polidocanol and Tennis-Elbow

Injection therapy with glucocorticoids has been used since the 1950s as a treatment strategy for lateral epicondylitis (tennis elbow). Lately, several novel injection therapies have become available.. To assess the comparative effectiveness and safety of injection therapies in patients with lateral epicondylitis.. Systematic review and meta-analysis.. Randomized controlled trials comparing different injection therapies for lateral epicondylitis were included provided they contained data for change in pain intensity (primary outcome). Trials were assessed using the Cochrane risk of bias tool. Network (random effects) meta-analysis was applied to combine direct and indirect evidence within and across trial data using the final end point reported in the trials, and results for the arm-based network analyses are reported as standardized mean differences (SMDs).. Seventeen trials (1381 participants; 3 [18%] at low risk of bias) assessing injection with 8 different treatments-glucocorticoid (10 trials), botulinum toxin (4 trials), autologous blood (3 trials), platelet-rich plasma (2 trials), and polidocanol, glycosaminoglycan, prolotherapy, and hyaluronic acid (1 trial each)-were included. Pooled results (SMD [95% confidence interval]) showed that beyond 8 weeks, glucocorticoid injection was no more effective than placebo (-0.04 [-0.45 to 0.35]), but only 1 trial (which did not include a placebo arm) was at low risk of bias. Although botulinum toxin showed marginal benefit (-0.50 [-0.91 to -0.08]), it caused temporary paresis of finger extension, and all trials were at high risk of bias. Both autologous blood (-1.43 [-2.15 to -0.71]) and platelet-rich plasma (-1.13 [-1.77 to -0.49]) were also statistically superior to placebo, but only 1 trial was at low risk of bias. Prolotherapy (-2.71 [-4.60 to -0.82]) and hyaluronic acid (-5.58 [-6.35 to -4.82]) were both more efficacious than placebo, whereas polidocanol (0.39 [-0.42 to 1.20]) and glycosaminoglycan (-0.32 [-1.02 to 0.38]) showed no effect compared with placebo. The criteria for low risk of bias were only met by the prolotherapy and polidocanol trials.. This systematic review and network meta-analysis of randomized controlled trials found a paucity of evidence from unbiased trials on which to base treatment recommendations regarding injection therapies for lateral epicondylitis.

Topics: Blood Transfusion, Autologous; Botulinum Toxins; Glucocorticoids; Humans; Hyaluronic Acid; Platelet-Rich Plasma; Polidocanol; Polyethylene Glycols; Randomized Controlled Trials as Topic; Sclerosing Solutions; Tennis Elbow; Viscosupplements

To appraise existing evidence for prolotherapy, polidocanol, autologous whole blood and platelet-rich plasma injection therapies for lateral epicondylosis (LE).. Systematic review.. Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine.. names and descriptors of the therapies and LE.. All human studies assessing the four therapies for LE.. Results of five prospective case series and four controlled trials (three prolotherapy, two polidocanol, three autologous whole blood and one platelet-rich plasma) suggest each of the four therapies is effective for LE. In follow-up periods ranging from 9 to 108 weeks, studies reported sustained, statistically significant (p<0.05) improvement in visual analogue scale primary outcome pain score measures and disease-specific questionnaires; relative effect sizes ranged from 51% to 94%; Cohen's d ranged from 0.68 to 6.68. Secondary outcomes also improved, including biomechanical elbow function assessment (polidocanol and prolotherapy), presence of abnormalities and increased vascularity on ultrasound (autologous whole blood and polidocanol). Subjects reported satisfaction with therapies on single-item assessments. All studies were limited by small sample size.. There is strong pilot-level evidence supporting the use of prolotherapy, polidocanol, autologous whole blood and platelet-rich plasma injections in the treatment of LE. Rigorous studies of sufficient sample size, assessing these injection therapies using validated clinical, radiological and biomechanical measures, and tissue injury/healing-responsive biomarkers, are needed to determine long-term effectiveness and safety, and whether these techniques can play a definitive role in the management of LE and other tendinopathies.

