Treatment Of Chronic Lateral Epicondylitis Research Articles

The Clinical Results of Percutaneous Drilling in the Treatment of Chronic Lateral Epicondylitis

The Clinical Results of Percutaneous Drilling in the Treatment of Chronic Lateral Epicondylitis

Statistical Analysis of Percutaneous Tenotomy Outcomes in Chronic Lateral Epicondylitis

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

Efficacy of Percutaneous Tenotomy in Chronic Lateral Epicondylitis Over Time

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

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

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

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

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

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

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

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

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

Comparison of platelet-rich plasma and extracorporeal shock wave therapy in patients with chronic lateral epicondylitis: A prospective, randomized-controlled study

Objectives In this study, we aimed to investigate the effectiveness or comparative therapeutic superiority of exercise, extracorporeal shock wave therapy (ESWT), and platelet-rich plasma (PRP) on pain, grip strength and functional activities in chronic lateral epicondylitis (LE). Patients and methods Between January 2016 and February 2017, a total of 74 patients (14 males, 60 females; mean age; 49.7±7.6 years, range, 26 to 60 years) with chronic LE were included in this prospective, randomized-controlled study. All patients received stretching and eccentric strengthening exercises for three months. The patients were divided into three groups. The first group (Exercises group, n=24) was given home exercises. The second group (ESWT+Exercises group, n=25) received one session of ESWT added once a week for three weeks. The third group (PRP+Exercises group, n=25) received one session of PRP in addition to the exercise program. All patients were evaluated for pain by Visual Analog Scale (VAS), for functionality by Disabilities of Arm, Shoulder and Hand (DASH) questionnaire and Patient-Rated Tennis Elbow Evaluation (PRTEE), handgrip strength by a dynamometer, and extensor tendon thickness by ultrasonography (USG) at baseline and at one, two, three, and six months. Results A significant improvement was found in the VAS, DASH, PRTEE, handgrip strength values at six months compared to between in all groups (p<0.001). Extensor tendon thickness as assessed by USG indicated no significant difference (p>0.05). Regarding the VAS activity levels, there was a significant difference in the PRP+Exercises group compared to the Exercises group at six months of follow-up (p<0.001). The decrease in the DASH scores during six-month follow-up was significantly higher in the PRP+Exercises group compared to the Exercises group (p=0.004). For the PRTEE scores at six months, the PRP+Exercises group showed a statistically significant improvement than both Exercises (p<0.001) and ESWT+Exercises (p=0.007) groups. Conclusion In the treatment of chronic LE, PRP combined with exercise seems to be superior to exercise or ESWT in terms of pain and functionality in chronic LE patients.

Early Results of a Novel Treatment Technique with Autologous Blood for Chronic Lateral Epicondylitis

Background: Chronic lateral epicondylitis can be a severe disabling condition. There is still lack of consensus on best treatment, as no single intervention has been proven to be superior regarding pain relief and improvement of function. Due to the self-limiting nature of this elbow condition, we are looking for a fast and safe treatment method to break through this pattern of pain and loss of elbow function. Autologous blood injection therapy by means of an automatic injection system, can be a promising new treatment option for this group of patients suffering from chronic lateral epicondylitis. In this study, we evaluated the short-term results of autologous blood injection therapy in a standardized way by using an automatic injection system (=ITEC device) for the treatment of chronic lateral epicondylitis. Methods: A total of 141 patients with chronic lateral epicondylitis (88 female, 53 male) were enrolled in this clinical treatment evaluation being treated with the ITEC device. The mean age of the patients was 50.0 years (19 years-73 years). Numeric rating scale (NRS) and a patient reported outcome measurement tool (Oxford Elbow Score (OES)) were measured at baseline, six weeks and three months follow-up. Results: Pain (NRS, OES) and elbow function / quality of life (OES) were significantly improved within 6 weeks after ITEC treatment. This improvement in NRS and OES sustained during the 3 months follow-up period. Conclusion: Autologous blood injection therapy by means of a new automatic injection system (ITEC device) is a safe and effective treatment method for patients with chronic lateral epicondylitis. More research is necessary to see if this effectiveness sustains in the long-term follow-up.

Effective treatment for chronic lateral epicondylitis using ultrasound-guided intratissue electrolysis

article: Effective treatment for chronic lateral epicondylitis using ultrasound-guided intratissue electrolysis - Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2021 June;180(6):257-62 - Minerva Medica - Journals

Comparison of low level laser therapy and extracorporeal shock wave in treatment of chronic lateral epicondylitis.

