Went to recent program that stated that though there were studies that showed no difference – there was one that did when injecting Platelet Rich Plasma versus using once spin down plasma (Autologous Whole Blood)
The improvement was only statistically better at 6 weeks but not earlier or later
Am J Sports Med. 2011 Oct;39(10):2130-4. doi: 10.1177/0363546511417113. Epub 2011
Aug 2.
Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial.
Thanasas C, Papadimitriou G, Charalambidis C, Paraskevopoulos I, Papanikolaou A.
http://www.ncbi.nlm.nih.gov/pubmed/21813443
- Autologous Whole Blood – serum from spun down once blood
- Platelet rich plasma – spun down twice to concentrate
Technique – “was a single injection of 3 mL of autologous peripheral whole blood, deep at the origin of wrist extensors with a peppering technique (single skin insertion, deep peripheral multiple sites of injection) under aseptic technique with the assistance of ultrasound guidance.”
PRP same technique.
“Patients of both groups were requested to refrain from heavy labor activities for a week. A week after the injection, each patient was reassessed and given a simple program of stretching and eccentric loading exercises to be performed on an individual basis twice every day for 5 weeks.”
on no meds
Results:
The difference of pain of 0.8 is not clinically significant and only statistically so at 6 weeks.
Another study compared dry needling to dry needling followed by plasma injection:
Skeletal Radiol. 2013 Nov;42(11):1515-20.
Do blood growth factors offer additional benefit in refractory lateral epicondylitis? A prospective, randomized pilot trial of dry needling as a stand-alone procedure versus dry needling and autologous conditioned plasma.
Stenhouse G, Sookur P, Watson M.
http://www.ncbi.nlm.nih.gov/pubmed/23912197
refractory for 19 months and VAS pain scores some worse than last study
needled or injected at 0 and 1 month
Technique:
- “1–2 ml of 1 % lignocaine was injected immediately deep into the deep fascia using a 23-G needle.”
- needling: fine needle (23G) in and out through the long axis of the tendon without exiting the skin approximately 40–50 times to pepper the tendon
- injection – needled first then 3 mls autologous conditioned plasma (ACP).
done initially and at one month
Results:
Comment – at least on the basis of this article, using serum looks like a reasonably good option in chronic tennis elbow. I think the second study’s needling was excessive and they did not have the physio program the first one had so got worse results. Autologous didn’t look very good there.