Standardized Tendon Fenestration with Injection of Autologous Blood for Treatment of Lateral Epicondylitis

2020 ◽  
Author(s):  
Chul Ki Goorens ◽  
Pascal Wernaers ◽  
Joost Dewaele
Keyword(s):  
Tennis Elbow ◽  
Autologous Blood ◽  
Lateral Epicondylitis ◽  
Pain Scale ◽  
Short Term ◽  
Shockwave Therapy ◽  
Other Substances ◽  
Injured Tendon ◽  
Satisfaction Rates

AbstractLateral epicondylitis (LE) of the elbow is often treated with conservative methods. Several techniques including injections with different substances are widely performed. No standardization exists. This prospective study describes the results of the short-term follow-up of 56 patients with mean age 48 years (range: 30–68 years) treated with the Instant Tennis Elbow Cure Medical device, which fenestrates the injured tendon in a standardized way through a holder of 12 small needles. Depth and position of the needles are determined beforehand by ultrasonography. Unprepared autologous blood was injected through the holder in the tendon. Visual analog pain scale (VAS) decreased significantly in rest by 61% and during activity by 47% after 6 weeks. VAS decreased significantly in rest by 79% and during activity by 66% after 3 months. VAS did not remain significantly different after 6 months. Satisfaction rates were 71% after 6 weeks and 82% after 6 months. This suggests that the therapeutical effect sustains and in some cases increases over time. Patient Related Tennis Elbow Evaluation score ameliorated after 3 months by 71%. Comparative studies are needed to confirm this effect versus other techniques as physiotherapy, shockwave therapy, and injections with other substances.

scholarly journals Effectiveness of Autologous Blood and Steroid Injection in Tennis Elbow Based on Visual Analog Score Pain Score and Nirschl Stage

2020 ◽  
Vol 18 (1) ◽  
pp. 15-17
Author(s):  
Gopal Sagar DC
Keyword(s):  
Pain Score ◽  
Steroid Injection ◽  
Tennis Elbow ◽  
Corticosteroid Injection ◽  
Autologous Blood ◽  
Lateral Epicondylitis ◽  
Significant Difference ◽  
Group A ◽  
Group B

Introduction: Lateral epicondylitis or Tennis elbow is one of the most common causes of lateral elbow pain. Local steroid injection is a time tested treatment for providing symptomatic relief. Local injection of autologous blood in a case of lateral epicondylitis provides pain relief due to its cellular and humoral factor and triggers a healing cascade. Aims: This study aims to compare the outcomes of the autologous blood injection and local corticosteroid injection in the treatment of tennis elbow. Methods: This is a Hospital based study on conducted in the Department of Orthopedics at Nepalgunj Medical College from July 2018 to June 2019. 42 patients with unilateral tennis elbow were divided into two groups-Group A-21 patients (Autologous Blood Injection) and Group B-21 patients (Steroid Injection). Group A received 2 ml of autologous venous blood and mixed with 1 ml of 2% lignocaine solution; Group B patients received 80 mg (in 2 ml) of methyl Prednisolone acetate and 1ml of 2% lignocaine solution. Visual Analogue Scale pain score and Nirschl stage of patients were evaluated before injection and at 2, 6, and 12 weeks of injection were noted and analyzed. Results: Preinjection mean VAS pain score was - 7.48±0.75, 7.52±0.68 in Group A, and Group B respectively while the Nirschl stage was 5.62±0.59 and 5.6±0.5 in group A and B, these scores among two group was not statistically significant. At 2 weeks follow up both groups showed improvement without any significant difference between two groups (p=0.84 and 0.549), while group A had better improvement in VAS pain score at 6 weeks (p=0.001). At 12 weeks follow-up within each group, there was significant VAS pain and Nirschl stage improvement (p=0.001) but there was no significant difference between the two groups. Conclusion: Injection of autologous blood and corticosteroid injection is equally effective in the treatment of Tennis elbow at 12 weeks final follow-up.