The aim of this study was to compare the efficacy of extracorporeal shock wave therapy (ESWT) ver-sus low-level laser therapy (LLLT) in treating chronic lateral epicondylitis (CLE). In this prospective study, 52 patients (24 males, 28 females; mean age=48 years; age range=30-70 years) with a diagnosis of CLE were included and randomized into two groups (26 in each group): ESWT group (14 males, 12 females; mean age=48±10 years) or LLLT group (10 males, 16 females; mean age=48±11 years). ESWT was applied for 5 weeks with one session per week, while LLLT was applied with 15 sessions on consecutive days. All patients were evaluated using Disability of the Arm, Shoulder and Hand Questionnaire (DASH), Patient-Related Lateral Epicondy-litis Evaluation (PRTEE), and the 36-Item Short-Form Health Survey (SF-36) before and after the treatments. In the comparison of baseline data between treatment groups, significant differences were observed only in SF-Physical functioning and SF-Energy/fatigue scores (p=0.035 and p=0.038, re-spectively), which were 77.1±17.2 and 56.3±17.2 in ESWT group and 66.5±18.0 and 44.8±21.5 in LLLT group, respectively. In the comparison of post-treatment data between groups, there were sig-nificant differences in all scores (p<0.05) except two subscales of SF-36, which were SF-role limita-tions due to emotional problems (p=0.092) and physical health (p=0.147), respectively. The other subscales of SF-36, PRTEE and DASH scores obtained after the treatments were better in ESWT group than in LLLT group. The comparison of pre-and post-treatment scores in each group revealed significant improvements in all scores (p<0.05), except SF-36 subscales, including energy/fatigue, emotional well-being, social functioning, and general health scores (p>0.05). Evidence from this study revealed that although both treatment modalities were effective in the treatment of CLE, ESWT seemed to more effective in pain relief and functional recovery than LLLT. Level II, Therapeutic study.

Comparative study of peppering versus single injection technique in treatment of chronic lateral epicondylitis elbow

Aim: To compare the effectiveness of peppering technique with single injection technique by using steroid along with local anaesthetic injection in the treatment of chronic lateral epicondilitis(LE) of Elbow. Materials and Methods: In this prospective randomized study, conducted among 66 patients. All patients were divided into two equal groups: peppering technique group (PRI) and single injection technique group (SNI), based on the injection technique. The patients in both groups were treated with local injection of a steroid(1ml Methylprednisolone) and local-anesthetic agent(1ml lignocaine). The effect was measured by change in elbow pain intensity as per Visual Analogue Scale (VAS) for pain. We included patients with Chronic LE of at least 6months duration while patients who have taken previous local steroid injections and uncontrolled diabetes were excluded. Patients were followed up at 2weeks, 6weeks and 6months. The Statistical Package for the Social Sciences (SPSS) version 24 software was used for all statistical calculations. Results: In this study, 66 patients were included (34 male & 32 female) with the most affected between 30-60 years. In our study, there was considerably lesser VAS score at 2 weeks, at 6 weeks and at 6 months follow-ups in both the groups comparing to the pre-injection VAS. At 6-months, the good results were 90%(n=30) in the PRI group compared to 72%(n=24) in SNI group. Thus the success rate for Peppering technique is significantly higher than the single-injection technique. Conclusion: In our study we conclude that peppering injection technique is better than single injection technique in terms of reduced pain which was assessed by VAS in the treatment of chronic lateral epicondylitis of elbow in the long-term follow up. Keywords: Tennis elbow treatment, Local injection, Corticosteroid, Chronic lateral epicondylitis, Peppering technique

Comparative effectiveness of extracorporeal shock wave therapy, local corticosteroid injection, and conventional physiotherapy in treatment of chronic lateral epicondylitis

