Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Comparison of the effectiveness of extensor muscle strengthening exercise by itself, exercise with polydeoxyribonucleotide injection, and exercise with extracorporeal shockwave therapy in lateral epicondylitis: a randomized controlled trial

  • Shim, Bum Jin (Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College) ;
  • Seo, Eun-Min (Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College) ;
  • Hwang, Jung-Taek (Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College) ;
  • Kim, Do-Young (Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College) ;
  • Yang, Jae-Shin (Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College) ;
  • Seo, Su-Jung (Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College) ;
  • Hong, Myung Sun (Department of Radiology, Chuncheon Sacred Heart Hospital, Hallym University Medical College)
  • Received : 2021.05.10
  • Accepted : 2021.07.26
  • Published : 2021.12.01
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Abstract

Background: Extensor muscle strengthening exercises with counterforce braces (EX) is a conventional conservative treatment for lateral epicondylitis (LE) of the elbow. In addition, polydeoxyribonucleotide (PDRN) or extracorporeal shockwave therapy (ESWT) has been recently used for LE. Methods: Sixty-three patients with chronic LE participated in this study and randomly allocated in three groups (G1: EX, G2: EX+PDRN injection, and G3: EX+ESWT). All of the three groups were taught to perform EX at the first out-patient department (OPD) visit. Group 2 was injected with 3 mL PDRN (5.625 mg/3 mL), while group 3 received ESWT at the first OPD visit. Visual analog scale pain score, Mayo elbow performance score (MEPS), and ultrasonographic examination were checked before, 6 weeks, and 12 weeks after the treatments. Results: Overall functional scores and ultrasonographic findings in all three groups improved after treatment. The mean MEPS in group 2 improved more than groups 1 and 3 at 6 weeks (G1, 56.9>62.4; G2, 54.3>65.0; G3, 55.7>62.6), and more than group 1 at 12 weeks (G1, 56.9>67.9; G2, 54.3>73.6). The mean common extensor tendon depth (CETD) on ultrasonography in group 2 increased more than groups 1 and 3 at 6 and 12 weeks (6 weeks: G1, 0.385>0.386; G2, 0.332>0.392; G3, 0.334>0.357; 12 weeks: G1, 0.385>0.409; G2, 0.332>0.438; G3, 0.334>0.405 [cm]). Conclusions: PDRN injections combined with EX exhibited a greater improvement in mean MEPS and mean CETD compared to EX only or EX combined with ESWT for LE within the 12 weeks follow-up.

Keywords

Acknowledgement

The authors wish to thank the orthopedic nurses, Yun-Il Choe, Byeong-Yi Choi, and Ye-Rin Yoon for checking the visual analog scale score and Mayo elbow performance score and helping with the ultrasonographic examinations.

References

  1. Gunduz R, Malas Fu, Borman P, Kocaoglu S, Ozcakar L. Physical therapy, corticosteroid injection, and extracorporeal shock wave treatment in lateral epicondylitis: clinical and ultrasonographical comparison. Clin Rheumatol 2012;31:807-12. https://doi.org/10.1007/s10067-012-1939-y
  2. Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial. Am J Sports Med 2013; 41:625-35. https://doi.org/10.1177/0363546512472975
  3. Kim GM, Yoo SJ, Choi S, Park YG. Current trends for treating lateral epicondylitis. Clin Shoulder Elb 2019;22:227-34. https://doi.org/10.5397/cise.2019.22.4.227
  4. Lee GJ, Park D. Usefulness of polydeoxyribonucleotide as an alternative to corticosteroids in patients with lateral epicondyitis: a case series. Medicine (Baltimore) 2018;97:e10809. https://doi.org/10.1097/MD.0000000000010809
  5. Altavilla D, Squadrito F, Polito F, et al. Activation of adenosine A2A receptors restores the altered cell-cycle machinery during impaired wound healing in genetically diabetic mice. Surgery 2011;149:253-61. https://doi.org/10.1016/j.surg.2010.04.024
  6. Galeano M, Bitto A, Altavilla D, et al. Polydeoxyribonucleotide stimulates angiogenesis and wound healing in the genetically diabetic mouse. Wound Repair Regen 2008;16:208-17. https://doi.org/10.1111/j.1524-475x.2008.00361.x
  7. Kwon DR, Park GY, Moon YS, Lee SC. Therapeutic effects of umbilical cord blood-derived mesenchymal stem cells combined with polydeoxyribonucleotides on full-thickness rotator cuff tendon tear in a rabbit model. Cell Transplant 2018;27:1613-22. https://doi.org/10.1177/0963689718799040
  8. Dedes V, Tzirogiannis K, Polikandrioti M, Dede AM, Mitseas A, Panoutsopoulos GI. Comparison of radial extracorporeal shockwave therapy with ultrasound therapy in patients with lateral epicondylitis. J Med Ultrason (2001) 2020;47:319-25. https://doi.org/10.1007/s10396-019-01002-9
  9. Nirschl RP, Kraushaar BS. Keeping tennis elbow at arm's length: simple, effective strengthening exercises. Phys Sportsmed 1996; 24:61-2. https://doi.org/10.1080/00913847.1996.11947953
  10. Gulabi D, Uysal MA, Akca A, Colak I, Cecen GS, Gumustas S. USG-guided injection of corticosteroid for lateral epicondylitis does not improve clinical outcomes: a prospective randomised study. Arch Orthop Trauma Surg 2017;137:601-6. https://doi.org/10.1007/s00402-017-2657-3
  11. Aspenberg P, Virchenko O. Platelet concentrate injection improves Achilles tendon repair in rats. Acta Orthop Scand 2004; 75:93-9. https://doi.org/10.1080/00016470410001708190
  12. Franchini M, Cruciani M, Mengoli C, et al. Efficacy of platelet-rich plasma as conservative treatment in orthopaedics: a systematic review and meta-analysis. Blood Transfus 2018; 16:502-13.
  13. Stasinopoulos D, Johnson MI. Effectiveness of extracorporeal shock wave therapy for tennis elbow (lateral epicondylitis). Br J Sports Med 2005;39:132-6. https://doi.org/10.1136/bjsm.2004.015545
  14. Haake M, Konig IR, Decker T, et al. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis: a randomized multicenter trial. J Bone Joint Surg Am 2002;84:1982-91. https://doi.org/10.2106/00004623-200211000-00012
  15. Chung B, Wiley JP. Effectiveness of extracorporeal shock wave therapy in the treatment of previously untreated lateral epicondylitis: a randomized controlled trial. Am J Sports Med 2004; 32:1660-7. https://doi.org/10.1177/0363546503262806
  16. Ozkut AT, Kilincoglu V, Ozkan NK, Eren A, Ertas M. Extracorporeal shock wave therapy in patients with lateral epicondylitis. Acta Orthop Traumatol Turc 2007;41:207-10.
  17. Yelland M, Rabago D, Ryan M, et al. Prolotherapy injections and physiotherapy used singly and in combination for lateral epicondylalgia: a single-blinded randomised clinical trial. BMC Musculoskelet Disord 2019;20:509. https://doi.org/10.1186/s12891-019-2905-5
  18. Struijs PA, Kerkhoffs GM, Assendelft WJ, Van Dijk CN. Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both-a randomized clinical trial. Am J Sports Med 2004;32:462-9. https://doi.org/10.1177/0095399703258714