Radial Shock Wave Therapy in Patients with Lateral Epicondylitis

Folia Medica ◽  
2012 ◽  
Vol 54 (3) ◽  
pp. 35-41 ◽  
Author(s):  
Elena M. Ilieva ◽  
Roumen M. Minchev ◽  
Nedyalka S. Petrova
Keyword(s):  
Shock Wave ◽  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Functional Condition ◽  
Shock Wave Therapy ◽  
Therapeutic Modalities ◽  
Shockwave Therapy ◽  
The Past ◽  
One Year

ABSTRACT Introduction: Lateral epicondylitis, or “tennis elbow”, is a relatively common disorder. Various therapeutic modalities have been tried in an attempt to manage the disorder but neither the conservative methods nor the surgical options have proved to be benefi cial so far. During the past decade in the USA and European countries and the past several years in Bulgaria, the shock wave therapy (focused and radial) has been introduced as a method of choice in the treatment of chronic tendynopathies. The AIM of the present study was to make quantitative assessment of the effect of radial shockwave therapy in patients with lateral epicondylitis. PATIENTS AND METHODS: The study included 16 patients with lateral epicondylitis (9 males, 7 females, mean age 47.2 ± 2.3 yrs) of mean duration of 15.06 ± 4.06 months. We used the BTL-5000 radial shockwave therapy equipment and performed 5 procedures (one per week). The total number of shocks was 2500, the pressure was 2 Bars: 1500 shocks of 5 Hz frequency followed by 500 shocks of 10 Hz frequency were applied locally on the lateral epicondyle and 500 shocks of 2 Bar pressure and 5 Hz frequency were applied along the muscles near the insertion. The patients were evaluated 5 times: before treatment, immediately after the end of treatment and at 3, 6 and 12 months of follow-up. Pain was assessed at rest, on palpation and by the Thomsen test using a visual analogue scale (VAS). The patient-rated tennis elbow evaluation (PRTEE) questionnaire was used to assess the patients‘ pain, functional condition and limitations in performing specifi c activities, as well as for the overall self evaluation. RESULTS: We found signifi cant difference (p < 0.05) between the mean pain scores (at rest, on palpation and by Thomsen test) before treatment and these scores obtained immediately after treatment, the decrease sustained at 3, 6 and 12 months. VAS showed decrease from 3.75 ± 0.49 before therapy to 2.44 ± 0.39 after treatment, to 1.94 ± 0.46 at 3 months and to 0.69 ± 0.38 at one year at rest, from 7.44 ± 0.38 before therapy to 4.69 ± 0.51 after treatment, to 3.56 ± 0.40 at 3 months and 1.46 ± 0.56 at one year at palpation, and from 5.87 ± 0.46 before therapy to 3.5 ± 0.29 after it, to 2.5 ± 0.40 at 3 months and 1 ± 0.38 at one year in the Thomsen test. The pain, function and the total score as assessed on the patient-rated scale (PRTEE) also showed statistically signifi cant improvement (p < 0.05) after completion of therapy and over the whole follow-up. Total score decreased from 56.75 ± 2.34 before therapy to 39.38 ± 3.96 after treatment, to 27.53 ± 3.7 at 3 months and to 13.69 ± 4.48 at one year. CONCLUSION: Based on the results of this preliminary study we could recommend the radial shock wave therapy in the treatment of lateral epicondylitis of more than 6 months‘ duration if the condition is recalcitrant to other conservative methods of treatment.

scholarly journals Autologous Blood Injection and Wrist Immobilisation for Chronic Lateral Epicondylitis

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Nicola Massy-Westropp ◽  
Stuart Simmonds ◽  
Suzanne Caragianis ◽  
Andrew Potter
Keyword(s):  
Tennis Elbow ◽  
Autologous Blood ◽  
Lateral Epicondylitis ◽  
Contralateral Limb ◽  
Cortisone Injection ◽  
Autologous Blood Injection ◽  
Blood Injection ◽  
And Function ◽  
Prospective Longitudinal ◽  
Extensor Carpi Radialis

