Pain relief after intratendinous injections in patients with Tennis elbow – results of a randomised study

Eva Zeisig ^1*, Martin Fahlström ², Lars Öhberg ³ and Håkan Alfredson ⁴

¹ Department of Surgical and Perioperative Sciences, Sports Medicine, Umeå University, Sweden
² Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Sweden
³ Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Sweden
⁴ Department of Surgical and Perioperative Science, Sports Medicine, Umeå University, Sweden

^* To whom correspondence should be addressed. E-mail: eva.zeisig{at}vll.se.

Accepted 12 January 2008

Abstract

Background: Tennis elbow is known to be difficult to treat. US- and 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 (Lidocain + Adrenalin), in patients with tennis elbow.

Design: Prospective, randomised, double-blinded, controlled, cross-over.

Setting: Sports Medicine Unit, Umeå University.

Patients: Thirty-two patients (thirty-six elbows), age 27-66 years, with a long duration of elbow pain diagnosed as tennis elbow, were included in the study. All patients were followed up three and twelve 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 P) or the local anaesthetic Lidocain + Adrenalin (Group L+A). At the 3-months follow-up, additional injection with Polidocanol were offered to both groups (cross-over for Group L+A).

Main Outcome Measurements: Satisfaction with treatment (Yes/No), elbow pain during activity (VAS), and maximum voluntary grip strength.

Results: There were no significant (p<0.05) differences in the outcome between Group P and Group L+A. In both groups, there was a significantly lower VAS at the three and twelve months follow-up, and the grip strength was significantly higher at the twelve months follow-up in Group P.

Conclusions: US- and CD-guided intra-tendinous injections gave pain relief in patients with tennis elbow. There were similar results using Polidocanol and Lidocain + Adrenalin injections.

Key Words: injections, pain, tennis elbow, treatment, ultrasonography

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