Clinical and ultrasonographical effectiveness of platelet rich plasma (PRP) therapy added to extracorporeal shock wave therapy (ESWT) in patients with lateral epicondylitis: prospective randomized controlled study

Objectives: The aim of our study is to determine the effectiveness of adding PRP or Sham PRP injections to a home exercise program and ESWT treatment in patients with chronic lateral epicondylitis, assessing their impact on pain, grip strength, functional activities, quality of life, and USG parameters, as well as to investigate the comparative superiority of these treatments. Material and methods: The study included a total of 91 patients, aged between 18 and 65 years, who had been experiencing symptoms for more than 3 months and were diagnosed with lateral epicondylitis. Patients were randomized to into three treatment groups. Each group was assigned a home program consisting of daily stretching and eccentric strengthening exercises for 3 months, along with a total of 3 sessions of ESWT (8 Hz, 2.0 bar, 2000 pulses) administered once a week for 3 weeks. The first group received a single dose of PRP injection, ESWT, and exercise; the second group was given a single dose of sham PRP injection, ESWT, and exercise; and the third group underwent ESWT and exercise therapy. Patients were evaluated a total of three times: before treatment (T0), at the end of treatment (T1: at 4 weeks), and 12 weeks after treatment (T2). Patients were assessed using the Visual Analog Scale (VAS) for rest, movement, and nighttime pain intensity; Jamar dynamometer for hand grip strength; Patient-Rated Tennis Elbow Evaluation (PRTEE) and Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) for functionality; SF-36 for quality of life; isokinetic dynamometry for wrist extensor and flexor strength; and ultrasonographic changes, including common extensor tendon (CET) thickness measurements and total ultrasound (USG) scale score parameters (hypoechogenicity, neovascularity, heterogeneity, bone abnormality). Results: A total of 91 patients participated in this study, of whom 65 (71.4%) were women and 26 (28.6%) were men. The participants exhibited a homogeneous distribution in terms of demographic data. Statistically significant improvements were observed in the follow-ups of all three treatment groups in terms of VAS for rest, movement, and night pain, hand grip strength, PRTEE scores for pain, function, and total, Quick DASH, SF-36 subparameters, USG assessments (CET thickness, hypoechogenicity, and TUSS), and isokinetic dynamometer evaluations of flexion and extension muscle strength. When comparing the groups, it was observed that in T1 and T2 measurements, the first group demonstrated superiority in reducing VAS scores for movement and night pain compared to the other groups. The follow-up measurements did not reveal any significant difference between the groups in terms of VAS scores for rest. In the T1 measurement, the first group showed superiority in hand grip strength compared to the second group, while in the T2 measurement, the first group exhibited superiority over the other groups. In the T2 measurements, it was observed that the first group had a superiority over only the third group in terms of PRTEE scores for pain, function, and total values. In the T2 measurements, it was found that the first group was superior to the other groups in terms of Quick DASH scores. No significant differences were observed between the groups in all ultrasonographic evaluation parameters in both the T1 and T2 measurements. In the muscle strength assessments conducted using the isokinetic dynamometer device, it was found that in both T1 and T2 measurements, the first group had a superiority over the second group in terms of both flexion and extension muscle strength evaluations. However, in the evaluation of extension muscle strength, only in the T1 measurement, the third group was superior to the second group. Conclusions: The combined use of ESWT and PRP in the treatment of lateral epicondylitis has been found to be superior to using ESWT alone in improving clinical parameters such as pain, functionality, hand grip strength, and quality of life. However, while these treatment methods have positive effects on ultrasonographic parameters, they have not demonstrated superiority over each other in this aspect. In conclusion, the combination of ESWT and PRP therapy appears to be effective and reliable in the treatment of lateral epicondylitis.