Platelet-Rich Plasma Compared With Other Common Injection Therapies in the Treatment of Chronic Lateral Epicondylitis

2016 ◽  
Vol 25 (1) ◽  
pp. 77-82 ◽  
Author(s):  
Tristan Rodik ◽  
Brendon McDermott
Keyword(s):  
Whole Blood ◽  
Platelet Rich Plasma ◽  
Corticosteroid Injection ◽  
Lateral Epicondylitis ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Bottom Line ◽  
And Function ◽  
Corticosteroid Injections

Clinical Scenario:Lateral epicondylitis (LE) is a relatively common pathology capable of producing chronic debilitation in a variety of patients. A newer treatment for orthopedic conditions is platelet-rich plasma (PrP) local injection.Focused Clinical Question:Is PrP a more appropriate injection therapy for LE than other common injections such as corticosteroid or whole blood?Summary of Key Findings:Four studies were included: 1 randomized controlled trial (RCT), 2 double-blind RCTs, and 1 cohort study. Two studies involved comparisons of PrP injection to corticosteroid injection. One of the studies involved a 2-y follow-up while another involved a 1-y follow-up. Another study involved the comparison of PrP injection with whole-blood injection with a 6-mo follow-up. The final study included a PrP-injection group and control group. The 2 studies involving PrP vs corticosteroid injections with 2-y and 1-y follow-ups both favored PrP over corticosteroid injection in terms of pain reduction and function increases. The third study favored PrP injections over whole-blood injections at 6 mo regarding pain reduction. All studies demonstrated significant improvements with PrP over comparison injections or no injection.Clinical Bottom Line:PrP injections provide more favorable pain and function outcomes than whole blood and corticosteroid injections for 1–2 y after injection.Strength of Recommendation:Consistent findings from RCTs suggest level 1b evidence in support of PrP injection as a treatment for LE.

Effectiveness of Corticosteroid Injections in the Treatment of Plantar Fasciitis

2016 ◽  
Vol 25 (2) ◽  
pp. 202-207 ◽  
Author(s):  
Shanna L. Karls ◽  
Kelli R. Snyder ◽  
Peter J. Neibert
Keyword(s):  
Plantar Fasciitis ◽  
Platelet Rich Plasma ◽  
Corticosteroid Injection ◽  
Term Treatment ◽  
Clinical Scenario ◽  
Bottom Line ◽  
Long Term Treatment ◽  
Level 2 ◽  
Corticosteroid Injections

Clinical Scenario:For active individuals, plantar fasciitis (PF) is one of the most clinically diagnosed causes of heel pain. When conservative treatment fails, one of the next most commonly used treatments includes corticosteroid injections. Although PF has been identified as a degenerative condition, rather than inflammatory, corticosteroid injection is still commonly prescribed. However, the literature has not been examined to determine the effect of corticosteroid injection on PF.Focused Clinical Question:Are corticosteroid injections more effective than other interventions (placebo, platelet-rich plasma, and tenoxicam injections) in the short- and long-term treatment of PF?Summary of Key Findings:Corticosteroid injections are not more effective in the long-term treatment of PF pain than other treatments (platelet-rich plasma, tenoxicam).Clinical Bottom Line:The level 2 and 3 evidence shows that corticosteroids are more effective than placebo injections but are no more effective than tenoxicam injections and perhaps less effective than platelet-rich plasma treatment.Strength of Recommendation:Level 2 and 3 evidence suggests that corticosteroid injections are not more effective in the long-term treatment of PF than platelet-rich plasma or tenoxicam.

scholarly journals Effect of Platelet-Rich Plasma (PRP) versus Autologous Whole Blood on Pain and Function Improvement in Tennis Elbow: A Randomized Clinical Trial

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Seyed Ahmad Raeissadat ◽  
Leyla Sedighipour ◽  
Seyed Mansoor Rayegani ◽  
Mohammad Hasan Bahrami ◽  
Masume Bayat ◽  
...  
Keyword(s):  
Whole Blood ◽  
Tennis Elbow ◽  
Platelet Rich Plasma ◽  
Autologous Blood ◽  
Pressure Pain Threshold ◽  
Lateral Epicondylitis ◽  
Autologous Whole Blood ◽  
Significant Difference ◽  
Group 2 ◽  
And Function

Background. Autologous whole blood and platelet-rich plasma (PRP) have been both suggested to treat chronic tennis elbow. The aim of the present study was to compare the effects of PRP versus autologous whole blood local injection in chronic tennis elbow. Methods. Forty patients with tennis elbow were randomly divided into 2 groups. Group 1 was treated with a single injection of 2 mL of autologous PRP and group 2 with 2 mL of autologous blood. Tennis elbow strap, stretching, and strengthening exercises were administered for both groups during a 2-month followup. Pain and functional improvements were assessed using visual analog scale (VAS), modified Mayo Clinic performance index for the elbow, and pressure pain threshold (PPT) at 0, 4, and 8 weeks. Results. All pain and functional variables including VAS, PPT, and Mayo scores improved significantly in both groups 4 weeks after injection. No statistically significant difference was noted between groups regarding pain scores in 4-week follow-up examination (P>0.05). At 8-week reevaluations, VAS and Mayo scores improved only in PRP group (P<0.05). Conclusion. PRP and autologous whole blood injections are both effective to treat chronic lateral epicondylitis. PRP might be slightly superior in 8-week followup. However, further studies are suggested to get definite conclusion.

