Injectant | SORT recommendation | Anatomical evaluation | Injectant preparation | Added injectants | Injection technique | Volume injected | Injection schedule |
Polidocanol | 2B | Palpatory exam, U/S and Colour Doppler exam; elbow structures are examined while seated, with arm resting on a table in 70–80 degrees of elbow flexion and wrist pronation | None; stock polidocanol 10 mg/ml solution used | None | U/S and Colour Doppler-guided injections at the common extensor origin at the lateral epicondyle. The aim is to inject polidocanol intravascularly; however, due to the small size of neovessels, the solution may be delivered perivascularly. | 0.4–1.1 ml; one injection, using three to five needle sticks to ensure coverage of neovessels | One to two injection sessions, approximately 3 months apart |
Autologous Whole Blood | 3C | Palpatory exam ± U/S exam | 2 ml autologous whole blood collected at the time of injection | Topical anaesthetic | Injection to undersurface of extensor carpi radialis brevis46 47 or area of maximal tendon disruption on U/S exam33 | 2 ml | Study-dependent; one to three injection sessions, approximately 1 month apart |
Platelet-Rich Plasma | 2B | Palpatory exam | Preparation of syringes with anticoagulant, then 20–60 ml of whole blood is drawn from peripheral vein | Proprietary, kit-dependent; anticoagulant | U/S-guided single injection, using five to seven needle sticks, 1 cm distal to the origin of the common extensor tendon | 1 ml per cm2 of involved tissue, up to total of 2–3 ml | Single injection session |
Blood is centrifuged | |||||||
Preparation of the injection site with local anaesthetic | |||||||
Prolotherapy | 1B | Palpatory exam | None; injectant prepared from stock solution of 50% dextrose and 5% morrhuate sodium | Saline and topical anaesthetics: lidocaine and sensorcaine | Injection at tender entheses of ligament and tendon structures at the lateral epicondyle and supracondylar ridge; precise location and number of injections per session as well as the number of sessions per treatment course are patient-specific, determined by exam | 0.5 ml per injection, three to five injections per session | 3 monthly sessions |
U/S, ultrasound