The effects of inclusion of minimal-dose corticosteroid in autologous whole blood and dextrose injection for the treatment of lateral epicondylitis

2021 ◽  
pp. 1-6
Author(s):  
Sang Hoon Lee ◽  
Hyun Hee Choi ◽  
Min Cheol Chang
Keyword(s):  
Grip Strength ◽  
Whole Blood ◽  
Rating Scale ◽  
Prospective Trial ◽  
Lateral Epicondylitis ◽  
Extensor Tendon ◽  
Numeric Rating Scale ◽  
Minimal Dose ◽  
Dexamethasone Palmitate ◽  
Autologous Whole Blood

BACKGOUND: Lateral epicondylitis (LE) is one of the most common musculoskeletal disorders that causes pain. OBJECTIVES: We evaluated the effect of the inclusion of a minimal dose of corticosteroid in a solution comprising autologous whole blood (AWB), 20% dextrose, and 2% lidocaine for treating LE. METHODS: In this randomized prospective trial LE patients were allocated to the CS+ group (n= 70; solution comprising 1 mL AWB, 1 mL 20% dextrose, 0.4 mL 2% lidocaine, and 0.1 mL (0.4 mg) dexamethasone palmitate; injected into the common wrist extensor tendon) or the CS- group (n= 70; same solution as above but without dexamethasone palmitate). Five injections were administered at monthly intervals. At each visit, pain intensity was evaluated using the numeric rating scale (NRS), and grip strength was measured using a hand-grip dynamometer. RESULTS: In the CS+ and CS- groups, 1 and 10 patients dropped out, respectively. In both groups, the NRS scores at each evaluation were significantly lower than the pretreatment scores. The NRS scores from pretreatment to the second and third visits were significantly lower in the CS+ group than those in the CS- group. However, at the fourth and fifth visits, and 6 months after the last injection (the sixth visit), the degree of pain reduction between the groups was not significantly different. Grip strength increased significantly over time in both groups. At each evaluation, grip strength was significantly higher than that at the pretreatment stage. However, the degree of increase was not significantly different between groups. CONCLUSIONS: The inclusion of a minimal dose of corticosteroid in the AWB and 20% dextrose injection can reduce pain, especially during early treatment.

The Effect of Botulinum Toxin Injection into the Common Extensor Tendon in Patients with Chronic Lateral Epicondylitis: A Randomized Trial

Pain Medicine ◽  
2019 ◽  
Vol 21 (9) ◽  
pp. 1971-1976 ◽  
Author(s):  
Sang Hoon Lee ◽  
Hyun Hee Choi ◽  
Min Cheol Chang
Keyword(s):  
Botulinum Toxin ◽  
Pain Relief ◽  
Grip Strength ◽  
Dose Group ◽  
Rating Scale ◽  
Botulinum Toxin Injection ◽  
Botulinum Toxin Type A ◽  
Lateral Epicondylitis ◽  
Extensor Tendon ◽  
The Common

Abstract Background Botulinum toxin (BTX) is widely used for pain control in various musculoskeletal disorders. Objectives We evaluated the analgesic effect of botulinum toxin type A (BTX-A) in chronic lateral epicondylitis and compared the effect between 10 and 50 IU of BTX-A. Methods Sixty subjects with chronic lateral epicondylitis were included and underwent a BTX-A injection in the common extensor tendon. The subjects were randomly allocated into two groups: the small-dose group (SD group; 30 subjects, 10 IU) and large-dose group (LD group; 30 subjects, 50 IU). Treatment outcomes were evaluated by measuring the pain level using the numeric rating scale (NRS) and measuring grip strength before and one, two, three, four, five, and six months after treatment. Results Subjects in both groups showed a significant decrease in NRS scores at all evaluation time points after treatment. The reduction in NRS scores was significantly greater in the LD group at one, two, three, and four months after treatment. Six months after treatment, 19 subjects (63.3%) in the SD group and 21 (70%) in the LD group reported successful pain relief (pain relief ≥50%). The rate of successful pain relief was not significantly different between the two groups. Grip strength was more increased in the LD group at one, two, three, four, and six months after treatment. Conclusions BTX-A injection into the common extensor tendon can be a good treatment option for chronic lateral epicondylitis. The 50-IU BTX-A injection achieved a better outcome than the 10-IU 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 Open release versus radiofrequency microtenotomy in the treatment of lateral epicondylitis: a prospective randomized controlled trial

