Golfer and Tennis Elbow
Spring time is in full force and, here at StemCell ARTS, we often see patients who have worn their bodies out participating in their favorite outdoor activities. Golfer and tennis players are common athletes that our physicians come across. Golfer’s elbow is inflammation that causes pain and discomfort where the tendons of the forearm connect to the inside of the elbow. Tennis elbow is similar to Golfer’s elbow, but differs in that the pain occurs on the outside of the elbow. These injuries are abundant among both professional and non-professional athletes. These injuries can also be seen in patients who do not engage in either golf or tennis.
Treatments Provided at StemCell ARTS
Usually, the treatments for these conditions are easily resolved with an injection of cortisone that helps resolve the inflammation. However, for those with chronic Golfer and Tennis elbow, we are able to provide long-lasting and non-invasive treatments options for you! Prolotherapy and Platelet Rich Plasma provide more permanent relief because we are utilizing your body’s own healing capabilities instead of masking your symptoms. Schedule an appointment with us today and let us get you back to those hole-in-ones!
Watch Dr. Friedlis’ video on how we would treat Golfer’s and Tennis Elbow here at StemCell ARTS!
A condition commonly known as “Tennis Elbow”, lateral epicondylitis develops as a result of overuse of the muscles in the forearm. Simple daily activities such as repeated lifting, twisting or gripping can cause inflammation of the tendons and occasionally result in a series of small tears, generating significant pain.
The elbow joint is comprised of three bones joining the upper arm with the lower forearm. This joint is supported by surrounding muscles, tendons and ligaments. As the inflammation increases, the pain can become severe and limit daily activities. Traditionally, to combat the pain, patients turn to over-the-counter anti-inflammatories or corticosteroid injections. While these measures may temporarily reduce the pain, they can also slow down the healing process. As the body’s ability to heal the area becomes inhibited, the inflammation can no longer be reduced, resulting in chronic elbow pain.
New regenerative treatments use a patient’s biological material to heal lateral epicondylitis. A recent study has found that patients suffering from elbow pain reported a significantly larger improvement in pain following a PRP injection, as opposed to a cortisone injection. Following the Regenexx PRP protocol, whole blood is drawn from the patient and isolated in the onsite lab; removing all of the contaminating red and white cells. From there, the platelets are concentrated and injected into the joint where the growth factors attract repair cells to the site of injury and start the healing process. Usually, within 2-3 sessions, patients experience an improvement in pain and function. Patients are able to return to normal activity without undergoing invasive surgery.
Los Angeles Angels’ starting pitcher, Garrett Richards, faced surgical intervention following a high-grade tear of his ulnar collateral ligament. A common injury among pitchers, due to the wear and tear placed on the elbow, surgery to repair an ulnar collateral ligament can results in long periods of recovery. Athletes choosing to proceed with stem cell therapy can avoid lengthy periods of downtime and rehabilitation, typically associated with surgery. Stem cell therapy gets athletes back in the game, quickly!
As Regenexx Network Physicians, we’re part of the only stem cell treatment network to publish this type of analysis of patient outcome data. The analysis is made possible thanks to the massive numbers that have been accumulating for years in the Regenexx patient registry.
This patient outcome data is not part of a controlled trial. Every patient becomes part of a registry to track outcomes and any complications. This data is a compilation of patient input to the Regenexx Patient Registry at regular intervals following their Regenexx Procedure.
Elbow tenderness and pain with resisted wrist extension are common manifestations of lateral epicondylar tendinopathy, also known as tennis elbow. Previous studies have suggested platelet-rich plasma (PRP) to be a safe and effective therapy for tennis elbow.
To evaluate the clinical value of tendon needling with PRP in patients with chronic tennis elbow compared with an active control group.
Randomized controlled trial; Level of evidence, 2.
A total of 230 patients with chronic lateral epicondylar tendinopathy were treated at 12 centers over 5 years. All patients had at least 3 months of symptoms and had failed conventional therapy. There were no differences in patients randomized to receive PRP (n = 116) or active controls (n = 114). The PRP was prepared from venous whole blood at the point of care and contained both concentrated platelets and leukocytes. After receiving a local anesthetic, all patients had their extensor tendons needled with or without PRP. Patients and investigators remained blinded to the treatment group throughout the study. A successful outcome was defined as 25% or greater improvement on the visual analog scale for pain.
Patient outcomes were followed for up to 24 weeks. At 12 weeks (n = 192), the PRP-treated patients reported an improvement of 55.1% in their pain scores compared with 47.4% in the active control group (P = .163). At 24 weeks (n = 119), the PRP-treated patients reported an improvement of 71.5% in their pain scores compared with 56.1% in the control group (P = .019). The percentage of patients reporting significant elbow tenderness at 12 weeks was 37.4% in the PRP group versus 48.4% in the control group (P = .143). Success rates for patients at 12 weeks were 75.2% in the PRP group versus 65.9% in the control group (P = .104). At 24 weeks, 29.1% of the PRP-treated patients reported significant elbow tenderness versus 54.0% in the control group (P = .009). Success rates for patients with 24 weeks of follow-up were 83.9% in the PRP group compared with 68.3% in the control group (P = .037). No significant complications occurred in either group.
No significant differences were found at 12 weeks in this study. At 24 weeks, however, clinically meaningful improvements were found in patients treated with leukocyte-enriched PRP compared with an active control group.
Commentary on Platelet Rich Plasma, Stem Cells and Regenerative Medicine
The study was a randomized, double-blind, multi-center controlled trial of 230 patients. Patients received needling of their elbow tendons with and without PRP. At 24 weeks the PRP patients reports a 71.5% improvement in their pain compared to 56.1 in the control group. (P = 0.027) Patients treated with PRP also had less elbow tenderness at each follow up point. (See Graph Below) Overall, 84% of the PRP patients were successfully treated compared to 68.3% of the control group. (P = 0.012)
This is the largest study done to date using PRP. There are now over 340 patients who have been treated with the same system (Biomet GPS PRP) and techniques confirming the value of PRP as a treatment for chronic tennis elbow. Importantly, there is also a decade long experience using PRP with an excellent safety profile. PRP with this newly released data can now be confidently used for chronic tennis elbow patients prior to considering surgical intervention.