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Egyptian Rheumatology and Rehabilitation
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Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline. A comparative study

Egyptian Rheumatology and Rehabilitation volume 44, pages 1–10 (2017)Cite this article

Abstract

Background

Lateral epicondylitis (LE) is the most common overuse syndrome and related to excessive wrist extension, known as tendonitis of the extensor muscles of the forearm, and refers to pain and tenderness over the lateral epicondyle of the humerus.

Local corticosteroid injection has short-term benefits in pain reduction, global improvement, and grip strength compared with placebo (saline or lidocaine) and other conservative treatments.

Autologous platelet-rich plasma (PRP) injection has gained popularity within the sports medicine literature because of its presumed safety and ease of use as a potential treatment for any musculoskeletal problems by inducing cell proliferation and promoting the healing process.

This thesis was carried out to assess the effectiveness of different types of injections (PRP, glucocorticoid, and saline) in improving pain and function in patients with LE.

Patients and methods

This study included 45 patients with LE (more than 3 months) between 31 and 58 years of age. All patients were subjected to assessment of history, clinical examination by the visual analogue scale (VAS), functional assessment by patient-rated tennis elbow evaluation (PRTEE), laboratory investigations, and ultrasonography assessment of the elbow.

All the patients were divided randomly into three groups: group I received a saline injection, group II received a PRP injection, and group III received a corticosteroid injection. Patients were reassessed clinically and by ultrasound after 3 months.

Results

The present study showed that VAS and PRTEE scores were highly significantly reduced after injection in group II than group I and group III. Moreover, the reductions in VAS and PRTEE were highly significantly different in group III in comparison with group I.

In terms of ultrasonographic changes and reduction in tenderness, there was a highly significant improvement in group II than group I and group III. Moreover, the reduction was highly significantly different in group III than group I.

Conclusion

PRP injection may offer several therapeutic advantages over corticosteroid injection.

References

  1. Silverstein B, Welp E, Nelson N. Claims incidence of work-related disorders of the upper extremities. Am J Public Health 1995; 88: 1827–1833.

    Article  Google Scholar 

  2. Verhaar JA. Tennis elbow: anatomical, epidemiological and therapeutic aspects. Int Orthop 1994; 18:263–267.

    Article  CAS  Google Scholar 

  3. McCormack RR, Inman RD, Wells A, Berntsen C, Imbus HR. Prevalence of tendinitis and related disorders of the upper extremity in a manufacturing workforce. J Rheumatol 1999; 17:958–964.

    Google Scholar 

  4. Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol 2011; 25:43–57.

    Article  Google Scholar 

  5. Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemically and electron microscopy studies. J Bone Joint Surg Am 1999; 81:259–278.

    CAS  Google Scholar 

  6. Fredberg U, Bolvig L. Significance of ultra-sonographically detected asymptomatic tendinosis in patellar and achilis tendons of elite soccer players: a longitudinal study. Am J Sports Med 2002; 30:488–491.

    Article  Google Scholar 

  7. Grassi W, Filippucci E, Farina A, Cervini C. Sonographic imaging of tendons. Arthritis Rheum 2000; 43:969–976.

    Article  CAS  Google Scholar 

  8. Allen GM, Wilson DJ. Ultrasound in sports medicine: a critical evaluation. Eur J Radiol 2007; 62:79–85.

    Article  Google Scholar 

  9. Cyriax J, Troisier O. Hydrocortisone and soft-tissue lesions. Br Med J 1953; 2:966–968.

    Article  CAS  Google Scholar 

  10. Krogh TP, Bartels EM, Ellingsen T, Pedersen KS, Buchbinder R, Fredberg U, et al. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med 2013; 6:1435–1446.

    Article  Google Scholar 

  11. Aspenberg P, Virchenko O. Platelet concentrate injection improves achilles tendon repair in rats. Acta Orthop Scand 2004; 75:93–99.

    Article  Google Scholar 

  12. Borzini P, Mazzucco L. Tissue regeneration and in loco administration of platelet derivatives: clinical outcome, heterogeneous products and heterogeneity of the effector mechanisms transfusion. Transfusion 2005; 45:1759–1767.

    Article  CAS  Google Scholar 

  13. ReganW, Grondin P, Morrey BF. Lateral epicondylitis (tennis elbow). In: DeLee J, Drez D, Miller M, editors. DeLee and Drez’s Orthopaedic, sports medicine. 3rd ed. Philadelphia, PA: Saunders Elsevier 2009. 1197–1204

    Google Scholar 

  14. Rodriguez CS. Pain measurement in the elderly: a review. Pain Manag Nurs 2001; 2:38–46.

    Article  CAS  Google Scholar 

  15. Faes M, Van den Akker B, De Lint JA, Kooloos JGM, Hopman MTE. Dynamic extensor brace for lateral epicondylitis. Clin Orthop Relat Res 2006; 442:149–157.

