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The effect of autologous platelet rich plasma in treatment lateral epicondylitis
?smail A??r,Bar?? ?ayp?nar,Osman Mert Topkar,Mustafa Karahan
Dicle Medical Journal , 2011,
Abstract: Lateral epicondylitis (tennis elbow) is the most commonly diagnosed cause of lateral elbow pain. The aim of this study was to compare the effect of single dose corticosteroid and autologous platelet rich plasma (PRP) injection in the treatment of tennis elbow.Materials and methods: The 15 elbow of 15 patients (6 male and 9 female) was included in the study, who applied to our clinic with lateral elbow pain and diagnosed as lateral epicondylitis. A single dose of 0,5 ml Bethametasone and 0,5 ml Prilocaine mixture was applied to first group and single dose 1 ml autologous PRP was locally applied to the second group.Results: In the early follow-ups the results of corticosteroid group were better than latter follow-ups, however in PRP group the results were worst in early follow-ups but better results were obtained in later follow-ups according to Verhaar scoring system.Conclusion: According to our results, the beneficial effects of PRP injection in lateral epicondylitis increases over time but further studies with more patients and longer follow up durations should done in order to more clarified this subject.
Epicondilite lateral do cotovelo Lateral epicondylitis of the elbow
Marcio Cohen,Geraldo da Rocha Motta Filho
Revista Brasileira de Ortopedia , 2012, DOI: 10.1590/s0102-36162012000400002
Abstract: A epicondilite lateral, também conhecida como cotovelo do tenista, é uma condi o comum que acomete de 1 a 3% da popula o. O termo epicondilite sugere inflama o, embora a análise histológica tecidual n o demonstre um processo inflamatório. A estrutura acometida com mais frequência é a origem do tend o extensor radial curto do carpo e o mecanismo de les o está associado à sua sobrecarga. O tratamento incruento é o de escolha e inclui: repouso, fisioterapia, infiltra o com cortisona ou plasma rico em plaquetas e a utiliza o de imobiliza o específica. O tratamento cirúrgico é recomendado quando persistem impotência funcional e dor. Tanto a técnica cirúrgica aberta quanto a artroscópica com ressec o da área tendinosa degenerada apresenta bons resultados na literatura. Lateral epicondylitis, also known as tennis elbow, is a common condition that is estimated to affect 1% to 3% of the population. The word epicondylitis suggests inflammation, although histological analysis on the tissue fails to show any inflammatory process. The structure most commonly affected is the origin of the tendon of the extensor carpi radialis brevis and the mechanism of injury is associated with overloading. Nonsurgical treatment is the preferred method, and this includes rest, physiotherapy, cortisone infiltration, platelet-rich plasma injections and use of specific immobilization. Surgical treatment is recommended when functional disability and pain persist. Both the open and the arthroscopic surgical technique with resection of the degenerated tendon tissue present good results in the literature.
Efficacy of injection of steroids for lateral epicondylitis  [PDF]
R Maharjan,G Gurung
Journal of Institute of Medicine , 2010, DOI: 10.3126/joim.v32i3.4958
Abstract: Introduction: Lateral epicondylitis (Tennis elbow) is one of the most common lesions of the arm. Corticosteroid injection has been described as one of the treatment modalities for this disorder with variable clinical benefit. The purpose of this study was to analyze the short-term and long-term effects of the local injection of methylprednisolone to treat lateral epicondylitis. Methods: A prospective comparative study was carried out in the Department of Orthopaedics in Bir Hospital from October 2009 to February 2011. Study was undertaken in 40 patients to analyze the short-term and long-term effects of the local injection of methylprednisolone for the treatment of lateral epicondylitis. Twenty patients in each group were included in the study. Patients assigned to experimental group received a single injection of 1 percent lidocaine with forty milligrams of methylprednisolone and control group received a single injection of 1 percent lidocaine with saline solution. Results: Corticosteroid injection gave better pain relief in a shorter time than the placebo group. Pain was significantly improved in steroid group in comparison to placebo group till third successive follow ups with maximum improvement at eighteen weeks (p=0.000). However, the groups did not differ with regards to pain at six months as determined with a clinical pain score and visual analogue scale. Conclusions: Local injections of steroids provide rapid pain relief but only short-term benefits in the treatment of lateral epicondylitis. Key word: Epicondylities; Steroid injection; tennis elbow DOI: http://dx.doi.org/10.3126/joim.v32i3.4958 Journal of Institute of Medicine , December, 2010; 32:3 34-38
Autologous Blood Injection and Wrist Immobilisation for Chronic Lateral Epicondylitis  [PDF]
Nicola Massy-Westropp,Stuart Simmonds,Suzanne Caragianis,Andrew Potter
Advances in Orthopedics , 2012, DOI: 10.1155/2012/387829
