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.
Connell
David A
DA
Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, H47 4Lp, UK. david.connell@rnoh.nhs.uk
Ali
Kaline E
KE
Ahmad
Muaaze
M
Lambert
Simon
S
Corbett
Steven
S
Curtis
Mark
M
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