures. At weeks 5 and 13, all PRTEE scores (pain, function, and total) were remarkably improved in the focused and radial groups (p<0.001), but not in the sham group (p>0.05). Focused ESWT was superior to radial ESWT for the change of pain scores from baseline to week 5 (18.8±13.9 vs. 11.8±9.1; p=0.026) and week 13 (17.8±13.1 vs. 11.7±10.5, p=0.084). Focused ESWT was more effective than radial ESWT for the change of function scores from baseline to weak 5 (17.9±12.5 vs. 11.2±9.5; p=0.025) and week 13 (16.9±11.6 vs. 10.7±10.1; p=0.032). Focused ESWT was superior to radial ESWT for the change of total scores from baseline to week 5 (36.7±25.9 vs. 23.0±17.2; p=0.021) and week 13 (34.7±24.3 vs. 22.4±18.5; p=0.044). Focused and radial ESWT are effective in lateral epicondylitis. The focused ESWT is superior to the radial ESWT. Thus, focused ESWT should be preferred in lateral epicondylitis. Lateral epicondylitis, Shock wave, Randomised sham-controlled trial.

Low-load exercise program and platelet-rich plasma for intrasubstance tear in lateral elbow tendinopathy: protocol for a double-blinded randomized clinical trial

Background: Lateral elbow tendinopathy (LET) is one of the most common musculoskeletal conditions. Treatment includes a series of therapeutic alternatives. However, the resolution takes nearly 24 months. Platelet-rich plasma (PRP) is an effective option, especially when the tendon presents an intrasubstance tear (IST). It is unknown what type of rehabilitation plan is more effective after this treatment. Aim: To perform a study protocol of a double-blinded, randomized clinical trial to determine the efficacy of a specific low-load exercise program in patients with LET and IST treatment with PRP under US-guided Methods: A single-center, parallel-controlled, randomized, double-blinded, phase III trial was pro-posed. Patients over 18 years-old diagnosed with LET and IST treated with US-guided PRP will be selected. Two arms of treatment will be allocated with a ratio a 1:1 ratio (low-load exercise protocol vs. conventional exercise program). The principal outcome will be the reduction of the tendon tear size. Secondary outcomes will include Patient-Rated Tennis Elbow Evaluation score, visual analogue scale, and handgrip at baseline, 3, 6, and 12 months of follow-up. Statistical tests will be 2-sided t-test with an alpha level (significance level) of 0.05. Discussion: The intervention aims to significantly reduce tendon tear size and improve pain and functionality in patients with LET and IST treated with US-guided PRP. We proposed one of the first studies in the literature that considered a detailed standardized exercise protocol applied to these patients. The result could be used to speed up treatment save time and money, help evaluate guidelines, and improve patients' and athletes' quality of life.

Chronic lateral elbow tendinopathy with a supervised graded exercise protocol

Study DesignProspective Case Series. BackgroundVariety of studies inquired the effectiveness of exercise treatment in LET (Lateral Elbow Tendinopathy). The research on the effectiveness of these approaches are still ongoing and very much needed due to the uncertainty of the subject. PurposeWe aimed to understand how the application of exercises in a graded manner affect the treatment outcomes in terms of pain and function. MethodsThis study is completed by 28 patients with LET and it was planned as a prospective case series. Thirty participants were included to participate in the exercise group. Basic Exercises (Grade 1) were performed for four weeks. Advanced Exercises (Grade 2) were performed for another four weeks. The VAS (Visual Analog Scale), pressure algometer, the PRTEE (Patient-Rated Tennis Elbow Evaluation) and a grip strength dynamometer were used to measure outcomes. The measurements were performed at baseline, at the end of four weeks and at the end of eight weeks. ResultsInvestigation of the pain scores revealed that all VAS scores (p < 0.05, ES = 1.35; 0.72; 0,73 activity, rest, and night respectively) and pressure algometer results were improved both during basic (p < 0.05, ES = 0.91) and advanced exercises (p < 0.05, ES = 0,41). PRTEE scores were found to be improved in patients with LET after basic and advanced exercises (p > 0.001, ES = 1.15; p > 0.001, ES = 1.56 respectively). The grip strength only changed after basic exercises (p = 0.003, ES = 0.56). ConclusionsThe basic exercises were beneficial for both pain and function. However, advanced exercises are required for obtaining further improvements in terms of pain, function, and grip strength.

