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Comparison of the efficacy of corticosteroid, dry needling, and PRP application in lateral epicondylitis

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to compare the short-term efficacy of dry needling, corticosteroids, and platelet-rich plasma application (PRP) in the management of lateral epicondylitis.

Methods

The study included 72 patients diagnosed with lateral epicondylitis divided into three groups of 24 individuals using the sealed envelope method. Group 1 underwent dry needling, Group 2 received 40 mg methylprednisolone acetate, and Group 3 received PRP treatment. Patients were assessed using the visual analog scale (VAS) and the Disabilities of the Shoulder, Arm, and Hand (DASH) score, and Jamar grip strength before treatment and 3rd week and 3rd month.

Results

At the 3rd month, the mean VAS score was 1.16 ± 0.56 in dry needling group and 0.75 ± 0.60 in corticosteroids group, showing a statistically significant difference between dry needling and corticosteroids group, and between corticosteroids and PRP group (p = 0.015 and p = 0.000, respectively). At the 3rd week and 3rd month, VAS scores decreased in each treatment modality group, showing a statistically significant difference between the groups (p < 0.01). Jamar grip strength increased over time in all groups. There were no significant differences between the DASH scores of all groups at the 3rd week (p > 0.05). DASH scores decreased significantly from the 3rd week to the 3rd month in dry needling and corticosteroids group (p < 0.01), while it increased slightly in PRP group during the same period with a statistically insignificant change (p > 0.05). DASH scores decreased significantly at the 3rd month for all groups (p = 0.014).

Conclusion

Dry needling is an effective and safe application for the short-term treatment of lateral epicondylitis.

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References

  1. Waugh EJ (2005) Lateral epicondylalgia or epicondylitis: what’s in a name? J Orthop Sports Phys Ther 35:200–202

    Article  Google Scholar 

  2. Hudak PL, Cole DC, Haines AT (1996) Understanding prognosis to improve rehabilitation: the example of lateral elbow pain. Arch Phys Med Rehabil 77(6):586–593. https://doi.org/10.1016/s0003-9993(96)90300-7

    Article  CAS  PubMed  Google Scholar 

  3. Hsieh LF, Kuo YC, Lee CC (2018) Comparison between corticosteroid and lidocaine injection in the treatment of tennis elbow: a randomized, double-blinded, controlled trial. Am J Phys Med Rehabil 97:83–89

    Article  Google Scholar 

  4. Vaquero-Picado A, Barco R, Antuña SA (2016) Lateral epicondylitis of the elbow. EFORT Open Rev 1:391–397

    Article  Google Scholar 

  5. Luk JK, Tsang RC, Leung HB (2014) Lateral epicondylalgia: the midlife crisis of a tendon. Hong Kong Med J 20:145–151

    PubMed  Google Scholar 

  6. Bhabra G, Wang A, Ebert JR (2016) Lateral elbow tendinopathy: development of a pathophysiology based treatment algorithm. Orthop J Sports Med 4:2325967116670635

    Article  Google Scholar 

  7. Ozkut AT, Kilinçoğlu V, Ozkan NK, Eren A, Ertaş M (2007) Extracorporeal shock wave therapy in patients with lateral epicondylitis. Acta Orthop Traumatol Turc 41:207–210

    PubMed  Google Scholar 

  8. Tsikopoulos K, Tsikopoulos I, Simeonidis E, Papathanasiou E, Haidich AB, Anastasopoulos N et al (2016) The clinical impact of platelet rich plasma on tendinopathy compared to placebo or dry needling injections: a meta-analysis. Phys Ther Sport 17:87–94

    Article  Google Scholar 

  9. Lewis M, Hay EM, Paterson SM, Croft P (2005) Local corticosteroid injections for tennis elbow: does the pain get worse before it gets better? Results from a randomized controlled trial. Clin J Pain 21(4):330–334

    Article  Google Scholar 

  10. Assendelft WJ, Hay EM, Adshead R, Bouter LM (1996) Corticosteroid injections for lateral epicondylitis: a systematic overview. Br J Gen Pract 46(405):209–216

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Smidt N, van der Windt DA, Assendelft WJ, Deville WL (2002) Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomized controlled trial. Lancet 359:657–662

    Article  CAS  Google Scholar 

  12. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B (2006) Mobilization with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: a randomized trial. BMJ 333(7575):939

    Article  Google Scholar 

  13. Buchbinder R, Johnston RV, Barnsley L, Assendelft WJJ, Bell SN, Smidt N (2011) Surgery for lateral elbow pain. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003525.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  14. Andia I, Rubio-Azpeitia E, Maffulli N (2015) Platelet rich plasma modulates the secretion of inflammatory/angiogenic proteins by inflamed tenocytes. Clin Orthop Relat Res 473(5):1624–1634

    Article  Google Scholar 

  15. Galatz LM, Gerstenfeld L, Heber-Katz E, Rodeo SA (2015) Tendon regeneration and scar-formation: the concept of scarless healing. J Orthop Res 33(6):823–831

    Article  Google Scholar 

  16. Hudgens JL, Sugg KB, Grekin JA, Gumucio JP, Bedi A, Mendias CL (2016) Platelet rich plasma activates pro-inflammatory signaling pathways and induces oxidative stress in tendon fibroblasts. Am J Sports Med 44(8):1931–1940

