Lateral epicondylitis: an internal comparison in the same patient

Chronic lateral epicondylitis is a common painful condition affecting the elbow. Many treatments have been proposed to alleviate the pain. Surgical treatment options include open, arthroscopic, and percutaneous debridement techniques, while nonoperative modalities have traditionally included physical therapy, bracing, and cortisone injections. Platelet-rich plasma injections have recently gained popularity as an additional treatment option, with early reports of success in elite athletes. The largest study of platelet-rich plasma injections for treatment of lateral epicondylitis showed improvement by platelet-rich plasma compared to corticosteroid injections. This article presents a case of a 55-year-old right-hand-dominant woman with bilateral lateral epicondylitis refractory to multiple corticosteroid injections and physical therapy, treated with platelet-rich plasma injection in the right elbow and concomitant arthroscopic extensor carpi radialis brevis tendon release and debridement in the left elbow. At 4-month follow-up, her visual analog scale was 80/100 in the elbow receiving platelet-rich plasma compared to 10/100 on her operative side, and platelet-rich plasma treatment was considered a failure. The patient then underwent arthroscopic debridement of the right elbow for recalcitrant pain. At 1-year follow-up, both elbows were improved after operative treatment (visual analog scale 10/100 right and 0/100 left), consistent with several studies that have reported improvements from arthroscopic extensor carpi radialis brevis debridement as high as 95%. In our experience, arthroscopic extensor carpi radialis brevis debridement is a safe and efficacious method for treating chronic lateral epicondylitis. Further studies are required to define the role of platelet-rich plasma injections in the treatment of this condition.