Radial or Focal Extracorporeal Shock Wave Therapy in Lateral Elbow Tendinopathy: A Real-Life Retrospective Study

Lateral elbow tendinopathy (LET) is characterized by pain, poor muscle strength of the wrist ex-tensors, and disability. Among the conservative rehabilitative approaches, focal as well as radial extracorporeal shock wave therapy (ESWT), are considered effective in LET management. The objective of this study was to compare the safety and effectiveness of focal (fESWT) and radial (rESWT) in terms of LET symptoms and the strength of wrist extensors, taking into account potential gender differences. This is a retrospective longitudinal cohort study of patients with LET treated with ESWT that had received a clinical and functional evaluation, including visuo-analogic scale (VAS), muscle strength using an electronic dynamometer during Cozen's test, and the patient-rated tennis elbow evaluation (PRTEE) questionnaire. Follow-ups were carried out weekly in four visits after enrollment, and at 8 and 12 weeks. During the follow-ups, the VAS score decreased in both treatments, even if patients receiving fESWT reported early pain relief compared to those treated with rESWT (time for treatment p-value < 0.001). Additionally, peak muscle strength increased independently of the device used, and again more rapidly in the fESWT group (time for treatment p-value < 0.001). In the stratified analysis for sex and for the type of ESWT, rESWT appears to be less effective in female participants in terms of mean muscle strength and PRTEE scores, without differences according to the type of device used. The rESWT group reported a higher rate of minor adverse events (i.e., discomfort, p = 0.03) compared to fESWT. Our data suggest that both fESWT and rESWT might be effective in improving LET symptoms, even if the higher rate of painful procedures were reported in patients treated with rESWT.

Effect of premodulated interferential current versus diadynamic current on the management of lateral elbow tendinopathy

Abstract Study aim: To compare the effect of premodulated interferential current (PREMOD IFC) and diadynamic current (DD) with exercise training on the management of lateral elbow tendinopathy (LET). Material and methods: One hundred and four patients with unilateral LET from both genders (55 females and 49 males) were randomly allocated into two groups. Group A received PREMOD IFC in addition to the exercises, and group B received DD with the same exercises. The outcomes were maximum grip strength assessed by the hand dynamometer, the pinch strength assessed by the pinch gauge dynamometer, and pain and functional disability of the forearm assessed by a patient-rated tennis elbow evaluation (PRTEE) questionnaire. All participants received electrical stimulation, consisting of three sessions per week for six weeks. Results: The mean PRTEE score, and grip strength were significantly improved after six weeks in favour of group A, while there was no significant difference between the two groups in pinch strength. (p &lt; 0.05). Conclusion: The results revealed that the combination of PREMOD IFC with exercises could improve pain, functional disability, and grip strength compared to DD with exercises in LET patients without a significant difference between the two groups in pinch strength.

Tennis elbow: a prospective comparative clinical study comparing the outcome of conservative of management local infiltrations of leucocyte enriched platelet-rich plasma and glucocorticoid

Background: Lateral epicondylitis is a painful condition of the elbow, characterised by pain and tenderness with resisted wrist extension. This study was carried out to evaluate the comparative efficacy of the local infiltration of leucocyte enriched platelet rich plasma (L-PRP) and methylprednisolone in patients with lateral epicondylitis.Methods: Sixty adult patients, between the ages 30 to 50 years, diagnosed with lateral epicondylitis of more than 12 weeks, were enrolled in the prospective randomised study. Their medical history and previous conservative treatment were recorded; the clinical evaluation of the tendinitis was made with the visual analogue scale (VAS), the disabilities of the arm, shoulder, and hand (DASH) outcome scores, the modified elbow performance index (MEPS), the functional assessment by patient-rated tennis elbow evaluation (PRTEE), together with the laboratory investigations. The patients were randomised using the computer-generated alphabets into two groups of 30: group A received PRP, and group B received corticosteroid.Results: Patients were seen at 4, 8 and 12 weeks to evaluate the post-injection status. VAS, DASH, and PRTEE scores were significantly reduced, and MEPS was significantly improved in group A compared to group B.Conclusions: PRP leads to superior healing with long-term therapeutic advantages compared to corticosteroids though it takes a little longer to have its effect.

