Both whole blood and platelet rich plasma work in resistent tennis elbow – but it takes 3 month for most improvement. There is no statistical difference between the 2 therapies.
Br J Sports Med. 2011 Mar 28. [Epub ahead of print]
Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections.
Creaney L, Wallace A, Curtis M, Connell D. abstract here
- Procedure: – “Blood was collected using a 21 gauge needle from the antecubital fossa into an 8.5 ml vacutainer tube with citrate anticoagulant. For patients randomly assigned to plasma injection, the blood was spun in a centrifuge at 2000 g for 15 min … and 1.5 ml was siphoned from the buffy coat layer”.
-“Tendons were first surface bathed with 2 ml bupivacaine, followed by a 2 min wait before proceeding to blood or plasma injections”
– Using Ultrasound, an Intratendinous cleft (tear) was identified (between “+” markers). Above tear, cleft opens into a cavity and fluid is injected in the tendon there with minimal resistance.
- 23 guage needle used – though not directed stated, persumed all 1.5 ml platelet rich plasma and same dose whole blood was injected. Dry needling of area was avoided.
- Shot was repeated at 1 month’s time
Steroid injections will give immediate relief when they take – best given early. They need to be repeated in 10 days if all is not better. Chronic tennis elbows don’t respond as well to steroid injection. This is because it has become a more generalized disease:
- supinator muscles radial tunnel syndrome
- cervical spine involvement
- forearm muscle triggers
- a localized neurovascular/blood vesssel growth “angiogenesis”
This will no longer respond to steroid injections and blood injections might be more reasonable approach. The use of platelet rich plasma may not offer any advantage though the amount used was small compared to a commercial product I saw demonstrated. I would like to dedicate this blog note to Christa M who wanted to know more about this…