Management of Lateral Epicondylitis
(Part 6)
This week’s column is a continuation on the discussion about the treatment modalities for Lateral Epicondylitis (LE).
As a recap, last week we discussed treatment modalities such as counterforce bracing, which may help inhibit and disperse the stress on the origin of affected extensor carpi radialis brevis (ECRB), and facilitating self-repair of the particular portion of the affected arm.
Extracorporeal shock-wave therapy (ESWT) is one of the commonly utilized treatment modalities that we discussed last week.
ESWT’s mechanism has not been completely clarified, which may include direct stimulation of healing, neovascularization, direct suppressive effects on nociceptors, and a hyperstimulation mechanism blocking the gate control.
ESWT is not the solution when seeking to reverse LE but surely this treatment modality can help improve the symptoms of LE.
Another treatment modality that is great for LE is acupuncture. Acupuncture is a simple, inexpensive, and beneficial treatment for musculoskeletal diseases, especially to address pain.
Yet, present data show conflicting results. Two systematic reviews have not concluded whether or not acupuncture was effective for LE.
This week we continue our discussion on other treatment modalities for LE.
Autologous Blood Injection (ABI) has been proven to be effective and widely used for treatment of LE. Some experts say that ABI works by initiating the inflammatory response around the affected tendon, resulting in cellular and humoral mediators to induce healing.
There are other experts that see ABI delivering growth factors inducing fibroblastic mitosis, triggering stem cells, and angiogenesis, probably promoting angiogenesis and collagen formation.
ABI may achieve good results in the short term; however, no benefit has been found in the medium- or long-term.
ABI has high risks of injection site pain and skin reaction.
This treatment should be limited to those recalcitrant cases when other modes of treatment are less effective.
Another treatment method is the Platelet-Rich Plasma (PRP) injection. The exact mechanisms of PRP is unknown. Some experts attribute the LE treatment to platelets releasing high concentrations of platelet-derived growth factors enhancing wound healing, bone healing, and tendon healing.
Yet studies report conflicting results, which make it hard to draw clear conclusions on how PRP can help treat LE.
Several studies have revealed that PRP does not provide significant benefits over corticosteroids, ABI, or even saline injections.
Surgery is another option for LE treatment. This can be an option for patients with persistent pain and disability that have failed appropriate non-operative management of LE.
Next week, we shall continue our discussion on the various treatment modalities that can be used to treat LE.