Study Suggests New Tennis-Elbow Treatment

By AARON RUPAR

A new treatment for the type of tendonitis commonly known as tennis elbow has shown great potential during initial tests, says a study in the November issue of The American Journal of Sports Medicine.

We took a component of the patient’s own concentrated blood platelets and injected them into the tendon of the sore elbow, said Dr. Allan Mishra, one of two authors of the study. This procedure aims to let the body heal itself.

The platelet-injection technique provided greater relief than more commonly used therapies that have failed to yield results, often resulting in surgery.

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, said Mishra. Ninety-three percent of patients in our study did well, which is as good a result as patients who have tendon surgery.

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. The ailment involves a degeneration of the tendon above the elbow that controls the movements of the wrist and hand.

Although the number of people suffering from tennis elbow is unknown, Mishra told United Press International it is in the tens if not hundreds of thousands.

Treatments such as rest, non-steroidal anti-inflammatory drugs, bracing, physical therapy and injections of corticosteroids (cortisone shots) are often used to treat tennis elbow, but recent studies have called their efficacy into question. Those who suffer longest resort to surgical repair of the tendon when all other therapies have failed.

While treatments such as cortisone shots only cover up the symptoms of tendonitis, platelet injection addresses the root cause of tennis elbow.

Blood platelets contain powerful growth factors that initiate healing in the tendon. In addition, Mishra theorizes that platelets may also send signals to other cells in the body, drawing them to the injured area to help in repair.

In the study, 15 people who had severe tennis elbow for an extended period of time received a one-time injection of platelet-rich plasma. A control group of five people with similar symptoms was injected with a local anesthetic.

At four weeks post-treatment the platelet-treated group reported a mean 46 percent improvement versus a mean 17 percent improvement in the control group. Eight weeks after treatment, the platelet-treated patients reported a mean 60 percent improvement while the control group reported a mean 16 percent improvement.

At six months post-treatment, the platelet-treated patients’ reported scores had improved 81 percent over their baseline scores. At a two-year evaluation, 93 percent of these patients reported complete satisfaction with the treatment and 7 percent were partially satisfied.

Nearly all of the platelet-treated patients had returned to the activities of daily living, and more than 90 percent had returned to work or sporting activities.

The body has an extraordinary ability to heal itself, said Mishra. All we did was speed the process by taking blood from a different area, concentrating it, and putting it back into an area where there was relatively poor blood supply to help repair the damage.

Other studies have shown platelet-injection therapy to be useful in maxillofacial surgery, wound healing, microfracture repair and in the treatment of plantar faciitis. Treatment with platelets is still considered investigational, and further research is needed before it can be made available to the general population.