Ultrasound-guided autologous blood injection for tennis elbow
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- Connell, D.A., Ali, K.E., Ahmad, M. et al. Skeletal Radiol (2006) 35: 371. doi:10.1007/s00256-006-0081-9
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To assess the efficacy of autologous blood injection under sonographic guidance for the treatment of lateral epicondylitis.
Design and Patients
Thirty-five patients (23 men, 12 women, mean age 40.9) with refractory lateral epicondylitis (mean symptom duration 13.8 months) underwent sonographic evaluation prior to dry-needling the tendon and injection with autologous blood. Patients were reviewed, and measures of Nirschl and Visual Analogue Scores (VAS) were taken pre-procedure and post-procedure, at 4 weeks and 6 months.
Following autologous blood injections, significant reductions were reported for Nirschl scores, which decreased from a median (inter-quartile range) pre-procedure score of 6 (6–7), to 4 (2–5) at 4 weeks (p<0.001), and to 0 (0–1) at 6 months (p<0.001). Similarly, significant reductions were reported for VAS scores from a median (inter-quartile range) pre-procedure score of 9 (8–10), to 6 (3–8) at 4 weeks (p<0.001), and to 0 (0–1) at 6 months (p<0.001). Sonography demonstrated a reduction in the total number of interstitial cleft formations and anechoic foci; a significant reduction in tendon thickness from a mean (SD) of 5.15 mm (0.79) at baseline to 4.82 mm (0.62) at 6 months post-procedure (p<0.001) was observed. Hypoechoic change significantly reduced from a median (inter-quartile range) of 7 (6–7) at baseline to 2 (1–3) at 6 months post-procedure (p<0.001). Neovascularity also significantly decreased from a median (inter-quartile range) of 6 (4–7) at baseline to 1 (0–3) at 6 months post-procedure (p<0.001), although sonographic abnormality remained in many asymptomatic patients.
Autologous blood injection is a primary technique for the treatment of lateral epicondylitis. Sonography can be used to guide injections and monitor changes to the common extensor origin.