Topics: Blood Transfusion, Autologous; Humans; Injections; Naturopathy; Platelet-Rich Plasma; Polidocanol; Polyethylene Glycols; Randomized Controlled Trials as Topic; Sclerosing Solutions; Tennis Elbow

To compare three different ultrasound-guided injections for chronic tennis elbow.. Assessor-blinded, randomized controlled comparative trial.. 44 patients with clinically diagnosed tennis elbow, confirmed by Doppler ultrasound, received under ultrasound guidance, a single corticosteroid injection (n=14), or two injections (separated by 4 weeks) of either autologous blood (n=14) or polidocanol (n=16). Clinical and ultrasound examination was performed at baseline, 4, 12 and 26 weeks.. Complete recovery or much improvement was greater for corticosteroid injection than autologous blood and polidocanol at 4 weeks (p<0.001, number needed to treat 1 (95% CI 1-2)). In contrast, at 26 weeks corticosteroid was significantly worse than polidocanol (p=0.004, number needed to harm 2 (1-6)). Recurrence after corticosteroid injection was significantly higher than autologous blood or polidocanol (p=0.007, number needed to harm 2 (1-4)). Corticosteroid injection produced greater reduction in tendon thickness and vascularity than autologous blood at 4 weeks only. Compared to autologous blood, polidocanol reduced tendon thickness at 4 and 12 weeks and reduced echogenicity and hyperaemia after 12 or 26 weeks respectively.. Injections of corticosteroid cannot be recommended over polidocanol or autologous blood, because despite beneficial short-term effect there were inferior long-term effects. Whether polidocanol or autologous blood injections are effective is unknown, especially as their global effect profiles are not unlike previously reported for wait-and-see.

Topics: Adrenal Cortex Hormones; Adult; Anti-Inflammatory Agents; Blood Transfusion, Autologous; Female; Follow-Up Studies; Humans; Injections; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Single-Blind Method; Tennis Elbow; Treatment Outcome; Ultrasonography, Doppler, Color; Ultrasonography, Interventional

"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.. 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.. Prospective, randomised, controlled, double-blind, crossover study.. Sports Medicine Unit, Umeå University.. 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.. 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).. Satisfaction with treatment (Yes/No), elbow pain during activity (visual analogue scale), and maximum voluntary grip strength.. 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.. US and CD guided intratendinous injections gave pain relief in patients with tennis elbow. Polidocanol and lidocaine plus epinephrine injections gave similar results.

Topics: Adult; Aged; Anesthetics, Local; Cross-Over Studies; Double-Blind Method; Drug Therapy, Combination; Epinephrine; Female; Follow-Up Studies; Humans; Injections, Intra-Articular; Lidocaine; Male; Middle Aged; Pain Measurement; Patient Satisfaction; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Tennis Elbow; Treatment Outcome; Ultrasonography, Doppler, Color

Topics: Glucose; Humans; Injections, Intralesional; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sodium Morrhuate; Tennis Elbow

Sclerosing polidocanol injections targeting the area with neovessels (vascularity) have been demonstrated to give promising clinical results in patients with chronic painful Achilles and patellar tendinosis. Recently, we demonstrated vascularity in the extensor origin in patients with chronic painful tennis elbow, but not in controls with pain-free elbows. In this pilot study, 11 patients (four men and seven women, mean age 46 years) with the diagnosis of tennis elbow in altogether 13 elbows, were included. All patients had a long duration of pain symptoms (mean 23 months), and ultrasonography (US) + colour Doppler (CD) examination showed structural tendon changes with hypo-echoic areas, and a vascularity, corresponding to the painful area in the extensor origin. All patients were treated with US- and CD-guided injections of the sclerosing substance polidocanol, targeting the area with vascularity. At 8-month follow-up after treatment, there was a good clinical result in 11/13 elbows. Extensor origin pain during wrist loading activities (recorded on a VAS-scale) was significantly reduced (mean VAS from 75 to 34; P < 0.003), and maximal grip strength was significantly increased (from 29 to 40 kg; P < 0.025). Our findings indicate that one treatment with sclerosing polidocanol injections, targeting the area with vascularity in the extensor origin, has a potential to reduce the tendon pain and increase grip strength, in patients with chronic painful tennis elbow.

Topics: Adult; Arthralgia; Chronic Disease; Female; Follow-Up Studies; Humans; Injections, Intra-Articular; Male; Middle Aged; Patient Satisfaction; Pilot Projects; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Tendons; Tennis Elbow; Treatment Outcome; Ultrasonography, Doppler, Color; Ultrasonography, Interventional

Topics: Achilles Tendon; Humans; Patellar Ligament; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Tendinopathy; Tennis Elbow