Injection of tennis elbow: Hit and miss? A cadaveric study of injection accuracy

Keijsers, Renée; Bekerom, Michel P.J. van den; Koenraadt, Koen L. M.; Bleys, Ronald L. A. W.; Dijk, C. Niek van; Eygendaal, Denise; Collaborative, Elbow Study

doi:10.1007/s00167-016-4212-0

Cited by 19 publications

(11 citation statements)

References 23 publications

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“…We did not use ultrasound for guidance to localize needle placement or for the evaluation of tendon quality postoperatively. This should be noted in light of recent findings by Keijsers et al, 25 who reported that the majority of injections were intra-articular rather than intratendinous. However, with the combined experience of the 2 senior authors (R.W.C., A.L.O.)…”

Section: Discussionmentioning

confidence: 65%

Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques

Gaspar

Motto

Lewis

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance.Purpose:To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction.Results:At a mean follow-up of 40 months, significant improvements in VAS-P (mean, –6.1; 95% CI, –6.8 to –5.5; P < .0001), QuickDASH (mean, –46; 95% CI, –52 to –40; P < .0001), and PRTEE (mean, –57; 95% CI, –64 to –50; P < .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; P < .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group (P = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course.Conclusion:A PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength, and function demonstrated at a mean follow-up of longer than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short term to midterm.

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Section: Discussionmentioning

confidence: 65%

Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques

Gaspar

Motto

Lewis

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…We decided to use the sonography to better assess the soft tissue target and because the manual injection of the ECRB tendon often lacks accuracy with only 30% of reported hit target tissue. 14 For patients belonging to the ESW group, focal ESW were administered by means of an electromagnetic generator equipped with in-line US guidance in order to increase the reliability and effectiveness of the treatment (Minilith SL1, Storz ® , Tagerwilen, Switzerland).…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Autologous US-guided PRP injection versus US-guided focal extracorporeal shock wave therapy for chronic lateral epicondylitis: A minimum of 2-year follow-up retrospective comparative study

Alessio-Mazzola

Repetto

Biti

et al. 2018

J Orthop Surg (Hong Kong)

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“…Injections carried out manually for the treatment of TE are not accurate. 74 For future research on the effect of injection therapy, it is important that injections should be carried out in a reproducible and standardized way.…”

Section: Discussionmentioning

confidence: 99%

Tennis elbow

et al. 2018

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Injection of tennis elbow: Hit and miss? A cadaveric study of injection accuracy

Cited by 19 publications

References 23 publications

Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques

Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques

Autologous US-guided PRP injection versus US-guided focal extracorporeal shock wave therapy for chronic lateral epicondylitis: A minimum of 2-year follow-up retrospective comparative study

Tennis elbow

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