The Efficacy of Platelet Rich Plasma Combined with Steroid Injection in the Treatment of Resistant Lateral Epicondylitis

Yıl 2014, , 26 - 31, 01.12.2014

Erdem Aktaş Barış Yılmaz Baybars Ataoğlu Murat Arıkan Güray Toğral Murat İlikmen

https://doi.org/10.5505/aot.2014.18480

Öz

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.

Anahtar Kelimeler

Platelet Rich Plasma, Lateral Epicondylitis. Hand Grip Strenght

Dirençli Lateral Epikondilit Tedavisinde Trombositten Zengin Plazma ile Kombine Steroid Enjeksiyonunun Etkinliği

Öz

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.

Anahtar Kelimeler

Trombositten Zengin Plazma, Lateral Epikondilit, El Kavrama Gücü

Kaynakça

• 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