BackgroundLateral epicondylitis (LE) is a popular overuse syndrome involving the forearm’s extensor tendons. Corticosteroid (CS) injection is the popular injection used for management of LE. Extracorporeal shockwave therapy (ESWT) is a noninvasive alternative inducing the neovascularization, tendon repairing, and decreasing pain. Our study aimed to compare the effectiveness of ESWT versus local CS injection versus conventional physiotherapy (PT) in management of chronic LE.ResultsOur results revealed that the three groups displayed a significant decrease of VAS score, decrease of PRTEE score, and increase of grip strength compared to baseline (P < 0.05) at 4 weeks and 12 weeks of follow-up. However, there was a significant decrease of VAS score in ESWT and CS groups more than PT group at 4 weeks follow-up (P < 0.05) while ESWT group displayed a considerable improvement in functional disability score (decrease in PRTEE score) more than CS and PT groups at 4 and 12 weeks of follow-up (P < 0.05), with no considerable change in HGS between the three groups.ConclusionESWT, local CS injection, and conventional PT were efficient in management of chronic LE at 12 weeks of follow-up but ESWT had a higher effect decreasing pain and improving functional disability in daily life activity at short and long term follow-up.

Semicircumferential Detachment of the Extensor Enthesis For Surgical Treatment of Chronic Lateral Epicondylitis: A Prospective Study.

About 10% of patients with lateral epicondylitis are nonresponsive to conservative treatment; as controversy persists on etiology and pathogenesis of this pathology, there is no surgical technique universally approved. The purpose of this study is to describe and evaluate the clinical outcomes of our technique consisting in a semicircumferential and partial detachment of the entire extensor apparatus enthesis. The technique was performed on 14 consecutive patients affected by painful chronic epicondylitis between January 2010 and April 2016. Two patients were lost during follow-up. At 6 months, 1 year, and 2 years after surgery patients were revaluated. Outcomes were assessed using Visual Analog Scale, DASH score (Disability of the Arm, Shoulder, and Hand), Jamar test, and time to return to work. The mean surgical time was 16 minutes. The postoperative outcomes were excellent in most patients as mean Visual Analog Scale score improved from 9.25 to 2.6 and mean DASH score improved from 82.9 to 29.6. No recurrence was recorded at 2 years of follow-up. The procedure is rapid to perform, reproducible and provides low complication rates and no relapse in our experience. As a result, we recommend this technique in nonresponding to conservative treatment lateral epicondylitis.

Comparison of platelet-rich plasma and laser therapy in treatment of chronic lateral epicondylitis

BackgroundLateral epicondylitis (LE) is the most frequent cause of chronic lateral elbow pain in adults that represents an encumbrance on social and professional life of patients. Many treatment modalities that have been used in the management of LE have recently come into question. Platelet-rich plasma (PRP) and low-level laser therapy (LLLT) have been tried for management of chronic tendinopathies but with some debate about their effectiveness.ObjectivesThis study compared the effectiveness of local injection of PRP and LLLT in pain reduction and functional improvement in chronic LE.Patients and methodsThis randomized double-blinded, prospective study included 104 eligible patients with chronic LE. Fifty-two patients were treated with local PRP injection and 52 were treated by intermittent LLLT. They were evaluated at 3 and 6 months for subjective pain using visual analog scale (VAS), functional outcome, and grip strength.ResultsPain was assessed using the subjective VAS which was improved in both PRP and LLLT groups, DASH score and grip strength revealed improvement in both groups. This improvement was of highly statistical significance in both groups when compared with baseline evaluation (P<0.001). On comparing the PRP group with the LLLT group, there was significant improvement in VAS at 6 months only, whereas there were significant improvements in functional outcome and grip strength evaluation at 3- and 6-month follow-up for PRP group.ConclusionTreating patients with LE with PRP injection improves pain and function more effectively compared with LLLT.

Comparative study of Platelate Rich Plasma VS Corticosteriods for the treatment of Chronic Lateral Epicondylitis

The aim of this study is to compare the efficacy and safety of PRP, Corticosteroids and placebo injections for the treatment of chronic lateral epicondylitis. .The objectives were to study pain and function using various tools like VAS (Visual Analouge Score), Function and Disability score for both PRP and Corticosteroid. Keywords: Platelate rich plasma, Corticosteriods, Chronic lateral epicondylitis

Comparison of steroid injection and platelet-rich plasma injection in the treatment of chronic lateral Epicondylitis

