title: Medial epicondylitis: is ultrasound guided autologous blood injection an effective treatment?
abstract: OBJECTIVE
  To assess if ultrasound guided autologous blood injection is an effective treatment for medial epicondylitis.
  
  
  METHODS
  Twenty patients (13 men, 7 women) with refractory medial epicondylitis with symptom duration of 12 months underwent sonographic evaluation. Tendinosis was confirmed according to three sonographic criteria: echo texture, interstitial tears and neovascularity. The tendon was then dry needled and autologous blood was injected. Patients were reviewed at 4 weeks and at 10 months. VAS scores and modified Nirschl scores were assessed pre-procedure and post-procedure.
  
  
  RESULTS
  There was significant reduction in VAS pain score between pre-procedure and 10 months post-procedure when it had a median (IQR) of 1.00 (1-1.75), range 0-7. The median (IQR) Nirschl score, which at pre-procedure was 6.00 (5-7), range 4-7, had decreased at 4 weeks to 4.00 (2.25-5), range 2-7, and at 10 months to 1.00 (1-1.75), range 0-7, revealing a significant decrease (z = 3.763, p<0.001). The hypo-echoic change in the flexor tendon significantly decreased between pre-procedure, when there was a mean (SD) of 6.45 (1.47), and at 10 months, when it was 3.85 (2.37) (p<0.001). Doppler ultrasound showed that neovascularity decreased between pre-procedure, when there was a mean (SD) of 6.10 (1.62), range 4-9, and at 10 months, when it was 3.60 (2.56), range 0-9 (p<0.001).
  
  
  CONCLUSIONS
  The combined action of dry needling and autologous blood injection under ultrasound guidance appears to be an effective treatment for refractory medial epicondylitis as demonstrated by a significant decrease in VAS pain and a fall in the modified Nirschl scores.
authors.affiliation: Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
authors.forename: S P
authors.initials: SP
authors.lastname: Suresh
authors.forename: K E
authors.initials: KE
authors.lastname: Ali
authors.forename: H
authors.initials: H
authors.lastname: Jones
authors.forename: D A
authors.initials: DA
authors.lastname: Connell
mesh_terms: D000328:Adult; D000368:Aged; D001804:Blood Transfusion, Autologous / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D013716:Tennis Elbow / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional