Epicondylitis and PRP

What is epicondylitis or tennis elbow?

Lateral epicondylitis, commonly known as tennis elbow, is considered one of the most prevalent elbow conditions. It is a degenerative tendon process that affects the common extensor tendon, and more specifically the extensor carpi radialis brevis tendon. Its prevalence in the general population is around 4%, while in manual workers (laborers, housekeepers, professional athletes, etc.) it can reach 7%. Its highest incidence occurs between the ages of 40 and 60, and there are usually no differences based on gender.

How to treat epicondylitis?

There are many proposed treatments for the acute and chronic forms of this condition, with common goals:

• pain control
• return to daily activities
• prevent loss of function and mobility
• control progressive tendon deterioration
• improve strength and endurance

These treatments are conservative in the vast majority of cases, with good clinical results.

• Manual therapy
• Stretching and strengthening exercises. See stretching and strengthening exercises for epicondylitis.
• Dry needling
• Shock waves
• Percutaneous intratissue electrolysis
• Corticosteroid injections

What if the above treatments don't work?

Despite the positive results obtained by these techniques, there is no single treatment or specific protocols that are completely infallible and unify therapeutic criteria. Therefore, in recent years, interest in biological therapies has grown, with the most interest being platelet-rich plasma treatment, commonly known as PRP.

This platelet-rich plasma reduces inflammation, provides fibrin to injured tissue, reduces local fibrosis, and possesses cell assembly and mechanical support properties. All these properties are thanks to the content of these preparations: growth factors, cytokines, platelet morphogens and fibrogens, and various plasma proteins.

What can we improve with PRP treatment for epicondylitis?

The primary objective of intratendinous PRP injections is to attract, activate, and mobilize cells that contribute to tendon repair, such as tenoblasts, satellite cells, and macrophages.

There are several studies comparing PRP treatment with other accepted injection treatments, such as corticosteroids, autologous blood (from the same patient), or local anesthetics. The vast majority are controversial due to the lack of consensus regarding protocols that explain the type of injection, quantity, number of applications, and method of application.
Comparative studies of PRP injections with local anesthetics showed no differences after 12 weeks of treatment, but did show a 25% improvement in pain (VAS scale) after 24 weeks of treatment in patients treated with PRP. Regarding corticosteroid injections, some studies observe a clinical and functional difference in favor of PRP injections compared to corticosteroid injection therapy, especially in follow-up visits at 3 and 6 months. In these studies, corticosteroids have lost effectiveness while PRP maintains its improvement rates. The authors recommend the use of PRP if long-term, effective treatment is desired.

What is the PRP treatment procedure for epicondylitis?

There are several proposed protocols for the use of PRP in epicondylitis. We detail the one that most closely resembles our method of treatment:

1. Prior ultrasound examination.
2. PRP preparation and activation under sterile conditions.
3. Infiltration along the longitudinal axis and under ultrasound guidance, from distal to proximal, parallel to the tendon fibers. After reaching the degenerative area of the tendon, 3 to 5 ml are injected intratendinously and intramuscularly.
4. After removing the needle, we will continue to infiltrate the healthy tendon, muscle, and surrounding fat to activate satellite cells, with 2 to 3 ml of injection.
5. Cryotherapy for pain control lasts 10 minutes.
6. We will not use corticosteroids or local anesthetics due to demonstrated cellular toxicity.
7. 24-hour joint/sports rest, continuing with cryotherapy 2-3 times a day.
8. Oral non-anti-inflammatory analgesia is recommended, as it can interact with the tendon regeneration process.
9. 2 to 3 ultrasound-guided PRP injections are recommended, with an interval of one per week depending on the patient's progress.
10. Weekly ultrasound monitoring.
11. Physiotherapy treatment with eccentric exercises.

Do you suffer from epicondylitis? Make an appointment with Dr. Jordi Jiménez. He will see you in the center of Palma and help you regain your quality of life.