Assessing the effectiveness of PRP infiltration Vs Triamcinolone injection for management of lateral epicondylitis

Vol 32| Issue 2 | July – Dec 2019 | page: 26-30 | Raphael Thomas, M Raffic, Anoop S


Authors: Raphael Thomas [1], M Raffic [1], Anoop S [1]

[1] Department of Orthopaedics, Sree Gokulam Medical College, Venjaramoodu, Trivandrum, Kerala, India.

Address of Correspondence

Dr. Anoop S,
Sree Gokulam Medical College, Venjaramoodu, Trivandrum, Kerala, India.
E-mail: anoopsuresh88@gmail.com


Abstract

Background: A common problem in the population today with a prevalence of 1%–3% is pain over the lateral aspect of elbow. A comparative study was done to assess the effectiveness of single infiltration of platelet-rich plasma (PRP) to a single injection of triamcinolone and a normal saline placebo injection for the management of Lateral Epicondyle pain of Humerus over a 6 month duration.
Materials and Methods: Visual analog scale (VAS) was used to evaluate the effectiveness of the different treatment modalities and a comparative study was done over a period of 6 months with 2nd, 4th month and 6th month followup following treatment. Out of 58 patients in the study, 27 were Females and 31 were Males. Patients included in the survey were between 20 and 40 years and belonged to either sex and had their complaints for over 3-month duration. Patients with elbow pain aetiology due to other problems or those who had previous treatment with any form of injection were excluded from the study. 1ml of 2% Xylocaine was injected before injecting the treatment modality formulation decided under trial. Pain scoring was done using VAS and FPS. Statistical analysis was done using Fisher’s exact test at 12 and 24 weeks.
Results: 29 elbows were included in each group with 27 females and 31 males. At 2nd and 4th months, patients in both the PRP and triamcinolone groups had pain relief (P < 0.05). At the 6th month follow-up, statistically significant results of better pain relief was found with the PRP group when compared to the triamcinolone group. In triamcinolone group 13 patients had injection site hypopigmentation and 3 patients had subdermal atrophy.
Conclusion: After following up the patient it was seen that PRP gives better pain relief when compared to injection of triamcinolone as treatment of tennis elbow and there is also need for long term studies to asses the duration of symptom relief and to confirm the findings from our study.
Keywords: PRP, Platelet Rich Plasma, Infiltration, Triamcinolone, Steroid, Saline, Placebo, Lateral Epicondylitis, Tennis Elbow.


References

1. Allander E. Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes. Scand J Rheumatol 1974;3:145-53.
2. Chard MD, Hazleman BL. Tennis elbow – A reappraisal. Br J Rheumatol 1989;28:186-90.
3. Major HP. Lawn tennis elbow. BMJ 1883;2:557.
4. Kraushaar B, Nirschl R. Tendinosis of the elbow (tennis elbow): Clinical features and findings of histological, immunohistochemical and electron microscopic studies. JBJS 1999;81A: 259.
5. Nirschl RP, Pettrone F. Tennis elbow: The surgical treatment of lateral epicondylitis. JBJS 1979;61A: 832.
6. Brummel J, Baker CL 3rd, Hopkins R, Baker CL Jr. Epicondylitis: Lateral. Sports Med Arthrosc 2014;22:e1-6.
7. Nirschl RP, Ashman ES. Elbow tendinopathy: Tennis elbow. Clin Sports Med 2003;22:813-36.
8. Walz DM, Newman JS, Konin GP, Ross G. Epicondylitis: Pathogenesis, imaging, and treatment. Radiographics 2010;30:167-84.
9. Saccomanni B. Corticosteroid injection for tennis elbow or lateral epicondylitis: A review of the literature. Curr Rev Musculoskelet Med 2010;3:38-40.
10. Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg Am 2003;28:272-8.
11. Chung B, Wiley JP. Effectiveness of extracorporeal shock wave therapy in the treatment of previously untreated lateral epicondylitis: A randomized controlled trial. Am J Sports Med 2004;32:1660-7.
12. Galvin R, Callaghan C, Chan WS, Dimitrov BD, Fahey T. Injection of botulinum toxin for treatment of chronic lateral epicondylitis: Systematic review and meta-analysis. Semin Arthritis Rheum 2011;40:585-7.
13. Tosun HB, Gumustas S, Agir I, Uludag A, Serbest S, Pepele D, et al. Comparison of the effects of sodium hyaluronate- chondroitin sulphate and corticosteroid in the treatment of lateral epicondylitis: A prospective randomized trial. J Orthop Sci 2015;20:837-43.
14. Lubkowska A, Dolegowska B, Banfi G. Growth factor content in PRP and their applicability in medicine. J Biol Regul Homeost Agents 2012;26 2 Suppl 1:3S-22S.
15. Ahmad Z, Brooks R, Kang SN, Weaver H, Nunney I, Tytherleigh-Strong G, et al. The effect of platelet-rich plasma on clinical outcomes in lateral epicondylitis. Arthroscopy 2013;29:1851-62.
16. Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: A randomized, double-blind, placebo-controlled trial. Am J Sports Med 2013;41:625-35.
17. Brkljac M, Kumar S, Kalloo D, Hirehal K. The effect of platelet-rich plasma injection on lateral epicondylitis following failed conservative management. J Orthop 2015;12 Suppl 2:S166-70. 21.
18. Raeissadat SA, Rayegani SM, Hassanabadi H, Rahimi R, Sedighipour L, Rostami K. Is Platelet-rich plasma superior to whole blood in the management of chronic tennis elbow: One year randomized clinical trial. BMC Sports Sci Med Rehabil 2014;6:12.
19. Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: Platelet-rich plasma versus corticosteroid injection with a 1-year followup. Am J Sports Med 2010;38:255-62.
20. Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: A double-blind randomized controlled trial with 2-year followup. Am J Sports Med 2011;39:1200-8.
21. Arirachakaran A, Sukthuayat A, Sisayanarane T, Laoratanavoraphong S, Kanchanatawan W, Kongtharvonskul J. Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: Systematic review and network meta-analysis. J Orthop Traumatol 2016;17:101-12.
22. Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med 2006;34:1774-8.
23. Gautam VK, Verma S, Batra S, Bhatnagar N, Arora S. Platelet- rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: Clinical and ultrasonographic evaluation. J Orthop Surg (Hong Kong) 2015;23:1-5.
24. Park SK, Choi YS, Kim HJ. Hypopigmentation and subcutaneous fat, muscle atrophy after local corticosteroid injection. Korean J Anesthesiol 2013;65 6 Suppl: S59-61.


How to Cite this Article: Thomas R, Raffic M, Anoop S | Assessing the effectiveness of PRP infiltration Vs Triamcinolone injection for management of lateral epicondylitis | Kerala Journal of Orthopaedics | July – Dec 2019; 32(2): 26-30.

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