Summary

Combined polydeoxyribonucleotide injection could improve the outcome of Extensor muscle strengthening exercise in counterforce brace with extracorporeal shockwave therapy for lateral epicondylitis of elbow.

Abstract

Introduction

Extensor muscle strengthening exercise (EMSE) with extracorporeal shockwave therapy (ESWT) has been used for lateral epicondylitis (LE) of elbow. Polydeoxyribonucleotide (PDRN) is also a treatment option. However, few studies have reported the combined treatment. The purpose of this study is to investigate the synergistic effect of PDRN for EMSE with ESWT in LE of elbow.

Materials And Methods

Forty-eight patients with chronic LE were enrolled in this single center, double-blinded randomized controlled trial and allocated in two groups (G1: EMSE+ESWT+saline injection and G2: EMSE+ESWT+PDRN injection). All the two groups were taught to perform EMSE and received ESWT at the first out-patient department (OPD) visit. Group 1 was injected with 3mL saline while group 2 was injected with 3mL PDRN (5.625mg/3mL). Functional outcomes including visual analog scale of pain (VAS), Mayo elbow performance score (MEPS), hand grip strength index (HGSI) and ultrasonographic examination were checked just before, and at 6 and 12 weeks after the treatments.

Results

The demographic data of the two groups were not significantly different. Overall functional scores and ultrasonographic findings in the two groups improved after treatment. The mean MEPS and common extensor tendon depth (CETD) in group 2 increased more than those in group 1 (6.9<15.2: p=0.002 and 0.01<0.03: p=0.003) while the mean color doppler activity (CDA) in group 2 decreased more that in group 1 (0.44<0.81: p=0.001) at 6 weeks after the treatments. At 12 weeks after the treatments, the mean CETD and HGSI in group 2 increased more than those in group 1 (0.05<0.07: p=0.008 and 0.10<0.20: p=0.035).

Conclusion

Combined PDRN injection could improve the outcome of EMSE with ESWT for LE of elbow.