Epicondylitis and PRP

Lateral epicondylitis, commonly known as tennis elbow, is considered one of the most prevalent elbow pathologies. 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.

PROPOSED TREATMENTS

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

• pain control;
• return to activities of daily living;
• 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,
• Dry needling,
• Shock waves,
• Percutaneous intratissue electrolysis,
• Corticosteroid/PRP injections

PLATELET-RICH PLASMA (PRP) TREATMENT

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 treatment with platelet-rich plasma, 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.

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 infiltrations, there are studies that observe a clinical and functional difference in favor of PRP infiltrations compared to corticosteroid infiltration therapy, especially in controls at 3 and 6 months, in which corticosteroids have lost treatment effectiveness while PRP maintains its improvement rates, the authors recommending the use of PRP if an effective long-term treatment is desired.

PROTOCOL FOR THE USE OF PRP IN EPICONDYLITIS

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

• Prior ultrasound examination.
• PRP preparation and activation under sterile conditions.
• 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 of intratendinous and intramuscular injections are injected.
• After withdrawing the needle, we continue to infiltrate the healthy tendon, muscle, and surrounding fat to activate satellite cells, with 2 to 3 ml.
• Cryotherapy for pain control for 10 minutes.
• We will not use corticosteroids or local anesthetics due to demonstrated cellular toxicity.
• 24-hour joint/sports rest, followed by cryotherapy 2-3 times daily.
• Oral non-anti-inflammatory analgesia, as it can interact with the tendon regeneration process.
• 2 to 3 ultrasound-guided PRP injections are recommended, with an interval of one per week depending on the patient's progress.
• Weekly ultrasound monitoring.
• 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.