Usefulness of polydeoxyribonucleotide as an alternative to corticosteroids in patients with lateral epicondyitis: A case series

Abstract

Rationale: Local corticosteroid injections are commonly used as an easy, cost-effective treatment for patients with lateral epicondylitis (LE). Despite their strong anti-inflammatory effect, repeated injections of corticosteroids are not recommended in LE because they can aggravate tearing of the tendons.

Patient concerns: A 65-year-old (Case1) man and a 59-year-old (Case2) man had a 2-month history of right lateral elbow pain exacerbation.

Diagnoses: Lateral epicondylitis with hypervascularity of the common extensor tendon.

Intervention: After informed consent was provided, ultrasound (US)-guided polydeoxyribonucleotide (PDRN) injections were made into on the common extensor tendons of both patients.

Outcomes: After 2 weeks from PDRN injection, both patients reported significant pain relief. The US 2 weeks after the PDRN injection showed that the hypervascularity of the common extensor tendon in both patients had been completely cured, although there was no significant change in the findings of tendinosis.

Lessons: PDRN may be useful for patients with LE because there were no negative effects on tendon cells and tissues in previous in vitro and in vivo studies, despite its anti-inflammatory effects.

Figure 1

Lateral epicondylitis in a 65-year-old man with tendinosis of the right common extensor tendon. A−C, Longitudinal US image of the common extensor tendon origin shows hypervascularity (arrow heads), marked heterogeneity with numerous hyperechoic calcifications (arrows) and hypoechoic intrasubstance tears throughout the tendon, findings consistent with severe chronic tendinosis. D, Local administration of polydeoxyribonucleotide (PDRN) was performed on the common extensor tendon. E & F, Ultrasound imaging of the common extensor tendons obtained two weeks after the procedure showed complete resolution of hypervascularity, although there was no significant change in the findings of tendinosis.

Figure 2

Lateral epicondylitis in a 59-year-old man with tendinosis of the right common extensor tendon. A−C, Longitudinal US image of the common extensor tendon origin shows hypervascularity (arrow heads), marked heterogeneity with numerous hyperechoic calcifications (arrows) and hypoechoic intrasubstance tears throughout the tendon, findings consistent with severe chronic tendinosis. D, Local administration of polydeoxyribonucleotide (PDRN) was performed on the common extensor tendon. E & F,) Ultrasound imaging of the common extensor tendons obtained two weeks after the procedure showed complete resolution of hypervascularity, although there was no significant change in the findings of tendinosis.