Treatment of Lateral Elbow Pain with PRP

Pain on the outside aspect of the elbow is referred to as lateral epicondylitis or tennis elbow.  It can be quite disabling affecting both the quality of life and range of motion.

Lateral epicondylitis is caused by irritation of the common extensor tendons as they insert onto the bony surface of the elbow.

PRP (platelet rich plasma) has become increasing popular as non surgical treatment in common orthopedic conditions.

Has it been used in the treatment of elbow pain?

Yes!

Peerbooms demonstrated PRP to be more effective than steroids in the treatment of lateral elbow pain.  100 patients were randomly assigned treatment with either PRP or steroids.  At one year 73% of patients treated with PRP reported significant improvement vs 49% in the steroid group.

Steroid use has been associated with significant side effects including ligament and cartilage compromise and cell death (apoptosis).

At the Centeno-Schultz Clinic advanced cell treatments including PRP are used in the treatment of lateral elbow pain and other common orthopedic conditions including meniscus tears, supraspinatus tears,  osteoarthritis of hip, knee and ankles.  MSK ultrasound and or x-ray is used in injections to ensure accurate placement of platelets.

Elbow Pain Now Addicted to Narcotics

55 year old patient presented with a 2 year history of left elbow pain which was constant in duration, 8/10 in severity, progressive in nature, localized on the lateral (outside) aspect of elbow without any radiations.  Patient drives a city bus and sustained a slip and fall injury in which he struck his left elbow. He denied any neck or arm pain.  Treatment to date had included massage, x-rays, cortisone injections into the joint and oral narcotics.  Narcotics were started “since other therapies had failed”.  Patient had a known addictive personality and was a recovering alcoholic. He was using up to 8 Vicodin /day as prescribed.

On physical examination he had extreme tenderness over the outside aspect of the elbow (lateral epicondyle) and multiple tender points along the extensor muscles in his forearm. His neurologic exam was normal.

Lateral epicondylitis  is theorized to be an injury of repetitive microtrauma/overuse.

It is commonly caused by  commonly associated with playing tennis  and other racquet sports.

It can also be caused by sustained contraction of the extensor muscles in the forearm which result in excessive force on the tendon where it is attached on the bone.  Treatment is two-fold: relax the dysfunctional muscle and promote healing.  This is possible by IMS and prolotherapy.

Following regenerative therapy at the Centeno-Schultz Clinic, patient had reduction in his pain, increase in range of motion and elimination of all narcotics.

Elbow Pain: Missing the Picture

Patient returned today after initial evaluation for lateral elbow pain.  She has a 5 year history of elbow pain, localized along the lateral aspect, constant in duration, progressive in nature without any radiations.  Pain was throbbing in character and aggravated by external rotation and her daily work responsibilities.  Therapies to date had included physical therapy, massage, chiropractic care, x-rays of elbow, evaluation by sports medicine physician, trial of anti-inflammatory medications and muscle relaxants. 

Physical examination demonstrated point tenderness along the lateral epicondyle and multiple trigger points in the extensor muscles.  Neurologic exam was normal.   Cervical spine had mild reduction in range of motion which was painful.  Specifically she had pain with extension and lateral rotation.

Given her poor response to conservative therapy, persistence of symptoms and neck pain and restriction motion, I was concerned that her pain was arising from a degenerate disc in her cervical spine.  That would make sense since the muscles in her arm which were painful receive their information from the C6 nerve.  If there is compression of the nerve root,  pain and muscle dysfunction can result.

Her cervical MRI demonstrated degeneration of the C5/6 disc and compression of the C6 nerve root.

A thorough examination is essential.  This is the standard at the Centeno-Schultz Clinic.  Regenerative options for this patient include prolotherapy, IMS, cervical injections with PRP and stem cell therapy.

Elbow Pain: PRP and Prolotherpy

Pain localized on the outside of the elbow is referred to as tennis elbow or lateral epicondylitis.

A group of muscles called the extensors attach to the outside bony surface of the elbow.

Tendons attach  muscle to bone.  To better visualize this, image the rope that extends from your tent to the stake.  During a wind storm there is increased tension on the rope which starts to pull on the tent stake.  The greater the stress on the rope, the greater the force on the stake.  So to with increasing tightness in muscle:  there is more tension on the stake (tendon attachment to bone).  The result is PAIN.

Treatment at the Centeno-Schultz Clinic begins with a thorough evaluation and examination.  Prolotherapy and PRP are effective therapies to reduce the inflammation and irritation at the site where the extensor tendons attach to the bone.  Equally important is to treat the underlying cause:  the dysfunctional tight muscles, like the tent rope, which are straining its anchor.  This is treated with IMS. Treatment at the Centeno-Schultz Clinic includes treating the pain as well as addressing the underlying issue that gave rise to the pain.

Lateral Epicondylitis

Lateral epicondylitis otherwise known as tennis elbow is a overuse injury involving the extensor muscles that originate on the bony prominence (epicondyle) on the outside (lateral) aspect of the elbow.  It is more properly termed a tendinosis that specifically involves the origin of the extensor carpi radialis brevis muscle.  Nirschl and Pettrone attributed the cause of lateral epicondylitis to be tearing in the origin of the extensor carpi radialis brevis (ECRB) muscle.

The extensor carpi radialis brevis (ECRB) muscle originates from the lateral epicondyle. It functions to move the wrist so that the hand moves away from the palm and towards the thumb.

Many patients with tennis elbow are involved in work or recreational activities that require repetitive use of the forearm muscle. Pain can be  severe and burning  localized on the outside part of the elbow.   In most cases the pain starts slowly and escalates over weeks or months.

Conservative therapy includes limiting repetitive use of the forearm.  Orthotics can only help diminish symptoms of tennis elbow.

These can reduce symptoms by resting the muscles and tendons.  The surgical procedure involves removing diseased tendon tissue and reattaching normal tendon tissue to bone.

Alternative therapies include prolotherapy, platelet-rich plasma and stem cell therapy.  At Regenexx patients are able to use their own stem cells to regenerate torn ligaments and tendons.