Treating Elbow Pain with Platelet Rich Plasma Therapy:
One of the most common sports related orthopedic injuries we treat at Performance Rehabilitation & Regenerative Medicine is tennis elbow. This condition presents with pain and/or weakness in the muscle group on the outside of the elbow (lateral side). Obviously, this condition commonly arises from the respective sport for which it is named, however in clinical practice this is not always the case. Medically, this condition is known as elbow tendonitis, affecting some 7 million Americans each year.
What are Tendons?
Tendons are thick bands of tissue that connect muscle to bone and are responsible for joint movement and stability. It is very common for tendons to become injured as a result of repetitive motion and /or poor biomechanics, which is very common in tennis and other racquet sports. As a result, the tendon becomes inflamed, irritated, and sometimes will tear resulting in intense pain and often weakness in the muscle. This inflammatory reaction is called a tendonitis in the acute phase (1-2 months). Since tendons have a very poor blood supply healing is often slow and incomplete which results in chronic inflammation and scar tissue in the tendon (tendonosis) thus, significantly impairing the movement, strength, stability and function of the elbow. All of which are necessary to be fully engaged in your sport whether you are a weekend “warrior” or a professional tennis player.
Traditionally, the medical care path included non-steroidal, anti-inflammatory, oral medication (NSAID’s), cortisone injections, physical therapy and home management. Physicians and therapists alike recognize that there is limited success with the current care path and have welcomed the advancements in Platelet Rich Plasma Therapy. Until recently, if a patient failed conservative treatment, their only option was a surgical release of the tendon and debridement, which has limited success.
Platelet Rich Plasma Therapy (PRP).
PRP therapy is an exciting new procedure within the sub-specialty of Regenerative Medicine that is offering non-surgical, orthopedic solutions to otherwise potentially surgical conditions. PRP is the future for treating chronic, unresponsive tendon conditions.
The Role of Platelet Rich Plasma (PRP) Therapy.
In PRP, the physician utilizes the body’s own natural healing abilities to treat chronic injuries. Many orthopedic conditions don’t properly heal because the body is unable to provide the proper quantity of specialized cells for healing, repairing and reduction of inflammation. PRP solves this problem.
First the physician will perform a detailed examination and history, ruling out other conditions that may have similar presentations. The physician will perform an x-ray, diagnostic ultrasound and MRI of the region in question, to determine the pain generating structures. Often, the patient is suffering from tendonitis of the wrist extensor muscles and supporting structures, this can be easily identified on diagnostic ultrasound. Once that physician determines that you have failed more conservative interventions and that you are a candidate for PRP, the patient will progress to the treatment.
The PRP Procedure.
The treatment is performed in-office during a 45-minute same-day procedure. The process is surprisingly simple, blood is drawn from the patient and processed it in an FDA approved medical device, to separate the healing power of platelets from blood plasma. The doctor then takes that concentrated healing platelets of the patient’s own blood and re-introduces it or “grafts” it into a specific injured site (which has been identified on diagnostic ultrasound), to regenerate and repair injured tissue, decrease inflammation and reduce the healing time. Most current research concludes PRP can deliver 500%-1000% more growth factor and bio active proteins to the injured area then would occur their naturally.
PRP and Anti-inflammatory effects.
The most recent data in the field of Regenerative Medicine, is revealing that PRP has tremendous ant-inflammatory properties as well as reparative, by inhibiting Cox-1 and Cox-2 proteins, in the inflammatory cascade. Reducing inflammation is a key component in decreasing the patient’s pain levels, which will accelerate the rehabilitative process and ultimately return the athlete to full function. Clinically, our experience dictates excellent results with using PRP in lieu of cortisone for tendon, bursa and intra-articular injections, with fewer side effects reported
It is essential that the patient understands that the procedures described above are to repair injured or degenerated tissue. Results are seen in 1-3 months and patient does not typically experience immediate relief of symptoms. We encourage our patients to undergo 4-8 weeks of physical therapy and rehabilitation after the PRP procedure to regain full strength, function and return to an active lifestyle.
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About the Authors:
Joseph Mejia D.O., F.A.A.P.M.& R, is a graduate of University of Michigan and West Virginia School of Osteopathic Medicine. He is Board Certified in Physical Medicine & Rehabilitation and Sports Medicine. Dr. Mejia received his Fellowship Training in Interventional Pain Management from University of Medicine and Dentistry. He has advanced training in Regenerative Medicine and is the Medical Director and Partner of Performance Rehabilitation and Integrated Medicine.
Ronald Spiaggia, D.C. is a graduate of New York Chiropractic College. He is a Board Certified Chiropractic Physician. His expertise is in conservative, non-surgical treatment of acute and chronic spinal and extremity disorders, with a clinical focus on herniated discs, spinal rehabilitation and sports injuries. He is the Founder and Clinical Director of Performance Rehabilitation and Integrated Medicine.