Medial epicondylitis: is ultrasound guided autologous blood injection an effective treatment?

Objective: To assess if ultrasound guided autologous blood injection is an effective treatment for medial epicondylitis. Methods: Twenty patients ( 13 men, 7 women) with refractory medial epicondylitis with symptom duration of 12 months underwent sonographic evaluation. Tendinosis was confirmed according to three sonographic criteria: echo texture, interstitial tears and neovascularity. The tendon was then dry needled and autologous blood was injected. Patients were reviewed at 4 weeks and at 10 months. VAS scores and modified Nirschl scores were assessed pre-procedure and post-procedure. Results: There was significant reduction in VAS pain score between pre-procedure and 10 months post-procedure when it had a median (IQR) of 1.00 ( 1 - 1.75), range 0 - 7. The median ( IQR) Nirschl score, which at pre-procedure was 6.00 ( 5 - 7), range 4 - 7, had decreased at 4 weeks to 4.00 (2.25 - 5), range 2 - 7, and at 10 months to 1.00 ( 1 - 1.75), range 0 - 7, revealing a significant decrease ( z = 3.763, p< 0.001). The hypo-echoic change in the flexor tendon significantly decreased between pre-procedure, when there was a mean (SD) of 6.45 (1.47), and at 10 months, when it was 3.85 (2.37) ( p< 0.001). Doppler ultrasound showed that neovascularity decreased between pre-procedure, when there was a mean ( SD) of 6.10 (1.62), range 4 - 9, and at 10 months, when it was 3.60 (2.56), range 0 - 9 ( p< 0.001). Discussion: The combined action of dry needling and autologous blood injection under ultrasound guidance appears to be an effective treatment for refractory medial epicondylitis as demonstrated by a significant decrease in VAS pain and a fall in the modified Nirschl scores.