Management of Lateral Epicondylitis (Part 7)
We continue this week our series, discussing the treatment measures for Lateral Epicondylitis (LE).
Let’s have a recap of the modalities that were discussed last week.
We start our recap by discussing autologous blood injection (ABI) – 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 duration following the treatment, however, no benefit has been found in the medium or long-term duration following the treatment.
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.
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. Surgery can be an option for patients with persistent pain and disability that have failed appropriate non-operative management of LE.
This week, we continue with the other treatment modalities for LE.
There are three surgical approaches to treat LE, which are open, percutaneous, and arthroscopic techniques.
The focus of surgery to treat LE is to debride the degenerated portion of the extensor carpi radialis brevis (ECRB) with or without repairing the ECRB tendon.
Surgery can provide good results.
Let’s discuss open surgery as a modality for the treatment of LE. It involves a small lateral incision with dissection and degenerated tendon identification. Surgery is performed as a means to repair the tendon. It can also be performed in order to lengthen band fix the tendon for treatment of LE.
The short-term results of surgery is classified by patients as good to excellent by 85% of patients with an overall improvement rate of 98% and a return to full activity in 85% of patients.
About 84% of patients reported little or no pain, and 92% patients returned to normal elbow range of motion, while 93% of patients could return to their sports, after surgery. The overall improvement rate was 97%.
Percutaneous surgical approach is mainly used for releasing the common extensor tendon origin at the LE.
This surgical technique is known to be safe, reliable, and cost-effective.
Elbow arthroscopy has been used for the treatment of LE. It is a minimally invasive and efficient surgical procedure.
Various studies show a lower complication rate of arthroscopic treatment than that of open and percutaneous surgeries.
We just concluded the discussion on the different treatment modalities on LE. Next week, we move on to another topic.