A STUDY OF LOCAL CORTICOSTEROIDS INJECTION vs DRY NEEDLING IN LATERAL EPICONDYLITIS

2021 ◽  
pp. 20-22
Author(s):  
Nisarg J Shah ◽  
Sunny M Patel ◽  
Yogesh B kucha
Keyword(s):  
Tennis Elbow ◽  
Platelet Rich Plasma ◽  
Lateral Epicondylitis ◽  
Common Disease ◽  
Line Treatment ◽  
Second Line ◽  
Dry Needling ◽  
Effective Treatment Option ◽  
Group 2 ◽  
Corticosteroid Injections

Lateral epicondylitis is also known as a Tennis elbow is a common disease of middle age which is painful and functionally limiting entity affecting the upper extremity & causes decreased productivity. The rst line treatment for LE is topical and oral anti-inammatory drugs from ice st applications and brace used. If the 1 line treatment fails second line treatment generally invasive are offered and second-line therapeutic regimens include saline, corticosteroid or platelet-rich plasma injections. Dry needling is relatively new for treating the same. We hypothesized that dry needling would be as effective as second-line treatment for LE. Here we compared the outcomes of second-line treatment, local steroids and dry needling. MATERIALS AND METHODS: The study involved 50 patients having LE, dividing into 2 groups. Patients in group 1 received dry needling, where as those in group 2 received second-line treatment, consisting of local corticosteroid injections. The patients were evaluated after 2 and 4 weeks on the bases of Patients – rated tennis elbow evaluation score (PRTEE). RESULTS:Both treatment were equally effective at 2 and 4 weeks. The effectiveness of both are same and both intervals but someone dry needling has low complications rate in compare to local steroids. CONCLUSION: Because of the low complication rate, dry needling is a safe method, and it might be an effective treatment option for LE same as the second line treatment of local corticosteroid injections.

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 Management of tennis elbow: a survey of UK clinical practice

2017 ◽  
Vol 11 (3) ◽  
pp. 233-238 ◽  
Author(s):  
Marcus Bateman ◽  
Andrew G. Titchener ◽  
David I. Clark ◽  
Amol A. Tambe
Keyword(s):  
Online Survey ◽  
Tennis Elbow ◽  
Platelet Rich Plasma ◽  
Second Line ◽  
Cross Sectional ◽  
Shockwave Therapy ◽  
Plasma Injection ◽  
Wide Variability ◽  
The Uk ◽  
Corticosteroid Injections

Background Tennis elbow is a common condition in the UK but there are no guidelines on how best to manage the condition. The purpose of the present study was to establish the current UK practice in managing patients with chronic tennis elbow. Methods A cross-sectional online survey of UK surgeons and therapists was conducted in June 2017. Results In total, 275 responses were received, the majority from consultant surgeons and experienced physiotherapists. In total, 81% recommended exercise-based physiotherapy as the first-line intervention. Second-line treatments varied widely, with corticosteroid injections being the most popular (27%), followed by shockwave therapy, platelet-rich plasma injection, surgery, acupuncture and a wait-and-see policy. Conclusions There is wide variability of treatments offered when physiotherapy fails patients with tennis elbow. The majority of second-line interventions lack evidence to support their use and, in the case of corticosteroid injections, may even be harmful in the long term. There is a clear need for national guidance based on best evidence to aid clinicians in their treatment approach.

scholarly journals Effects of intralesional platelet-rich plasma in the patients with lateral epicondylitis of elbow

2019 ◽  
Vol 12 (3) ◽  
pp. 138-141
Author(s):  
Mohammad Tariqul Islam ◽  
M. A. Shakoor ◽  
Afsana Mahjabin ◽  
Md. Ali Emran
Keyword(s):  
Visual Analogue Scale ◽  
Daily Living ◽  
Analogue Scale ◽  
Tennis Elbow ◽  
Platelet Rich Plasma ◽  
Lateral Epicondylitis ◽  
Activity Of Daily Living ◽  
Evaluation Tool ◽  
Plasma Injection ◽  
The Difference

Lateral epicondylitis (tennis elbow) is a major cause of musculoskeletal pain involving common extensor origin of the forearm. This study was done to determine the effects of platelet-rich plasma on 15 patients with lateral epicondylitis. Selected patients were given intralesional platelet-rich plasma injection, activity of daily living instructions and paracetamol. Patients were assessed every 14 days interval by visual analogue scale, and the patient rated tennis elbow evaluation. Treatment response according to visual analogue scale and patient rated tennis elbow evaluation tool, the difference of improvement was found in respect to time, from pretreatment W1 (just before 1st Intervention) score to W11 score in every alternate week (p<0.005). This indicates that intralesional platelet-rich plasma is effective in the patients with lateral epicondylitis of elbow.

