Hyaluronic Acid injections for Chronic Tennis Elbow

Background: For most patients, tennis elbow (TE) resolves within six months of onset. For those with persistent and painful TE, nonsurgical treatment options are limited. Thousands of studies have tried to find effective treatment for TE, but usually fail. In this study, we test the hypothesis that injections with hyaluronic acid (HA) are effective at treating chronic pain from TE. Methods Patients with a minimum of six months of pain from TE were randomized equally into one of two groups, injection with HA or saline control, and followed for one year. Outcome measures included Visual Analogue Score (VAS pain), the shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH) and patient rated tennis elbow evaluation (PRTEE). Results Seventeen of the 18 HA-injected patients (94%) completed the study. The average age was 51.9 years and 10 were male. Patients had an average of 28.1 months of pain before entering the study. VAS in the HA group improved from a baseline of 76.4 to 14.3 at 12 months. All 17 patients in the HA group showed VAS improvement above minimal clinically important difference (MCID) of at least 18. PRTEE improved from 67 to 28.1. QuickDASH improved from 53.7 to 22.5. To our knowledge, this improvement is greater than can be seen in any other non-surgical treatment for TE. Conclusions HA injections showed significant success in pain relief by three months. Patients continued to improve for the 12-month duration of the study. This study indicates that patients with chronic lateral epicondylitis may benefit from injections of hyaluronic acid rather than having to undergo surgery.