Nguyen Chantal T, Lee Michelle H, Kaufman Matthew W, Meng Yue, Koduri Jyotsna A, Abrams Geoffrey, Cheung Emilie V, Freehill Michael T, Roh Eugene Y
Division of Physical Medicine & Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA.
JSES Int. 2024 Aug 28;9(1):231-236. doi: 10.1016/j.jseint.2024.08.183. eCollection 2025 Jan.
Medial and lateral epicondylitis, characterized by repetitive microtraumas to common flexor and extensor tendons, respectively, are common causes of elbow pain in adults. Though symptoms are generally self-limiting, 10% of cases are refractory to conservative management, persisting for greater than 18 months, and leading to surgery, which can have increased risk of complications. There is minimal data on sustained pain relief and functional benefit for newer nonsurgical management options, such as minimally invasive needle tenotomy (MINT), and platelet-rich plasma (PRP) for chronic elbow epicondylitis. Additionally, no previously established correlation exists between magnetic resonance imaging (MRI) severity of chronic epicondylitis with pain and functional improvement in MINT- and PRP-treated patients.
A retrospective review of 51 adults (n = 23 for MINT; n = 28 for PRP) was conducted to investigate long-term outcomes in pain relief (via visual analog scale or VAS) and improvements in upper extremity function (via quick disability of the arm, shoulder, and hand questionnaire or qDASH). These outcomes were correlated with radiographic evidence of epicondylitis severity, assessed by the grade of epicondylitis and percentage thickness of tendon tears.
There were significant improvements in pain (VAS), but no significant differences in function (qDASH) following MINT and PRP. On average, VAS score improved by 2.6 ( < .001) post-MINT and by 3.8 ( < .001) post-PRP combined for all follow-up time points. No adverse events were reported over the entire study. A significantly higher percentage of patient-reported pain relief was noted post-MINT at all follow-up time points. VAS and qDASH outcomes post-MINT and post-PRP were not correlated with the initial MRI severity of epicondylitis.
There are multifactorial benefits of both MINT and PRP as safe, nonopen surgical modalities that can be used, despite MRI severity, to provide sustained pain relief for patients with refractory elbow epicondylitis.
内侧和外侧上髁炎分别以常见屈肌腱和伸肌腱的重复性微创伤为特征，是成人肘部疼痛的常见原因。虽然症状通常具有自限性，但10%的病例对保守治疗无效，持续超过18个月，并导致手术，而手术可能会增加并发症风险。关于较新的非手术治疗方法，如微创针刀松解术（MINT）和富血小板血浆（PRP）治疗慢性肘部上髁炎的持续疼痛缓解和功能益处的数据极少。此外，在接受MINT和PRP治疗的患者中，慢性上髁炎的磁共振成像（MRI）严重程度与疼痛和功能改善之间此前未发现相关性。
对51名成年人（MINT组23例；PRP组28例）进行回顾性研究，以调查疼痛缓解的长期结果（通过视觉模拟量表或VAS）和上肢功能改善情况（通过手臂、肩部和手部快速残疾问卷或qDASH）。这些结果与通过上髁炎分级和肌腱撕裂厚度百分比评估的上髁炎严重程度的影像学证据相关。
MINT和PRP治疗后疼痛（VAS）有显著改善，但功能（qDASH）无显著差异。在所有随访时间点，MINT治疗后VAS评分平均改善2.6（<0.001），PRP治疗后平均改善3.8（<0.