scholarly journals STUDY COMPARING THE EFFICACY OF PLATELET RICH PLASMA VERSUS TRIAMCINOLONE IN TREATING TENNIS ELBOW

2019 ◽  
Vol 3 (7) ◽  
Author(s):  
Pratush Kumar Goyal ◽  
Anil Kumar Pandey ◽  
Akhil Bansal ◽  
Mohammad Zuber
Keyword(s):  
Tennis Elbow ◽  
Platelet Rich Plasma ◽  
Randomized Study ◽  
Lateral Epicondylitis ◽  
Age Group ◽  
Elbow Pain ◽  
Therapy Assessment ◽  
Pre Treatment ◽  
Gandhi Medical College ◽  
Group 1

Background: Lateral epicondylitis is seen more commonly in non-athletes than athletes. Non-operative methods are the mainstay of treatment being effective in more than 95% of cases. Platelet rich plasma (PRP) has shown promising results in many studies as compared to steroid injection & other modes of conservative management. Hence, this study was done to evaluate PRP efficacy in our clinical setup and in the people of age group most commonly being affected. Methods: This randomized study was conducted at Gandhi Medical College & Hamidia Hospital, Bhopal, for a period of two years from Aug 2015 to Sep 2017 on 60 consenting patients diagnosed as suffering from lateral epicondylitis. Using lottery method for randomization the patients were divided into two groups, based on which the treatment was received. Group –1 with 30 patients received 2 ml of PRP. Group –2 with 30 patients received 2 ml of Triamcinolone injection. The data collected and recorded in the appropriate proforma. Post therapy assessment was done using with Oxford elbow score. Results:  Average age at presentation was 31.11 years, Range of age was from 20 to 40 years. Maximum incidence was in the age group of 35 to 40 years. Female preponderance was observed in Group 1. Most common presenting complaint was elbow pain seen in 100% of cases. Most common side involved was the dominant side right side involvement was seen in 41 cases and left side in 19 cases. The Oxford elbow score pre-treatment in all the groups was not statistically significant and the Oxford elbow score at the end of 6 weeks,12 weeks and 24 weeks treatment showed that PRP is better than  steroid  in control of pain. Conclusion: Lateral epicondylitis/Tennis elbow is a painful debilitating condition of elbow, which creates disturbance in functional activities. A single injection of PRP at the site of the elbow pain resulted in relief of pain in patients with longer duration as compared to local steroids to other conservative treatments. Keywords: Tennis elbow, Platelet rich plasma, Steroid, Triamcinolone, Lateral epicondylitis

scholarly journals P469 Stay in class or switch out of class after anti-TNF failure in inflammatory bowel disease (IBD). Real-world data from a large district general hospital

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S414-S414
Author(s):  
H Johnson ◽  
S Vythilingam ◽  
S McLaughlin
Keyword(s):  
Clinical Remission ◽  
Disease Type ◽  
Line Treatment ◽  
Second Line ◽  
Real World Data ◽  
Effective Treatment Option ◽  
Significant Cost ◽  
Third Line ◽  
Biologic Drug ◽  
Third Line Treatment

Abstract Background Biosimilar infliximab (IFX) and adalimumab (ADA) are well-proven cost-effective anti-TNF drugs in IBD; in our practice, the majority of patients with IBD receive IFX or ADA first line. Since the introduction of Vedolizumab (VED) and Ustekinumab (UST) some have recommended switching out of class after failing a single anti-TNF. This practice has significant cost implications. To establish the outcome of treatment response in patients treated with a second anti-TNF agent after anti-TNF failure compared with the outcome of patients treated with VED and UST after anti-TNF failure. Methods We maintain a prospective IBD database. We searched our database for the outcomes of patients who failed their first anti-TNF drug but were in a clinical remission 6 months after changing to a second or third biologic drug. Disease type, age, gender and response to their second and third biologic drug were recorded. Clinical remission was defined as off steroids with calprotectin &lt;250 and no symptoms of active IBD. Results Two hundred and eighty-seven patients were identified. One hundred and forty (48.8%) were male. Mean age was 43.2 (range 18–94). Disease type was 75 (26%) UC, 210 (73.2%) CD, 2 (0.7%) IBD-U. One hundred and ninety-three patients received IFX 1st line, 118 (40%) failed. Of these 84 (72%) received ADA, 28 (24%) VED and 6 (5%) UST second line. Remission with second-line treatment was achieved in 58 (69%); ADA, 18 (64%); VED, 6 (100%); UST. Remission with third line treatment; was achieved in 6 (100%); VED; 5 (100%); UST. Ninety-four patients received ADA 1st line, 33 (35%) failed. Of these 11 (33%) received IFX, 10 (30%) VED and 8 (24%) UST second line. Remission with second-line treatment was achieved in 6 (55%); IFX, 10 (100%); VED and 8 (100%); UST. Remission with third line treatment; was achieved in 1 (100%); VED, 4 (100%); UST. Conclusion Our data suggest that treatment with ADA after IFX failure is an effective treatment option whereas IFX treatment after ADA failure is less effective. It is interesting that the majority of those who failed the anti-integrin treatment second line responded to third line ADA. These data are consistent with earlier anti-TNF studies including GAIN (Gauging Adalimumab efficacy in Infliximab Non-responders) and SWITCH (Switch to adalimumab in patients with Crohn’s disease controlled by maintenance infliximab: prospective randomised SWITCH trial) which demonstrated that anti-TNF failure is not a class effect. We recommend prescribing a second anti-TNF after anti-TNF failure in preference to using an anti-integrin second line. This practice will lead to significant cost savings for the health care economy.

