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

• Published in: Journal of science and medicine in sport Vol. 20; no. 6; pp. 528 - 533
• Main Authors: Branson, R, Naidu, K, du Toit, C, Rotstein, A.H, Kiss, R, McMillan, D, Fooks, L, Coombes, B.K, Vicenzino, B
• Format: Journal Article
• Language: English
• Published: Australia Elsevier Ltd 01.06.2017; Elsevier Limited
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Anti-Inflammatory Agents - therapeutic use; Blood products; Blood Transfusion, Autologous; Clinical trials; Colour Doppler; Elbow; Female; Follow-Up Studies; Growth factors; Humans; Injections; Lateral epicondylalgia; Male; Middle Aged; Pain; Patients; Physical Medicine and Rehabilitation; Polidocanol; Polyethylene Glycols - therapeutic use; Rheumatoid arthritis; Sclerosing Solutions - therapeutic use; Single-Blind Method; Sports Medicine; Studies; Tennis Elbow - diagnostic imaging; Tennis Elbow - therapy; Treatment Outcome; Ultrasonography; Ultrasonography, Doppler, Color; Ultrasonography, Interventional; Melbourne Victoria Australia; blood products; Lateral epicondylalgia; polidocanol; ultrasonography; colour doppler; Polidocanol; Blood products; Colour Doppler; Ultrasonography
• ISSN: 1440-2440; 1878-1861
• DOI: 10.1016/j.jsams.2016.10.010

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 4weeks) of either autologous blood (n = 14) or polidocanol (n = 16). Clinical and ultrasound examination was performed at baseline, 4,12 and 26weeks. Results Complete recovery or much improvement was greater for corticosteroid injection than autologous blood and polidocanol at 4weeks (p < 0.001, number needed to treat 1 (95% CI 1 to 2). In contrast, at 26weeks corticosteroid was significantly worse than polidocanol (p = 0.004, number needed to harm 2 (1 to 6). Recurrence after corticosteroid injection was significantly higher than autologous blood or polidocanol (p = 0.007, number needed to harm 2 (1 to 4). Corticosteroid injection produced greater reduction in tendon thickness and vascularity than autologous blood at 4weeks only. Compared to autologous blood, polidocanol reduced tendon thickness at 4 and 12weeks and reduced echogenicity and hyperaemia after 12 or 26weeks 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.