FUNCTIONAL OUTCOME OF TENNIS ELBOW (LATERAL EPICONDYLITIS) TREATED BY LOCAL INJECTION OF PLATELET RICH PLASMA

Objective: The aim of the study was to evaluate the efficacy of local injection of platelet rich plasma in management of patients with tennis elbow who failed to respond to conservative management. Methods: This was a prospective and cohort study in which 80 patients with lateral epicondylitis (Tennis elbow) were included on the basis of a predefined inclusion and exclusion criteria. Demographic details were noted. Patients were treated by local injection of autologous platelet rich plasma. Patients were followed up for 6 months. Relief of pain as well as functional improvement was assessed by patient-rated tennis elbow evaluation (PRTEE) score. SSPS 21.0 software was used for statistical analysis and p&lt;0.05 was taken as statistically significant. Results: Out of 80 studied cases, there were 36 (45%) males and 44 (55%) females with a M: F ratio of 1:1.22. The mean age of male (42.77±9.95 years) as well as female (41.06±9.56 years) was found to be comparable. Nineteen (23.75%) patients were involved in plumbing, 16 (20%) patients were involved in activities that required forceful use of screwdrivers such as electric work, 8 (10%) patients were involved in gardening, and 7 (8.75%) patients were involved in production or laying of bricks. Twelve (15%) patients were professional tennis player. The mean PRTEE score was 74.24±9.74 at the time of presentation. There was significant reduction in PRTEE score during follow-up and at the time of last follow-up visit, PRTEE score was found to be 8.32±2.56. Conclusion: Local injection of autologous platelet rich plasma is effective in managing patients of lateral epicondylitis (Tennis elbow) who fail to respond to conservative management.

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

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

Repeated magnetic resonance imaging at 6 follow-up visits over a 2-year period after platelet-rich plasma injection in patients with lateral epicondylitis.

The efficacy of platelet-rich plasma (PRP) for lateral epicondylitis has been demonstrated. However, the healing process monitored by repeated magnetic resonance imaging (MRI) is unclear. The purpose of this study was to evaluate sequential changes using MRI in patients with lateral epicondylitis treated by PRP injection at 6 follow-up visits over a 2-year period. Thirty patients who underwent PRP treatment for lateral epicondylitis and sequential MRI evaluation were prospectively enrolled. The MRI scores (ranging from 0 to 3) and clinical scores, including the visual analog scale (VAS) pain score and Patient-Rated Tennis Elbow Evaluation (PRTEE) score, were measured at baseline (before treatment) and 1, 3, 6, 12, 18, and 24 months after the procedure. Sequential changes in the MRI scores and clinical scores during the treatment period were evaluated. In addition, the associations between MRI scores and clinical scores were assessed. The mean MRI score at baseline was 2.30, and the mean MRI scores at 1, 3, 6, 12, 18, and 24 months after the procedure were 1.97, 1.77, 1.13, 0.73, 0.60, and 0.33, respectively. Significant improvements in the MRI scores occurred by 3 months and continued over a period of 24 months. Regarding the clinical scores, the mean VAS pain scores were 72 at baseline, 48 at 1 month, 34 at 3 months, 28 at 6 months, 15 at 12 months, 14 at 18 months, and 11 at 24 months and the mean PRTEE scores were 56, 36, 26, 18, 8, 9, and 6, respectively. Significant improvements in the VAS pain score and PRTEE score occurred by 1 month and continued over a period of 12 months. There was little association between the MRI scores and clinical scores. Continuous tendon recovery assessed by MRI was found during a 2-year period after PRP treatment. Improvements in the MRI scores followed and continued longer than improvements assessed by the clinical scores.

Effects of splinting and three injection therapies (corticosteroid, autologous blood and prolotherapy) on pain, grip strength, and functionality in patients with lateral epicondylitis

Objectives This study aims to compare the efficacy of the wrist splint and the injection of corticosteroid, autologous blood, and hypertonic dextrose in the treatment of lateral epicondylitis (LE). Patients and methods A total of 120 patients (43 males, 77 females; mean age: 45.7±7.7 years; range, 18 to 65 years) diagnosed with LE between December 2013 and June 2015 were included in the study and randomized into four groups. The first group was administered 20 mg methylprednisolone acetate + 2 mL 2% prilocaine, the second group 2 mL venous blood + 0.5 mL prilocaine, and the third group 2 mL 30% dextrose + 0.5 mL prilocaine injections. A second injection was administered to the third group one month later. The fourth group was recommended to use only a wrist splint. Pre-treatment and post-treatment evaluations of the patients were carried out at one and six months by the Visual Analog Scale (VAS) in terms of pain, by Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire in terms of functional level, and by the Jamar dynamometer in terms of grip strength. Results In all groups, VAS values at one and six months after treatment were found to be lower in comparison to baseline. Except for the splint group, a significant improvement was observed in all three injection groups in terms of grip strength and PRTEE values at six months compared to the baseline values. In the comparison of the groups, no significant difference was observed in terms of improvement in VAS scores and grip strength. While corticosteroid injection was significantly effective in terms of PRTEE pain, function, and total scores only at one month, the autologous injection was effective in terms of PRTEE function and total scores at only six months after treatment. There were no significant differences for splint and prolotherapy groups in terms of PRTEE scores. Conclusion Corticosteroid injection, autologous blood injection, and prolotherapy are effective and safe long-term methods in LE treatment.

Management of Lateral Epicondylitis: A Prospective Comparative Study Comparing the Local Infiltrations of Leucocyte Enriched Platelet-Rich Plasma (L-aPRP), Glucocorticoid and Normal Saline.