scholarly journals Incorporating hematopoietic stem-cell transplantation after second-line carfilzomib-lenalidomide-dexamethasone (KRd)

2020 ◽  
Vol 11 ◽  
pp. 204062072092104
Author(s):  
Ja Min Byun ◽  
Sung-Soo Yoon ◽  
Youngil Koh ◽  
Chang-Ki Min ◽  
Jae Hoon Lee ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Clinical Benefit ◽  
Line Treatment ◽  
Second Line ◽  
Hematopoietic Stem ◽  
Group 2 ◽  
Group 1

Background: Traditionally believed to be an integral part of multiple myeloma (MM) treatment, the role of hematopoietic stem-cell transplantation (HSCT) is being challenged. As such, we sought to evaluate the impact of HSCT in the era of novel agents. Methods: A multicenter, retrospective, longitudinal cohort study was carried out between January 2016 and December 2018. A total of 55 patients who received VTD (bortezomib-thalidomide-dexamethasone) as first-line treatment and KRd (carfilzomib-lenalidomide-dexamethasone) as second-line treatment were analyzed for outcomes. Results: The enrolled patients were divided into Group 1, defined as those who continued KRd treatment until progression ( n = 41), versus Group 2, defined as those who underwent HSCT after a certain number of cycles of KRd ( n = 14). Both groups showed a generally favorable response to KRd, with overall response rate (ORR) of 87.9% and clinical benefit rate of 92.8% after a median of seven cycles in Group 1, and ORR 92.8% and clinical benefit rate 100% after median of five cycles in Group 2. However, significantly poorer progression-free survival (PFS) ( p = 0.004) was observed in Group 1 (median 12 months) compared with Group 2 (median not reached). Multivariate analyses identified HSCT after KRd as potential risk factors associated with PFS. Also, in Group 1, bortezomib refractoriness was associated with significantly shorter PFS compared with those who were responsive (median 12 months versus 14 months, respectively, p = 0.039). Conclusions: In conclusion, even with the advent of novel agents, HSCT still remains a valuable treatment modality with additive efficacy.

Impact of Second-Generation Tyrosine Kinase Inhibitors As Second Line Treatment for Patients with Chronic Myeloid Leukemia,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3780-3780 ◽  
Author(s):  
J Valentin Garcia-Gutierrez ◽  
Pilar Herrera ◽  
Lorena L Abalo ◽  
Maria Dolores Rey ◽  
Maria Calbacho ◽  
...  
Keyword(s):  
Myeloid Leukemia ◽  
Second Generation ◽  
Kinase Inhibitors ◽  
Salvage Treatment ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Group 2 ◽  
Group 1

