Functional outcome of autologous platelet rich plasma injection in plantar fasciitis and tennis elbow

Recent developments in cellular and molecular biology have emerged as a potent tool in the management of orthopaedic illnesses and injuries. Upon binding to the target cell receptor, the growth factor from platelets triggers the activation of an intracellular signal transduction system, which results in a biological response that is essential for chemotaxis, cell proliferation, and osteoblastic differentiation. The aim of this study is to determine the efficacy and safety of autologous platelet-rich plasma injection in tennis elbow and plantar fasciitis. We conducted a prospective study with patients who were suffering from plantar fasciitis (n=37) or tennis elbow (n=23) and were given with autologous platelet-rich plasma injection. A short term follow up of all these cases were done at regular intervals for 1, 4, 8, and 12 weeks. The clinical outcomes were analyzed with severity of pain and movements of the pathological part. The functional outcomes were analyzed with VAS and AOFAS scoring for plantar fasciitis and VAS and Mayo’s elbow scoring for tennis elbow. All these patients were statistically analyzed by repeated measures ANOVA test. Our investigation found a statistically significant difference between pre-procedural and post-procedural scores in both the subjective (VAS) and functional (AOFAS and Mayo elbow score) grading systems used in this study. Patients who received an autologous platelet-rich plasma injection experienced a statistically significant (p <0.05) improvement in their ability to combat both of the musculoskeletal illnesses studied. Autologous platelet-rich plasma acts as a promising efficacious biological therapeutic agent for use in musculoskeletal disorders such as plantar fasciitis and tennis elbow without major complications upon its usage.

Allogeneic platelet-derived growth factors local injection in treatment of tennis elbow: a prospective randomized controlled study

Purpose The purpose of this study aimed to evaluate the efficacy of local injection of allogeneic platelet-derived growth factors in treatment of patients with tennis elbow. Patients and methods This study included 120 tennis elbow patients randomly divided into two groups. The patients were locally injected with allogeneic growth factors (treatment group) or with normal saline (control group). The outcomes were assessed using Patient-Related Tennis Elbow Evaluation (PRTEE) and quick Disabilities of the Arm, Shoulder and Hand (qDASH) scales. The clinical outcomes were accordingly classified as excellent, good and poor. The patient’s satisfaction and adverse effects were also recorded. Results There was no statistically significant difference between the two groups regarding the age, gender, dominant arm or the pre-injection scores. At three month follow-up, the reductions in the mean PRTEE and qDASH scores were 88.7% and 70.6% in the treatment group versus 21.8% and 14.9% in the control group, respectively. At the last follow-up, the outcomes in the treatment group were excellent in 85% of patients and good in 15%, versus 8% and 32% in the control group. Overall, 95% were satisfied in the treatment group compared to 25% in control group. Forty patients in the treatment group experienced mild transient post-injection pain. Conclusion This study strongly suggests that local injection of allogeneic platelet-derived growth factors could be a promising safe treatment option for tennis elbow with significant pain relief, functional improvement and patient’s satisfaction. Yet, additional larger studies are needed to assess the durability of these outcomes.

Hyaluronic acid injections for chronic tennis elbow

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.

Platelet-rich plasma injection for tennis elbow: did it ever work?

Platelet-rich plasma (PRP) is a commonly used treatment for tendinopathies such as tennis elbow despite the questionable evidence of its efficacy. A recent Cochrane review suggests that it likely does not provide clinically meaningful benefits in people with tennis elbow. In this viewpoint, we discuss how lack of regulation allowed aggressive marketing and clinical use without normal phases of drug development and approval process or rigorous evidence of benefits. Since several phases of development were bypassed, we still do not know the optimal preparation method and dosing of PRP for tendinopathies. Furthermore, several clinical trials compared PRP with other interventions although it was unclear if PRP was better than placebo and these comparisons created distraction rather than improved understanding of its effects.