The Effect of Dry Needling on Patient-Reported Outcomes in Individuals With Chronic Ankle Instability: A Critically Appraised Topic

2019 ◽  
Vol 24 (5) ◽  
pp. 186-192
Author(s):  
Jennifer F. Mullins ◽  
Arthur J. Nitz ◽  
Matthew C. Hoch
Keyword(s):  
Patient Reported Outcomes ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
The Other ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Dry Needling ◽  
Bottom Line ◽  
Patient Reported

Clinical Scenario: Chronic ankle instability (CAI) and its associated recurrent sprains, feelings of instability, and decreased function occur in approximately 40% of individuals that suffer an ankle sprain. Despite these continued deficits, more effective treatment has yet to be established. Decreased sensorimotor function has been associated with CAI and may be amenable to dry needling treatment, thereby improving patient-reported outcomes (PROs). Focused Clinical Question: Does dry needling improve PROs in individuals with CAI? Summary of Key Findings: Two studies were identified that examined dry needling in participants with CAI. One of the two studies reported improvements in PROs (PEDro score 7/10) while the other study did not identify any changes (PEDro score 9/10). The inconsistent results were likely related to different treatment durations and follow-up timelines across the included evidence. Clinical Bottom Line: Based on the included studies, there is inconsistent evidence that dry needling can improve PROs in individuals with CAI. Strength of Recommendation: Utilizing the Strength of Recommendation Taxonomy (SORT) guidelines, level B evidence exists to recommend dry needling treatment to improve PROs for individuals with CAI.

scholarly journals The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: A systematic review

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 11 ◽  
Author(s):  
Walid Ben-Nafa ◽  
Wendy Munro
Keyword(s):  
Systematic Review ◽  
Platelet Rich Plasma ◽  
Corticosteroid Injection ◽  
Lateral Epicondylitis ◽  
Extensor Tendon ◽  
Symptomatic Improvement ◽  
Tendon Thickness ◽  
Randomised Controlled ◽  
Level 2 ◽  
Corticosteroid Injections

Introduction: Lateral epicondylitis is a common musculoskeletal disorder of the upper limb. Corticosteroid injection has been widely used as a major mode of treatment. However, better understanding of the pathophysiology of the disease led to a major change in treating the disease, with new options including platelet-rich plasma (PRP) are currently used. Objectives/research aim: To systematically evaluate the effect of corticosteroid versus PRP injections for the treatment of LE. Hypothesis: PRP injections provide longer-term therapeutic effect and less rate of complications compared to corticosteroid injection. Level of evidence: Level 2 evidence (4 included studies are of level 1 evidence, 1 study of level 2 evidence). Design: Systematic Review (according to PRISMA guidelines). Methods: Eleven databases used to search for relevant primary studies comparing the effects of corticosteroid and PRP injections for the treatment of LE. Quality appraisal of studies performed using Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, CASP Randomised Controlled Trial Checklist, and SIGN Methodology Checklist 2. Results: 732 papers were identified. Five randomised controlled trials (250 Patients) met the inclusion criteria. Clinical findings: Corticosteroid injections provided rapid symptomatic improvement with maximum effect at 6/8/8 weeks before symptoms recurrence, whereas PRP showed slower ongoing improvements up to 24/52/104 weeks(3 studies). Corticosteroid showed more rapid symptomatic improvement of symptoms compared to PRP up to the study end-point of 3 months(1 study). Comparable therapeutic effects of corticosteroid and PRP were observed at 6 weeks(1 study). Ultrasonographic Findings: (1) Doppler activity decreased more significantly in patients who received corticosteroid compared to PRP. (2) Reduced tendon thickness and more patients with cortical erosion noted in corticosteroid group whereas increased tendon thickness and less number of patients with common extensor tendon tears noted in PRP group. (3) Fewer patients reported Probe-induced tenderness and oedema in the common extensor tendon in both corticosteroid and PRP groups (2 studies). Conclusion: Corticosteroid injections provide rapid therapeutic effect in the short-term with recurrence of symptoms afterwards, compared to the relatively slower but longer-term effect of platelet-rich plasma.