Abstract: 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. 1. Introduction Lateral epicondylitis or tennis elbow is a common condition that causes pain on the outside of the elbow, as well as pain and weakness during gripping. It has been found to occur in approximately 1.3% of people in studied populations [1]. Tennis elbow is commonly associated with obesity, smoking, and physical loading during activity, as well as playing tennis [1]. The site of long-term scarring has been shown (during ultrasound) to be where the extensor carpi radialis brevis muscle, which lifts the wrist, originates from the humerus [2]. There are many conservative treatments, including splinting, massage, injection of nonsteroidal anti-inflammatories, and alteration of tasks performed by the patient. There is high level, high quality evidence to suggest that extracorporeal shock wave therapy has little or no benefit [3] and that the evidence for orthotics and splints is not clear [4], but a high number of studies suggest that injection of nonsteroidal anti-inflammatories provides good immediate pain relief, with variable recurrence rates of symptoms [4]. Corticosteroid injection has been shown to provide short-term relief but relapse rates are high [5]. Autologous blood injection (ABI) is theorized to stimulate a
EFFICACY OF PHONOPHORESIS AND IONTOPHORESIS OF NAPROXEN IN THE TREATMENT OF LATERAL EPICONDYLITIS  [PDF]
Shyam D.Ganvir
Journal of Pharmaceutical and Scientific Innovation , 2012,
Abstract: The aim of study see the efficacy of iontophoresis, phonophoresis and to compare their effects in the treatment of lateral epicondylitis, it was Randomized controlled trial at Padmashree Dr.Vithalrao Vikhe Patil Foundations, medical hospital,Physiotherapy OPD,AHMEDNAGAR (M.S) This study was carried out with 31 patients who had lateral epicondylitis and randomized into two groups. Group A and Group B, Naproxen was applied to the group A using Phonophoresis (19 patients-23 extremities) and to the group B using iontophoresis(12 patients – 14 extremities).Both groups were treated by other conventional physiotherapy in the form -cryotherapy, strengthening and stretching exercises. it outcomes was Pain scores (at rest, during motion, with pressure, weight lifting).Grip strength and Nirschl- Petterone Grading System were evaluated before and after treatment. Results: Pain scores decreased, grip strength and Nirsch- Petterone Grading System statistically significantly increased in both groups after treatment (p<0.05), but there were no statistical differences between groups before or after treatment (p>0.05).Conclusion: The results suggest that iontophoresis and phonophoresis of naproxen are equally effective electrotherapy methods in the treatment of lateral epicondylitis.
Autologus Blood Injection for Recurrent Lateral Epicondylitis
M. Dehghani, M.D.,? M. Moayedfar, M.D.
Journal of Mazandaran University of Medical Sciences , 2007,
Abstract: Background and purpose: Tennis elbow is a common complaint. Several treatment strategies, such as corticosteroid injections and physical terapy and braces have been described with no predictable efficacy. The purpose of this study was to evaluate prospectively the result of refractory lateral epicondylitis with autologus blood injections.Materials and Methods: Twenty two patients with lateral epicondylitis were injected with 2 mL of autologous blood under the extensor carpi radialis brevis. All patients had failed the two previous non surgical treatments including all or combination of physical therapy, splintinge, non steroidal anti-inflammatory medication and prior steroid injection. The patients were evaluated with patient-rated Tennis Elbow Evaluation (PRTEE).Results: The average fallow-up period was 7.3 months (range, 4-10mo). After autologus blood injection, the average pain score decreased from 43.7 to 9.1 (P-value < 0.001). The average functional score decreased from 42.4 to 10.1 (P-value <0.001).Conclusion: On the basis of this study, this minimally invasive treatment advocates refractory Tennis elbow.
Effects of corticosteroid on the expressions of neuropeptide and cytokine mRNA and on tenocyte viability in lateral epicondylitis
Han Soo,An Hee,Song Ji,Shin Dong
Journal of Inflammation , 2012, DOI: 10.1186/1476-9255-9-40
Abstract: Background The purpose of this study was to determine the reaction mechanism of corticosteroid by analyzing the expression patterns of neuropeptides (substance P (SP), calcitonin gene related peptide (CGRP)) and of cytokines (interleukin (IL)-1α, tumor growth factor (TGF)-β) after corticosteroid treatment in lateral epicondylitis. In addition, we also investigated whether corticosteroid influenced tenocyte viability. Methods The corticosteroid triamcinolone acetonide (TAA) was applied to cultured tenocytes of lateral epicondylitis, and the changes in the mRNA expressions of neuropeptides and cytokines and tenocyte viabilities were analyzed at seven time points. Quantitative real-time polymerase chain reaction and an MTT assay were used. Results The expression of SP mRNA was maximally inhibited by TAA at 24 hours but recovered at 72 hours, and the expressions of CGRP mRNA and IL-1α mRNA were inhibited at 24 and 3 hours, respectively. The expression of TGF-β mRNA was not significant. Tenocyte viability was significantly reduced by TAA at 24 hours. Conclusions We postulate that the reaction mechanism predominantly responsible for symptomatic relief after a corticosteroid injection involves the inhibitions of neuropeptides and cytokines, such as, CGRP and IL-1α. However the tenocyte viability was compromised by a corticosteroid.
Common extensor origin release in recalcitrant lateral epicondylitis - role justified?
