October 24, 2024
Tennis elbow presents as a pain and stiffness originating at the outside of the elbow. Approximately 10 million Americans suffer with tennis elbow annually. It is a self-limiting disease, meaning that symptoms will eventually resolve on their own. The disease course usually runs 12-16 months. Traditional treatment methods have done little to reduce the course of disease, but recent developments in regenerative medicine show promising results with PRP injections.
Tennis elbow, also known as lateral epicondylitis, is commonly associated with racquet sports, but can affect anyone who undergoes repetitive gripping of the thumb and first two fingers. The muscle that extends and abducts the wrist is stressed if gripping activities are accompanied by force, as with swinging a racquet, manual labor, or factory work. The Extensor Carpi Radialis Brevis (ECRB) is the muscle most commonly involved in epicondylitis. The stress of repetitive motion results in micro-traumas at the lateral epicondyle where the ECRB inserts.
Clinicians hoping to shorten the duration of lateral epicondylitis are turning to platelet rich plasma therapy facilitate the repair of micro-traumas associated with repetitive use. A 2011 comparative study followed 100 patients for two years after administering a single corticosteroid injection or a single platelet rich plasma injection. Researchers assessed pain outcomes with the visual analogue scale (VAS) and functionality with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. They found a significant reduction in pain and improvement in functionality for the group receiving PRP injections.⁵
Another study compared PRP injections with autologous whole blood. Twenty-eight patients were randomized to receive a single 3 ml injection of either whole blood or platelet rich plasma. To prepare the PRP researchers drew 27 ml of blood in the presence of an anticoagulant. Whole blood was centrifuged at 3200 rpm for 15 minutes to isolate 3ml of leukocyte rich PRP. The PRP was injected with a peppering technique. Rather than adding an activator, researchers relied on local collagen to activate the platelets. Pain was assessed according to the VAS scale and functionality with the Liverpool elbow score. The study found statistically significant improvements for the PRP group at the 6-week follow up.⁶
The regeneration of damaged tissues occurs as platelets release growth factors at the site of injury. Platelets are non-nucleated fractions of cytoplasm. Megakaryocytes, cells located in your bone marrow, manufacture platelets to spread throughout your bloodstream. Their primary role is to coagulate blood, and direct surrounding cells to increase cell migration and proliferation at the site of damaged tissue, such as a skin opening or internal trauma. The platelets release growth factors like platelet derived growth factor, fibroblast growth factor, and connective tissue growth factor, at the injury which initiate a healing cascade.⁷
It’s interesting that the researchers in the later study chose to utilize leukocyte rich PRP. Leukocytes are known to increase catabolic and inflammatory effects on tendon cells. Some researchers hypothesize leukocyte rich PRP could slow the tenon healing process.⁸ Leukocytes would be more beneficial in the presence of an open wound where inflammation would defend the patient against infection.⁹
Daniel Zengel, an executive with over 10 years of experience in the pharmaceutical and medical device space, is dedicated to delivering industry-leading, cost-effective products to US-based medical providers. Specializing in regenerative medicine, Daniel focuses on sales, training, and marketing support to help clinics across the country successfully implement platelet-rich plasma (PRP) therapy.
Whether you are interested in offering PRP for aesthetic or musculoskeletal indications, we will provide you with everything you need to get great outcomes while increasing revenue!