ORIGINAL ARTICLE

Medial epicondylitis: is ultrasound guided autologous blood injection an effective treatment?

S P Suresh¹, K E Ali¹, H Jones², D A Connell¹

¹ Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
² Department of Rheumatology, Kingston Hospital NHS Trust, Kingston-Upon-Thames, Surrey KT2 7QB, UK

Correspondence to:
David A Connell
Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK; david.connell{at}rnoh.nhs.uk

Objective: To assess if ultrasound guided autologous blood injection is an effective treatment for medial epicondylitis.

Methods: Twenty patients (13 men, 7 women) with refractory medial epicondylitis with symptom duration of 12 months underwent sonographic evaluation. Tendinosis was confirmed according to three sonographic criteria: echo texture, interstitial tears and neovascularity. The tendon was then dry needled and autologous blood was injected. Patients were reviewed at 4 weeks and at 10 months. VAS scores and modified Nirschl scores were assessed pre-procedure and post-procedure.

Results: There was significant reduction in VAS pain score between pre-procedure and 10 months post-procedure when it had a median (IQR) of 1.00 (1–1.75), range 0–7. The median (IQR) Nirschl score, which at pre-procedure was 6.00 (5–7), range 4–7, had decreased at 4 weeks to 4.00 (2.25–5), range 2–7, and at 10 months to 1.00 (1–1.75), range 0–7, revealing a significant decrease (z = 3.763, p<0.001). The hypo-echoic change in the flexor tendon significantly decreased between pre-procedure, when there was a mean (SD) of 6.45 (1.47), and at 10 months, when it was 3.85 (2.37) (p<0.001). Doppler ultrasound showed that neovascularity decreased between pre-procedure, when there was a mean (SD) of 6.10 (1.62), range 4–9, and at 10 months, when it was 3.60 (2.56), range 0–9 (p<0.001).

Discussion: The combined action of dry needling and autologous blood injection under ultrasound guidance appears to be an effective treatment for refractory medial epicondylitis as demonstrated by a significant decrease in VAS pain and a fall in the modified Nirschl scores.

Keywords: autologous blood; medial epicondylitis; treatment; ultrasound

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Commentary

D P Beall³

³ Clinical Radiology, University of Oklahoma, Oklahoma City, Oklahoma, USA; dpb{at}okss.com

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Commentary

Andrea S Klauser⁴

⁴ Medical University Innsbruck, Radiology II, Innsbruck, Austria; andrea.klauser{at}uibk.ac.at

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