Purpose. This study explored the effect of autologous blood injection (with ultrasound guidance) to the elbows of patients who had radiologically assessed degeneration of the origin of extensor carpi radialis brevis and failed cortisone injection/s to the lateral epicondylitis.Methods. This prospective longitudinal series involved preinjection assessment of pain, grip strength, and function, using the patient-rated tennis elbow evaluation. Patients were injected with blood from the contralateral limb and then wore a customised wrist support for five days, after which they commenced a stretching, strengthening, and massage programme with an occupational therapist. These patients were assessed after six months and then finally between 18 months and five years after injection, using the patient-rated tennis elbow evaluation.Results. Thirty-eight of 40 patients completed the study, showing significant improvement in pain; the worst pain decreased by two to five points out of a 10-point visual analogue for pain. Self-perceived function improved by 11–25 points out of 100. Women showed significant increase in grip, but men did not.Conclusions. Autologous blood injection improved pain and function in a worker’s compensation cohort of patients with chronic lateral epicondylitis, who had not had relief with cortisone injection.

scholarly journals Effect of Platelet-Rich Plasma (PRP) versus Autologous Whole Blood on Pain and Function Improvement in Tennis Elbow: A Randomized Clinical Trial

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Seyed Ahmad Raeissadat ◽  
Leyla Sedighipour ◽  
Seyed Mansoor Rayegani ◽  
Mohammad Hasan Bahrami ◽  
Masume Bayat ◽  
...  
Keyword(s):  
Whole Blood ◽  
Tennis Elbow ◽  
Platelet Rich Plasma ◽  
Autologous Blood ◽  
Pressure Pain Threshold ◽  
Lateral Epicondylitis ◽  
Autologous Whole Blood ◽  
Significant Difference ◽  
Group 2 ◽  
And Function

Background. Autologous whole blood and platelet-rich plasma (PRP) have been both suggested to treat chronic tennis elbow. The aim of the present study was to compare the effects of PRP versus autologous whole blood local injection in chronic tennis elbow. Methods. Forty patients with tennis elbow were randomly divided into 2 groups. Group 1 was treated with a single injection of 2 mL of autologous PRP and group 2 with 2 mL of autologous blood. Tennis elbow strap, stretching, and strengthening exercises were administered for both groups during a 2-month followup. Pain and functional improvements were assessed using visual analog scale (VAS), modified Mayo Clinic performance index for the elbow, and pressure pain threshold (PPT) at 0, 4, and 8 weeks. Results. All pain and functional variables including VAS, PPT, and Mayo scores improved significantly in both groups 4 weeks after injection. No statistically significant difference was noted between groups regarding pain scores in 4-week follow-up examination (P>0.05). At 8-week reevaluations, VAS and Mayo scores improved only in PRP group (P<0.05). Conclusion. PRP and autologous whole blood injections are both effective to treat chronic lateral epicondylitis. PRP might be slightly superior in 8-week followup. However, further studies are suggested to get definite conclusion.

scholarly journals Comparison between prolozone therapy and extracorporeal shockwave therapy in management of pain and function in resistant cases of lateral epicondylitis: a randomised controlled trial

2020 ◽  
Vol 7 (8) ◽  
pp. 1216
Author(s):  
Margaret Chabungbam ◽  
Akoijam Joy Singh ◽  
Longjam Nilachandra Singh ◽  
Yumnam Ningthemba ◽  
Sreejith C. ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Tennis Elbow ◽  
Controlled Trial ◽  
Lateral Epicondylitis ◽  
Painful Condition ◽  
Extracorporeal Shockwave Therapy ◽  
Extracorporeal Shockwave ◽  
Shockwave Therapy ◽  
Vas Score ◽  
Randomised Controlled

Background: Lateral epicondylitis also known as the tennis elbow is a painful condition of the elbow caused by overuse. The disease imparts significant disability to those affected in terms of the quantity and quality of work done.Methods: A randomised controlled trial was conducted in the Department of Physical Medicine and Rehabilitation, RIMS, Imphal for a period of 1 year from February 2017 to January 2018. Eighty-four patients with resistant lateral epicondylitis recruited were divided into 2 groups- group A received Prolozone injection while group B underwent Extracorporeal Shockwave Therapy (ESWT).Results: Assessments of VAS (Visual Analog Scale) and PRTEE (Patient Rated Tennis Elbow Evaluation) were done at 8 weeks and 24 weeks. The mean VAS score in Prolozone group improved from 7.22±0.89 to 4.04±1.01 at 8 weeks to 1.67±0.70 at end of 24 weeks. In ESWT group, mean VAS score improved to 3.91±0.72 at 8 weeks and reduced to 2.3±0.68 at end of 24 weeks. PRTEE improved significantly in both the groups, from 85.33±3.29 to 24.87±2.10 in Prolozone group, and from 85.17±2.83 to 41.89±3.17 in ESWT group.Conclusions: The improvement in pain and disability is better in prolozone group than ESWT (p<0.05) in chronic lateral epicondylitis.

