scholarly journals Hyaluronic acid injections for chronic tennis elbow

Author(s):  
Gershon Zinger ◽  
Alexander Bregman ◽  
Ori Safran ◽  
Shaul Beyth ◽  
Amos Peyser

Abstract Background For 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. Methods Patients 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. Results Eighteen 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. Conclusions HA 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.

2021 ◽  
Author(s):  
Gershon Zinger ◽  
Alexander Bregman ◽  
Ori Safran ◽  
Shaul Beyth ◽  
Amos Peyser

Abstract Background For most patients, tennis elbow (TE) resolves within six months of onset. For those with persistent and painful TE, nonsurgical treatment options are limited. Thousands of studies have tried to find effective treatment for TE, but usually fail. In this study, we test the hypothesis that injections with hyaluronic acid (HA) are effective at treating chronic pain from TE. Methods Patients with a minimum of six months of pain from TE were randomized equally into one of two groups, injection with HA or saline control, and followed for one year. Outcome measures included Visual Analogue Score (VAS pain), the shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH) and patient rated tennis elbow evaluation (PRTEE). Results Seventeen of the 18 HA-injected patients (94%) completed the study. The average age was 51.9 years and 10 were male. Patients had an average of 28.1 months of pain before entering the study. VAS in the HA group improved from a baseline of 76.4 to 14.3 at 12 months. All 17 patients in the HA group showed VAS improvement above minimal clinically important difference (MCID) of at least 18. PRTEE improved from 67 to 28.1. QuickDASH improved from 53.7 to 22.5. To our knowledge, this improvement is greater than can be seen in any other non-surgical treatment for TE. Conclusions HA injections showed 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 injections of hyaluronic acid rather than having to undergo surgery.


2017 ◽  
Vol 5 (12) ◽  
pp. 232596711774207 ◽  
Author(s):  
Michael P. Gaspar ◽  
Michael A. Motto ◽  
Sarah Lewis ◽  
Sidney M. Jacoby ◽  
Randall W. Culp ◽  
...  

Background: Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance. Purpose: To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction. Results: At a mean follow-up of 40 months, significant improvements in VAS-P (mean, –6.1; 95% CI, –6.8 to –5.5; P < .0001), QuickDASH (mean, –46; 95% CI, –52 to –40; P < .0001), and PRTEE (mean, –57; 95% CI, –64 to –50; P < .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; P < .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group ( P = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course. Conclusion: A PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength, and function demonstrated at a mean follow-up of longer than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short term to midterm.


Folia Medica ◽  
2012 ◽  
Vol 54 (3) ◽  
pp. 35-41 ◽  
Author(s):  
Elena M. Ilieva ◽  
Roumen M. Minchev ◽  
Nedyalka S. Petrova

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.


Author(s):  
Chul Ki Goorens ◽  
Pascal Wernaers ◽  
Joost Dewaele

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.


2020 ◽  
Vol 7 (8) ◽  
pp. 1216
Author(s):  
Margaret Chabungbam ◽  
Akoijam Joy Singh ◽  
Longjam Nilachandra Singh ◽  
Yumnam Ningthemba ◽  
Sreejith C. ◽  
...  

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.


2020 ◽  
Vol Volume 13 ◽  
pp. 399-410
Author(s):  
Elisabetta Garavaglia ◽  
Cinzia Sala ◽  
Manuela Busato ◽  
Gilberto Bellia ◽  
Nadia Tamburlin ◽  
...  

2020 ◽  
Vol 47 (1) ◽  
Author(s):  
Mona Mohamed Mohamed Ismael ◽  
Mona Mahmoud Arafa ◽  
Abeer Ahmed Kadry El Zohiery ◽  
Soha Eldessouki Ibrahim

Abstract Background Lateral 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. Results Our 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. Conclusion ESWT, 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.


2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Trisha Plastini ◽  
Arthur Staddon

Sertoli-Leydig Cell Tumors (SLCTs) make up <1% of all ovarian tumors and are benign or malignant, androgen-secreting tumors. Rhabdomyosarcoma (RMS) is a heterogeneous group of malignant tumors that resemble developing skeletal muscle. There have been case reports of patients with concurrent SLCT and RMS with limited treatment options. We aim to demonstrate treatment strategies used in our patients, which seemed to have prolonged survival when compared to prior case reports of patients not cured by surgical resection. Herein we describe 22 cases of SLCT with RMS elements as discussed in prior case reports and three cases from the authors’ institution. Of the 19 cases from prior case reports, five were lost to follow-up and two had NED after surgical intervention. Eleven patients had recurrence and were deceased within one year. Of those patients not surgically cured, only three patients were documented as living beyond two years, all of whom received chemotherapy. The three patients presented from our institution had clinical evidence of response to chemotherapy that is traditionally used for RMS. In conclusion, chemotherapy with doxorubicin and ifosfamide has activity in patients with SLCT and RMS as does salvage chemotherapy with vincristine, irinotecan, and temozolomide.


2011 ◽  
Vol 39 (11) ◽  
pp. 2429-2435 ◽  
Author(s):  
Cheng-Li Lin ◽  
Jung-Shun Lee ◽  
Wei-Ren Su ◽  
Li-Chieh Kuo ◽  
Ta-Wei Tai ◽  
...  

Background: In patients with lateral epicondylitis recalcitrant to nonsurgical treatments, surgical intervention is considered. Despite the numerous therapies reported, the current trend of treatment places particular emphasis on minimally invasive techniques. Purpose: The authors present a newly developed minimally invasive procedure, ultrasonographically guided percutaneous radiofrequency thermal lesioning (RTL), and its clinical efficacy in treating recalcitrant lateral epicondylitis. Study Design: Case series: Level of evidence, 4. Methods: Thirty-four patients (35 elbows), with a mean age of 52.1 years (range, 35-65 years), suffered from symptomatic lateral epicondylitis for more than 6 months and had exhausted nonoperative therapies. They were treated with ultrasonographically guided RTL. Patients were followed up at least 6 months by physical examination and 12 months by interview. The intensity of pain was recorded with a visual analog scale (VAS) score. The functional outcome was evaluated using grip strength, the upper limb Disability of Arm, Shoulder and Hand (QuickDASH) outcome measure, and the Modified Mayo Clinic Performance Index (MMCPI) for the elbow. The ultrasonographic findings regarding the extensor tendon origin were recorded, as were the complications. Results: At the time of the 6-month follow-up, the average VAS score in resting (from 4.9 to 0.9), palpation (from 7.6 to 2.5), and grip (from 8.2 to 2.9) had improved significantly compared with the preoperative condition ( P < .01). The grip strength (from 20.6 to 27.0 kg) and QuickDASH score (from 54.3 to 21.0) had also improved significantly ( P < .01). The MMCPI score improved from “poor” to “excellent.” The ultrasonographic finding revealed that the thickness of the common extensor tendon origin did not change significantly. At the final follow-up (mean, 14.3 months; range, 12-21 months), the patients reported a 78% reduction in pain compared with the preoperative status. No major complications were noted in any patient. Conclusion: Ultrasonographically guided RTL for recalcitrant lateral epicondylitis was found to be a minimally invasive treatment with satisfactory results in this pilot investigation. This innovative method can be considered as an alternative treatment of recalcitrant lateral epicondylitis before further surgical intervention.


1997 ◽  
Vol 6 (3) ◽  
pp. 226-234 ◽  
Author(s):  
Wendy I. Drechsler ◽  
John F. Knarr ◽  
Lynn Snyder-Mackler

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.


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