PRP TREATMENTS

A simple therapy for tennis elbow that utilizes the patient’s own blood has shown a tremendous amount of promise in curing lateral epicondylitis or “tennis elbow.”

Tennis elbow is an overuse injury to the tendon that attaches the forearm muscles to the outer aspect of the elbow. It occurs in tennis players but is a very common problem seen daily in an orthopaedic and sports medicine practice. It can occur from hammering, painting, using a screwdriver or other types of repetitive motion.

There are many treatment options including rest, anti-inflammatory medicines, physical therapy, bracing and corticosteroid injections. Many of these treatments have not provided long lasting relief and none actual cause the tendon to heal. Those that suffer chronic pain may eventually need surgery and even then may continue to have problems.

Platelets are components of red blood cells that cause blood to clot. The platelets release substances that are know as “growth factors” that lead to tissue healing as witnessed by anyone that has ever suffered from a cut on the skin. The growth factors have been shown to lead to the healing of tendons, something no other treatment can claim.

The process involves drawing the patient’s own blood and then removing the platelets from the blood and then injecting the concentrated platelets into the tendon. The concentrated platelets are termed PRP (platelet-rich plasma).

This technology has been used for years in facial surgery to aid in healing and also in other tissue grafts for the same purpose. PRP treatments for inflamed tendons in various parts of the body have been used for years in Europe to treat such problems as tennis elbow, Achilles tendonitis, and patellar tendonitis. It has also been used successfully in the US for the treatment of plantar fasciitis.

A study published in the American Journal of Sports Medicine in November 2006 showed that over 90% of patients were “completely satisfied” with their results according the author.

“The medical literature and outcome studies in athletes in Europe tell us that this treatment does work,” according to Dr. Henry Stiene, MD, a sports medicine specialist at Beacon who performs this procedure. “The injection does not provide the instant relief that a corticosteroid injection does, but the big difference is that PRP can actually heal the tendon over a period of time while corticosteroids only stop the inflammation, but do not cause the tendon to heal and over time can actually weaken the tendon.” Chronic inflammation weakens the muscle that is attached to the tendon. Coupled with a few simple exercises that stretch and strengthen the tendon, most patients can expect to do well. An MRI may be done prior to the injection to insure that there is not a major tear in the tendon that might best be treated surgically.

Corticosteroids or “cortisone” as they are commonly referred to cannot be injected into weight bearing tendons such as the patellar tendon of the knee and Achilles tendon of the ankle because they can weaken the tendon and can cause it to rupture and because of this treatment for these problems has also been limited. PRP can be safely injected into these tendons without the risk of rupture.

Tendons many times have a relatively poor blood supply and therefore have a limited capacity to heal. “I believe that over time, it will be found that PRP may not be for everyone, especially in those that conditions that limit blood supply to a tendon such as smokers and poorly controlled diabetics and those who do constant repetitive motion with the elbow and wrist as required for their job. For most patients, however, PRP does offer a solid, alternative treatment for most who wish not to have surgery” states Dr. Stiene.

The PRP injection process takes less than an hour and performed in Beacon’s outpatient surgery center. With the exception of Medicare, most insurance companies will approve the procedure after pre-authorization. Patients also need to realize that for a number of weeks after the injection, they cannot do any heavy, repetitive motions with the elbow in order to allow the tendon to heal.

Regenerative Injection Therapy with Growth Factors in Platelet Rich Plasma (Brochure)
Understanding Your PRP Procedure (Presentation - PDF)