The aim of this study was to evaluate the therapeutic effect of corticosteroid injections and platelet-rich plasma (PRP) injections in the treatment of chronic lateral epicondylitis. The study group comprised of 60 patients divided into two equal groups. In the corticosteroid group (Group A; n=30), 2 ml of methylprednisolone (40 mg/ml) was injected along with 1 ml of 0.5% bupivacaine. In the PRP group (Group B; n=30), PRP was obtained from the patients’ own blood and injected in a single dose. Results were calculated using pre-injection and post-injection Visual Analog Scale (VAS) and Disabilities for Arm, Shoulder and Hand (DASH) score. All patients enrolled in the study completed a 3 month follow-up. There were no complaints of any side-effects to the administered corticosteroid or platelet-rich plasma. No infection or any other complications were reported at the end of 3 months. On final follow-up, the outcome between the 2 groups was comparable in terms of VAS and DASH scores. This study concluded that PRP therapy proves to be more effective in relieving pain than corticosteroid injections in treatment of lateral epicondylitis.

Le traitement arthroscopique de l’epicondylalgie chronique préserve la proprioception du coude

Study designRetrospective cohort study. IntroductionA new method of accurately assessing the compromised elbow's proprioception was developed for this post-surgical population using information from previous neurophysiologic proprioception studies of healthy elbows. HypothesisThis retrospective cohort study investigated the patterns and the degree of proprioceptive impairment and recovery following arthroscopic surgery for chronic lateral epicondylitis. Material and methodsParticipants had undergone arthroscopic elbow surgery two years prior to this study (n=15). Healthy, non-injured volunteers with similar demographics (n=15) served as controls. Both groups were evaluated using quantitative measures of joint position sense for proprioceptive functioning. In order to obtain the most accurate proprioceptive measurements, inter-individual interaction and visual input biases were eliminated. Retrospective chart reviews were performed to compare qualitative self-reported measures of proprioceptive function in arthroscopic surgery patients before surgery and two years post-surgery. ResultsActive and passive joint repositioning outcome measurements were similar between groups (p>0.05). No significant differences were found among any angles except one: passive joint position sense at 120° of flexion (p<0.05). At this angle, the arthroscopy group showed greater deviation from target angles than the control group. The novel proprioceptive testing method we developed was found to be accurate and reliable. DiscussionOutcomes of arthroscopic treatment of chronic lateral epicondylitis with no decortication yielded outcomes measure similar to those of healthy controls. The sole significant difference was at 120° flexion passive joint repositioning, with a higher negative angular deviation from the target point. We propose that our study results and specific proprioception method may have implications for improving accuracy of future elbow arthroscopy and proprioceptive recovery in this population. Level of evidenceII, low-powered prospective randomized trial.

Arthroscopic chronic tennis elbow surgery preserves elbow proprioception

Study designRetrospective cohort study. IntroductionA new method of accurately assessing the compromised elbow's proprioception was developed for this postsurgical population using information from previous neurophysiologic proprioception studies of healthy elbows. HypothesisThis retrospective cohort study investigated the patterns and the degree of proprioceptive impairment and recovery following arthroscopic surgery for chronic lateral epicondylitis. Material and methodsParticipants had undergone arthroscopic elbow surgery two years prior to this study (n=15). Healthy, non-injured volunteers with similar demographics (n=15) served as controls. Both groups were evaluated using quantitative measures of joint position sense for proprioceptive functioning. In order to obtain the most accurate proprioceptive measurements, interindividual interaction and visual input biases were eliminated. Retrospective chart reviews were performed to compare qualitative self-reported measures of proprioceptive function in arthroscopic surgery patients before surgery and two years post-surgery. ResultsActive and passive joint repositioning outcome measurements were similar between groups (p>0.05). No significant differences were found among any angles except one: passive joint position sense at 120° of flexion (p<0.05). At this angle, the arthroscopy group showed greater deviation from target angles than the control group. The novel proprioceptive testing method we developed was found to be accurate and reliable. DiscussionOutcomes of arthroscopic treatment of chronic lateral epicondylitis with no decortication yielded outcomes measure similar to those of healthy controls. The sole significant difference was at 120° flexion passive joint repositioning, with a higher negative angular deviation from the target point. We propose that our study results and specific proprioception method may have implications for improving accuracy of future elbow arthroscopy and proprioceptive recovery in this population. Level of evidenceII, low-powered prospective randomized trial.

Comparison of Ozone and Extracorporeal Shockwave Therapy in the Treatment of Chronic Lateral Epicondylitis

Comparison of Ozone and Extracorporeal Shockwave Therapy in the Treatment of Chronic Lateral Epicondylitis