EPICONDYLITIS: TREATMENT WITH ULTRASOUND-GUIDED INFILTRATION OF PLATELET-RICH PLASMA (PRP)

EPICONDYLITIS: ULTRASOUND-GUIDED INFILTRATIONS WITH PLATELET-RICH PLASMA (PRP)
DR. JORDI JIMÉNEZ

Lateral epicondylitis of the elbow is one of the most common conditions seen in the offices of orthopedic surgeons, rehabilitation specialists, rheumatologists, and primary care physicians. In most cases, it is due to excessive and repeated extension of the wrist during work or sports. The incidence is estimated to be between 1% and 3% of the general population. The most common age of onset is between 35 and 50 years, with a similar gender ratio.

Although the term epicondylitis is still used today, the absence of inflammatory cells in the affected tendon has been scientifically proven. It is a chronic degenerative condition of the common extensor tendon of the elbow, composed of four tendons, the most frequently affected of which is the extensor carpi radialis brevis tendon. It is a very prevalent condition in manual workers (laborers, chambermaids, etc.) and racquet sports players (hence its name tennis elbow).

The treatment modalities widely used for the conservative treatment of lateral epicondylitis pursue various objectives:

• Analgesic treatment: pain control.
• Ultrasound-guided corticosteroid injections: pain control.
• Physiotherapy: prevent loss of function and mobility, improve endurance and strength.
• Eccentric exercises: control progressive tendon deterioration.
• Ultrasound-guided PRP injections: stimulate tendon repair and regeneration.

Ultrasound-Guided Infiltrations with Platelet-Rich Plasma (PRP)
Since there is no unified therapeutic protocol for the conservative management of lateral epicondylitis, a combination of analgesic, rehabilitation-physiotherapeutic, and infiltrative pharmacological treatment is usually the standard.
Within this available therapeutic arsenal, we find platelet-rich plasma, popularly known as PRP (https://drjordijimenez.com/en/treatments/infiltrations-with-platelet-rich-plasma-prp).

The platelet factors provided by PRP attract, activate, and mobilize the cellularity necessary for tendon repair and regeneration, which is the primary objective.
Although the disparity in the preparations presented in different publications (regarding preparation kits, addition of leukocytes to the final product, centrifugation, or PRP activation) currently prevents obtaining strong evidence for introducing PRP into different treatment guidelines for various musculoskeletal pathologies, there are multiple studies that support symptomatic improvement after its use in traumatology. There is consensus on its use in chronic tendinopathies, such as lateral epicondylitis, among others.

Considerations for the use of PRP in lateral epicondylitis
How do we work?

1. We recommend up to 3 ultrasound-guided PRP injections, with an interval of one per week depending on the patient's progress.
2. We perform a prior ultrasound examination, locate the target structure and the degenerative area to be injected.
3. PRP preparation, activation, and ultrasound-guided injection are always carried out under sterile conditions.
4. We do not use local anesthetics, which can interfere with platelet growth factors.
5. We recommend cryotherapy three times a day.
6. Joint rest for 48 hours.
7. We avoid nonsteroidal analgesics (NSAIDs) one week before and one week after the procedure.
8. Biweekly ultrasound follow-up.
9. Eccentric exercises are recommended.

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