    Article  Google Scholar 

  17. Chen X, Jones A, Park C, Vangsness CT Jr (2018) The efficacy of platelet rich plasma on tendon and ligament healing: a systematic review and meta-analysis with bias assessment. Am J Sports Med 46(8):2020–2032

    Article  Google Scholar 

  18. Krey D, Borchers J, McCamey K (2015) Tendon-needling for treatment of tendinopathy:a systematic review. Phys Sportsmed 43:80–86

    Article  Google Scholar 

  19. Tsikopoulos K, Tsikopoulos I, Simeonidis E, Papathanasiou E, Haidich AB, Anastasopoulos N et al (2016) The clinical impact of platelet-rich plasma on tendinopathy compared to placebo or dry needling injections: a meta-analysis. Phys Ther Sport 17:87–94

    Article  Google Scholar 

  20. McShane JM, Shah VN, Nazarian LN (2008) Sonographically guided percutaneous-needle tenotomy for treatment of common extensor tendinosis in the elbow: is a corticosteroid necessary? J Ultrasound Med 27:1137–1144

    Article  Google Scholar 

  21. Mattie R, Wong J, McCormick Z, Yu S, Saltychev M, Laimi K (2017) Percutaneous-needle tenotomy for the treatment of lateral epicondylitis: a systematic review of the literature. PM R 9:603–611

    Article  Google Scholar 

  22. James SLJ, Ali K, Pocock C, Robertson C, Walter J, Bell J et al (2007) Ultrasound guided dry needling and autologous blood injection for patellar tendinosis. Br J Sports Med 41(8):518–522. https://doi.org/10.1136/bjsm.2006.034686

    Article  PubMed  PubMed Central  Google Scholar 

  23. Stenhouse G, Sookur P, Watson M (2013) Do blood growth factors offer additional benefit in refractory lateral epicondylitis? A prospective, randomized pilot trial of dry needling as a stand-alone procedure versus dry-needling and autologous conditioned plasma. Skelet Radiol 42:1515–20

    Article  Google Scholar 

  24. Mishra AK, Skrepnik NV, Edwards SG, Jones GL, Sampson S, Vermillion DA et al (2014) Efficacy of platelet rich plasma for chronic tennis elbow:a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med 42:463–471. https://doi.org/10.1177/0363546513494359

    Article  PubMed  Google Scholar 

  25. Suzuki T, Iwamoto T, Matsumura N, Nakamura M, Matsumoto M, Sato K (2019) Percutaneous tendon-needling without ultrasonography for lateral epicondylitis. Keio J Med. https://doi.org/10.2302/kjm.2019-0004-OA

    Article  PubMed  Google Scholar 

  26. Barnes DE, Beckley JM, Smith J (2015) Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study. J Shoulder Elbow Surg 24:67–73. https://doi.org/10.1016/j.jse.2014.07.017

    Article  PubMed  Google Scholar 

  27. Tsikopoulos K, Tsikopoulos I, Simeonidis E, Papathanasiou E (2016) The clinical impact of platelet rich plasma on tendinopathy compared to placebo or dry needling injections: a meta-analysis. Phys Ther Sport 17:87–94

    Article  Google Scholar 

  28. De Vos RJ, Windt J, Weir A (2014) Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review. Br J Sports Med 48:952–956

    Article  Google Scholar 

  29. Chard MD (2003) Regional and wide spread pain. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (eds) The elbow. Rheumatology, 3rd edn. Mosby, Philadelphia, pp 631–41

    Google Scholar 

  30. Genc H, Cakit BD, Saracoglu M (2010) The effects of local steroid injection on pain, disability, and hand functions in patients with lateral epicondylitis. J Musculoskelet Pain 18:49–57

    Article  Google Scholar 

  31. Mardani-Kivi M, Karimi-Mobarakeh M, Karimi A (2013) The effects of corticosteroid injection versus local anesthetic injection in the treatment of lateral epicondylitis: a randomized single-blinded clinical trial. Arch Orthop Trauma Surg 133:757–763

    Article  Google Scholar 

  32. Price R, Sinclair H, Heinrich I, Gibson T (1991) Local injection treatment of tennis elbow–hydrocortisone, triamcinolone, and lignocaine compared. Br J Rheumatol 30(1):39–44

    Article  CAS  Google Scholar 

  33. Bellapianta J, Swartz F, Lisella J, Czajka J, Neff R, Uhl R (2011) Randomized prospective evaluation of injection techniques for the treatment of lateral epicondylitis. Orthopedics 34(11):e708–e712. https://doi.org/10.3928/01477447-20110922-13

    Article  PubMed  Google Scholar 

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Orthopedic and Traumatology, Batman Training and Research Hospital, Batman, Turkey

    Erdal Güngör

  2. Department of Physical Medicine and Rehabilitation, Batman Training and Research Hospital, Batman, Turkey

    Zeynep Karakuzu Güngör

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  1. Erdal Güngör
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  2. Zeynep Karakuzu Güngör
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Correspondence to Erdal Güngör.

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Güngör, E., Karakuzu Güngör, Z. Comparison of the efficacy of corticosteroid, dry needling, and PRP application in lateral epicondylitis. Eur J Orthop Surg Traumatol 32, 1569–1575 (2022). https://doi.org/10.1007/s00590-021-03138-2

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  • DOI: https://doi.org/10.1007/s00590-021-03138-2

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