Lateral epicondylitis: New trends and challenges in treatment

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Abstract

Lateral epicondylitis (LE) is a chronic aseptic inflammatory condition caused by repetitive microtrauma and excessive overload of the extensor carpi radialis brevis muscle. This is the most common cause of musculoskeletal pain syndrome in the elbow, inducing significant pain and limitation of the function of the upper limb. It affects approximately 1-3% of the population and is frequently seen in racquet sports and sports associated with functional overload of the elbow, such as tennis, squash, gymnastics, acrobatics, fitness, and weight lifting. Typewriters, artists, musicians, electricians, mechanics, and other professions requiring frequent repetitive movements in the elbow and wrists are also affected. LE is a leading causation for absence from work and lower sport results in athletes. The treatment includes a variety of conservative measures, but if those fail, surgery is indicated. This review summarizes the knowledge about this disease, focusing on risk factors, expected course, prognosis, and conservative and surgical treatment approaches.

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Treatment of chronic elbow tendinosis with buffered platelet-rich plasma.

Allan Mishra, Terri Pavelko (2006)

Elbow epicondylar tendinosis is a common problem that usually resolves with nonoperative treatments. When these measures fail, however, patients are interested in an alternative to surgical intervention. Treatment of chronic severe elbow tendinosis with buffered platelet-rich plasma will reduce pain and increase function in patients considering surgery for their problem. Cohort study; Level of evidence, 2. One hundred forty patients with elbow epicondylar pain were evaluated in this study. All these patients were initially given a standardized physical therapy protocol and a variety of other nonoperative treatments. Twenty of these patients had significant persistent pain for a mean of 15 months (mean, 82 of 100; range, 60-100 of 100 on a visual analog pain scale), despite these interventions. All patients were considering surgery. This cohort of patients who had failed nonoperative treatment was then given either a single percutaneous injection of platelet-rich plasma (active group, n = 15) or bupivacaine (control group, n = 5). Eight weeks after the treatment, the platelet-rich plasma patients noted 60% improvement in their visual analog pain scores versus 16% improvement in control patients (P =.001). Sixty percent (3 of 5) of the control subjects withdrew or sought other treatments after the 8-week period, preventing further direct analysis. Therefore, only the patients treated with platelet-rich plasma were available for continued evaluation. At 6 months, the patients treated with platelet-rich plasma noted 81% improvement in their visual analog pain scores (P =.0001). At final follow-up (mean, 25.6 months; range, 12-38 months), the platelet-rich plasma patients reported 93% reduction in pain compared with before the treatment (P <.0001). Treatment of patients with chronic elbow tendinosis with buffered platelet-rich plasma reduced pain significantly in this pilot investigation. Further evaluation of this novel treatment is warranted. Finally, platelet-rich plasma should be considered before surgical intervention.

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Tennis elbow. The surgical treatment of lateral epicondylitis.

R P Nirschl, F A Pettrone (1979)

Of the 1,213 clinical cases of lateral tennis elbow seen during the time period from December 19, 1971, to October 31, 1977, eighty-eight elbows in eighty-two patients had operative treatment. The lesion that was consistently identified at surgery was immature fibroblastic and vascular infiltration of the origin of the extensor carpi radialis brevis. A specific surgical technique was employed, including exposure of the extensor carpi radialis brevis, excision of the identified lesion, and repair. The results at follow-up were rated as excellent in sixty-six elbows, good in nine, fair in eleven, and failed in two. There was an over-all improvement rate of 97.7 per cent, and 85.2 per cent of the patients returned to full activity including rigorous sports.

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Current Clinical Recommendations for Use of Platelet-Rich Plasma

Adrian D. K. Le, Lawrence Enweze, Malcolm DeBaun … (2018)

Purpose of Review This review evaluates current clinical literature on the use of platelet-rich plasma (PRP), including leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP), in order to develop evidence-based recommendations for various musculoskeletal indications. Recent Findings Abundant high-quality evidence supports the use of LR-PRP injection for lateral epicondylitis and LP-PRP for osteoarthritis of the knee. Moderate high-quality evidence supports the use of LR-PRP injection for patellar tendinopathy and of PRP injection for plantar fasciitis and donor site pain in patellar tendon graft BTB ACL reconstruction. There is insufficient evidence to routinely recommend PRP for rotator cuff tendinopathy, osteoarthritis of the hip, or high ankle sprains. Current evidence demonstrates a lack of efficacy of PRP for Achilles tendinopathy, muscle injuries, acute fracture or nonunion, surgical augmentation in rotator cuff repair, Achilles tendon repair, and ACL reconstruction. Summary PRP is a promising treatment for some musculoskeletal diseases; however, evidence of its efficacy has been highly variable depending on the specific indication. Additional high-quality clinical trials with longer follow-up will be critical in shaping our perspective of this treatment option.

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Author and article information

Contributors

Vesselin Karabinov

Georgi P Georgiev

Journal

Journal ID (nlm-ta): World J Orthop

Journal ID (publisher-id): WJO

Title: World Journal of Orthopedics

Publisher: Baishideng Publishing Group Inc

ISSN (Electronic): 2218-5836

Publication date Collection: 18 April 2022

Publication date (Electronic): 18 April 2022

Volume: 13

Issue: 4

Pages: 354-364

Affiliations

Clinic of Neurology, National Cardiology Hospital, Sofia 1000, Bulgaria

Department of Orthopedics and Traumatology, University Hospital Queen Giovanna-ISUL, Medical University of Sofia, Sofia 1527, Bulgaria. georgievgp@ 123456yahoo.com

Author notes

Author contributions: All authors made significant contributions to the preparation of this manuscript; Karabinov V participated in the review of the literature and selection of appropriate materials, wrote the article, and critically revised the article; Georgiev GP created the concept of this manuscript, wrote the article, critically revised the article, and participated in the final approval.

Corresponding author: Georgi P Georgiev, MD, PhD, Assistant Professor, Department of Orthopedics and Traumatology, University Hospital Queen Giovanna-ISUL, Medical University of Sofia, Byalo More Str., Sofia 1527, Bulgaria. georgievgp@ 123456yahoo.com

Article

Other ID: jWJO.v13.i4.pg354

DOI: 10.5312/wjo.v13.i4.354

PMC ID: 9048498

PubMed ID: 35582153

SO-VID: dc171b0e-1a28-4711-82ed-60b5f3605552

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This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Lateral epicondylitis: New trends and challenges in treatment

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Abstract

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Hematology and Oncology Discovery

Most cited references 75

Treatment of chronic elbow tendinosis with buffered platelet-rich plasma.

Tennis elbow. The surgical treatment of lateral epicondylitis.

Current Clinical Recommendations for Use of Platelet-Rich Plasma

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