Navigation Links
New biologic treatment for tennis elbow may replace surgery for chronic sufferers

A person suffering from tennis elbow may not have to look any further than his or her own body for the most effective treatment, according to a study published in the November issue of The American Journal of Sports Medicine.

Specially-prepared platelets taken from the patient which are then re-injected into the tendon of the affected elbow provides more relief than more commonly-used therapies which have failed to yield results, often resulting in surgery, concludes study authors Allan Mishra MD and Terri Pavelko, PAC, PT, of the Menlo Medical Clinic, Stanford University Medical Center, Menlo Park, Calif.

"Ours is the first in vivo human investigation of this novel biologic treatment for chronic severe elbow tendonitis in patients who have simply 'flunked out' of other treatments," says Dr. Mishra. "Ninety-three percent of patients in our study did well, which is as good a result as patients who have tendon surgery."

"There is very little risk here; we are using the patient's own blood taken right in the doctor's office, and the whole procedure takes less than an hour," Mishra says. "The results of our pilot study indicate this therapy is as effective as surgery, with sustained and significant improvement over time, no side effects, and high patient acceptance."

Tennis elbow (lateral epicondylitis or tendonitis) isn't restricted to those who frequent tennis courts, but is a common problem for people whose activities require strong gripping or repetitive wrist motions. It is a degeneration of the tendon above the elbow that controls the movements of the wrist and hand. Treatments such as rest, nonsteroidal anti-inflammatory drugs, bracing, physical therapy, and injections of corticosteroids (cortisone shots) are often used but recent studies have called into question their efficacy. Those who suffer longest resort to surgical repair of the tendon when all other therapies have failed.

Mishra and Pavelko evaluated 140 patients who had tennis elbow for longer than 3 months and had scored at least a 60 of 100 using a visual analog scale (a continuum on which a person rates the severity of his/her pain: 0 = no pain; 100 = maximum pain). They all had completed a course of physical therapy and had tried some combination of anti-inflammatory medicines, bracing or cortisone shots, all without relief of symptoms. Twenty of the original 140 patients evaluated met these strict criteria and were enrolled in the study. These 20 represented the most severe tendonitis patients who had not improved with time or nonsurgical treatment.

Fifteen patients received a one-time injection of platelet-rich plasma (PRP) into their affected elbow. (Platelets are blood components responsible for the formation of clots in response to injury, but also contain powerful growth factors; plasma is the liquid portion of the blood.) Blood was drawn from a patient's unaffected arm and spun down in the physician's office lab to separate the blood's components. Approximately a half-teaspoon (2 to 3 mL) of this material ?over 500% richer in platelets than whole blood ?was then injected into the tendon of the sore elbow. These 15 patients had tennis elbow for 15 months and the average patient age was 48 years. Their baseline score on the pain scale was 80.3.

Five patients served as a control (non-PRP) group and received a 2 to 3 mL injection of a local anesthetic (bupivacaine with epinephrine) into the affected elbow. The mean duration of symptoms in this group was 12 months and average patient age was 42 years. Their baseline score on the pain scale was 86.

Twenty-four hours post-treatment both groups began a 2-week standardized stretching program and at 4 weeks patients were allowed to return to normal sporting and recreational activities. Follow-up visits were planned at 4 weeks, 8 weeks and 6 months post-treatment, with a final overall evaluation. Using the visual analog scale , at 4 weeks post-treatment the PRP-treated group reported a mean 46 percent improvement versus a mean 17 percent improvement in the control group. Eight weeks after treatment, the PRP patients reported a mean 60 percent improvement while the control group reported a mean 16 percent improvement. At eight weeks, 3 of the 5 control patients had either sought other treatment for their condition or had left the study, limiting further analysis to the PRP-treated patients.

At 6 months post-treatment, the PRP-treated patients' visual analog pain scores had improved 81 percent over their baseline scores. At a 2-year evaluation, 93 percent of these patients reported "complete satisfaction" with the treatment and 7 percent were "partially satisfied." Nearly all of the PRP-treated patients had returned to the activities of daily living and over 90 percent had returned to work or sporting activities.

Platelet-rich plasma contains powerful growth factors that initiate healing in the tendon, but may also send signals to other cells in the body drawing them to the injured area to help in repair, Mishra theorizes. Early studies have shown PRP therapy to be useful in maxillofacial surgery, wound healing, microfracture repair, and in the treatment of plantar faciitis. Treatment with PRP is still considered investigational and further research is needed before it can be made available to the general population.

"The body has an extraordinary ability to heal itself," says Mishra. "All we did was speed the process by taking blood from a different area, concentrating it, and putting it back into an area where there was relatively poor blood supply to help repair the damage."


Source:American Orthopaedic Society for Sports Medicine

Related biology news :

1. NYU researchers simulate molecular biological clock
2. Automatic extraction of gene/protein biological functions from biomedical text
3. DuPonts first biologically derived polymer receives global recognition
4. Glow-in-the-dark zebrafish at UH hold keys to biological clocks
5. Discovery clarifies role of peptide in biological clock
6. A new way to share models of biological systems
7. Engineers improve plastics potential for use in implants by linking it to biological material
8. New book expands biological classifications to account for alien life
9. Technique offers new view of dynamic biological landscape
10. UC Berkeley researchers create a biologically-inspired artificial compound eye
11. Nano machine switches between biological and silicon worlds
Post Your Comments:

(Date:11/12/2015)...  A golden retriever that stayed healthy despite having ... provided a new lead for treating this muscle-wasting disorder, ... of MIT and Harvard and the University of São ... Cell, pinpoints a protective gene that boosts ... The Boston Children,s lab of Lou Kunkel , ...
(Date:11/10/2015)... Nov. 10, 2015  In this report, ... basis of product, type, application, disease indication, ... this report are consumables, services, software. The ... safety biomarkers, efficacy biomarkers, and validation biomarkers. ... are diagnostics development, drug discovery and development, ...
(Date:11/4/2015)... 4, 2015 --> ... published by Transparency Market Research "Home Security Solutions Market - ... 2015 - 2022", the global home security solutions market is expected ... 2022. The market is estimated to expand at a ... to 2022. Rising security needs among customers at homes, ...
Breaking Biology News(10 mins):
(Date:12/1/2015)... , Dec. 2, 2015  Researchers using modern imaging techniques ... archaeological site were able to learn about the health conditions ... presented today at the annual meeting of the Radiological Society ... France , unearthed several grave sites dating ... --> France , unearthed several grave ...
(Date:12/1/2015)... ... December 01, 2015 , ... ... talks at SPIE Photonics Europe 2016, the premier research conference in Europe ... event will run 4-7 April 2016 in the Square Brussels Meeting Centre. ...
(Date:12/1/2015)... , December 1, 2015 ... a touch activated lancet that features Owen Mumford,s unique ... , booth 1403, Unistik® Touch is a touch activated ... --> Owen Mumford, a leading medical device ... of medical devices, available initially in the US before ...
(Date:12/1/2015)... , Dec. 1, 2015 Today the Allen ... Seattle,s South Lake Union neighborhood, ... of Mercer Street and Westlake Avenue North, the 270,000 ... Allen Institute for Brain Science and the Allen Institute ... philanthropist and founder of the Allen Institute. "We started ...
Breaking Biology Technology: