Role of Ultrasound Guided Platelet-Rich Plasma (PRP) Injection in Treatment of Lateral Epicondylitis (original) (raw)
Related papers
Rheumatology (Oxford, England), 2015
The aim was to assess the efficacy of two intra-tendinous injections of platelet-rich plasma (PRP) on epicondylitis of recent evolution (≤3 months). Our study was a double-blind placebo-controlled randomized trial. Two US-guided injections of either PRP (autologous conditioned plasma) or saline solution were performed with an interval of 4 weeks. The exclusion criterion was previous CS infiltration. Patients were monitored by an independent evaluator blinded to treatment at baseline and 1, 3, 6 and 12 months of follow-up. The primary evaluation criterion was the relative improvement from baseline to 6 months in pain score on visual analog scale (0-10). Secondary criteria were the Roles-Maudsley score and the assessment of pain on isometric contraction of extensor carpi radialis brevis and extensor digitorum communis. Twenty-five patients were randomly assigned to each group. Three patients in each arm dropped out before 6 months. In both groups, the pain score [mean (s.d.)] decrease...
Cureus, 2022
Objective Ultrasound-guided platelet-rich plasma (PRP) injections, as well as needle tenotomy, are becoming increasingly popular in the treatment of epicondylitis. Whether ultrasound (US) findings predict the clinical benefit of these techniques is unclear at the moment. This study aimed to investigate the relationship between the presence of tendon tear assessed by US and the therapeutic response of the PRP injection following needle microtenotomy in patients with epicondylitis. Methodology This is a retrospective observational study. Twenty-six patients with chronic (>three months) lateral epicondylitis recalcitrant to conservative treatment or corticosteroid injection. Patients underwent US-guided microtenotomy followed by PRP injection. Data regarding gender, age, US findings at baseline, and numeric pain rating scale (NPRS) scores before and after intervention were collected. Pain improvement rates were calculated at several follow-up time points, namely one, three, six, and...
Treatment of Medial Epicondylitis with Local Injection of Platelet Rich Plasma
The Journal of medical research, 2017
Introduction:: Medial epicondylitis is commonly referred to as ‘‘golfer’s elbow,’’ and is characterized by pathologic changes to the musculo-tendinous origin at the medial epicondyle. Actually, epicondylitis is not an inflammatory process, but it is a tendinosis that results from tendon microscopic tearing, followed by an incomplete reparative response. Several treatment options are available as nonsteroidal anti-inflammatory medications, physiotherapy, extracorporeal shock wave therapy, local steroid injections and more recently local injection of platelet rich plasma (PRP). Surgery reserved for resistant cases when the mentioned modalities fail. Patients and method: This study included 27 patients presented to ElHadara University Hospital with chronic symptomatic medial epicondylitis for more than 6 months. All cases received single local injection of PRP and followed up for 3 months after injection. Patientsassessment was done using the VAS and DASH scoring system at the initia...
Journal of orthopaedic surgery (Hong Kong), 2015
To evaluate the clinical and ultrasonographic changes in the morphology and vascularity of the common extensor tendon after injecting platelet-rich plasma (PRP) or corticosteroid (CS) for recalcitrant lateral epicondylitis (LE). 30 patients aged 18 to 60 years with recalcitrant (>6 months) LE not responsive to oral medication or non-invasive treatment were randomised to receive PRP (n=15) or CS (n=15) injection. Patients were assessed using the visual analogue scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand Scale (DASH) score, Oxford Elbow Score, modified Mayo Clinic performance index for the elbow (modified Mayo score), and hand grip strength. Ultrasonography was performed by a musculoskeletal ultrasonologist to evaluate for tear at the common extensor origin, oedema at the common extensor origin, cortical erosion, probe-induced tenderness, and thickness of the tendon. The VAS for pain, DASH score, Oxford Elbow Score, modified Mayo score, and hand grip strength ...
Journal of orthopaedics, 2015
We assessed the effect PRP injection on pain and function in patients with lateral epicondylitis where conservative management had failed. We prospectively reviewed 34 patients. The mean follow-up was 26 weeks (range 6-114 weeks). We used the Oxford Elbow Score (OES) and progression to surgery to assess outcomes. 88.2% improved their OES. 8.8% reported symptom progression. One patient had no change. No patients suffered adverse reactions. Two patients underwent an open release procedure. One had the injection repeated. An injection of PRP improves pain and function in patients suffering from LE where conservative management has failed.
Indian Journal of Physical Medicine and Rehabilitation
Introduction: Tendinopathy is common in professional athletes as well as in sedentary people. It occurs in 30-50% of all sports-related injuries. Injection of autologous blood has been reported beneficial for the treatment of tendinopathy. It is hypothesized that transforming growth factor-β and basic fibroblast growth factor carried in the blood will act as humoral mediators to induce the healing cascade. Musculoskeletal ultrasound can document the pathology before the injection and accurately identify the site for injection. It also helps in monitoring tendon healing. Materials and methods: This randomized controlled trial was carried out after obtaining permission from Research Ethics Board between September 2016 and August 2018 in the Department of Physical Medicine and Rehabilitation (PMR), Regional Institute of Medical Sciences (RIMS), Imphal, Manipur. Ninety-two patients with lateral epicondylitis were included in this study. The independent variables considered were age, sex, occupation, duration, and side of affection. The intervention group received autologous blood injection (ABI), whereas the control group received Inj. triamcinolone acetonide 40 mg under musculoskeletal ultrasound guidance. Results and observations: Out of 92 patients recruited, 54 patients were females (58.69%) and 38 were males (41.33%). The intervention group consisted of 26 females and 20 males with a mean age group of 47.20 ± 10.06 years while the control group consisted of 28 females and 18 males with a mean age group of 46.20 ± 8.79 years. There was a significant improvement in the visual analog scale (VAS) and patient-rated tennis elbow evaluation (PRTEE) score in the ABI group compared to the control group in 6 months follow-up. There was also a significant improvement in neovascular, echotexture grading, and tendon size in the ABI group compared to the control group in 6 months follow-up. Conclusion: The study showed that a single injection of ultrasound-guided ABI is significantly more effective in reducing pain and disability in resistant lateral epicondylitis at 6 months as compared to steroid injection. This study also confirmed that there was significant improvement of ultrasound parameters in the ABI group compared to the steroid injection group and may be considered as an alternative to surgery in resistant lateral epicondylitis.