scholarly journals Autologous Blood and Platelet-Rich Plasma Injections in the Treatment of Achilles Tendinopathy: A Critically Appraised Topic

2017 ◽  
Vol 26 (3) ◽  
pp. 279-285 ◽  
Author(s):  
Cori Sinnott ◽  
Hayley M. White ◽  
Jennifer W. Cuchna ◽  
Bonnie L. Van Lunen
Keyword(s):  
Platelet Rich Plasma ◽  
Autologous Blood ◽  
Achilles Tendinopathy ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Invasive Treatment ◽  
Painful Condition ◽  
Physically Active ◽  
Age Related ◽  
And Function

Clinical Scenario:Achilles tendinopathy is a painful condition commonly affecting the general and athletic population. It presents with localized pain, stiffness, and swelling in the midportion of the Achilles tendon. The physical stress placed on the tendon results in microtrauma, which leads to subsequent inflammation and degeneration. While it is not surprising that this condition affects the physically active, nearly one-third of Achilles tendinopathy cases occur in sedentary individuals. Etiology for this condition stems from a change in loading patterns and/or overuse of the tendon, resulting in microscopic tearing and degenerative changes. There are numerous causes contributing to the maladaptive response in these patients, such as mechanical, age-related, genetic, and vascular factors. The treatment for these patients is typically load management and eccentric strengthening of the gastrocnemius–soleus complex. Unfortunately, conservative treatment can lead to surgical intervention in up to 45% of cases. A relatively new phenomenon in the treatment of this condition is the use of autologous blood injections (ABI) and platelet-rich plasma injections (PRPI). This need for a less invasive treatment fostered more investigation into ABI and PRPI to treat these nonresponsive patients. However, the evidence concerning the effectiveness of these treatments in patients with Achilles tendinopathy has not been synthesized.Focused Clinical Question:In patients with Achilles tendinopathy, how do variations of ABI and PRPI compared with a placebo and/or eccentric training affect pain and function?

scholarly journals A better functional outcome with platelet rich plasma compared with local steroid injection in tennis elbow

2021 ◽  
Vol 7 (1) ◽  
pp. 24-28
Author(s):  
Shilp Verma ◽  
Anwar A ◽  
Alok Chandra Agarwal ◽  
Ranjeet Choudhary ◽  
Ankit Kumar Garg
Keyword(s):  
Steroid Injection ◽  
Tennis Elbow ◽  
Platelet Rich Plasma ◽  
Corticosteroid Injection ◽  
Symptomatic Relief ◽  
Lateral Epicondylitis ◽  
Treatment Modalities ◽  
Functional Activities ◽  
Local Steroid Injection

Lateral epicondylitis commonly referred to as 'tennis elbow,' is mainly observed in the 3rd and 4th decade of life in around 2% -3% of the population. Treatment modalities for lateral epicondylitis include analgesics, immobilization, tennis elbow brace, local steroid infiltration, and ultrasound therapy. Recent studies have explored the effectiveness of platelet-rich plasma (PRP) injections in lateral epicondylitis. We used the block randomization technique. Two groups were prepared with 30 patients in each group. One group of patients received PRP and the other received local steroid injection. Patients were evaluated at the time of procedure and immediately after the procedure, at six weeks, three months, and six months, using the visual analog score and Liverpool's elbow score. At the end of 6 months, follow-up patients in the PRP injection group show good clinical and functional compare to the steroid group of patients. PRP and local corticosteroid injection provide symptomatic relief in the treatment of lateral epicondylitis. PRP infiltration gives better results in pain relief and functional activities with statically significant values when compared with corticosteroid injections.

scholarly journals Management of lateral epicondylitis (tennis elbow) by local infiltration of platelet rich plasma an outcome study

2020 ◽  
Vol 6 (5) ◽  
pp. 963
Author(s):  
Pradeep Kumar Kumawat ◽  
Rajesh Goel ◽  
Urmila Kumhar ◽  
Rahul Parmar ◽  
Rajesh Sharma ◽  
...  
Keyword(s):  
Biological Therapy ◽  
Tennis Elbow ◽  
Platelet Rich Plasma ◽  
Lateral Epicondylitis ◽  
P Value ◽  
Outcome Study ◽  
Post Intervention ◽  
Local Infiltration ◽  
And Function