2017 ◽  
Vol 10 (1) ◽  
pp. 45-51 ◽  
Author(s):  
Katharine Hamlin ◽  
Christopher Munro ◽  
Scott L. Barker ◽  
Sean McKenna ◽  
Kapil Kumar
Keyword(s):  
Randomized Controlled Trial ◽  
Grip Strength ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Controlled Trial ◽  
Lateral Epicondylitis ◽  
Open Release ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Significant Difference

Background Optimal surgical treatment of lateral epicondylitis remains uncertain. Recently, radiofrequency microtenotomy (RFMT) has been proposed as a suitable treatment. We compared RFMT with standard open release (OR) in this prospective randomized controlled trial. Methods In total, 41 patients with symptoms for at least 6 months were randomized into two groups: 23 patients had RFMT and 18 had OR. Two patients from RFMT withdrew. Each patient underwent Numerical Rating Scale (NRS) pain score, grip strength and Disabilities of the Arm, Shoulder and Hand (DASH) scores pre-operatively and at 6 weeks. Pain and DASH scores were repeated at 6 months and 12 months. Results NRS pain scores improved by 4.8 points for RFMT and by 3.9 points for OR. There was a significant improvement in both groups from pre-operative scores, although there was no statistically significant difference between the groups at 1 year. Grip strength improved by 31% in the RFMT group compared to 38% in OR. There was no significant difference between the initial and 6 weeks scores or between treatments. At 1 year, DASH was 39.8 points for RFMT and 24.4 points for OR. There was a significant improvement in both groups from pre-operative scores, although there was no statistically significant difference between the groups at 1 year. Conclusions Both groups showed significant improvements and similar benefit to the patient. The results of the present study do not show any benefit of RFMT over the standard OR. As a result of the extra expense of RFMT, we therefore recommend that OR is offered as the standard surgical management.

Clinical and Ultrasonographic Results of Ultrasonographically Guided Percutaneous Radiofrequency Lesioning in the Treatment of Recalcitrant Lateral Epicondylitis

2011 ◽  
Vol 39 (11) ◽  
pp. 2429-2435 ◽  
Author(s):  
Cheng-Li Lin ◽  
Jung-Shun Lee ◽  
Wei-Ren Su ◽  
Li-Chieh Kuo ◽  
Ta-Wei Tai ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Grip Strength ◽  
Surgical Intervention ◽  
Current Trend ◽  
Case Series ◽  
Lateral Epicondylitis ◽  
Extensor Tendon ◽  
Level Of Evidence ◽  
Vas Score

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.

scholarly journals Outcome analysis of percutaneous tenotomy in chronic lateral epicondylitis elbow

2020 ◽  
Vol 6 (2) ◽  
pp. 382
Author(s):  
Vipin Sharma ◽  
Punit Katoch ◽  
Seema Sharma ◽  
Manish Sharma ◽  
Manoj Gandhi ◽  
...  
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Tertiary Care ◽  
Lateral Epicondylitis ◽  
Extensor Tendon ◽  
Outcome Analysis ◽  
Post Intervention ◽  
Numerical Rating ◽  
Percutaneous Tenotomy ◽  
Limiting Condition

