Joost Peerbooms

125 Discussion complications have been reported with injections of corticosteroids, such as fad pad atrophy and tendon rupture. 4,5,7 Lateral Epicondylitis Lateral epicondyle tendinopathy, also known as ‘tennis elbow’, is a common cause of pain and disability. It has been suggested that repetitive microtrauma of the extensors of wrist and hand can induce an angiofibroblastic reaction, leading to pain. 8 Our study shows that corticosteroid injections are inferior to PRP injections in the treatment of tendinopathy. Our results are supported by several meta-analyses. 9-11 Li et al. conducted a meta- analysis to compare PRP injections with corticosteroid injections in patients with lateral epicondylitis. 9 They used seven medium to high quality randomised controlled trials (RCTs) for inclusion in their study. 12-18 The meta-analysis revealed that corticosteroid injections result in better outcomes in the Disability Arm, Shoulder, and Hand (DASH) scores compared to PRP treatments for lateral elbow epicondylitis during the first few weeks (four to eight weeks). PRP injections resulted in reduced pain and improved function in the visual analogue scale (VAS) and DASH scores and were more effective than corticosteroid injections after a longer follow-up period (24 weeks after the injection). Tang et al. published a meta-analysis to compare PRP, autologous blood (AB) injections and corticosteroid injections in patients with lateral epicondylitis. 10 They included RCTs that compared any two forms of these injections. PRP yielded a better outcome in pain (VAS) and function (DASH) in the long term than AB or corticosteroid injections. However, in the short term, corticosteroids ranked first. In another meta-analysis, Xu et al. came to the same conclusion. PRP injections showed a superior improvement in reducing pain and improving elbow function compared with corticosteroids injections in the long term. 11 However, studies comparing PRP with a normal saline solution did not show that PRP was more effective. 14,19,20 The same was seen for autologous blood compared to PRP. 21-23 Comparing our studies ( Chapter 5 and 6 ) with the main conclusions of reviews and meta- analyses, we conclude that our own studies are in line with the literature. We conclude that PRP injections have a better and longer-lasting effect than corticosteroid injections do. Other studies, however, found no benefit of PRP injections over other substances, including saline solutions. Therefore, final conclusions about the effectiveness of PRP cannot be drawn yet. 24 Plantar Fasciitis Plantar fasciitis is a syndrome characterised by pain at the attachment site of the plantar fascia to the calcaneus. It is one of the most common causes of heel pain. Plantar fasciitis is more common in runners and people who are overweight. Small tears in the fascia at the attachment site are believed to cause that pain. The condition of more than 90% of 8