Which injection therapies are used in the treatment of medial epicondylitis?

Updated: Jan 24, 2019
  • Author: Craig C Young, MD; Chief Editor: Craig C Young, MD  more...
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Studies show that injected corticosteroids result in an acute improvement of symptoms that are related to medial epicondylitis; however, the long-term outcome remains unchanged. [13, 26, 27, 28] In cases of recalcitrant medial epicondylitis, consider corticosteroid injection. [1] In addition, other causes of elbow pain should be considered; always obtain a plain radiograph of the elbow before injecting corticosteroids.

Cortisone injection for medial epicondylitis is relatively simple. The area of maximal tenderness is palpated; then, using sterile technique, inject this area with a small amount of cortisone (see Medication, below). [29]

Alternative treatments are either autologous blood injection or platelet-rich plasma (PRP) injection. The use of autologous blood or PRP injected into the site of tenderness is thought to stimulate an acute inflammatory reaction and concentrate various growth factors (eg, transforming growth factor-beta, basic fibroblast growth factor, platelet-derived growth factor, epidermal growth factor, vascular endothelial growth factor, connective-tissue growth factor), which leads to reinitiation of the healing process. This therapy has been shown to be effective in limited studies of chronic inflammatory musculotendinous conditions. [30, 31, 32, 33, 34, 35]

Another possible alternative treatment for medial epicondylitis might be injection with botulinum toxin. [36] However, at this time, the use of botulinum toxin for treatment of medial epicondylitis is an off-label, experimental use.

Extracorporeal shock wave therapy (ESWT) has been proposed as a treatment option for epicondylitis. This treatment modality appears to have few, if any, adverse effects. However, to date, results from studies are mixed, with most investigations studying lateral epicondylitis. [37, 38, 39, 40, 41, 42]

The use of nitroglycerin patches as modulators of nitric oxide, which would then stimulate collagen production by fibroblasts, has also been studied for the treatment of lateral epicondylitis. Significant improvement was noted in the treatment group compared with the placebo group. [43] However, a more recent randomized, double-blind study of patients with chronic patellar tendinopathy showed no significant effect. [44] The authors of a meta-analysis of 7 clinically relevant, high-quality randomized controlled trials involving 446 subjects (including 2 that focused on lateral epicondylitis) concluded that topical nitroglycerin patches were significantly more effective than placebo for the treatment of chronic tendinopathies. [45]

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