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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPlatelet-rich plasma (PRP) was not more effective in relieving the pain due to epicondylitis (tennis elbow) compared with saline when each was delivered by ultrasound-guided injection. However, both groups showed significant decreases in pain scores from baseline at 6 months, suggesting to investigators that tendon stimulation may be the actual mechanism behind the observed lesion repair and improvement in pain symptoms.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EShoulder \u0026amp; Elbow Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EShoulder \u0026amp; Elbow Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPlatelet-rich plasma (PRP) was not more effective in relieving the pain due to epicondylitis (tennis elbow) compared with saline when each was delivered by ultrasound-guided injection. However, both groups showed significant decreases in pain scores from baseline at 6 months, suggesting to investigators that tendon stimulation may be the actual mechanism behind the observed lesion repair and improvement in pain symptoms.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EPatrick Le Goux, MD, Rheumatology, H\u00f4pitaux Universitaires Paris Ile-de-France Ouest, Boulogne-Billancourt, France, noted that the significant decrease in pain scores observed over the course of the trial in both groups was exciting and suggested that the healing process may actually be stimulated by the injection process, a technique known as \u201cprolotherapy.\u201d\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EProf. Le Goux explained that local corticosteroid injections represent a standard of care for epicondylitis but may actually impair the healing process [Coombes BK et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EProf. Le Goux noted that intratendinous injections of PRP containing growth factors have been proposed to aid tendon repair [Peerbooms JC et al. \u003Cem\u003EAm J Sports Med\u003C\/em\u003E 2010], and the injection technique has been reported to be augmented by ultrasound guidance [Chiavaras MM, Jacobson JA \u003Cem\u003ESemin Musculoskelet Radiol\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EProf. Le Goux and colleagues conducted this prospective, double-blind, placebo-controlled randomized trial from 2011 to 2012. Patients with epicondylitis lasting 3 months or fewer were enrolled. Other potential causes of pain were ruled out, and features of epicondylitis were confirmed by magnetic resonance imaging, ultrasound, or both. Patients with previous corticosteroid infiltration were excluded.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EPatients received 2 ultrasound-guided injections of either PRP or saline solution at 4-week intervals and were monitored by an independent clinical evaluator, who was blinded to the treatment, at baseline and 1-, 3-, 6-, and 12-month time points. PRP was obtained from each patient, treated by centrifugation only to concentrate the material, and reinjected into the injured joint of the same patient. Injections were done in a blinded and identical manner for both treatments by using a dual-chamber syringe that penetrated 3 layers into the tendon to target the lesion without entering it.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EEach treatment group comprised 25 patients following randomization; however, 3 patients in each arm withdrew from the study within 6 months, due to reasons unrelated to treatment. Patients were evaluated at 6 months for the decrease in pain score from baseline (primary evaluation criteria) using a visual analog scale (VAS; range, 0 to 10). At 6 months, pain scores were reduced by 54.7% with PRP versus 63.6% with saline (p=0.24).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003ESecondary endpoints included assessment of pain (yes\/no) during isometric contraction of the extensor carpi radialis brevis and the extensor digitorum communis and measurement of the degree of pain using the Roles and Maudsley score (range, 1 to 4). Mean baseline Roles and Maudsley scores were 6.8 (\u00b10.8) in the PRP group and 7 (\u00b11) in the saline group; a mean reduction of 1.5 points was observed in both groups at 12 months.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003ENo significant differences between treatment groups were observed at 6 or 12 months in either primary or secondary criteria.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EHowever, significant patient benefit was observed; both groups showed a 50% reduction of pain scores within 3 to 6 months. At 6 and 12 months, respectively, 34% and 66% of all patients were asymptomatic, defined as VAS scores of 1 or less. The proportion of patients with persistent pain at 12 months was equivalent at 23.8% in both groups. No adverse events were reported.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EProf. Le Goux attributed the pain reduction observed with both treatments to the stimulating role of ultrasound-guided intratendinous injections, or prolotherapy, on the process of tendon repair. He further commented that the study was limited by not including a group of patients with epicondylitis who received no treatment so that the pain reduction observed over time with natural healing could be compared with the PRP and saline results.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/17\/18.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp3o1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}