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A 2-year sonographic follow-up after intratendinous injection therapy in patients with tennis elbow
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
2010 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 44, no 8, 584-587 p.Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
BMJ Publishing Group , 2010. Vol. 44, no 8, 584-587 p.
Keyword [en]
Tennis elbow, injection treatment
National Category
Medical and Health Sciences Sport and Fitness Sciences
Research subject
Rehabilitation Medicine
Identifiers
URN: urn:nbn:se:umu:diva-3483DOI: 10.1136/bjsm.2008.049874ISI: 000278712200010OAI: oai:DiVA.org:umu-3483DiVA: diva2:142208
Available from: 2008-09-22 Created: 2008-09-22 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Tennis elbow: sonographic findings and intratendinous injection treatment
Open this publication in new window or tab >>Tennis elbow: sonographic findings and intratendinous injection treatment
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Umeå: Idrottsmedicin, 2008. 79 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1207
Keyword
tennis elbow, ultrasound, colour Doppler, injections, catecholamines
National Category
Clinical Science
Identifiers
urn:nbn:se:umu:diva-1857 (URN)978-91-7264-639-1 (ISBN)
Public defence
2008-10-10, Hörsal B, Samhällsvetarhuset, Umeå universitet, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2008-09-22 Created: 2008-09-22 Last updated: 2010-03-03Bibliographically approved

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