A person suffering from tennis elbow may not have to look any further than his or her own body for the most effective treatment, according to a study published in the November issue of The American Journal of Sports Medicine.
Specially-prepared platelets taken from the patient which are then re-injected into the tendon of the affected elbow provides more relief than more commonly-used therapies which have failed to yield results, often resulting in surgery, concludes study authors Allan Mishra MD and Terri Pavelko, PAC, PT, of the Menlo Medical Clinic, Stanford University Medical Center, Menlo Park, Calif.
"Ours is the first in vivo human investigation of this novel biologic treatment for chronic severe elbow tendonitis in patients who have simply 'flunked out' of other treatments," says Dr. Mishra. "Ninety-three percent of patients in our study did well, which is as good a result as patients who have tendon surgery."
"There is very little risk here; we are using the patient's own blood taken right in the doctor's office, and the whole procedure takes less than an hour," Mishra says. "The results of our pilot study indicate this therapy is as effective as surgery, with sustained and significant improvement over time, no side effects, and high patient acceptance."
Tennis elbow (lateral epicondylitis or tendonitis) isn't restricted to those who frequent tennis courts, but is a common problem for people whose activities require strong gripping or repetitive wrist motions. It is a degeneration of the tendon above the elbow that controls the movements of the wrist and hand. Treatments such as rest, nonsteroidal anti-inflammatory drugs, bracing, physical therapy, and injections of corticosteroids (cortisone shots) are often used but recent studies have called into question their efficacy. Those who suffer longest resort to surgical repair of the tendon when all other therapies have failed.
Mishra and Pavelko evaluated 140 patients who had tennis elbow for longer than 3 months and had scored at least a 60 of 100 using a visual analog scale (a continuum on which a person rates the severity of his/her pain: 0 = no pain; 100 = maximum pain). They all had completed a course of physical therapy and had tried some combination of anti-inflammatory medicines, bracing or cortisone shots, all without relief of symptoms. Twenty of the original 140 patients evaluated met these strict criteria and were enrolled in the study. These 20 represented the most severe tendonitis patients who had not improved with time or nonsurgical treatment.
Fifteen patients received a one-time injection of platelet-rich plasma (PRP) into their affected elbow. (Platelets are blood components responsible for the formation of clots in response to injury, but also contain powerful growth factors; plasma is the liquid portion of the blood.) Blood was drawn from a patient's unaffected arm and spun down in the physician's office lab to separate the blood's components. Approximately a half-teaspoon (2 to 3 mL) of this material - over 500% richer in platelets than whole blood - was then injected into the tendon of the sore elbow. These 15 patients had tennis elbow for 15 months and the average patient age was 48 years. Their baseline score on the pain scale was 80.3.
Five patients served as a control (non-PRP) group and received a 2 to 3 mL injection of a local anesthetic (bupivacaine with epinephrine) into the affected elbow. The mean duration of symptoms in this group was 12 months and average patient age was 42 years. Their baseline score on the pain scale was 86.