Comparison of corticosteroid, autologous blood or sclerosant injections for chronic tennis elbow

Branson, R., Naidu, K., du Toit, C., Rotstein, A. H., Kiss, R., McMillan, D., Fooks, L., Coombes, B. K. and Vicenzino, B. (2017) Comparison of corticosteroid, autologous blood or sclerosant injections for chronic tennis elbow. Journal of Science and Medicine in Sport, 20 6: 528-533. doi:10.1016/j.jsams.2016.10.010

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Author Branson, R.
Naidu, K.
du Toit, C.
Rotstein, A. H.
Kiss, R.
McMillan, D.
Fooks, L.
Coombes, B. K.
Vicenzino, B.
Title Comparison of corticosteroid, autologous blood or sclerosant injections for chronic tennis elbow
Journal name Journal of Science and Medicine in Sport   Check publisher's open access policy
ISSN 1878-1861
1440-2440
Publication date 2017-06-01
Year available 2017
Sub-type Article (original research)
DOI 10.1016/j.jsams.2016.10.010
Open Access Status File (Author Post-print)
Volume 20
Issue 6
Start page 528
End page 533
Total pages 6
Place of publication Chatswood, NSW, Australia
Publisher Elsevier Australia
Language eng
Subject 2732 Orthopedics and Sports Medicine
3612 Physical Therapy, Sports Therapy and Rehabilitation
Abstract Objectives To compare three different ultrasound-guided injections for chronic tennis elbow. Design Assessor-blinded, randomized controlled comparative trial. Methods 44 patients with clinically diagnosed tennis elbow, confirmed by Doppler ultrasound, received under ultrasound guidance, a single corticosteroid injection (n = 14), or two injections (separated by 4 weeks) of either autologous blood (n = 14) or polidocanol (n = 16). Clinical and ultrasound examination was performed at baseline, 4, 12 and 26 weeks. Results Complete recovery or much improvement was greater for corticosteroid injection than autologous blood and polidocanol at 4 weeks (p < 0.001, number needed to treat 1 (95% CI 1–2)). In contrast, at 26 weeks corticosteroid was significantly worse than polidocanol (p = 0.004, number needed to harm 2 (1–6)). Recurrence after corticosteroid injection was significantly higher than autologous blood or polidocanol (p = 0.007, number needed to harm 2 (1–4)). Corticosteroid injection produced greater reduction in tendon thickness and vascularity than autologous blood at 4 weeks only. Compared to autologous blood, polidocanol reduced tendon thickness at 4 and 12 weeks and reduced echogenicity and hyperaemia after 12 or 26 weeks respectively. Conclusions Injections of corticosteroid cannot be recommended over polidocanol or autologous blood, because despite beneficial short-term effect there were inferior long-term effects. Whether polidocanol or autologous blood injections are effective is unknown, especially as their global effect profiles are not unlike previously reported for wait-and-see.
Formatted abstract
Objectives: To compare three different ultrasound-guided injections for chronic tennis elbow.

Design: Assessor-blinded, randomized controlled comparative trial.

Methods: 44 patients with clinically diagnosed tennis elbow, confirmed by Doppler ultrasound, received under ultrasound guidance, a single corticosteroid injection (n = 14), or two injections (separated by 4 weeks) of either autologous blood (n = 14) or polidocanol (n = 16). Clinical and ultrasound examination was performed at baseline, 4, 12 and 26 weeks.

Results: Complete recovery or much improvement was greater for corticosteroid injection than autologous blood and polidocanol at 4 weeks (p < 0.001, number needed to treat 1 (95% CI 1–2)). In contrast, at 26 weeks corticosteroid was significantly worse than polidocanol (p = 0.004, number needed to harm 2 (1–6)). Recurrence after corticosteroid injection was significantly higher than autologous blood or polidocanol (p = 0.007, number needed to harm 2 (1–4)). Corticosteroid injection produced greater reduction in tendon thickness and vascularity than autologous blood at 4 weeks only. Compared to autologous blood, polidocanol reduced tendon thickness at 4 and 12 weeks and reduced echogenicity and hyperaemia after 12 or 26 weeks respectively.

Conclusions: Injections of corticosteroid cannot be recommended over polidocanol or autologous blood, because despite beneficial short-term effect there were inferior long-term effects. Whether polidocanol or autologous blood injections are effective is unknown, especially as their global effect profiles are not unlike previously reported for wait-and-see.
Keyword Blood products
Colour Doppler
Lateral epicondylalgia
Polidocanol
Ultrasonography
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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