“Injections for tennis elbow: Sometimes they work, sometimes they don’t.”

Written by admin on January 9, 2013 – 8:45 am -

NEW YORK (Reuters Health) Sep 27 – Among the variety of injections that have been tested for lateral epicondylitis – tennis elbow – it remains unclear which ones work and which ones don’t, a new systematic review concludes.

Tennis elbow affects 1% to 3% of the population and peaks between the ages of 45 and 54 years. Injection therapies have included glucocorticoids, platelet-rich plasma (PRP), autologous blood, prolotherapy, hyaluronic acid, botulinum toxin, polidocanol, and glycosaminoglycan polysulfate.

In an effort to determine which injection therapies work best, Dr. Robin Christensen from Copenhagen University Hospital, Frederiksberg, Denmark and colleagues conducted a systematic review of 17 randomized controlled trials that evaluated eight different injection therapies in 1,381 patients.

They considered only two outcomes: change in pain intensity and adverse events (including the number of adverse events leading to withdrawal).

Glucocorticoid, polidocanol, and glycosaminoglycan polysulfate proved to be no better than placebo in relieving pain of tennis elbow, according to the report online September 12 in the American Journal of Sports Medicine.

Botulinum toxin was marginally effective compared with placebo but was associated with significant side effects (transient paresis and weakness). Moreover, all trials of botulinum toxin had high or unclear risk of bias.

Autologous blood, PRP, prolotherapy, and hyaluronic acid were all significantly more effective than placebo, but only prolotherapy was significantly better than placebo after excluding results from trials with high or unclear bias.

Transient pain after injection was common in all the trials, but there were no withdrawals due to adverse events and no serious adverse events.

Overall, only three of the trials (18%) were judged to be low risk of bias.

The researchers conclude, “Our systematic review and network meta-analysis found a paucity of evidence from unbiased trials on which to base treatment recommendations regarding injection therapies for lateral epicondylitis.”

“Further high-quality trials are needed and should have an adequate sample size, valid inclusion criteria, including confirmation of the diagnosis with imaging, and valid and reliable patient-relevant outcome measures,” they add.


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I don’t play tennis, how do I have “tennis elbow”?

Written by admin on January 7, 2013 – 8:52 am -

You don’t have to be Serena Williams or Roger Federer to be diagnosed with “tennis elbow”. You may be surprised to learn that most of my patients with this condition have never played tennis, even once! Tennis elbow, or lateral epicondylitis, is the progressive degeneration of the tendons that attach the forearm muscles to the outside of the elbow.

Originally presumed to be an inflammatory condition, “tendonitis,” it is now well accepted that true tendonitis is only rarely present. The term “tennis elbow” originates in the high prevalence of the malady in tennis players. Players experience pain when grasping the racquet with backhand strokes being most problematic, but any grasping activity, even non-athletic, may be associated with pain. Primarily an overuse injury, racquet sports athletes, as well as painters, carpenters, and mechanics, are prone to developing tennis elbow.

Symptoms of tennis elbow include pain localized on the outside of the elbow, weak grip strength, and pain with specific motions (picking up a gallon of milk, turning a door knob, or holding a cup of coffee).

There are surgical and non surgical treatment options for tennis elbow. Non surgical options include: oral or topical anti-inflammatory medication, braces designed to change the angle of action of the tendon, lessen pressure at its boney insertion and decrease pain, exercises to stretch and strengthen the muscles and steroid injections directly into the tendon. Initially, rest, particularly avoiding those motions that cause the most pain are ideal. Once symptoms subside, stretching and strengthening the elbow will help prevent further damage to the tendon. We have recently enjoyed success with a promising emerging technique, Platelet Rich Plasma (PRP), injections directly into the failing tendon. Surgical treatment is an outpatient procedure in which the surgeon removes the defective tendon. The recovery time from surgery is a few weeks before normal subsistence level activities can be performed painlessly and 10-12 weeks before sport and weight activities can be resumed.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com or you can follow him on twitter: @drmarkgalland.

Kate Anderson, ATC/LAT is a post-graduate fellow at GOSM, Galland Orthopaedic and Sports Medicine. Follow her on twitter @kattethegreatt.


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