Randomised trial of treatment for tennis elbow comparing the effects of different injection treatments on pain reduction
Comparative effectiveness of ultrasound-guided injection with either autologous platelet rich plasma or glucocorticoid for ultrasound-proven lateral epicondylitis: a three-arm randomised placebo-controlled trial
Monash University
180 participants
Jun 5, 2013
Interventional
Conditions
Summary
Lateral epicondylitis (LE) or tennis elbow is a debilitating musculoskeletal condition that can result in significant disability, health care utilisation, lost productivity and costs. Glucocorticoid injection is of proven short-term benefit, but beyond 8 weeks its benefits have not been established and some studies have even suggested a rebound worsening of symptoms. Autologous platelet rich plasma (PRP) appears to be a promising new treatment for LE however strong evidence for its efficacy from high quality randomised placebo-controlled trials is currently lacking. The aim of this study is to compare the effectiveness of ultrasound-guided injection with either autologous platelet rich plasma or glucocorticoid using a three-arm randomised placebo-controlled trial design.
Eligibility
Inclusion Criteria4
- lateral elbow pain > or = six weeks duration
- reproducibility of pain by two or more of the following tests: palpation of the lateral epicondyle and/or the common extensor origin of the elbow, gripping, resisted wrist or second or third finger extension (dorsiflexion)
- ultrasound-confirmed lesion
- ability to read and write in English
Exclusion Criteria16
- bilateral symptoms of lateral elbow pain
- any other elbow pathology
- generalised inflammatory arthritis such as rheumatoid arthritis
- concurrent shoulder and/or neck pain and/or pain proximal to the elbow on the affected side
- any wound or skin lesion on the lateral side of the affected elbow
- neurological symptoms or signs in the affected arm
- severe infection
- known malignancy
- bleeding disorder
- previous surgery to the elbow
- local glucocorticoid injection in the previous six months
- oral glucocorticoids in the previous three months
- large tear > or = 15mm in the common extensor origin
- or a torn lateral collateral ligament
- lack of informed consent
- any other reason thought likely to result in inability to complete the trial
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Interventions
1) single ultrasound guided injection of autologous platelet rich plasma (2ml) into the site of maximal abnormality in the elbow. To obtain the autologous platelet rich plasma, 5 ml of venesected blood will be centrifuged for 7 minutes at 1500 revs/sec and then the buffy coating and 2ml of the supernatant will be aspirated using a 22 gauge needle into a 3ml syringe. This 2ml will then be injected into the elbow. 2) single ultrasound guided injection of glucocorticoid (Celestone Chronodose 1ml + 1 ml normal saline) into the site of maximal abnormality in the elbow
Locations(2)
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ACTRN12613000616774