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Pain relief after intratendinous injections in patients with tennis elbow: results of a randomised study

¹ Department of Surgical and Perioperative Science, Sports Medicine, University of Umeå, Umeå, Sweden
² Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, University of Umeå, Umeå, Sweden
³ Department of Radiation Sciences, Diagnostic Radiology, University of Umeå, Umeå, Sweden

Correspondence to:
E Zeisig, Sports Medicine Unit, Department of Surgical and Perioperative Science, Umeå University, 901 87 Umeå, Sweden; eva.zeisig{at}vll.se

Background: "Tennis elbow" is a difficult condition to treat. Ultrasonography (US) and colour Doppler (CD) guided injections with polidocanol targeting the area with increased blood flow in the extensor origin have shown promising clinical results.

Objective: To evaluate and compare effects of US and CD guided intratendinous injections with sclerosing polidocanol and a local anaesthetic (lidocaine + epinephrine), in patients with tennis elbow.

Design: Prospective, randomised, controlled, double-blind, crossover study.

Setting: Sports Medicine Unit, Umeå University.

Patients: 32 patients (36 elbows), age range 27 to 66 years, with a long duration of elbow pain diagnosed as tennis elbow, were included in the study. All patients were followed up 3 and 12 months after treatment. Two patients were excluded due to other interventions during the study.

Interventions: One US and CD guided injection with the sclerosing agent polidocanol (group 1) or the local anaesthetic lidocaine plus epinephrine (group 2). At the 3 month follow-up, additional injections with polidocanol were offered to both groups (crossover for group 2).

Main outcome measures: Satisfaction with treatment (Yes/No), elbow pain during activity (visual analogue scale), and maximum voluntary grip strength.

Results: There were no significant (p<0.05) differences in the outcome between group 1 and group 2. In both groups, there was a significantly lower VAS at the 3-month and 12-month follow-ups, and grip strength was significantly higher at the 12-month follow-up.

Conclusions: US and CD guided intratendinous injections gave pain relief in patients with tennis elbow. Polidocanol and lidocaine plus epinephrine injections gave similar results.