DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20170541

Autologous blood injection technique in the treatment of refractory lateral elbow tendinopathy

M. A. Q. Ansari, M. Nayeemuddin, M. M. Farhan

Abstract


Background: Lateral elbow tendinopathy is a very common clinical condition whose management by the consultant often shifts from one to another modality. This study was conducted to know the efficacy of a minimally invasive technique of autologous blood injection in patients who were resistant to more conservative methods.

Methods: This is a randomized prospective study of forty-eight patients (median age, 37 to 40 years), presenting with lateral elbow symptoms for a duration of more than six weeks and failed to respond to other methods of conservative treatment. Patients were consecutively grouped into treatment with autologous blood injections (Group I, n = 24) and control group with injection of normal saline (Group II, n = 24). 1 ml of autologous blood was drawn from dorsal venous arch and injected into the site of maximum tenderness over lateral aspect of the elbow under all aseptic precautions for all patients in group I. Similarly 1 ml of normal saline was injected at the site of maximum tenderness for patients in group II.  Results were evaluated based on severity of the elbow complaints, tenderness and Cozen’s test at the end of follow-up of twenty weeks.

Results: The incidence of this condition was more in the third decade 39.6% (n=19), with female preponderance 58.3% (n=28) and the dominant arm being more commonly involved 58.3% (n=28). Excellent results were found in group I in n=15 (62.5%) whereas poor results were more in group II in n=14 (58.3%). Group I had poor result only in n=03 (12.5%) of patients who later were given another dose of autologous blood or were treated surgically.

Conclusions: Injection of autologous blood is a very efficacious minimally invasive procedure with satisfactory results in patients of lateral elbow tendinopathy who do not respond to other conservative methods of treatment.


Keywords


Autologous blood injection, Lateral elbow tendinopathy, Elbow pain

Full Text:

PDF

References


Major HP. Lawn-tennis elbow. BMJ. 1883;2:557.

Haahr JP, Andersen JH. Physical and psychosocial risk factors for lateral epicondylitis. A population based case-referent study. Occup Environ Med. 2003;60:322-9.

Binder AI, Hazleman BL. Lateral humeral epicondylitis: A study of natural history and the effect of conservative therapy. Br J Rheumatol. 1983;22:73-6.

Haahr JP, Andersen JH. Prognostic factors in lateral epicondylitis: A randomized trial with one-year follow-up in 266 new cases treated with minimal occupational intervention or the usual approach in general practice. Rheumatol (Oxford). 2003;42:1216-25.

Roles NC, Maudsley RH. Radial tunnel syndrome: Resistant tennis elbow as a nerve entrapment. J Bone Joint Surg Br. 1972;54:499-508.

Kelley JD, Lombardo SJ, Pink M, Perry J, Giangarra CE. Electromyographic and cinematographic analysis of elbow function in tennis players with lateral epicondylitis. Am J Sports Med. 1994;22:359-63.

Ljung BO, Alfredson H, Forsgren S. Neurokinin 1-receptors and sensory neuropeptides in tendon insertions at the medial and lateral epicondyles of the humerus: Studies on tennis elbow and medial epicondylalgia. J Orthop Res. 2004;22:321-7.

Nirschl RP, Pettrone FA. Tennis elbow: The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 1979;61:832-9.

Baker CL Jr, Murphy KP, Gottlob CA, Curd DT. Arthroscopic classification and treatment of lateral epicondylitis: Two-year clinical results. J Shoulder Elbow Surg. 2000;9:475-82.

Ruch DS, Papadonikolakis A, Campolattaro RM. The posterolateral plica: A cause of refractory lateral elbow pain. J Shoulder Elbow Surg. 2006;15:367-70.

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;81:259-78.

Mackay D, Rangan A, Hide G, Hughes T, Latimer J. The objective diagnosis of early tennis elbow by magnetic resonance imaging. Occup Med (Lond). 2003;53:309-12.

Nirschl RP, Ashman ES. Elbow tendinopathy: Tennis elbow. Clin Sports Med. 2003;22:813-36.

Martinez-Silvestrini JA, Newcomer KL, Gay RE, Schaefer MP, Kortebein P, Arendt KW. Chronic lateral epicondylitis: Comparative effectiveness of a home exercise program including stretching alone versus stretching supplemented with eccentric or concentric strengthening. J Hand Ther. 2005;18:411-9.

Van De Streek MD, Van Der Schans CP, De Greef MH, Postema K. The effect of a forearm/hand splint compared with an elbow band as a treatment for lateral epicondylitis. Prosthet Orthot Int. 2004;28:183-9.

Hay EM, Paterson SM, Lewis M, Hosie G, Croft P. Pragmatic randomized controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. BMJ. 1999;319:964-8.

LewisM, Hay EM, Paterson SM, Croft P. Local steroid injections for tennis elbow: Does the pain get worse before it gets better? Results from a randomized controlled trial. Clin J Pain. 2005;21:330-4.

Altay T, Günal I, Oztürk H. Local injection treatment for lateral epicondylitis. Clin Orthop Relat Res. 2002;398:127-30.

Verhaar AN, Walenkamp GHIM, Van Mameren H, Kester ADM, Van Der Lind AJ. Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. J Bone Joint Surg (Br). 1996;78:128-32.

Wong MW, Tang YY, Lee SK, Fu BS, Chan BP, Chan CK. Effect of dexamethasone on cultured human tenocytes and its reversibility by platelet derived growth factor. J Bone Joint Surg Am. 2003;85:1914-20.

Smith AG, Kosygan K, Williams H, Newman RJ. Common extensor tendon rupture following corticosteroid injection for lateral tendinosis of the elbow. Br J Sports Med. 1999;33:423-5.

Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg [Am]. 2003;28:272-8.

Wong SM, Hui AC, Tong PY, Poon DW, Yu E, Wong LK. Treatment of lateral epicondylitis with botulinum toxin: A randomized, double-blind, placebo-controlled study. Ann Intern Med. 2005;143:793-7.

Cyriax JH. The pathology and treatment of tennis elbow. J Bone Joint Surg. 1936;18:921-40.

Dunkow PD, Jatti M, Muddu BN. A comparison of open and percutaneous techniques in the surgical treatment of tennis elbow. J Bone Joint Surg Br. 2004;86:701-4.

Dellon AL, Kim J, Ducic I. Painful neuroma of the posterior cutaneous nerve of the forearm after surgery for lateral humeral epicondylitis. J Hand Surg [Am]. 2004;29:387-90.

Shapiro GS, Weiland AJ. Reactive bone formation after surgery for lateral epicondylitis. J Shoulder Elbow Surg. 2002;11:383-5.