A Comparison of Two Treatment Regimens for Lateral Epicondylitis: A Randomized Trial of Clinical Interventions

1997 ◽  
Vol 6 (3) ◽  
pp. 226-234 ◽  
Author(s):  
Wendy I. Drechsler ◽  
John F. Knarr ◽  
Lynn Snyder-Mackler
Keyword(s):  
Physical Therapy ◽  
Radial Head ◽  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Controlled Clinical Trial ◽  
Treatment Regimens ◽  
Strengthening Exercises ◽  
Positive Results

Eighteen subjects participated in a randomized controlled clinical trial to compare the effectiveness of two physical therapy treatments for tennis elbow. The subjects were divided into two groups: In the neural tension group (NTG), the head of the radius was mobilized and specific physical therapy mobilizations were used to address hypomobility of the radial nerve. The standard treatment group (STG) received ultrasound, transverse friction massage, and stretching and strengthening exercises for the extensors of the wrist. All subjects were treated twice weekly for 6 to 8 weeks. Follow-up data were obtained at 3 months post-treatment. Subjects who received radial head mobilization improved over time (p <.05), while those who did not receive radial head mobilization did not improve. Results of the NTG treatment were linked to the radial head treatment, and isolated effects of the NTG treatment could not be determined. There were no long-term positive results in the STG.

Ten- to 14-Year Follow-up of the Nirschl Surgical Technique for Lateral Epicondylitis

2007 ◽  
Vol 36 (2) ◽  
pp. 261-266 ◽  
Author(s):  
Jonathan H. Dunn ◽  
John J. Kim ◽  
Lonnie Davis ◽  
Robert P. Nirschl
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Scoring Systems ◽  
Intensity Scale ◽  
The Mean ◽  
Mini Open

Background Good to excellent short-term results have been reported for the surgical treatment of lateral epicondylitis using various surgical techniques. Hypothesis Surgical treatment for lateral epicondylitis using the mini-open Nirschl surgical technique will lead to durable results at long-term follow-up. Study Design Case series; Level of evidence, 4. Methods Records from 139 consecutive surgical procedures (130 patients) for lateral epicondylitis performed by 1 surgeon between 1991 and 1994 were retrospectively reviewed. Eighty-three patients (92 elbows) were available by telephone for a mean follow-up of 12.6 years (range, 10–14 years). Outcome measures included the Numeric Pain Intensity Scale, Nirschl and Verhaar tennis elbow–specific scoring systems, and American Shoulder and Elbow Surgeons elbow form. Preoperative data were collected retrospectively. Results The mean age of the study group was 46 years (range, 23–70 years) with 45 men and 38 women. Eighty-seven of the procedures were primary, and 5 were revision tennis elbow surgeries. Concomitant procedures were performed in 30 patients including ulnar nerve release in 24 patients, medial tennis elbow procedures in 23 patients, shoulder arthroscopy in 2 patients, carpal tunnel release in 1 patient, and triceps debridement and osteophyte excision in 1 patient. The mean duration of preoperative symptoms was 2.2 years (range, 2 months to 10 years). The mean Nirschl tennis elbow score improved from 23.0 to 71.0, and the mean American Shoulder and Elbow Surgeons score improved from 34.3 to 87.7 at a minimum of 10-year follow-up ( P < .05). The Numeric Pain Intensity Scale pain score improved from 8.4 preoperatively to 2.1 ( P < .05). Results were rated as excellent in 71 elbows, good in 6 elbows, fair in 9 elbows, and poor in 6 elbows by the Nirschl tennis elbow score. By the criteria of Verhaar et al, the results were excellent in 45 elbows, good in 32 elbows, fair in 8 elbows, and poor in 7 elbows. Eighty-four percent good to excellent results were achieved using both scoring systems. Ninety-two percent of the patients reported normal elbow range of motion. The overall improvement rate was 97%. Patient satisfaction averaged 8.9 of 10. Ninety-three percent of those available at a minimum of 10-year follow-up reported returning to their sports. Conclusion The mini-open Nirschl surgical technique with accurate resection of the tendinosis tissue remains highly successful in the long term.