Abstract Abstract 3780 Background: Imatinib has shown an outstanding improvement in the prognosis of chronic myeloid leukemia (CML) patients. Nevertheless, some of them have proven to be resistant or intolerant to imatinib. For these patients, second-generation tyrosine kinase inhibitors (TKIs) are available. These drugs may be indicated in different circumstances as primary or second resistance, suboptimal responses or intolerance.The real benefits of second-generation TKIs as salvage treatment are surely in dependence with the indication in each case and are, therefore, difficult to evaluate. Second-generation TKIs are being evaluated as first line treatment compared to imatinib with quite favourable outcomes so long, but have not yet been compared with a strategy combining imatinib followed by second-generation TKIs for patients with previous unfavourable responses. Aims: Evaluate the real benefit of second-generation TKIs in second line treatment for CML patients regardless of the indication for its use. Study groups and methods: We have studied 98 patients treated with imatinib as first tyrosin kinase inhibitor (TKI) in our centre. These patients have been classified according whether second-generation TKIs were available or not. Group 1 includes 60 patients treated since 2001 to 2005, when the only salvage treatment was an increased imatinib dose, chemotherapy or allogenic stem cell transplantation. Group 2 includes 38 patients treated since 2005 until today. In the second group second-generation TKIs (dasatinib or nilotinib) were used according to the indications mentioned above. Follow up period was 39 months and 32 months for group 1 and 2 respectively. Sokal risk index was high in 14% and 16%; intermediate 42 % and 40%; and low in 44% and 44 % for group 1 and 2 respectively. Results: The use of second-generation TKIs as second line resulted in significant benefit to patients in terms of responses. Complete cytogenetic responses (CCR) at any time were achieved in 73% and 86% for patients in group 1 and 2 (p=.09). Probability of the achievement of mayor molecular responses (MMR) was 42% vs 71% for group 1 and 2 respectively [p=.009; ratio=0.3 (0.1–0.7)]. Response rates at the last follow up for group 1 and 2 were: MMR: 33% vs 62%; CCR: 68% vs 94% and failure 32% vs 6% (p=.008). Progression free survival (including all the patients who started treatment) was 88% vs 94% for group 1 and 2 respectively. We found no correlation among responses and some prognostic factors (Sokal index, mutations at the TK domain or imatinib plasma levels). Imatinib doses were increased in 21 patients (35%) in group 1 (reasons for increasing doses were failure in 14 patients and suboptimal responses in 7 patients). 10 patients (26%) in group 2 received second-line TKIs as second line treatment (4 because imatinib failure, 3 by suboptimal responses and 3 due to intolerance). Conclussions: The use of second-generation TKIs as salvage has improved the responses of CML patients treated with TKIs. Once the second-generation TKIs has shown benefit compared to imatinib in first line treatment, this therapeutic strategy should be compared vs the use of imatinib followed of second-line TKIs for patients without optimal responses to imatinib. Disclosures: Montalban: Red Temática de Investigación Cooperativa en Cancer (RETICC): Research Funding; Asociación Española contra el Cancer: Research Funding.

scholarly journals The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: A systematic review

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 11 ◽  
Author(s):  
Walid Ben-Nafa ◽  
Wendy Munro
Keyword(s):  
Systematic Review ◽  
Platelet Rich Plasma ◽  
Corticosteroid Injection ◽  
Lateral Epicondylitis ◽  
Extensor Tendon ◽  
Symptomatic Improvement ◽  
Tendon Thickness ◽  
Randomised Controlled ◽  
Level 2 ◽  
Corticosteroid Injections

Introduction: Lateral epicondylitis is a common musculoskeletal disorder of the upper limb. Corticosteroid injection has been widely used as a major mode of treatment. However, better understanding of the pathophysiology of the disease led to a major change in treating the disease, with new options including platelet-rich plasma (PRP) are currently used. Objectives/research aim: To systematically evaluate the effect of corticosteroid versus PRP injections for the treatment of LE. Hypothesis: PRP injections provide longer-term therapeutic effect and less rate of complications compared to corticosteroid injection. Level of evidence: Level 2 evidence (4 included studies are of level 1 evidence, 1 study of level 2 evidence). Design: Systematic Review (according to PRISMA guidelines). Methods: Eleven databases used to search for relevant primary studies comparing the effects of corticosteroid and PRP injections for the treatment of LE. Quality appraisal of studies performed using Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, CASP Randomised Controlled Trial Checklist, and SIGN Methodology Checklist 2. Results: 732 papers were identified. Five randomised controlled trials (250 Patients) met the inclusion criteria. Clinical findings: Corticosteroid injections provided rapid symptomatic improvement with maximum effect at 6/8/8 weeks before symptoms recurrence, whereas PRP showed slower ongoing improvements up to 24/52/104 weeks(3 studies). Corticosteroid showed more rapid symptomatic improvement of symptoms compared to PRP up to the study end-point of 3 months(1 study). Comparable therapeutic effects of corticosteroid and PRP were observed at 6 weeks(1 study). Ultrasonographic Findings: (1) Doppler activity decreased more significantly in patients who received corticosteroid compared to PRP. (2) Reduced tendon thickness and more patients with cortical erosion noted in corticosteroid group whereas increased tendon thickness and less number of patients with common extensor tendon tears noted in PRP group. (3) Fewer patients reported Probe-induced tenderness and oedema in the common extensor tendon in both corticosteroid and PRP groups (2 studies). Conclusion: Corticosteroid injections provide rapid therapeutic effect in the short-term with recurrence of symptoms afterwards, compared to the relatively slower but longer-term effect of platelet-rich plasma.

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