Jiaan Zhu1, Bing Hu, Chunyan Xing, Jia Li. 1. Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. zhujiaan70@hotmail.com
Abstract
INTRODUCTION: This report evaluates the efficacy of percutaneous needle puncture under sonographic guidance in treating lateral epicondylitis (tennis-elbow). METHODS: Ultrasound-guided percutaneous needle puncture was performed on 76 patients who presented with persistent elbow pain. Under a local anesthetic and sonographic guidance, a needle was advanced into the calcification foci and the calcifications were mechanically fragmented. This was followed by a local injection of 25 mg prednisone acetate and 1% lidocaine. If no calcification was found then multiple punctures were performed followed by local injection of 25 mg prednisone acetate and 1% lidocaine. A visual analog scale (VAS) was used to evaluate the degree of pain pre-and posttreatment at 1 week to 24 weeks. Elbow function improvement and degree of self-satisfaction were also evaluated. RESULTS: Of the 76 patients, 55% were rated with excellent treatment outcome, 32% good, 11% average, and 3% poor. From 3 weeks posttreatment, VAS scores were significantly reduced compared with the pretreatment score (P<0.05) and continued to gradually decline up to 24 weeks posttreatment. Sonography demonstrated that the calcified lesions disappeared completely in 13% of the patients, were reduced in 61% of the patients, and did not change in 26% of the patients. Color Doppler flow signal used to assess hemodynamic changes showed a significant improvement after treatment in most patients. CONCLUSION: Ultrasound-guided percutaneous needle puncture is an effective and minimally invasive treatment for tennis elbow. Sonography can be used to accurately identify the puncture location and monitor changes.
INTRODUCTION: This report evaluates the efficacy of percutaneous needle puncture under sonographic guidance in treating lateral epicondylitis (tennis-elbow). METHODS: Ultrasound-guided percutaneous needle puncture was performed on 76 patients who presented with persistent elbow pain. Under a local anesthetic and sonographic guidance, a needle was advanced into the calcification foci and the calcifications were mechanically fragmented. This was followed by a local injection of 25 mg prednisone acetate and 1% lidocaine. If no calcification was found then multiple punctures were performed followed by local injection of 25 mg prednisone acetate and 1% lidocaine. A visual analog scale (VAS) was used to evaluate the degree of pain pre-and posttreatment at 1 week to 24 weeks. Elbow function improvement and degree of self-satisfaction were also evaluated. RESULTS: Of the 76 patients, 55% were rated with excellent treatment outcome, 32% good, 11% average, and 3% poor. From 3 weeks posttreatment, VAS scores were significantly reduced compared with the pretreatment score (P<0.05) and continued to gradually decline up to 24 weeks posttreatment. Sonography demonstrated that the calcified lesions disappeared completely in 13% of the patients, were reduced in 61% of the patients, and did not change in 26% of the patients. Color Doppler flow signal used to assess hemodynamic changes showed a significant improvement after treatment in most patients. CONCLUSION: Ultrasound-guided percutaneous needle puncture is an effective and minimally invasive treatment for tennis elbow. Sonography can be used to accurately identify the puncture location and monitor changes.
Authors: Michael P Gaspar; Michael A Motto; Sarah Lewis; Sidney M Jacoby; Randall W Culp; A Lee Osterman; Patrick M Kane Journal: Orthop J Sports Med Date: 2017-12-06