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

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

What is lateral epicondylitis?

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. It is most often 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, scientific evidence has shown that there are no inflammatory cells in the affected tendon. It is a chronic degenerative condition of the common extensor tendon of the elbow, which is made up 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 sportsmen (hence its name "tennis elbow").

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

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

Ultrasound-guided platelet-rich plasma (PRP) injections

Since there is no unified therapeutic protocol for the conservative management of lateral epicondylitis, a combination of analgesic, rehabilitation-physical, and infiltrative pharmacological treatment is usually the standard.
Among this available therapeutic arsenal is platelet-rich plasma, popularly known as PRP (See article on PRP treatment).

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 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, multiple studies support symptomatic improvement after its use in traumatology.
There is consensus on its use in chronic tendinopathies, such as lateral epicondylitis, among others.

What is the procedure for treating epicondylitis with PRP?

1. We recommend up to 3 ultrasound-guided PRP injections, spaced once a week, depending on the patient's progress.
2. We perform a prior ultrasound examination, locate the target structure and degenerative area to be injected.
3. PRP preparation, activation, and ultrasound-guided injection are always performed 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.

DR. JORDI JIMÉNEZ GENERAL TRAUMATOLOGY SPORTS TRAUMATOLOGY ULTRASOUND-GUIDED THERAPIES

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.