Skeletal Radiology

, Volume 35, Issue 6, pp 371–377

Ultrasound-guided autologous blood injection for tennis elbow

  • David A. Connell
  • Kaline E. Ali
  • Muaaze Ahmad
  • Simon Lambert
  • Steven Corbett
  • Mark Curtis
Scientific Article

Abstract

Objective

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.

Results

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.

Conclusions

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.

Keywords

Ultrasound Autologous blood Lateral epicondylitis Dry needling Treatment Tendon healing 

References

  1. 1.
    Osgood RB. Radiohumeral bursitis, epicondylitis, epicondylalyia (tennis elbow). Arch Surg 1922;4:420–433Google Scholar
  2. 2.
    Almekinders LC, Baynes AJ, Bracey LW. An in vitro investigation into the effects of repetitive motion and nonsteroidal anti-inflammatory medication on human tendon fibroblasts. Am J Sports Med 1995;23:119–123PubMedCrossRefGoogle Scholar
  3. 3.
    Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg [Am] 2003;28:272–278CrossRefGoogle Scholar
  4. 4.
    O’Brien M. Functional anatomy and physiology of tendons. Clin Sports Med 1992;11:505–520PubMedGoogle Scholar
  5. 5.
    Cyriax JH. The pathology and treatment of tennis elbow. J Bone Joint Surg 1936;18–4:921–940Google Scholar
  6. 6.
    Iwasaki M, Nakahara H, Nakata K, Nakase T, Kimura T, Ono K. Regulation of proliferation and osteochondrogenic differentiation of periosteum-derived cells by transforming growth factor-β and basic fibroblast growth factor. J Bone Joint Surg Am 1995:77:543–554PubMedGoogle Scholar
  7. 7.
    Nirschl RP. Elbow tendinosis/ tennis elbow. Clin Sports Med 1992;11:851–870PubMedGoogle Scholar
  8. 8.
    Connell D, Burke F, Coombes P, McNealy S, Freeman D, Pryde D, Hoy G. Sonographic examination of lateral epicondylitis. Am J Roentgenol 2001;176:777–782Google Scholar
  9. 9.
    Nirschl RP, Pettrone FA. Tennis elbow: the surgical treatment of lateral epicondylitis. J Bone Joint Surg Am 1979;61:832–839PubMedGoogle Scholar
  10. 10.
    Kraushaar BS, Nirschl RP. Tendinosis of the elbow (Tennis Elbow). Clinical features and findings of histological, immunohistochemical and electron microscopy studies. J Bone Joint Surg Am 1999;81:269–278Google Scholar
  11. 11.
    Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am 2005;87:187–202PubMedCrossRefGoogle Scholar
  12. 12.
    Zamora AJ, Marini JF. Tendon and myotendinous junction in an overloaded skeletal muscle of the rat. Anat Embryol 1988;179:89–96PubMedCrossRefGoogle Scholar
  13. 13.
    Backman C, Boquist L, Friden J, Lorentzon R, Toolanen G. Chronic Achilles paratenonitis with tendinosis: an experimental model in the rabbit. J Orthop Res 1990;8:541–547PubMedCrossRefGoogle Scholar
  14. 14.
    Murphy PG, Loitz BJ, Frank CB, Hart DA. Influence of exogenous growth factors on the synthesis and secretion of collagen types I and III by explants of normal and healing rabbit ligaments. Biochem Cell Biol 1994;72:403–409PubMedCrossRefGoogle Scholar
  15. 15.
    Oakes BW. Tissue healing and repair: tendons and ligaments. In: Frontera WR (ed) Rehabilitation of sports injuries: scientific basis. Blackwell Science, Boston 2003:8–21Google Scholar
  16. 16.
    Hooley CJ, Cohen RE. A model for the creep behaviour of tendon. Int J Biol Macromol 1979;1:123–132CrossRefGoogle Scholar
  17. 17.
    Amiel D, Akeson W, Harwood FL, Frank CB. Stress deprivation effect on metabolic turnover of medial collateral ligament collagen. A comparison between 9- and 12-week immobilization. Clin Orthop 1983;172:265–270PubMedGoogle Scholar
  18. 18.
    Khan KM, Cook JK. Overuse tendon Injuries. Clinical Sports Medicine, McGraw-Hill 2nd edition January 2001Google Scholar
  19. 19.
    Lian O, Holken KJ, Engebrestson L, Bahr R. Relationship between symptoms of jumper’s knee and the ultrasound characteristics of the patellar tendon among high level male volleyball players. Scand J Med Sci Sports 1996;6:291–296PubMedGoogle Scholar
  20. 20.
    Khan KM, Cook JL, Kiss ZS et al. Patellar tendon ultrasonography and jumper’s knee in elite female basketball players: a longitudinal study. Clin J Sport Med 1997;7:199–206PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2006

Authors and Affiliations

  • David A. Connell
    • 1
  • Kaline E. Ali
    • 1
  • Muaaze Ahmad
    • 1
  • Simon Lambert
    • 1
  • Steven Corbett
    • 2
  • Mark Curtis
    • 3
  1. 1.Department of RadiologyRoyal National Orthopaedic Hospital NHS TrustStanmoreUK
  2. 2.Guy’s & St. Thomas’ NHS TrustLondonUK
  3. 3.Kingston Hospital NHS TrustKingston upon ThamesUK

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