scholarly journals A better functional outcome with platelet rich plasma compared with local steroid injection in tennis elbow

2021 ◽  
Vol 7 (1) ◽  
pp. 24-28
Author(s):  
Shilp Verma ◽  
Anwar A ◽  
Alok Chandra Agarwal ◽  
Ranjeet Choudhary ◽  
Ankit Kumar Garg
Keyword(s):  
Steroid Injection ◽  
Tennis Elbow ◽  
Platelet Rich Plasma ◽  
Corticosteroid Injection ◽  
Symptomatic Relief ◽  
Lateral Epicondylitis ◽  
Treatment Modalities ◽  
Functional Activities ◽  
Local Steroid Injection

Lateral epicondylitis commonly referred to as 'tennis elbow,' is mainly observed in the 3rd and 4th decade of life in around 2% -3% of the population. Treatment modalities for lateral epicondylitis include analgesics, immobilization, tennis elbow brace, local steroid infiltration, and ultrasound therapy. Recent studies have explored the effectiveness of platelet-rich plasma (PRP) injections in lateral epicondylitis. We used the block randomization technique. Two groups were prepared with 30 patients in each group. One group of patients received PRP and the other received local steroid injection. Patients were evaluated at the time of procedure and immediately after the procedure, at six weeks, three months, and six months, using the visual analog score and Liverpool's elbow score. At the end of 6 months, follow-up patients in the PRP injection group show good clinical and functional compare to the steroid group of patients. PRP and local corticosteroid injection provide symptomatic relief in the treatment of lateral epicondylitis. PRP infiltration gives better results in pain relief and functional activities with statically significant values when compared with corticosteroid injections.

scholarly journals Short term results of a single autologous whole blood injection for treatment of resistant tennis elbow

2020 ◽  
Vol 6 (6) ◽  
pp. 1210
Author(s):  
Mubashir Maqbool Wani ◽  
Qazi Waris Manzoor ◽  
Arshad Bashir ◽  
Bashir Ahmed Mir ◽  
Suhail Wani
Keyword(s):  
Pain Score ◽  
Whole Blood ◽  
Tennis Elbow ◽  
Autologous Blood ◽  
Single Shot ◽  
Short Term ◽  
Autologous Whole Blood ◽  
Average Pain ◽  
Average Pain Score ◽  
Blood Injection

<p><strong>Background:</strong> Lateral epicondylitis commonly called tennis elbow is a common cause of elbow pain and involves degeneration of common extensor origin with no unanimously supported algorithm for the treatment. Recently, autologous blood injection has been reported for the treatment of resistant cases. We present the short term results of a single shot of autologous whole blood for the treatment of resistant tennis elbow.</p><p><strong>Methods: </strong>The study was conducted on 56 patients who fulfilled the other inclusion criteria’s. 2 ml of autologous whole blood was introduced just proximal to the lateral epicondyle and the contents were injected on the under surface of the extensor carpi radialis group of muscles. Pain severity using VAS and Nirschl Staging was assessed before injection and re-evaluation was done at 4 weeks, 12 weeks and 6 months.</p><p><strong>Results:</strong> Before the procedure average pain score was 7.5(range 5-9). The average Nirschl stage was 5.5 (range 4-7). After autologous blood injections the average pain score decreased to 4 at 4 weeks, 2.8 at 12 weeks and 2.5 at 6 months. The average Nirschl stage decreased to 3.53 at 4 weeks, 2.45 at 12 weeks and 2.3 at 6months. The reduction was statistically significant (p&lt;0.001). 28 out of 56 patients (50%) were completely relieved of pain with a pain score of 0 at 6 months. There was no major complication.</p><p><strong>Conclusions:</strong> A single injection of autologous whole blood for resistant tennis elbow is an economical and effective treatment and has an excellent safety profile.</p>

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