Musicians’ medicine – potential health problems among violinists and violists caused by playing the string instrument – the review of the literature

Introduction and purpose Musicians' medicine has received increasing attention recently. It is known that listening to music or playing an instrument has beneficial effects on cognitive and neural functions. Playing the string instrument demands repetitive precise movements of fingers and arms in a non-ergonomic posture that might give rise to health problems. The study aims to present the current state of knowledge regarding different potential health problems among violinists and violists. The article reviews the 24 newest scientific publications available on PubMed and Google Scholar. A brief description of the state of knowledge The literature review indicated several potential health consequences of excessive playing the violin or viola, as follows: Fiddler's neck and skin allergy, Garrod’s pads, temporomandibular disorders, carpal tunnel syndrome, cubital tunnel syndrome, tennis elbow, compression of the right ulnar nerve in the ulnar (Guyon's) canal, rotator cuff tendonitis, tenosynovitis, bursitis, focal dystonia, thoracic outlet syndrome, bone asymmetry, pain in the neck, cheeks, fingers, wrist, forearm, shoulder, waist, and the back. Conclusions Musicians should be aware of potential health problems that occur during prolonged playing the violin or the viola. An important issue is maintaining the accurate proportions between the amount of time spent playing the instrument and resting. The first signs of neurological or musculoskeletal changes should prompt the musician to seek professional medical help to prevent the disorder's progression.

COMPARATIVE STUDY REGARDING THE BENEFITS OF USING MEDICAL FLOSSING IN LATERAL EPICONDYLITIS

Although there are multiple published reviews about the effects of the most common techniques, such as stretching or the use of foam roller on the range of motion (Behm et al., 2016; Wilke et al., 2020) or performance parameters (Behm & Wilke, 2019; Konrad et al., 2021), there is no analysis on the effects of medical flossing. To date, two reviews have been publishedabout effectiveness of using ankle flossing to improve dorsiflexion amplitude or jump performance (Pisz et al., 2020; Kielur & Powden, 2020). This study aimed to investigate the effectiveness of medical flossing added to routine treatment in patients with epicondylitis, compared to conventional physiotherapy treatment. The study included 6 subjects who showed localized pain in the area of the lateral epicondyle exacerbated with the Cozen test. The other criteria for selecting patients were the duration of the symptoms, less than 3 months from the onset of the disease and pain intensity more than 5 on the Visual Analog scale.To monitor the evolution of the subjects involved, we used a visual analog pain scale to assess the intensity of pain at different times during the application of therapy, before and after the end of the treatment. Another tool used to measure the degree of pain and dysfunction was the PRTEE Questionnaire (Patient-Rated Tennis Elbow Evaluation). The rehabilitation program took place between August and September 2021, for 30 days, with afrequency of 3 times per week. 6 patients with lateral epicondylitis were included and medical flossing was used only in the case of 3 patients at each therapy session. The differences between groups at the time of the initial assessment, in terms of pain intensity were statistically insignificant (p=0.288, p>0.05). The results obtained in terms of decreasing pain were in favor of the use of medical flossing as an adjuvant method in specific pain existing in lateral epicondylitis. Although in both groups there was a decrease in pain after 4 weeks of treatment, the intervention group recorded significant reduced values compared to the control group (p=0.024; p<0.05). Regarding PRTEE Functional Score, at the final assesment there was a decrease in both groups, which means the functional condition of the patients has improved.

Comparison of the effectiveness of radial extracorporeal shock wave therapy and supervised exercises with neuromuscular inhibition technique in lateral epicondylitis: A randomized-controlled t

Objectives: The aim of this study was to evaluate and compare the effects of radial extracorporeal shock wave therapy (rESWT) and supervised exercises with neuromuscular inhibition (NMI) technique in improving pain, function, and grip strength in the treatment of patients with lateral epicondylitis (LE). Patients and methods: A total of 50 patients with LE (11 males, 30 females; median age: 46 years; range, 23 to 57 years) whose symptoms persisted for at least three months between February 2015 and August 2015 were included in the prospective, randomized-controlled, clinical study. The patients were divided into two groups as the rESWT group (n=25) receiving a total of three rESWT sessions (once per week with 1.8 bar pneumatic pressure, 10 Hz frequency, and with 2,000 pulses) and the exercise group (n=25) receiving supervised exercises with NMI (three times per week for three weeks). Pain and function were evaluated using Visual Analog Scale, the total Patient-Rated Tennis Elbow Evaluation, the Roles and Maudsley score, while the grip strength was evaluated using a hand dynamometer at one and three months after treatment compared to baseline. Results: A significant improvement was observed in all outcome criteria at one and three months after treatment, compared to baseline, in both the rESWT and exercise groups (p<0.05). There was no significant difference in terms of the changes in the outcome criteria between the groups (p>0.05). Conclusion: The rESWT seems to provide no significantly superior benefit than supervised exercises with NMI at least until the three months in the treatment of LE.