title: Comparison of corticosteroid, autologous blood or sclerosant injections for chronic tennis elbow.
abstract: OBJECTIVE
  To compare three different ultrasound-guided injections for chronic tennis elbow.
  
  
  METHODS
  Assessor-blinded, randomized controlled comparative trial.
  
  
  METHODS
  44 patients with clinically diagnosed tennis elbow, confirmed by Doppler ultrasound, received under ultrasound guidance, a single corticosteroid injection (n=14), or two injections (separated by 4 weeks) of either autologous blood (n=14) or polidocanol (n=16). Clinical and ultrasound examination was performed at baseline, 4, 12 and 26 weeks.
  
  
  RESULTS
  Complete recovery or much improvement was greater for corticosteroid injection than autologous blood and polidocanol at 4 weeks (p<0.001, number needed to treat 1 (95% CI 1-2)). In contrast, at 26 weeks corticosteroid was significantly worse than polidocanol (p=0.004, number needed to harm 2 (1-6)). Recurrence after corticosteroid injection was significantly higher than autologous blood or polidocanol (p=0.007, number needed to harm 2 (1-4)). Corticosteroid injection produced greater reduction in tendon thickness and vascularity than autologous blood at 4 weeks only. Compared to autologous blood, polidocanol reduced tendon thickness at 4 and 12 weeks and reduced echogenicity and hyperaemia after 12 or 26 weeks respectively.
  
  
  CONCLUSIONS
  Injections of corticosteroid cannot be recommended over polidocanol or autologous blood, because despite beneficial short-term effect there were inferior long-term effects. Whether polidocanol or autologous blood injections are effective is unknown, especially as their global effect profiles are not unlike previously reported for wait-and-see.
authors.affiliation: Olympic Park Sports Medicine Centre, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Branson
authors.affiliation: Olympic Park Sports Medicine Centre, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Naidu
authors.affiliation: Olympic Park Sports Medicine Centre, Australia.
authors.forename: C
authors.initials: C
authors.lastname: du Toit
authors.affiliation: Victoria House Medical Imaging, MIA Radiology, Australia.
authors.forename: A H
authors.initials: AH
authors.lastname: Rotstein
authors.affiliation: Victoria House Medical Imaging, MIA Radiology, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Kiss
authors.affiliation: Olympic Park Sports Medicine Centre, Australia.
authors.forename: D
authors.initials: D
authors.lastname: McMillan
authors.affiliation: Olympic Park Sports Medicine Centre, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Fooks
authors.affiliation: University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Australia; School of Biomedical Sciences, University of Queensland, Australia.
authors.forename: B K
authors.initials: BK
authors.lastname: Coombes
authors.affiliation: School of Biomedical Sciences, University of Queensland, Australia. Electronic address: b.vicenzino@uq.edu.au.
authors.forename: B
authors.initials: B
authors.lastname: Vicenzino
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001804:Blood Transfusion, Autologous; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D016037:Single-Blind Method; D013716:Tennis Elbow / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols
keywords: Blood products; Colour Doppler; Lateral epicondylalgia; Polidocanol; Ultrasonography