Effectiveness of ultrasound guided platelet rich plasma injection in comparison with extracorporeal shock wave therapy on improving pain and function in medial epicondylitis of elbow: a randomized controlled trial
DOI:
https://doi.org/10.18203/2349-3933.ijam20241625Keywords:
Medial epicondylitis, Platelet rich plasma, Extracorporeal shock wave therapy, Ultrasound guided, VAS, MEPSAbstract
Background: Effectiveness of ultrasound guided Platelet Rich Plasma injection in comparison with extracorporeal shock wave therapy on improving pain and function in medial epicondylitis of elbow: A randomized controlled trial Objective was to determine the effectiveness of ultrasound guided Platelet Rich Plasma injection in comparison with extracorporeal shock wave therapy on improving pain and function in medial epicondylitis of elbow.
Methods: Randomized controlled trial was conducted on fifty-four patients with medial epicondylitis of elbow attending Sports Medicine OPD at RIMS, hospital, Imphal, were selected for this study and randomized into 2 treatment groups: platelet rich plasma injection and extracorporeal shock wave therapy. The outcome measures were visual analog scale and Mayo elbow performance score. For descriptive statistics mean, standard deviation and frequency were used. Students t-test and Chi square tests were used for analysis of different variables. A p-value <0.05 was taken as significant.
Results: The baseline characteristics of the patients in the control and intervention group were not statistically significant. At the end of 12 weeks and 24 weeks, there was statistically significant improvement in both mean difference of VAS (p=0.04) (p=0.03) and MEPS (p=0.00) (p=0.03) from baseline in both the groups but this improvement was significantly more in the PRP group.
Conclusions: Platelet rich plasma injection is superior to extracorporeal shock wave therapy on improving pain and function in medial epicondylitis at the end of 6 months.
References
Leach RE, Miller JK. Lateral and medial epicondylitis of the elbow. Clin Sports Med. 1987;6(2):259-72.
McCarroll JR, Rettig AC, Shelbourne KD. Injuries in the Amateur Golfer. Phys Sportsmed. 1990;18(3):122-6.
Ollivierre CO, Nirschl RP, Pettrone FA. Resection and repair for medial tennis elbow. A prospective analysis. Am J Sports Med. 1995;23(2):214-21.
Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am. 1999;81(2):259-78.
Donaldson O, Vannet N, Gosens T, Kulkarni R. Tendinopathies Around the Elbow Part 2: Medial Elbow, Distal Biceps and Triceps Tendinopathies. Shoulder Elbow. 2014;6(1):47-56.
Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. J Am Acad Orthop Surg. 2015;23(6):348-55.
Batt ME. Golfing injuries. An overview. Sports Med. 1993;16(1):64-71.
Ciccotti MC, Schwartz MA, Ciccotti MG. Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med. 2004;23(4):693-705.
Pitzer ME, Seidenberg PH, Bader DA. Elbow tendinopathy. Med Clin North Am. 2014;98(4):833-49.
Taylor SA, Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health. 2012;4(5):384-93.
Kane SF, Lynch JH, Taylor JC. Evaluation of elbow pain in adults. Am Fam Physician. 2014;89(8):649-57.
Gabel GT, Morrey BF. Operative treatment of medical epicondylitis. Influence of concomitant ulnar neuropathy at the elbow. J Bone Joint Surg Am. 1995;77(7):1065-9.
Kijowski R, De Smet AA. Magnetic resonance imaging findings in patients with medial epicondylitis. Skeletal Radiol. 2005;34(4):196-202.
Park GY, Lee SM, Lee MY. Diagnostic value of ultrasonography for clinical medial epicondylitis. Arch Phys Med Rehabil. 2008;89(4):738-42.
Stahl S, Kaufman T. The efficacy of an injection of steroids for medial epicondylitis. A prospective study of sixty elbows. J Bone Joint Surg Am. 1997;79(11):1648-52.
Rompe JD, Hopf C, Kullmer K. Analgesic effects of extracorporeal shock-wave therapy on chronic tennis elbow. J Bone Joint Surg Br. 1996;78(2):233-7.
Trentini R, Mangano TI, Repetto I. Short- to midterm follow-up effectiveness of US-guided focal extracorporeal shock wave therapy in the treatment of elbow lateral epicondylitis. Musculoskelet Surg. 2015;99(1):S91-7.
Wang CJ and Chen HS. Shock wave therapy for patients with lateral epicondylitis of the elbow: a one- to two-year followup study. Am J Sports Med. 2002;30(3):422-5.
Gerdesmeyer L, Mittermayr R, Fuerst M, Al Muderis M, Thiele R, Saxena A, et al. Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy. Int J Surg. 2015;24(Pt B):154-9.
Trams E, Kulinski K, Kaminska KK, Pomianowski S, Kaminski R. The clinical use of platelet-rich plasma in knee disorder and surgery- a systemic review and meta-analysis. Life. 2020;10(94):1-41.
Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet‑rich plasma: From basic science to clinical applications. Am J Sports Med. 2009;37:2259‑72.
Hay EM, Paterson SM, Lewis M, et al. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment oflateral epicondylitis ofelbow in primary care. Br Med J. 1999;319(7215):964-8.
Gautam VK, Verma S, Batra S. Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. J Orthop Surg. 2015;23(1):1-5.
Smidt N, van der Windt DA, Assendelft WJ. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002;359:657-62.
Struijs PA, Smidt N, Arola H, van Dijk CN, Buchbinder R, Assendelft WJ. Orthotic devices for the treatment of tennis elbow. Cochrane Database Syst Rev. 2001;1:CD001821
Smidt N, van der Windt DA, Assendelft WJ, Deville WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002;359:657-62.
Buchbinder R, Green S, Bell S, Barnsley L, Smidt N, Assendelft WJ. Surgery for lateral elbow pain. Cochrane Database Syst Rev. 2002;3:CD003525.
Lee SS, Kang S, Park NK, Lee CW, Song HS, Sohn MK, et al. Effectiveness of initial extracorporeal shock wave therapy on the newly diagnosed lateral or medial epicondylitis. Ann Rehabil Med. 2012;36(5):681-7.
Grala P, Dadej R. Extacorporeal shock wave therapy unsuccessful for chronic medial epicondylitis. J Orthop Traumatol. 2007;8(4):195-8.
Hume PA, Reid D, Edwards T. Epicondylar injury in sport. Epidemiology, type, mechanisms, assessment, management and prevention. Sports Med. 2006;36(2):151-70.
Haake M, Hunerkopf M, Gerdesmeyer L, Konig IR. Extracorporeal shockwave therapy (ESWT) in epicondylitis humeri radialis. Areview of the literature. Orthopade. 2002;31(7):623-32.
Kamoda H, Ohtori S, Ishikawa T, Miyagi M, Arai G, Suzuki M, et al. The effect of platelet‑rich plasma on posterolateral lumbar fusion in a rat model. J Bone Joint Surg Am. 2013;95:1109‑16.
Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet‑rich plasma. Am J Sports Med. 2006;34:1774‑8.
Varshney A, Maheshwari R, Juyal A, Agrawal A, Hayer P. Autologous Platelet-rich Plasma versus Corticosteroid in the Management of Elbow Epicondylitis: A Randomized Study. Int J Appl Basic Med Res. 2017;7(2):125-8.
Peerbooms JC, Sluimer J, Bruijn DJ. Positive effects of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year followup. Am J Sports Med. 2010;38:255-62.