EFFICACY OF A SINGLE-INJECTION SODIUM HYALURONATE TREATMENT IN LATERAL EPICONDYLITIS

Authors

  • Inam Ullah Khan DHQ Hospital Battagram
  • Abdus Saboor Awan District Headquarter Hospital District Battagram
  • Aimal Sattar Khan Lady Reading Hospital, Peshawar
  • Imran Marwat
  • Muhammad Meraj

Abstract

 Background: Lateral epicondylitis or tennis elbow is a disease of tendons arising from common extensor origin at the lateral epicondyle of elbow and is commonly characterized by pain on supination of forearms as well as extension of fingers and wrists. Methods: This descriptive case series aims to determine the efficacy of a single-injection sodium hyaluronate treatment for lateral epicondylitis. The study was conducted at the Department of Orthopaedics. Ayub Teaching Hospital Abbottabad. From February 1 to August 31, 2014. Patients diagnosed with lateral epicondylitis were administered 1 cc of 1% Sodium hyaluronate 1 cm from the lateral epicondyle into the soft tissue. Results: Hyaluronic acid is more effective in patients with moderate pain of lateral epicondylitis (VAS score ≤7 than in patients with severe pain (VAS score >7). Paired sample t-test was used to compared the means of the pre- and post-procedure VAS score and the difference was found to be statistically very significant (p=0.00) with a mean±SD change in VAS of 2.31±1.35 at 4 weeks. Conclusion: A single injection of sodium hyaluronate is effective in management of moderate, but not severe pain of lateral epicondylitis.Keywords: Elbow; lateral epicondylitis; pain; sodium hyaluronate; tennis; corticosteroids

Author Biographies

Inam Ullah Khan, DHQ Hospital Battagram

Medical Officer

Abdus Saboor Awan, District Headquarter Hospital District Battagram

District Orthopedic Surgeon 

Aimal Sattar Khan, Lady Reading Hospital, Peshawar

Medical Officer

References

Orchard J, Kountouris A. The management of tennis elbow. BMJ 2011;342:d2687.

Ahmed GS, Ali M, Trago IA. Tennis elbow: role of local steroid injection. J Ayub Med Coll Abbottabad 2012;24(2):84–6.

Chesterton LS, Mallen CD, Hay EM. Management of tennis elbow. Open Access J Sports Med 2011;2:53–9.

Petrella RJ, Cogliano A, Decaria J, Mohamed N, Lee R. Management of Tennis Elbow with sodium hyaluronate periarticular injections. Sports Med Arthrosc Rehabil Ther Technol 2010;2:4.

Dlabach J, Miller R. Shoulder and Elbow Injuries. In: Canale ST, Beaty JH, Campbell WC, editors. Campbell’s operative orthopaedics. 12th ed. Vol. III. St. Louis, Mo.: Elevier/Mosby; 2012. p.2298–2345.

Ozturan KE, Yucel I, Cakici H, Guven M, Sungur I. Autologous blood and corticosteroid injection and extracoporeal shock wave therapy in the treatment of lateral epicondylitis. Orthopedics 2010;33(2):84–91.

Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 2010;376(9754):1751–67.

Tsai WY, Wu JL, Liu CC, Cherng CH, Tsai RY, Jean YH, et al. Early intraarticular injection of hyaluronic acid attenuates osteoarthritis progression in anterior cruciate ligament-transected rats. Connect Tissue Res 2013;54(1):49–54.

Bannuru R, Vaysbrot E, Agni M, Sullivan M, McAlindon TE. Hyaluronic acid: as effective as NSAIDS for knee osteoarthritis. A meta-analysis. Osteoarthritis Cartilage 2013;21:S298–9.

Wood N, Burton J. Bursitis and periarticular inflammation. In: Thomas SH, editor. Emergency department analgesia an evidence-based guide. Leiden: Cambridge University Press; 2008. p.145–50.

Petrella MJ, Cogliano A, Petrella RJ. Original research: long-term efficacy and safety of periarticular hyaluronic acid in acute ankle sprain. Phys Sportsmed 2009;37(1):64–70.

Beckett KS, McConnell P, Lagopoulos M, Newman RJ. Variations in the normal anatomy of the collateral ligaments of the human elbow joint. J Anat 2000;197(Pt 3):507–11.

Walz DM, Newman JS, Konin GP, Ross G. Epicondylitis: pathogenesis, imaging, and treatment. Radiographics 2010;30(1):167–84.

Chen J, Wang A, Xu J, Zheng M. In chronic lateral epicondylitis, apoptosis and autophagic cell death occur in the extensor carpi radialis brevis tendon. J Shoulder Elbow Surg 2010;19(3):355–62.

Coombes BK, Bisset L, Vicenzino B. A new integrative model of lateral epicondylalgia. Br J Sports Med 2009;43(4):252–8.

Hanson EC. Sodium hyaluronate--application in a community practice. Am J Orthop (Belle Mead NJ) 1999;28(11 Suppl):11–2.

Judson CH, Wolf JM. Lateral epicondylitis: review of injection therapies. Orthop Clin North Am 2013;44(4):615–23.

Yagi M, Sato N, Mitsui Y, Gotoh M, Hamada T, Nagata K. Hyaluronan modulates proliferation and migration of rabbit fibroblasts derived from flexor tendon epitenon and endotenon. J Hand Surg Am 2010;35(5):791–6.

Kumai T, Muneta T, Tsuchiya A, Shiraishi M, Ishizaki Y, Sugimoto K, et al. The short-term effect after a single injection of high-molecular-weight hyaluronic acid in patients with enthesopathies (lateral epicondylitis, patellar tendinopathy, insertional Achilles tendinopathy, and plantar fasciitis): a preliminary study. J Orthop Sci 2014;19(4):603–11.

Petrella R, Cogliano A, Decruze A. SAT0602 Management of epicondylitis with single local injection of sodium hyaluronate. Ann Rheum Dis 2017;76(Suppl 2):1002.

Dong W, Goost H, Lin XB, Burger C, Paul C, Wang ZL, et al. Injection therapies for lateral epicondylalgia: a systematic review and Bayesian network meta-analysis. Br J Sport Med 2016;50(15):900–8.

Published

2018-01-02

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