Introduction:Lateral epicondylitis is a painful condition of the elbow, characterised by pain and tenderness with resisted wrist extension. This study was carried out to evaluate the comparative efficacy of the local infiltration of L-PRP, methylprednisolone and normal saline in patients with lateral epicondylitis.Materials and methods:Sixty adult patients, between the ages 30 to 50 years, diagnosed with lateral epicondylitis of more than 12 weeks, were enrolled in the prospective randomised study. Their medical history and previous conservative treatment were recorded; the clinical evaluation of the tendinitis was made with the visual analogue scale (VAS), the disabilities of the arm, shoulder, and hand (DASH) outcome scores, the modified elbow performance index (MEPS), the functional assessment by patient-rated tennis elbow evaluation (PRTEE), together with the laboratory investigations. The patients were randomised using the computer-generated alphabets into three groups of 20: group A received saline, group B received PRP, and group C received corticosteroids.Results:Patients were seen at 4, 8 and 12 weeks to evaluate the post-injection status. VAS, DASH, and PRTEE scores were significantly reduced, and MEPS was significantly improved in group B compared to group A and group C. Moreover, the reductions in VAS and PRTEE were significantly different in group C compared to group A.Conclusion:PRP leads to superior healing with long-term therapeutic advantages compared to corticosteroids though it takes a little longer to have its effect.

Investigation of the efficacy and safety of ultrasoundstandardized autologous blood injection as treatment for lateral epicondylitis.

BackgroundThere are various conservative treatment options for lateral epicondylitis (LE). The aim is to evaluate pain, daily functioning, and complications after ultrasound-standardized autologous blood injections in patients with LE.MethodsFor this prospective cohort study, consecutive patients (>18 years) diagnosed with LE were included. Autologous blood was injected using a medical device containing an injection disposable with 12 small needles (Instant Tennis Elbow Cure [ITEC]) device. Patient-Rated Tennis Elbow Evaluation (PRTEE), subjective elbow score (SES), palpation and provocation pain, satisfaction, and complications of treatment were measured at baseline and two months after treatment. Paired t-tests and Fisher’s exact tests were used for calculating the difference between pre- and post-treatment outcomes.ResultsFifty-five elbows were analyzed. Mean time between pre- and post-treatment was 11.1 weeks (standard deviation [SD], 8.9 weeks). The mean PRTEE score decreased from 68.2 (SD, 15.7) before surgery to 53.2 (SD, 25.9; p<0.001) after. The mean SES improved from 36.9 (SD, 20.8) to 51.7 (SD, 27.4; p<0.001). Despite this improvement, only 44.7% of patients showed relevant clinical improvement in PRTEE, and 37.3% showed significant clinical improvement based on SES. Four patients reported a complication and the injection disposable failed three times.ConclusionsUltrasound-standardized autologous blood injection using the ITEC device is not an effective tool in reducing symptoms related to LE. This study showed that only half of all patients experienced a positive effect. In this heterogeneous cohort of patients, we showed no added value of ultrasound standardization.

Hyaluronic acid injections for chronic tennis elbow

BackgroundFor most patients, tennis elbow (TE) resolves within 6 months of onset. For those with persistent and painful TE, nonsurgical treatment options are limited. Thousands of studies have tried to find effective treatments for TE but have usually failed. In this study, we tested the hypothesis that injections with hyaluronic acid (HA) would be effective at reducing pain from chronic TE.MethodsPatients with a minimum of six months of pain from TE and with a pain level of 50 or greater (out of 100) were included in the study. They were randomized equally into one of two treatment groups: injection with HA or injection with saline control. Follow-up was conducted at 3, 6 and 12 months from the initial injection. Both the patient and the examiner at the follow-up visits were blinded to the treatment arm. The primary outcome measure was the visual analog scale (VAS pain) score at one year. Additional outcome measures included the shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) and Patient Rated Tennis Elbow Evaluation (PRTEE) scores.ResultsEighteen patients were randomized into the HA injection treatment arm, and 17 (94%) completed the study. The average age was 51.9 years, and 10 of the subjects were male. Patients had an average of 28.1 months of pain before entering the study. The VAS score in the HA group decreased from a baseline of 76.4–14.3 at 12 months. All 17 patients in the HA group showed VAS score reductions above the minimal clinically important difference (MCID) of at least 18. The PRTEE score improved from 67 to 28.1. The QuickDASH score improved from 53.7 to 22.5. Follow-up in the saline group was less than 50% and was therefore not used as a comparator.ConclusionsHA injections yielded significant success in pain relief by three months. Patients continued to improve for the 12-month duration of the study. This study indicates that patients with chronic lateral epicondylitis may benefit from receiving injections of hyaluronic acid rather than having to undergo surgery.