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Sclerosing polidocanol injections in chronic painful tennis elbow: promising results in a pilot study
Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper.
Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
2006 (Engelska)Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 14, nr 11, s. 1218-1224Artikel i tidskrift (Refereegranskat) Published
Ort, förlag, år, upplaga, sidor
2006. Vol. 14, nr 11, s. 1218-1224
Nyckelord [en]
Adult, Arthralgia/*therapy/ultrasonography, Chronic Disease, Female, Follow-Up Studies, Humans, Injections; Intra-Articular, Male, Middle Aged, Patient Satisfaction, Pilot Projects, Polyethylene Glycols/*therapeutic use, Sclerosing Solutions/*therapeutic use, Tendons/blood supply/innervation, Tennis Elbow/*therapy/ultrasonography, Treatment Outcome, Ultrasonography; Doppler; Color, Ultrasonography; Interventional
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:umu:diva-3481DOI: 10.1007/s00167-006-0156-0OAI: oai:DiVA.org:umu-3481DiVA, id: diva2:142206
Tillgänglig från: 2008-09-22 Skapad: 2008-09-22 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
Ingår i avhandling
1. Tennis elbow: sonographic findings and intratendinous injection treatment
Öppna denna publikation i ny flik eller fönster >>Tennis elbow: sonographic findings and intratendinous injection treatment
2008 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Tennis elbow (TE) is a relatively common painful condition affecting the upper extremity. The aetiology is not known, but TE is most often seen in middle aged individuals using repetitive and forceful gripping at work or recreational activities, and is referred to overuse injuries. The pathogenesis is not known, but there are so-called degenerative changes in the wrist- and finger-extensor muscle origin (common extensor origin - CEO). The pain mechanisms involved have not been scientifically clarified.

The studies in the present thesis aimed to 1) evaluate the structure and blood flow using ultrasound (US) and colour Doppler (CD) examinations of the CEO in patients with TE, and in pain-free elbows, 2) evaluate the clinical effects of US- and CD-guided intratendinous injection treatment with the sclerosing substance polidocanol, 3) evaluate the long term (2 years) effects of injection treatment on the tendon structure and blood flow, and 4) investigate if there is a local production of sympathetic and parasympathetic signal substances in non-neural cells in the CEO.

Structural tendon changes and high blood flow was found in the CEO in patients with TE, but not in pain-free controls. Remaining structural changes and additional bone spur formation at the lateral epicondyle, but not high blood flow, were seen 2 years after successful injection treatment. In a randomised double-blind study, US- and CD-guided intratendinous injection treatment with sclerosing polidocanol or the local anaesthetic lidocaine combined with epinephrine, targeting the region with high blood flow, was found to reduce pain and increase grip strength in patients with TE. There were no differences in the outcome between the two treatment groups. A local production of catecholamines, but not acetylcholine, was found in fibroblasts in the CEO, in patients with TE.

This thesis presents results showing US and CD examinations to be useful methods to diagnose TE, and to evaluate structure and blood flow in the CEO after treatment. US- and CD-guided injection treatment targeting high blood flow in the region with structural changes can reduce pain symptoms in patients with TE. The localised high blood flow, and local production of catecholamines in the tendon cells in the CEO, might be involved in the pain mechanisms.

Ort, förlag, år, upplaga, sidor
Umeå: Idrottsmedicin, 2008. s. 79
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1207
Nyckelord
tennis elbow, ultrasound, colour Doppler, injections, catecholamines
Nationell ämneskategori
Klinisk vetenskap
Identifikatorer
urn:nbn:se:umu:diva-1857 (URN)978-91-7264-639-1 (ISBN)
Disputation
2008-10-10, Hörsal B, Samhällsvetarhuset, Umeå universitet, Umeå, 13:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2008-09-22 Skapad: 2008-09-22 Senast uppdaterad: 2010-03-03Bibliografiskt granskad

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Zeisig, EvaAlfredson, Håkan

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