Faizal Rayan, Vittal SR Rao, Sanjay Purushothamdas, Cibu Mukundan, Syed O Shafqat
Journal of Orthopaedic Surgery and Research , 2010, DOI: 10.1186/1749-799x-5-31
Abstract: Lateral epicondylitis is characterised by localised pain over the origin of extensor muscles of the finger and wrist at the lateral epicondyle. The cornerstone of the diagnosis are detailed history regarding aggravating and relieving factors and the provocative tests like grasping in elbow extension, resisted wrist and long finger extension and resisted forearm supination[1]. There is often a decrease in the grip strength[1]. Differential diagnosis includes radial tunnel syndrome, radio humeral arthritis, osteochondritis of capitellum, posterolateral instability of the elbow and injury to lateral ante brachial cutaneous nerve [1-3]. An AP, lateral and radiocapitellar view are used as primary imaging modality in order to rule out intraarticular disease or a musculoskeletal tumor. The other imaging techniques like magnetic resonance imaging, electromyography and nerve conduction studies may be complementary[1].Most of the current non-operative modalities utilized in the treatment on lateral epicondylitis are not evidence based[1]. Most of the studies do not differentiate between clinical and statistical significance, and they were unable to depict any beneficial effect of their treatment over natural history of the condition. Patients who fail to respond to conservative measures may require surgery (<10%)[2]. Various operative techniques including open, percutaneous and arthroscopic techniques have been described[2]. Percutaneous procedure has an advantage of reduced morbidity but it has an inherent possibility of inadequate resection or recurrence [4]. Also it is not possible to rule out intraarticular pathology (concurrence of 18.8%)[5]. In the literature there is only one study comparing all three techniques, even though it was done retrospectively[2].In a 5 year period 40 patients referred by general practitioners as tennis elbow who had surgical intervention were reviewed in this retrospective study. The surgery was performed by the senior author. The inclusion c
Value of Ultrasonography on Diagnosis and Assessment of Pain and Grip Strength in Patients with Lateral Epicondylitis
Serdar Tarhan,Zeliha ünlü,Gülgün Y?lmaz Oval?,Yüksel Pabu??u
Romatizma , 2009,
Abstract: Objective: Lateral epicondylitis (LE) is generally diagnosed clinically. Ultrasonography (US) can provide useful information about the location, extent, and severity of LE. Our objective was to use US to confirm LE and to investigate the relationships between pain, grip strength, physical examination, and disability in these patients.Material and Methods: Fifty-two patients with unilateral LE were examined by US. Pain and functional status were assessed using a visual analog scale (VAS), physical functioning and bodily pain scales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and a patient-rated forearm evaluation questionnaire (PRFEQ). Grip strength and manual tests for LE were evaluated.Results: Clinical diagnosis of LE was confirmed by US in 28 (53.8%) patients. Our results showed close associations between clinical examination findings and SF-36 and PRFEQ assessments with pain in patients who had sonographic abnormalities. Grip strength was also correlated with clinical and functional evaluations in these cases. Conclusion: We concluded that evaluation of disability in LE requires methods different from those included in the traditional clinical examination. Pain and grip strength measurements provide numerical and quantitative data for evaluation of severity and disability in patients with sonographic findings of LE.
Clinical assessment of functional outcome in lateral epicondylitis managed by local infiltration of autologous blood
A Bharti, S Avasthi, K Solanki, S Kumar, A Swaroop, GK Sengar
Internet Journal of Medical Update - EJOURNAL , 2010,
Abstract: Lateral epicondylitis is a well known elbow disorder known to affect a variety of population. Though the disorder is expected to affect a lot of sports personnel, the incidence is not uncommon in persons of household activities. The management comprises of conservative to operative with a dilemma of what to be done in most of the affected population. A large number of interventions have been tried to delineate the best modality but none of them proved to be conclusive. The aim of the present study was to prove the efficacy of cheapest possible interventional modality autologous blood for treatment of Lateral Epicondylitis. Twenty five patients of Tennis elbow were included in this study who have attended the OPD of GSVM Medical College and associated LLR Hospital, Kanpur from November 2007 to April 2008 and fulfilled inclusion and exclusion criteria. 78% were females, mostly housewives involved in regular household activities. All the patients were infiltrated autologous blood with local anaesthetic infiltration. Patients were deprived of regular activities for 3 weeks after infiltration. Follow up was done at weekly interval for 2 weeks and then at 6th week and 12th week. Assessment was done using Visual Analogue Scale ( VAS) and Verhaar et al scoring system. Total follow up period was 3 months. We observed that the mean VAS score improved from preinfiltrative 6.40±1.22 to 0.48±1.53 with p value being < .001. 64% patients showed excellent results and 32% showed good results as per Verhaar et al scoring system on 12 weeks follow up. One patient did not respond to this procedure and showed poor result as per Verhaar et al score. Therefore, autologous blood infiltration is a safe and effective modality in treatment of Lateral Epicondylitis. KEY WORDS: Lateral epicondylitis; Autologous blood infiltration
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