The Efficacy of Platelet Rich Plasma Combined with Steroid Injection in the Treatment of Resistant Lateral Epicondylitis
Abstract
OBJECTIVE: To evaluate the impact of autologous platelet rich plasma (PRP) combined with steroid injection on hand grip strenght, pain and patient satisfaction in the treatment of lateral epicondylitis.METHODS: 84 patients, mean age 42.6 (23-62) years, diagnosed with unilateral resistant lateral epicondylitis was evaluated retrospectively. Group1 consisted of patients treated with local steroid injection (0,5ml Bethametasone+0.25 ml Prilokain) and PRP within 1 week interval to extensor carpi radialis brevis origo while group 2 consisted of patients who were subjected to single dose local PRP injection to the same localisation. Pretreatment and posttreatment 15-30-60 day hand grip strenght and Verhaar functional score data were evaluated.RESULTS: Mean pretreatment grip strenght of group1 patients were 0.42±0.17 (0.18-0.61) bar whereas posttreatment day 60 increased to 0.68±0.11(0.50-0.85). Group 2 mean pretreatment grip strenght was found to be 0.45±0.15 (0.19-0.84) bar, whereas posttreatment day 60 increased to 0.66±0.10 (0.44-082). Compared to group 2, the percentage of grip strenght increase in group 1 was significantly higher at days 15 and 30, whereas there was no difference at day 60 between groups. (p=0.277). Compared to group 2, Verhaar scores were found to be higher in group1 at days 15 and 30, whereas there was no difference between groups at day 60.CONCLUSION: Compared to PRP alone, steroid injection 1 week prior PRP administration can be preferred as an effective and safe method in cases which early maintanance of decreased grip strenght is mandatory.
References
- Barrington J, Hage W. Lateral epicondylitis (tenis elbow): treatment?. Curr Opin Orthop 2003;14:291-5 open, or arthroscopic
- Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med 1992;11:851-70
- Chard MD. The Elbow. In Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, editors. Rheumatology. 3rd ed. Mosby, London; 2003. p. 631-9
- Coonrad RW, Hooper WR. Tennis elbow: its course, natural management. J Bone Joint Surg Am 1973;55:1177-82 and surgical
- Keus SHJ, Smidt N, Assendelft WJJ. Treatment of lateral epicondylitis in general practice: result of a survey. Eur Gen Pract 2002;8:71-2
- Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of an autologous trombosit concentrate in lateral epicondylitis in a double-blind randomized controlled trial: trombosit-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med 2010;38:255-62
- Labelle H, Guibert R, Joncas J, Newman N, Fallaha M, Rivard CH. Lack of scientific evidence for the treatment of lateral epikondylitis of the elbow. An atempted meta-analysis. J Bone Joint Surg Br 1992;74:646-51
- Verhaar JA, Walenkamp GH, van Mameren H, et al. Local corticosteroid injected versus Cyriax-type physiotherapy for tenis elbow. J Bone Joint Surg Br 1996;7:128-32
- Akpınar S, Hersekli MA, Demirors H, Tandoğan RN. Lateral epikondilitte artroskopik gevsetme (olgu sunumu). 2001;12:87-90 Artroskopik Cerrahi
- Nirschl RP. Elbow tendinosis/tenis elbow. Clin Sport Med 1992;11:851-70
- Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tenis elbow):Clinical features and findings of histological immunohistochemical and electron microscopy studies. J Bone Joint Surg 1999;81:259- 79
- Schneeberger AG, Masquelet AC. Arterial vascularization of the proximal axtensor carpi radialis brevis tendon. Clin Orthop 2002;398;239-44
- Smidt N, van der Windt DA, Assendelf WJ, et al. Corticosteroid injections, physiotherapy, or a widt- and-see policy for lateral epicondylitis: a randomized controlled trial. Lancet 2002;359:657-62
- Altay T, Gunal I, Ozturk H. Local injection treatment for lateral epicondylitis. Clin Orthop 2002;398:127- 30
- Belhan O, Karakurt L. Humerus lateral epikondilit tedavisinde lokal steroid enjeksiyonu ile lateral epikondilit bandajının etkinliğinin karşılaştırılması. Fırat Tıp Dergisi 2008;13:24-7
- Walther M, Kirschner S, Koenig A, et al. Biomechanical evaluation of braces used for treatment of epicondylitis. J Shoulder Elbow Surg 2002;11:265-70
- Boyer MI, Hastings II H. Lateral tenis elbow: “Is there any science out there?”. J Shoulder Elbow Surg 1991;8:481-91
- Solveborn SA, Buch F, Mallmin H, et al. Cortisone injection with anesthetic additives for radial epicondylalgia 1995;316:99-105 elbow). Clin Orthop
- Verhaar JAN, Walenkamp GHIM, van Mameren H, Kester corticosteroid physiotherapy for tenis elbow. J Bone Joint Surg 1996;78B:128-32 Lindan versus cyriaxtype
Dirençli Lateral Epikondilit Tedavisinde Trombositten Zengin Plazma ile Kombine Steroid Enjeksiyonunun Etkinliği
