Elbow Treatments Compared

Hyaluronan Injection Pain Score Showed Superiority to All Other Treatments for Lateral Epicondylalgia

A systematic literature review and Bayesian network meta-analysis by Dong et al. compared a host of different treatment options for tennis elbow1. The Bayesian method differs from conventional meta-analyses in that it can compare every treatment with every other treatment and also compare multiple variances. 
In this study, change in pain score was used as the outcome measure. The graph below shows that hyaluronan (HYA), based on the study by Petrella2 in 2010 compared very favourably with all other treatments: 

All treatments compared with placebo - graph

Plot of different treatments compared with PLA.
AB, autologous blood; BT, botulinum toxin A;
CS, corticosteroid; GSGPS,glycosaminoglycan polysulfate;
HYA, hyaluronic acid; PLA, placebo;
PEP, peppering technique;PRO, prolotherapy;
PRP, platelet-rich plasma; WMD, weighted mean difference.

The study found that “in terms of pain score, HYA showed superiority to all of the other treatments”.


1. Dong W, et al. Br J Sports Med 2015;0:1–10. doi:10.1136/bjsports-2014-094387
2. Petrella RJ, Cogliano A, Decaria J, et al. Management of tennis elbow with sodium hyaluronate periarticular injections. Sports Med Arthrosc Rehabil Ther Technol 2010;2:4

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