Epidural injections can be performed from several different approaches; these include a caudal, interlaminar, or transforaminal approach. The approach your provider chooses is based on each individual patient’s clinical presentation, the personal preference and experience of the provider performing the injection, the desired outcome, and most importantly, the risks versus benefits of performing one type of epidural over another. Clinically, the purpose of all epidural injections is to place a mixture of steroid and local anesthetic at the source of the problem to decrease inflammation causing pain, and to promote healing and clinical improvement. The epidural steroid injection involves placing steroid medication in the inflamed area and significantly reduces nerve irritation thus improving pain. This treatment option has the potential to completely resolve pain and ultimately may prevent operative treatment.
Steroid injections are commonly used to treat rotator cuff tendinopathy, but controlled studies have demonstrated modest benefit, particularly in the long term. 34 Steroid injections should be reserved for patients who have discomfort that would limit them from engaging in rehabilitative exercises. Injections into the gluteal muscle versus guided injections into the subacromial bursa have demonstrated similar levels of pain relief. 35 Surgical options are available for patients with persistent symptoms, or for patients in whom function cannot be maintained.
MAIN OUTCOME MEASUREMENTS:Perceived improvement in symptoms at least 6 months after treatment, perceived change in visual analog scale score, assessment of functional pain, and overall satisfaction.
On average, patients were 48 years old, had symptoms for a median of 18 months before treatment, and answered the survey on average 15 months after treatment. Overall, 82% of patients indicated moderate to complete improvement in symptoms. The most common injection sites were the lateral epicondyle, Achilles, and patellar tendons. Other sites treated included the rotator cuff, hamstring, gluteus medius, and medial epicondyle, among others. Furthermore, 60% of patients received only 1 injection, 30% received 2 injections, and 10% received 3 or more injections. Patients' perceived decrease in visual analog scale score was 75%, from ± to ± (-, SD , 95% confidence interval - to -, P < .0001). In addition, at follow-up, 95% of patients reported having no pain at rest that disrupted their activities of daily living and 68% reported no pain during activities. A total of 85% of patients were satisfied with the procedure.
In this retrospective study, in which we evaluated administration of PRP for chronic tendinopathy, we found that the majority of patients reported a moderate (>50%) improvement in pain symptoms.