One of the most frequent problems that I assess in my office is pain at the elbow. Almost always there is a very tender spot on the bone along the outside of the elbow and pain radiating to the wrist. The pain is provoked by grasping, lifting and wrist use, in general. This is the classic Tennis Elbow. It is caused by an inflammation of the common extensor tendon, a band of connective tissue that comprises multiple tendons. This tendon attaches at the humerus (upper arm bone) and elbow area. The tendon(s) are the attachment point for muscles that run down the arm. In the lower arm the muscles form tendons again which connect to the bones of the hand. At the hand the tendons work to extend (pull back) the wrist and hand.

Once this set of tendons is inflamed it tends to stay that way for a very long time. It is thought that once this tendon is inflamed, it begins to degenerate, leading to tendon tearing. Sometimes, with time, the tendon spontaneously heals itself. Physical therapy, bracing, activity modifications and anti-inflammatory medications are all reasonable non-invasive therapies. But there are patients who do not experience symptom relief, and they are candidates for more invasive therapies, such as injections and surgery.

A traditional injection therapy for Tennis Elbow has been a combination of steroid and local anesthetic. While steroid injections may reduce the pain, they may also degenerate the tendon further.

A better approach is a Platelet Rich Plasma (PRP) injection. PRP entails drawing a patient’s blood, isolating and concentrating the platelets and then injecting the concentrated platelets into the common extensor tendon. Better because PRP does not contain steroids, so it won’t deteriorate the tendon, impact immunity or lead to blood sugar elevations. Better because it strengthens and improves the tendon as it relieves tendinitis pain. Better because the pain relief is superior to that with steroid injections. It should be considered the best therapy for Tennis Elbow. At Regenexx®, we customize the platelet concentrate in our on-site lab, assuring the patient of the highest concentration (dose) of platelets. This is far superior to the bedside machine method of platelet preparation employed by other clinics. Sometimes more than one injection is required to fully treat the tendon.

From the Hastie article.

I will mention surgery as an alternate treatment only to say that it should not be necessary in most cases.  I would reserve it for the most recalcitrant cases which don’t respond to PRP. Studies don’t really show any superiority of surgery to non-surgical therapies.

If you’ve been suffering from intractable pain at the elbow, call our Regenexx® office at Advanced PainCare today at 717-791-2860 to schedule your evaluation. We’re conveniently located in Camp Hill, PA.  For questions, please call our Regenexx® educator, Maddie, at 717-864-6985.

References:

• Bateman et al, Surgery for Tennis Elbow; a systematic review.  Shoulder Elbow. 2017 Dec11;11(1):35-44.
• Hastie, g, et al. Platelet rich plasma injections for lateral epicondylitis of the elbow reduce the need for surgical intervention. J Orthop. 2018 Jan31;15(1):239-241.