Ultrasound‑guided platelet‑rich plasma infiltration: A stupendous treatment for chronic tendinopathy
Background: Tendinopathy is a common and perplexing problem facing clinicians. It is the most common reason that patients seek medical attention for a musculoskeletal condition and accounts for approximately 30% of patient visits to general practitioners. Although originally considered an inflammatory problem, histopathologic analysis of tendinopathy has revealed evidence that this process is predominantly degenerative and is characterized by hypercellularity, vascular hyperplasia, and collagen disorganization. Since tendinopathy is primarily a degenerative condition, several new treatments have been developed in an attempt to stimulate tissue regeneration. One of these treatments is an injection of platelet‑rich plasma (PRP). Materials and Methods: This is a prospective study conducted in the Department of Orthopaedics on outpatients having tendinopathies. These patients were managed with PRP infiltration at the tendinopathy site. Current proposed sample size in the study is sixty patients between the age of 21 and 65 years. The patients who are clinically diagnosed were given PRP at the tendinopathy after identifying the site under ultrasound guidance. Patients were assessed according to the visual analog scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score pre‑ and post‑injection. Results: Patients in the fourth decade had major preponderance. Male gender was dominant with the problem of tendinopathies. Supraspinatus tendinopathy was most common among all tendinopathies. Comparison of VAS with each follow‑up showed 22.5% decrease in 1 st week and 58.58% relief in 4 th week. After evaluation using DASH score, there was 7.23% improvement in 1 st week, 12.43% in 4 th week, and 57.63% in 24 th week. Conclusion: The current investigation represents clinically based outcome study to evaluate the effectiveness of treating tendinopathy with ultrasonography‑guided PRP injection. There is reduced the risk of infection, better improvement regarding pain, restoration of mobility, and duration of time required for clinical improvement. None of these patients reported with the recurrence of symptoms when followed up after 6 months of treatment.
Trials, 2013
Background: Tendinopathy is a difficult problem to manage and can result in significant patient morbidity. Currently, the clinical use of platelet-rich plasma (PRP) in painful tendons is widespread but its efficacy remains controversial. Methods/Design: This study is a single-center, randomized double-blind controlled trial. Eighty patients will be allocated to have ultrasound (US)-guided needling combined with a leukocyte-depleted (that is, pure) PRP or lidocaine each alternate week for a total of two interventions. Outcome data will be collected before intervention, and at 6 weeks, 3, 6, and 12 months after intervention. Main outcome measure: Changes in pain and activity levels, as assessed by Disabilities of the Arm, Shoulder and Hand (DASH-E, Spanish version) score, at 6 months. We will compare the percentage of patients in each group that achieve a successful treatment defined as a reduction of at least 25% in the DASH-E score. Secondary outcome measures include changes in DASH-E at 3 and 12 months, changes in pain as assessed by the visual analogue scale (VAS) at the 6-week, 3-, 6-, and 12-month follow-up, changes in sonographic features and neovascularity, and percentage of patients in each group with adverse reactions at 3, 6, and 12 months. Discussion: The results of this study will provide insights into the effect of pure PRP in tendon and may contribute to identifying the best protocol for PRP application in tendinopathies.
International Journal of Medical and Biomedical Studies, 2021
Background: To study the platelet rich plasma injection in patients of chronic lateral epicondylitis Methods: This study was carried out prospectively on patients age of 18-70 years of both male and female gender suffering from lateral epicondylitis. Results: In this study we found that before injection almost patients had their VAS score were 8-10. None of the patients has been improved their VAS score to 0 at the 4th week 10.00% patients have been improved their VAS score 0 at the 4th month follow-up. Conclusion: We conclude that PRP injection significantly decrease pain and increased elbow performance at 6 months follow-up Keywords: PRP, Elbow, Modality
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2017
The purpose of this prospective, randomized study was to compare the efficacy of autologous platelet-rich plasma (PRP) injections and arthroscopic lateral release in treating chronic lateral epicondylitis (LE). Patients who had a clinical diagnosis of LE confirmed by ultrasound (US) were included in this study. A total of 101 patients received arthroscopic release (n = 50) or US-guided PRP injections (n = 51). Outcomes were assessed using a visual analog scale for pain, the Patient-Rated Tennis Elbow Evaluation (PRTEE), and a calibrated hand dynamometer for grip strength. Both patient groups experienced significant improvement in all measures. Between-group comparisons showed a significantly higher value in the PRP group only for grip strength at week 8 (P = .0073); all other significant differences were in favor of arthroscopy: overall pain (P = .0021), night pain (P = .0013), and PRTEE score (P = .0013) at week 104 and grip strength at weeks 24, 52, and 104 (all P < .0001). Con...