<p class="abstract"><strong>Background:</strong> Platelet-rich plasma (PRP) has been recently the emerging biological therapy in which a large pool of signals released from platelets producing a biological microenvironment for local and migrating cells for tissue regeneration. A prospective randomized observational study was done to assess the efficacy of autologous PRP injection in lateral epicondylitis of elbow.</p><p class="abstract"><strong>Methods:</strong> A total 100 patients of lateral epicondylitis were selected and treated from December 2015 to November 2017. VAS (visual analogue scale) and PRTEE (patient rated tennis elbow evaluation) scoring were used for clinical and functional assessment at pre-injection, 2<sup>nd</sup> week, 4<sup>th </sup>week, 3<sup>rd</sup> month and 6<sup>th</sup> month.<strong></strong></p><p class="abstract"><strong>Results:</strong> At the end of 6 months follow-up 61% patients were completely relieved of pain. 34% patients had mild pain that was significantly decreased (p value &lt;0.0001) from mean VAS (75) and mean PRTEE (78.62) to mean VAS (6.05) and mean PRTEE (5.63). 5 patients were lost their 6 months follow-up. There was a significant increase in post intervention pain for few days in 70% patients. Recurrence rate of 0% was noted at the end of 6 months follow-up.</p><p class="abstract"><strong>Conclusions:</strong> An injection of PRP improves pain and function in patients suffering from lateral epicondylitis.</p>

scholarly journals The Effect of Platelet-Rich Plasma on Elbow Tendinopathies: A Systematic Review

2013 ◽  
Author(s):  
Sarah Schwetlik ◽  
Luke Strempel
Keyword(s):  
Systematic Review ◽  
Cohort Study ◽  
Physical Function ◽  
Whole Blood ◽  
Platelet Rich Plasma ◽  
Autologous Blood ◽  
Sufficient Evidence ◽  
Quantitative Studies ◽  
And Function

Purpose: Elbow tendinopathies are common conditions that typically last 6 to 24 months. There is no clear consensus in the literature regarding the most effective management. Platelet-rich plasma (PRP) is an autologous blood product used for elbow tendinopathies with the aim of enhancing tissue regeneration. The aim of this systematic review was to evaluate the available evidence on the effectiveness and safety of PRP for reducing pain and physical function in elbow tendinopathies. Methods: Electronic databases were searched for relevant studies and data were extracted regarding the design, sample characteristics, interventions, and outcome measures. Each study was critically appraised for methodological quality using a modified tool for quantitative studies and presented in a narrative summary. Results: The search strategy identified 299 hits related to platelet-rich plasma and/or elbow tendinopathies. Five studies met the inclusion criteria; all were randomized controlled trials except one cohort study. All five studies showed improvements from baseline in pain and physical function with a PRP intervention. One study and its follow-up study showed significant improvements in pain and function with PRP compared to corticosteroid at 26, 52, and 104 weeks. Two studies compared PRP to whole blood, which did not find sufficient evidence to suggest one is more effective than the other. A cohort study found PRP was more effective than placebo at 4 and 8 weeks. Three studies reported on the safety of PRP and found no significant adverse effects. Conclusions: The current literature has some limitations and is insufficient to provide strong recommendations regarding the use of PRP in elbow tendinopathies over other modalities; however, these studies suggest that PRP may be more efficacious than corticosteroid injections, but that whole blood injections may be as effective as PRP.

The Use of Breathing Exercises in the Treatment of Chronic, Nonspecific Low Back Pain

2017 ◽  
Vol 26 (5) ◽  
pp. 452-458 ◽  
Author(s):  
Barton E. Anderson ◽  
Kellie C. Huxel Bliven
Keyword(s):  
Quality Of Life ◽  
Low Back Pain ◽  
Back Pain ◽  
Lung Function ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Low Back ◽  
Bottom Line ◽  
Breathing Exercises

Clinical Scenario:Research has shown a link between poor core stability and chronic, nonspecific low back pain, with data to suggest that alterations in core muscle activation patterns, breathing patterns, lung function, and diaphragm mechanics may occur. Traditional treatment approaches for chronic, nonspecific low back pain focus on exercise and manual therapy interventions, however it is not clear whether breathing exercises are effective in treating back pain.Focused Clinical Question:In adults with chronic, nonspecific low back pain, are breathing exercises effective in reducing pain, improving respiratory function, and/or health related quality of life?Summary of Key Findings:Following a literature search, 3 studies were identified for inclusion in the review. All reviewed studies were critically appraised at level 2 evidence and reported improvements in either low back pain or quality of life following breathing program intervention.Clinical Bottom Line:Exercise programs were shown to be effective in improving lung function, reducing back pain, and improving quality of life. Breathing program frequencies ranged from daily to 2–3 times per week, with durations ranging from 4 to 8 weeks. Based on these results, athletic trainers and physical therapists caring for patients with chronic, nonspecific low back pain should consider the inclusion of breathing exercises for the treatment of back pain when such treatments align with the clinician’s own judgment and clinical expertise and the patient’s preferences and values.Strength of Recommendation:Grade B evidence exists to support the use of breathing exercises in the treatment of chronic, nonspecific low back pain.

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