Ultrasound-guided autologous blood injection for tennis elbow.
OBJECTIVE
To assess the efficacy of autologous blood injection under sonographic guidance for the treatment of lateral epicondylitis.


METHODS
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.
Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, H47 4Lp, UK. david.connell@rnoh.nhs.uk
David A
DA
Connell
Kaline E
KE
Ali
Muaaze
M
Ahmad
Simon
S
Lambert
Steven
S
Corbett
Mark
M
Curtis
D000328:Adult; D001804:Blood Transfusion, Autologous / Q000379:methods*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D010147:Pain Measurement; D018709:Statistics, Nonparametric; D013716:Tennis Elbow / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional