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J Sci Med Sport. 2017 Jun;20(6):528-533. doi: 10.1016/j.jsams.2016.10.010. Epub 2016 Oct 29.

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

Author information

1
Olympic Park Sports Medicine Centre, Australia.
2
Victoria House Medical Imaging, MIA Radiology, Australia.
3
University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Australia; School of Biomedical Sciences, University of Queensland, Australia.
4
School of Biomedical Sciences, University of Queensland, Australia. Electronic address: b.vicenzino@uq.edu.au.

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.

KEYWORDS:

Blood products; Colour Doppler; Lateral epicondylalgia; Polidocanol; Ultrasonography

PMID:
28089102
DOI:
10.1016/j.jsams.2016.10.010
[Indexed for MEDLINE]

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