The Effectiveness of the Combination of PRP and ESWT in Lateral Epicondylitis
Condition: Musculoskeletal Diseases; Elbow Tendinitis; Lateral Epicondylitis; Platelet-Rich Plasma (PRP)
MeSH terms: Tennis Elbow; Musculoskeletal Diseases; Tendinopathy
Study type: Interventional

Summary: 
      The aim of this study is to determine the effectiveness of adding PRP or Sham PRP injection
      to ESWT treatment in patients with lateral epicondylitis on pain, muscle strength, functional
      activities, quality of life and work activities, and to determine the superiority of the
      treatments over each other.
    

Detailed description: 
      Lateral epicondylitis (LE) is one of the most common elbow problems. It is characterized by
      pain in the lateral epicondyle of the humerus and on the surface of the extensor muscles of
      the forearm. It is seen in those who perform activities involving repetitive forced wrist
      extension and can lead to chronic pain syndrome.

      Various treatment methods are used in the treatment of LE in order to reduce the patient's
      pain and increase his/her functional capacity. There are more than 40 treatment methods in
      the literature such as oral and local non-steroidal anti-inflammatory drugs (NSAID), cold
      application, deep friction massage, stretching and strengthening exercises, ultrasound,
      laser, ESWT, corticosteroid/botulinum toxin/glucosamine/autologous blood/platelet rich plasma
      (PRP) injections, prolotherapy, acupuncture, manipulation, and surgery.

      Extracorporeal shock wave therapy (ESWT) is a method that aims to provide treatment by
      focusing high amplitude sound waves on the area of the body to be applied.

      PRP is an autologous concentration of human platelets in a small volume of plasma produced by
      centrifuging a patient's own blood.

      This study was designed as a double-blind, prospective, placebo-controlled, randomized study.
      Participants were randomized into 3 groups: ESWT + therapeutic exercise, ESWT + Sham PRP
      injection + therapeutic exercise, ESWT + PRP injection + therapeutic exercise.

      Visual Pain Scale (VAS), Patient Rated Tennis Elbow Evaluation (PRTEE), Quick Disabilities of
      the Arm, Shoulder and Hand Score (Quick DASH), SF (Short form) -36 Quality of Life Scale,
      Handgrip strength with Jamar hydraulic hand dynamometer, Common extensor tendon thicknesses,
      peritendinous fluid, bone irregularities, calcifications, and diffuse tendon heterogeneity
      with ultrasound, upper extremity muscle strength with Isomed 2000 isokinetic device will be
      evaluated.

      It was planned that the evaluations were made and recorded by a blinded physician to the
      groups at the beginning of the treatment, at the 4th week and at the 12th week controls.
    

Intervention name(s): ESWT+Exercise; PRP+ESWT+Exercise; Sham PRP+ESWT+Exercise
Intervention type(s): Other; Procedure; Procedure
Intervention description(s): Radial ESWT treatment will be applied to patients for 3 weeks, once a week for a total of 3 sessions. Radial shock waves will be applied in circular motions by applying gel on the epicondylar area where the most pain and sensitivity is. In each session, 8 Hz, 2.0 bar, 2000 beats will be applied.
Therapeutic Exercise:
All patients will be taught a home exercise program including stretching and eccentric strengthening exercises by an experienced physiotherapist. The eccentric exercises consisted of the following: three sets of 10 repetitions for wrist and elbow ﬂexion; two sets of 10 repetitions for wrist extension strengthening, starting with 50% of maximum strength and density and increasing the resistance each week; and ﬁnally, two sets of 10 repetitions for the wrist ﬂexor and extensor muscle groups comprising 20s of stretching and 10s of relaxing using the unaﬀected hand. Exercise program will be done twice a day for 3 months.; Radial ESWT treatment will be applied to patients for 3 weeks, once a week for a total of 3 sessions. Radial shock waves will be applied in circular motions by applying gel on the epicondylar area where the most pain and sensitivity is. In each session, 8 Hz, 2.0 bar, 2000 beats will be applied.
Therapeutic Exercise:
All patients will be taught aforementioned home exercise program. Exercise program will be done twice a day for 3 months.
Procedure:
10 ml of venous blood taken from the patients will be put into the T-LAB® PRP kit (T-Biotechnology Laboratory, İstanbul, Turkey) and will then be centrifuged. Approximately 3 cc of the PRP obtained will be applied to the tendinosis area under USG guidance. All injections will be performed with long axis in-plane technique, using the ultrasound device (Esaote My Lab 70 XVision 6-18 Mhz linear probe).; Radial ESWT treatment will be applied to patients for 3 weeks, once a week for a total of 3 sessions. Radial shock waves will be applied in circular motions by applying gel on the epicondylar area where the most pain and sensitivity is. In each session, 8 Hz, 2.0 bar, 2000 beats will be applied.
Therapeutic Exercise:
All patients will be taught aforementioned home exercise program. Exercise program will be done twice a day for 3 months.
Procedure:
In Sham-PRP group,10 ml of venous blood will be taken and after the same waiting time 3 cc of 0.9% saline will be injected to the tendinosis area under USG guidance. All injections will be performed with long axis in-plane technique, using the ultrasound device (Esaote My Lab 70 XVision 6-18 Mhz linear probe).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Lateral Epicondylitis; Extracorporeal Shockwave Therapy (ESWT); Platelet-Rich Plasma (PRP)