Abstract
AMAÇ: Lateral epikondilit tedavisinde, otolog trombositten zengin plazma (TZP) ile kombine steroid enjeksiyonu yapılan hastalarda el kavrama gücü, ağrı ve hasta memnuniyeti sonuçlarının değerlendirilmesi.YÖNTEMLER: Unilateral dirençli lateral epikondilit tanısı alan, ortalama yaşı 42.6 (23-62), 26 erkek, 58 kadın toplam 84 hastaya uygulanan 2 farklı tedavi yöntemi retrospektif olarak incelendi. Extensor carpi radialis brevis origosuna 1 hafta ara ile lokal steroid (0,5ml Bethametasone+0.25 ml Prilokain) ve TZP uygulanan hastalar grup 1'e dahil edilirken, grup 2'ye aynı lokalizsayona sadece TZP enjeksiyonu uygulanan hastalar dahil edildi. Hastaların tedavi öncesi ve sonrası 15-30 ve 60. günde kaydedilen el kavrama güçleri ve Verhaar fonksiyonel skorları değerlendirildi.BULGULAR: Grup 1'deki hastaların kavrama gücü tedavi öncesi ortalama 0.42±0.17 (0.18-0.63) bar iken, tedavi sonrası 60. günde ortalama 0.68±0.11(0.38-0.84), grup 2'de kavrama gücü tedavi öncesi ortalama 0.45±0.15 (0.19-0.67) iken tedavi sonrası 0.66±0.10 (0.44-082) bar ölçüldü. Grup 1 el kavrama gücünda artış yüzdesi 15 ve 30. günlerde grup 2'ye oranla anlamlı olarak yüksek bulunurken 60. günde 2 grup arasında anlamlı fark bulunmadı (p=0.277).Verhaar skoru, grup 1'de grup 2'ye oranla 15 ve 30. günlerde anlamlı olarak yüksek iken 60. günde fark bulunamadı.SONUÇ: Tek başına TZP uygulamasına göre, steroid enjeksiyonunu takiben yapılan TZP, azalan el kavrama gücünün erken dönemde geri kazanılması gerekli olan vakalarda güvenli ve etkili bir yöntem olarak tercih edilebilir.
References
- Barrington J, Hage W. Lateral epicondylitis (tenis elbow): treatment?. Curr Opin Orthop 2003;14:291-5 open, or arthroscopic
- Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med 1992;11:851-70
- Chard MD. The Elbow. In Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, editors. Rheumatology. 3rd ed. Mosby, London; 2003. p. 631-9
- Coonrad RW, Hooper WR. Tennis elbow: its course, natural management. J Bone Joint Surg Am 1973;55:1177-82 and surgical
- Keus SHJ, Smidt N, Assendelft WJJ. Treatment of lateral epicondylitis in general practice: result of a survey. Eur Gen Pract 2002;8:71-2
- Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of an autologous trombosit concentrate in lateral epicondylitis in a double-blind randomized controlled trial: trombosit-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med 2010;38:255-62
- Labelle H, Guibert R, Joncas J, Newman N, Fallaha M, Rivard CH. Lack of scientific evidence for the treatment of lateral epikondylitis of the elbow. An atempted meta-analysis. J Bone Joint Surg Br 1992;74:646-51
- Verhaar JA, Walenkamp GH, van Mameren H, et al. Local corticosteroid injected versus Cyriax-type physiotherapy for tenis elbow. J Bone Joint Surg Br 1996;7:128-32
- Akpınar S, Hersekli MA, Demirors H, Tandoğan RN. Lateral epikondilitte artroskopik gevsetme (olgu sunumu). 2001;12:87-90 Artroskopik Cerrahi
- Nirschl RP. Elbow tendinosis/tenis elbow. Clin Sport Med 1992;11:851-70
- Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tenis elbow):Clinical features and findings of histological immunohistochemical and electron microscopy studies. J Bone Joint Surg 1999;81:259- 79
- Schneeberger AG, Masquelet AC. Arterial vascularization of the proximal axtensor carpi radialis brevis tendon. Clin Orthop 2002;398;239-44
- Smidt N, van der Windt DA, Assendelf WJ, et al. Corticosteroid injections, physiotherapy, or a widt- and-see policy for lateral epicondylitis: a randomized controlled trial. Lancet 2002;359:657-62
- Altay T, Gunal I, Ozturk H. Local injection treatment for lateral epicondylitis. Clin Orthop 2002;398:127- 30
- Belhan O, Karakurt L. Humerus lateral epikondilit tedavisinde lokal steroid enjeksiyonu ile lateral epikondilit bandajının etkinliğinin karşılaştırılması. Fırat Tıp Dergisi 2008;13:24-7
- Walther M, Kirschner S, Koenig A, et al. Biomechanical evaluation of braces used for treatment of epicondylitis. J Shoulder Elbow Surg 2002;11:265-70
- Boyer MI, Hastings II H. Lateral tenis elbow: “Is there any science out there?”. J Shoulder Elbow Surg 1991;8:481-91
- Solveborn SA, Buch F, Mallmin H, et al. Cortisone injection with anesthetic additives for radial epicondylalgia 1995;316:99-105 elbow). Clin Orthop
- Verhaar JAN, Walenkamp GHIM, van Mameren H, Kester corticosteroid physiotherapy for tenis elbow. J Bone Joint Surg 1996;78B:128-32 Lindan versus cyriaxtype
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Articles |
| Authors | |
| Publication Date | December 1, 2014 |
| Published in Issue | Year 2014 |