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Tennis elbow: sonographic findings and intratendinous injection treatment
Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
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 [en]
tennis elbow, ultrasound, colour Doppler, injections, catecholamines
Nationell ämneskategori
Klinisk vetenskap
Identifikatorer
URN: urn:nbn:se:umu:diva-1857ISBN: 978-91-7264-639-1 (tryckt)OAI: oai:DiVA.org:umu-1857DiVA, id: diva2:142210
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
Delarbeten
1. Extensor origin vascularity related to pain in patients with Tennis elbow
Öppna denna publikation i ny flik eller fönster >>Extensor origin vascularity related to pain in patients with Tennis elbow
2006 (Engelska)Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 14, nr 7, s. 659-663Artikel i tidskrift (Refereegranskat) Published
Nyckelord
Anesthetics; Local/administration & dosage, Blood Flow Velocity, Case-Control Studies, Female, Hand Strength, Humans, Injections; Intra-Articular, Lidocaine/administration & dosage, Male, Middle Aged, Pain Measurement, Tendons/*blood supply/*ultrasonography, Tennis Elbow/*physiopathology/*ultrasonography, Ultrasonography/methods, Weight-Bearing
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:umu:diva-3480 (URN)10.1007/s00167-006-0060-7 (DOI)
Tillgänglig från: 2008-09-22 Skapad: 2008-09-22 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
2. Sclerosing polidocanol injections in chronic painful tennis elbow: promising results in a pilot study
Öppna denna publikation i ny flik eller fönster >>Sclerosing polidocanol injections in chronic painful tennis elbow: promising results in a pilot study
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
Nyckelord
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:nbn:se:umu:diva-3481 (URN)10.1007/s00167-006-0156-0 (DOI)
Tillgänglig från: 2008-09-22 Skapad: 2008-09-22 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
3. Pain relief after intratendinous injections in patients with tennis elbow: results of a randomised study
Öppna denna publikation i ny flik eller fönster >>Pain relief after intratendinous injections in patients with tennis elbow: results of a randomised study
2008 (Engelska)Ingår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 42, nr 4, s. 267-271Artikel i tidskrift (Refereegranskat) Published
Nationell ämneskategori
Idrottsvetenskap
Identifikatorer
urn:nbn:se:umu:diva-3482 (URN)10.1136/bjsm.2007.042762 (DOI)
Tillgänglig från: 2008-09-22 Skapad: 2008-09-22 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
4. A 2-year sonographic follow-up after intratendinous injection therapy in patients with tennis elbow
Öppna denna publikation i ny flik eller fönster >>A 2-year sonographic follow-up after intratendinous injection therapy in patients with tennis elbow
2010 (Engelska)Ingår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 44, nr 8, s. 584-587Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background Tennis elbow is a tendinopathy affecting the upper extremity. Recent studies have shown high sensitivity for ultrasound (US) examination and high specificity for colour Doppler (CD) examination. There are no mid- or long-term follow-up investigations of the tendon structure and blood flow using these techniques.

Objective To use US and CD to study structure and blood flow in the extensor origin in patients with tennis elbow treated with intratendinous injections.

Design Follow-up study

Setting Sports Medicine Unit, Umeå University.

Patients 25 patients (28 elbows), mean age 46 years (range 27–66), treated with intratendinous injections due to chronic pain from tennis elbow.

Method US and CD examination of the extensor origin was carried out at inclusion and at follow-up two years after intratendinous injection treatment with polidocanol and/or a local anaesthetic.

Main outcome measurements US (structure) and CD (blood flow) findings.

Results All patients had structural tendon changes and high blood flow at inclusion when given the injection treatment. At the two-year follow-up, structural tendon changes were seen in 20/28 elbows and high blood flow was seen in 4/28 elbows. The majority of patients with a good clinical result after treatment had no visible blood flow (17/20), but the structural changes showed no relation to a good result (13/20 remaining changes).

Conclusions Doppler findings, but not structure, might be related to the clinical result after intratendinous injection treatment of tennis elbow.

Ort, förlag, år, upplaga, sidor
BMJ Publishing Group, 2010
Nyckelord
Tennis elbow, injection treatment
Nationell ämneskategori
Medicin och hälsovetenskap Idrottsvetenskap
Forskningsämne
rehabiliteringsmedicin
Identifikatorer
urn:nbn:se:umu:diva-3483 (URN)10.1136/bjsm.2008.049874 (DOI)000278712200010 ()
Tillgänglig från: 2008-09-22 Skapad: 2008-09-22 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
5. Immunohistochemical evidence of local production of catecholamines in cells of the muscle origins at the lateral and medial humeral epicondyles: of importance for the development of tennis and golfer's elbow?
Öppna denna publikation i ny flik eller fönster >>Immunohistochemical evidence of local production of catecholamines in cells of the muscle origins at the lateral and medial humeral epicondyles: of importance for the development of tennis and golfer's elbow?
2009 (Engelska)Ingår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 43, nr 4, s. 269-275Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: Tennis elbow (TE) is a painful condition affecting the common extensor origin at the lateral humeral epicondyle. Colour Doppler examination has shown increased blood flow at this site and the sensory, and sympathetic innervation patterns have been delineated. However, it is not known whether there is local production of catecholamines and/or acetylcholine in this tissue, which is the case in patellar and Achilles tendinopathies. OBJECTIVE: To investigate the possible presence of local production of catecholamines and acetylcholine in non-neuronal cells (fibroblasts) in connective tissue at the muscle origin at the lateral humeral epicondyle in patients with TE. DESIGN: Immunohistochemical studies were performed on biopsies taken from the extensor origin in patients with TE and in pain-free controls. For reference purpose, biopsies from the flexor origin in patients with golfer's elbow (GE) were also studied. PATIENTS: Seven patients with TE and four patients with GE. Six healthy asymptomatic individuals served as controls. Method: Immunohistochemistry, using antibodies detecting synthesising enzymes for catecholamines (tyrosine hydroxylase; TH) and acetylcholine (choline acetyltransferase; ChAT). RESULTS: TH-like immunohistochemical reactions were seen in fibroblasts in four of the seven patients with TE and two of the four patients with GE. No such reactions were detected in controls (0/6). No ChAT reactions were seen in any of the investigated specimens. CONCLUSIONS: There is evidence of local, non-neuronal production of catecholamines, but not acetylcholine, in fibroblasts in the tissue at the muscle origin at the lateral and medial epicondyles in patients with TE and GE, respectively, which might have an influence on blood vessel regulation and pain mechanisms in these conditions.

Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:umu:diva-32029 (URN)10.1136/bjsm.2008.054619 (DOI)19155232 (PubMedID)
Tillgänglig från: 2010-02-26 Skapad: 2010-02-26 Senast uppdaterad: 2018-06-08Bibliografiskt granskad

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