<p class="abstract"><strong>Background:</strong> Lateral epicondylitis elbow is a self-limiting condition with an unclear pathology. Conservative therapy is treatment of choice in lateral epicondylitis elbow but chronic lateral epicondylitis elbow (&gt;6 month) is a condition difficult to treat. Percutaneous extensor tendon release can be a viable treatment option in such conditions.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted in 2016 to 2017 at the Department of Orthopaedics Surgery in a tertiary care institute. 30 patients were treated by percutaneous tenotomy.  The outcome was assessed at follow ups using numerical rating scale (NRS), disabilities of the arm, shoulder, and hand questionnaire (DASH) and Oxford scores.<strong></strong></p><p class="abstract"><strong>Results:</strong> 30 elbows were included in this study. They were managed by percutaneous method (PT; n=30). The mean age of patients was 41.74 years (range 26-67 years). Females were affected more than males in both groups (3:1).    Dominant limb was involved in 86% of patients.73% of females were house wives exposed to household chores and manual activities while 40% of males were manual workers.  Mean hospital stay was 35 minutes (range 20-43 minutes). Patients were followed up at 3 month and 6 month post intervention. NRS, DASH, Oxford score assessment showed that all the scores were significantly decreased (p&lt;0.05) at 3 month and 6 month in patients undergoing percutaneous tenotomy. </p><p class="abstract"><strong>Conclusions:</strong> Lateral epicondylitis &gt;6 month duration is difficult to treat. Percutaneous tenotomy is effective modality of treatment in such conditions.</p>

scholarly journals Proprioceptive elbow training reduces pain and improves function in painful lateral epicondylitis—a prospective trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
B. Schiffke-Juhász ◽  
K. Knobloch ◽  
P. M. Vogt ◽  
L. Hoy
Keyword(s):  
Grip Strength ◽  
Prospective Trial ◽  
Lateral Epicondylitis ◽  
Dash Score ◽  
Level Of Evidence ◽  
Link Type ◽  
Significant Difference ◽  
Proprioceptive Training ◽  
Group A ◽  
Group B

Abstract Background In painful epicondylitis, previous studies reported deficiencies in elbow proprioception. In line, proprioceptive training of the lower limb has been reported substantial beneficial in a number of indications. Therefore, we have asked if a specified proprioceptive training using training devices that are capable of activating the deep musculature in the upper limb is able to reduce the symptoms of epicondylitis. Materials and methods We included 71 patients with painful lateral epicondylitis > 3 months. Interventions: Group A: Proprioceptive training intervention with a Flexibar® (9 min daily for 12 weeks). Group B: at least 40 min running or walking/week with the XCO® in addition to the proprioceptive training with the Flexibar® (9 min daily for 12 weeks), follow-up for 12 weeks. Primary end point: Pain on visual analogue scale (VAS, 0-10); secondary end points: DASH-Score (0 = very good, 100 = very poor), grip strength according to Jamar dynamometer (kg), vibration sensation measured with a 128 Hz tuning fork. Results The pain on VAS in group A was reduced significantly. 3.6 ± 2.0 to 2.4 ± 2.1 (−33%, p = 0.013), and from 3.7 ± 2.4 to 2.2 ± 1.9 (−41%, p = 0.004) in group B after 12 weeks. There was no significant difference between A and B (p = 0.899). In both groups, there was a significant improvement of the DASH-Score (A: 32 ± 15 to 14 ± 12, −56%, p < 0.001; B: 27 ± 12 to 12 ± 11, −55%, p = 0.001) without any difference between groups A and B (p = 0.339). Grip strength improvement in group A from 24 ± 12 to 33 ± 11 kg (+38%, p < 0.001), and from 29 ± 14 to 34 ± 11 kg (+15%, p < 0.001) in group B. In line, vibration sensation improved in both groups (A: 6.3 ± 0.6 to 6.5 ± 0.5, p = 0.0001; B: 6.3 ± 0.7 to 6.6 ± 0.5, p = 0.003). Conclusion A 12-week proprioceptive training with the Flexibar® improves pain, quality of life, grip strength and vibration sensation in patients with painful lateral epicondylitis. Level of evidence Ib, randomised clinical trial Trial registration German Clinical Trials Register, DRKS00024857, registered on 25 March 2021—retrospectively registered, http://apps.who.int/trialsearch/

scholarly journals Effect of hyaluronate and splinting alone versus combined treatment (splinting and hyaluronate) on thumb carpometacarpal osteoarthritis