    Article  Google Scholar 

  16. Mata-Castrillo M, Jaén-Díaz JI, Cerezo-López E, López-Castro F, Barceló- Galíndez JP, De la Fuente J, Balius-Mata R. Sonographic findings for the common extensor tendon of the elbow in the general population. J Ultrasound Med 2010; 12:1717–1724.

    Google Scholar 

  17. Krogh TP, Fredberg U, Pedersen KS, Christensen R, Jensen P, Ellingsen T. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid or saline: a randomized, double-blind, placebo-controlled trial. Am J Sports Med 2013; 41:625–635.

    Article  Google Scholar 

  18. Mishra A, Woodall J, Vieira A. Treatment of tendon and muscle using platelet-rich plasma. Clin Sports Med 2009; 125:113–115.

    Article  Google Scholar 

  19. Yadav R, Kothari SY, Borah D. Comparison of local injection of platelet rich plasma and corticosteroids in the treatment of lateral epicondylitis of humerus. J Clin Diagn Res 2015; 7:5–7.

    Google Scholar 

  20. Ferrari M, Zia S, Valbonesi M. A new technique for hemodilution, preparation of autologous platelet-rich plasma and intraoperative blood salvage in cardiac surgery. Int J Artif Organs 1987; 10:47–50.

    Article  CAS  Google Scholar 

  21. Antitua E, Andia I, Sanchez M, Azofra J, Del Mar Zalduendo M, Fuente M. Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF productions by human tendon cells in culture. J Orthop Res 2005; 25:281–286.

    Article  Google Scholar 

  22. Anitua M, Sánchez E, Nurden A, Nurden P, Orive G, Andía I. New insights into and novel applications for platelet-rich fibrin therapies. Trends Biotechnol 2006; 5:227–234.

    Article  Google Scholar 

  23. Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemol 2006; 164:1065–1074.

    Article  Google Scholar 

  24. Otoshi K, Takegami M, Sekiguchi M, Onishi Y, Yamazaki S, Otani K, et al. chronic hyperglycemia increases the risk of lateral epicondylitis: the locomotive syndrome and health outcome in Aziu Cohort study. Springer plus 2015; 4:407.

    Article  Google Scholar 

  25. Gautam VK, Verma S, Batra S, Bhatnagar N, Arora S. Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. J Orthop Surg (Hong Kong) 2015; 23:1–5.

    Article  CAS  Google Scholar 

  26. Chaudhury S, de La Lama M, Adler RS, Gulotta LV, Skonieczki B, Chang A, et al. Platelet-rich plasma for the treatment of lateral epicondylitis: sonographic assessment of tendon morphology and vascularity. Skeletal Radiol 2013; 42:91–97.

    Article  Google Scholar 

  27. Altay T, Günal I, Oztürk H. Local injection treatment for lateral epicondylitis. Clin Orthop Relat Res 2002; 398:127–130.

    Article  Google Scholar 

  28. Borrione P, Gianfrancesco AD, Pereira MT, Pigozzi F. Platelet-rich plasma in muscle healing. Am J Phys Med Rehabil 2010; 89:854–861.

    Article  Google Scholar 

  29. Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 2004; 62:489–496.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, 13 Gesr El Suez Heliopolis, Cairo, 11331, Egypt

    Mahmoud El Tayeb Nasser, Ahmed Z. El Yasaki &  Reem M. Ezz El Mallah PhD

  2. Physical Medicine, Mansheyet El Bakry Hospital, Ain Shams University, Cairo, Egypt

    Amal S. M. Abdelazeem

Authors
  1. Mahmoud El Tayeb Nasser
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  2. Ahmed Z. El Yasaki
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  3. Reem M. Ezz El Mallah PhD
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  4. Amal S. M. Abdelazeem
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Corresponding author

Correspondence to Reem M. Ezz El Mallah PhD.

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Nasser, M.E.T., El Yasaki, A.Z., Ezz El Mallah, R.M. et al. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline. A comparative study. Egypt Rheumatol Rehabil 44, 1–10 (2017). https://doi.org/10.4103/1110-161X.200838

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  • DOI: https://doi.org/10.4103/1110-161X.200838

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