Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 2 | July – Dec 2019 | Page 2-5 |  Rajendra Didel, Saurabh Kumar

Authors:  Rajendra Didel [1], Saurabh Kumar [2].

[1] Department of Orthopaedics, Govt Medical College, Pali, Rajasthan, India.
[2] Department of Orthopaedics, U.C.M.S & G.T.B Hospital, Delhi, India.

Address of Correspondence
Dr. Saurabh Kumar,
U.C.M.S & G.T.B Hospital, Delhi, India.
E-mail: srbrai@gmail.com

Abstract

Background: Lateral epicondylosis has been found to occur in approximately 2% of general population. It’s etiology and management still remains controversial. Various studies have shown benefits with local injection of autologous blood and polidocanol individually. However, there is paucity of studies comparing the results between these both, hence we envisage to compare the clinical and functional outcomes of local autologous blood versus polidocanol injection for the treatment of lateral epicondylosis of elbow.
Materials and methods: 60 patients (age group- 18 to 60 years)with clinically diagnosed lateral epicondylosis of elbow were enrolled for the study. They were randomized into 2 groups. Group I (n = 30) was treated with autologous blood injection and Group II (n = 30) with polidocanol injection after Nirschl staging. Patients were evaluated clinically at 6& 12 weeks after the injection and were again staged by Nirschl staging on both the visits.
Results: 34 patients successfully completed 12 weeks follow-up and were included in the analysis. It was observed that clinical outcomes in terms of Nirschl score at 6 and 12 weeks was better in Group I as compared to Group II. Statistical comparison between the two groups revealed that mean values of Nirschl score were lower in group I (4.41+1.004 and 3.71+1.532 at 6 weeks and 12 weeks of follow-up respectively) as compared to group II (4.76+1.300 and 4.47+1.281at 6 weeks and 12 weeks follow-up respectively). Down staging of disease symptom was clinically better in group I (16/17) as compared to group II (11/17). However the difference in the mean values of Nirschl score between the groups was not statistically significant (p=0.342).
Conclusion: Although autologous blood injection showed a better clinical improvement as compared to polidocanol injection, the difference was not statistically significant between these both.
Keywords: Lateral epicondylosis, Autologous blood injection, Polidocanol injection

References

1. Nirschl RP, Alvarado GJ. In: Morrey BF, Sanchez-Sotelo J, editors. The Elbow and Its Disorders, 4th ed. Philadelphia: Saunders Elsevier; 2009.
2. Sayegh ET, Strauch R J. Does nonsurgical treatment improve longitudinal outcomes of lateral epicondylitis over no treatment? A metaanalysis. ClinOrthopRelat Res. 2015 Mar;473(3):1093-107.
3. Judson CH, Wolf JM. Lateral epicondylitis: review of injection therapies. OrthopClin North Am. 2013 Oct;44(4):615 23.
4. Chop WM Jr. Tennis elbow. Postgrad Med. 1989 Oct;86(5):301-4, 307-8.
5. Hong QN, Durand MJ, Loisel P. Treatment of lateral epicondylitis: where is the evidence? Joint Bone Spine. 2004 Sep;71(5):369-73.
6. Almekinders LC, Temple JD. Etiology, diagnosis, and treatment of tendonitis:an analysis of the literature. Med Sci Sports Exerc. 1998 Aug;30(8):1183-90.
7. Calfee RP, Patel A, DaSilva MF, Akelman E. Management of lateral epicondylitis: current concepts. J Am AcadOrthop Surg. 2008 Jan;16(1):19- 29.
8. Zeisig E, Fahlström M, Ohberg L, Alfredson H. Pain relief after intratendinousinjections in patients with tennis elbow: results of a randomised study. Br JSports Med. 2008 Apr;42(4):267-71.
9. Jindal N, Gaury Y, Banshiwal RC, Lamoria R, Bachhal V. Comparison of shortterm results of single injection of autologous blood and steroid injection in tennis elbow: a prospective study. J OrthopSurg Res. 2013 Apr 27;8:10.
10. Wolf JM, Ozer K, Scott F, Gordon MJ, Williams AE. Comparison of autologousblood, corticosteroid, and saline injection in the treatment of lateralepicondylitis: a prospective, randomized, controlled multicenter
study. J HandSurg Am. 2011 Aug;36(8):1269-72.
11. Edwards SG, Calandruccio JH. Autologous blood injections for refractorylateral epicondylitis. J Hand Surg Am. 2003 Mar;28(2):272-8.
12. Ozturan KE, Yucel I, Cakici H, Guven M, Sungur I. Autologous blood and corticosteroid injection and extracoporeal shock wave therapy in the treatment oflateral epicondylitis. Orthopedics. 2010 Feb;33(2):84-91.
13. Kazemi M, Azma K, Tavana B, RezaieeMoghaddam F, Panahi A. Autologous bloodversus corticosteroid local injection in the short-term treatment of lateralelbow tendinopathy: a randomized clinical trial of efficacy. Am J Phys
MedRehabil. 2010 Aug;89(8):660-7.
14. Zeisig E, Ohberg L, Alfredson H. Sclerosingpolidocanol injections in chronic painful tennis elbow-promising results in a pilot study. Knee Surg Sports TraumatolArthrosc. 2006 Nov;14(11):1218-24.
15. Connell DA, Ali KE, Ahmad M, Lambert S, Corbett S, Curtis M. Ultrasoundguidedautologous blood injection for tennis elbow. Skeletal Radiol. 2006Jun;35(6):371-7.
16. Gani NU, Butt MF, Dhar SA, et al. Autologous blood injection in the treatment of Refractory Tennis Elbow. The Internet Journal of Orthopaedic Surgery 2007.
17. Creaney L, Wallace A, Curtis M, Connell D. Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med. 2011Sep;45(12):966-71.
18. Raeissadat SA, Sedighipour L, Rayegani SM, Bahrami MH, Bayat M, Rahimi R.Effect of Platelet-Rich Plasma (PRP) versus Autologous Whole Blood on Pain andFunction Improvement in Tennis Elbow: A Randomized Clinical Trial. Pain ResTreat. 2014;2014:191525.

(Abstract    Full Text HTML)      (Download PDF)