2020 ◽  
Vol 2 (1) ◽  
pp. 35-40
Author(s):  
Salvatore Denaro ◽  
Salvatore Boccaccio ◽  
Antonino Zocco
Keyword(s):  
Grip Strength ◽  
Rating Scale ◽  
Combined Treatment ◽  
Numeric Rating Scale ◽  
Group Iii ◽  
Pain Disability ◽  
Group I ◽  
Group Ii ◽  
Thumb Carpometacarpal ◽  
Carpometacarpal Osteoarthritis

Thumb carpometacarpal osteoarthritis can lead to global hand dysfunctions and its symptoms are pain and inability. The purpose of this study is to determine the effectiveness of hyaluronate in relieving these symptoms, and to compare it to orthosis and combined treatment (orthosis and hyaluronate). We enrolled 39 patients, evaluated at the baseline by using numeric rating scale (NRS) for pain, Disability of the Arm, Shoulder and Hand (DASH) and Dreiser Scale for disability degree, and Digital Hydraulic Pinch Gauge for grip strength. Eligible participants were randomly assigned to one of the three treatments: injection of hyaluronate (group I), combined treatment (hyaluronate and orthosis, Group II) and orthosis (hard-resting splint, Group III). Patients of Group I and Group II were injected by low molecular weight Hyaluronate once a week for three consecutive weeks. Injections were performed by means of the so-called blind technique. The data analysis indicated a significant decrease (P<0.01) of pain at week 4, further manifested at week 26 by all groups treated. The same occurred for functional symptoms, and grip strength. This improvement appears more evident in group I that received HA.

scholarly journals Incidence of tennis elbow and association of hand grip strength among college students

2020 ◽  
Vol 9 (1) ◽  
pp. 177
Author(s):  
Riyas Basheer K. B. ◽  
Subhashchandra Rai ◽  
Irshana Balkies A. M. ◽  
Jasim Junaid N. P.
Keyword(s):  
College Students ◽  
Grip Strength ◽  
Incidence Rate ◽  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Extensor Tendon ◽  
Lateral Epicondyle ◽  
Hand Grip ◽  
Local Tenderness ◽  
Left And Right

Background: Lateral epicondylitis is an overuse injury involving the origin of common extensor tendon at elbow joint. Among the college students there is more complaint on wrist and elbow. Objective was to find out the incidence of tennis elbow & grip strength among the students during the entire academic year.Methods: Three hundred and seventy subjects fulfilled the inclusion criteria with age respondents between seventeen to twenty four years. This study is done in those students who have local tenderness on palpation over the lateral epicondyle (grade 2). NPRS was used for measuring the pain intensity. Mill’s test and Cozen’s test was performed to confirm the tennis elbow. The subject is asked to squeeze the dynamometer three times with left and right hand respectively. There was one minute resting period between each squeeze were taken into account.Results: The incidence of confirmed tennis elbow was 4.05% & 2.70% in right and left respectively. Among those participants Mill’s test was positive in 16.2% on right and left side and Cozen’s test was positive in 8.1% on right side and 5.4% on left side. The mean rank of left and right grip strength for the students who are confirmed as tennis elbow were 52.75 Kg and 50.67 Kg and for not-confirmed were 36.56 Kg and 36.41 Kg respectively.Conclusions: The study concluded that 6.7% incidence rate of tennis elbow was observed in college students during the entire academic year. And also concluded there is no much significance correlation between grip strength and tennis elbow incidence rate.

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