Lateral Epicondylitis

Research Article

Austin Phys Med. 2019; 2(1): 1007.

Lateral Epicondylitis

Bernardino S*

Department of Orthopaedic and Trauma Surgery, ASL Bari Institution, Italy

*Corresponding author: Saccomanni Bernardino, Department of Orthopaedic and Trauma Surgery, ASL Bari Institution, Viale Regina Margherita, Altamura (Bari), Italy

Received: October 22, 2019; Accepted: November 20, 2019; Published: November 27, 2019

Abstract

Objectives: 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.

Results and Conclusions: 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. 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. 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.

Keywords: Autologous Blood Injection; Wrist Immobilisation; Lateral Epicondylitis

Key Messages: 1. This study still describes dramatic improvement in the functional ability of patients with chronic degenerative tennis elbow.

2. Chronic degenerative tennis elbow had autologous blood injection wrist immobilisation and a home exercise programme.

3. 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.

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 “healing cascade” of events, in the degenerated tendinous origin of extensor carpi radialis brevis [6]. Two to three milliliters of the patient’s blood is removed from their contralateral arm and then at the same appointment injected into the origin of extensor carpi radialis brevis. The injection is often done using ultrasound visualization, and a one milliliter of lidocaine or marcaine is added to the injection.

Given the physiological theory behind injecting autologous blood into a degenerated tendon, post injection therapy regimes would need to support the initial healing phase thought to occur following injection [6]. Four studies mentioned post injection rest in a wrist support splint or sling; then normal activity was resumed by six weeks after injection. In two studies patients were told to perform only light duties or use modified lifting for up to four weeks after injection. Stretching exercises were named in two studies; apart from these, post injection therapy was not described in detail.

There are eight published studies and one conference abstract of level II and IV evidence, of good to poor quality [7] regarding the efficacy of ABI in reducing pain in patients with tennis elbow. These studies (Summarized in Table 1) varied in the chronicity of patients’ symptoms, number of injections provided, type of assessments, and duration of followup of patients. The aim of this study is to evaluate the effect of ABI, splinting, and occupational therapy for patients with chronic LE, who have not been relieved by cortisone injection.

Citation: Bernardino S. Lateral Epicondylitis. Austin Phys Med. 2019; 2(1): 1007.