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
Results:
Comment:
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…
Greetings,
I had a PRP injection today for (Tennis Elbow) a tear in origin of the extensor carpi radialis brevis in my right elbow. Ultrasound guidance was used. I was surprised that there was an actual visible tear in the tendon, I thought my TE was caused by microscopic tears in my epicondile, small tears that were not given a chance to heal due to constant overuse. My TE was a result too much Hockey, gripping a hockey stick for hours on end over 10 years. I will post updates on my progress over the next few months. We’ll see if PRP helps.
Has the PRP worked? I have achilles tendon issues and the doctor is recommending PRP. Since my insurance won’t cover the expense, I wanted to get some input on the PRP and if it works.
Hi Greg . . . Was wondering if you were willing to post an update on your progress after the PRP therapy. I am scheduled next week due to a tear in the same area, with no relief from steriod shots. Hoping you have good news.
Greetings Linda,
Here is an update. Sorry it took so long to reply. A month After the initial PRP shot I did feel some improvement, less pain and more grip strength. I did not go back for a second shot. PRP is very expensive and I was hoping to treat the condition with physical therapy. Then I re-aggravated the condition somehow and the pain returned.
An MRI of the elbow showed no evidence of a tear or tendonosis, but I still have all the symptoms of TE!
A buddy recommended Prolotherapy. Prolotherapy works with the same concept as PRP, stimulate the healing of a tendon, and it is 1/2 the cost of PRP. After 4 prolotherapy treatments at 2 weeks apart I am getting better. It’s too early for a final judgment on Prolo. Dr. says I need to give the tendons more time to heal. Ultrasound revealed calcification of the tendon at the attachment so the Dr. performed Percutaneous Needle Tenotomy to break up the calcium deposits.
I’ll report back in another month.
Looking back I should never have gotten the Cortizone shots. The Cortizone eliminated the pain but did nothing to heal the tendon. The pain always returned a few months after the Cortizone shot anyway.
Would love to hear your experience with PRP.