A Comparative Study Of Efficacy Of Intra-lesional Dry Needling, Platelet Rich Plasma And Corticosteroid In Lateral Epicondylitis
Background: Lateral epicondylitis (LE) or Tennis Elbow (TE) is a common cause of musculoskeletal pain involving common extensor origin of the forearm with various treatment options available ranging from conservative, intra-lesional injection to surgical.
Material & Methods: 147 cases of recalcitrant Lateral Epicondylitis treated with intra-lesional dry needling (n=50), platelet rich plasma (PRP) (n=49) or corticosteroid (n=48) injections were compared for VAS and DASH score.
Results: The mean pre-injection VAS score in needling, PRP and steroid group improved from 67.48, 68.00 and 67.39 to 38.50, 36.37 and 36.85 at 24 weeks’ post-injection respectively which was statistically significant (p<0.05). The mean pre-injection DASH score in needling, PRP and steroid group improved from 57.72, 56.96 and 56.19 to 32.04, 31.37 and 31.17 24 weeks’ post-injection respectively, which was statistically significant with paired t test p value < 0.05.
Conclusion: All three procedures, intra-lesional dry needling, PRP and corticosteroid were equally effective in treating lateral epicondylitis, with improvement in both the functional as well as pain scores in long term, but immediate post procedural relief was found better in the corticosteroid group.
2. Morris M, Jobe FW, Perry J, Pink M, Healy BS. Electromyographic analysis of elbow function in tennis players. Am J Sports Med 1989;17:241–7.
3. Pomerance J. Radiographic analysis of lateral epicondylitis. J Shoulder Elbow Surg 2002;11:156–7.
4. Aoki M, Wada T, Isogai S, Kanaya K, Aiki H, Yamashita T. Magnetic resonance imaging findings of refractory tennis elbows and their relationship to surgical treatment. J Shoulder ElbowSurg 2005;14:172–7.
5. Hudak PL, Cole DC, Haines AT. Understanding prognosis to improve rehabilitation: the example of lateral elbow pain. Arch Phys Med Rehabil 1996;77:586–93.
6. Labelle H, Guibert R, Joncas J, Newman N, Fallaha M, Rivard CH. Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow. An attempted meta-analysis. J Bone Joint Surg. 1992;74(B):646–51.
7. Tonks JH, Pai SK, Murali SR. Steroid injection therapy is the best conservative treatment for lateral epicondylitis: a prospective randomized controlled trial. Int J Clin Pract. 2007;61(2):240–6.
8. Smith MA, Smith WT. Emerging techniques in orthopaedics: platelet-rich plasma. Orthop Nurs. 2011;30:260–3.
9. Behrens SB, Deren ME, Matson AP, Bruce B, Green A. A review of modern management of lateral epicondylitis. Phys Sports med. 2012;40(2):34-40.
10. Childress MA, Beutler A. Management of chronic tendon injuries. Am Fam Physician. 2013;87(7):486-90.
11. Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006;34(11);1774-8.
12. Mishra A, Collado H, Fredericson M. Platelet-rich plasma compared with corticosteroid injection for chronic lateral elbow tendinosis. PMR. 2009;1(4):366-70.
13. 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;18(6):12-6.
14. Simons DG, Travell JG, Simons LS. Myofascial pain and dysfunction: the trigger point manual. 2nd ed. Williams & Wilkins;Baltimore:1999.
15. Dommerholt J, Shah JP, Ballantyne JC, Rathmell JP, Fishman SM. Myofascial Pain Syndrome. 4th ed. Williams & Wilkins; Baltimore: 2010.
16. Jain S, Kelkar R, Banodha L, Gautam V. Treatment of lateral epicondylitis with autologous platelet rich plasma injection. Int J Orthop Sci. 2018;4(2):437-41.
17. Martinelli N, Marinozzi A, Carnì S, Trovato U, Bianchi A, Denaro V. Platelet-rich plasma injections for chronic plantar fasciitis. Int Orthop. 2013;37(5):839-42.
18. Yadav R, Kothari SY, Borah D. Comparison of Local Injection of Platelet Rich Plasma and Corticosteroids in the Treatment of Lateral Epicondylitis of Humerus. J Clin Diagn Res. 2015; 9(7):5–7.
19. Sukumar S, Mathias L, Rai S. Early effects of dry needling and low level laser therapy in chronic tennis elbow- an experimental study. Int J Health Sci Res. 2015;5(1):187-96.
20. Chowdry M, Gopinath KM, Kumar BNR, Kanmani TR. Comparative Study of Efficacy between Platelet-rich Plasma vs Corticosteroid Injection in the Treatment of Lateral Epicondylitis. J Med Sci. 2017;3(1):1-5.