TREATMENT OPTIONS FOR TENNIS ELBOW

Braces and Straps for Tennis Elbow

Physical Therapy for Tennis Elbow

Extra-Corporeal Shock Wave Treatment (ESWT) for Tennis Elbow

Corticosteroid Injections for Tennis Elbow

Low Level Laser Therapy for Tennis Elbow

Platelet Rich Plasma (PRP) Injection for Tennis Elbow

Autologous Blood Injections (ABI) for Tennis Elbow

Treatment Ratings

R E S C U R

RISK: 4/5 

Since the PRP comes from the patient’s own blood, there is no risk of disease transmission, and side effects appear rare, although pain and inflammation at the site of injection have been reported.

Kahlenberg CA, Knesek M, Terry MA. New Developments in the Use of Biologics and Other Modalities in the Management of Lateral Epicondylitis. Biomed Res Int. 2015;2015:439309.

E

EFFECTIVENESS: 3/5

A recent review of more than 300 studies concluded that PRP is more effective than autologous blood injection or corticosteroid injection, with less risk.

Arirachakaran A, Sukthuayat A, Sisayanarane T, Laoratanavoraphong S, Kanchanatawan W, Kongtharvonskul J. Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis. Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology. 2016;17(2):101-112. doi:10.1007/s10195-015-0376-5.

However, another recent study compared PRP injection with an injection of numbing medicine, and showed there were not many differences between the two groups, but also that nearly 80% had improvement.

Palacio EP, Schiavetti RR, Kanematsu M, Ikeda TM, Mizobuchi RR, Galbiatti JA. Effects of platelet-rich plasma on lateral epicondylitis of the elbow: prospective randomized controlled trial. Revista Brasileira de Ortopedia. 2016;51(1):90-95. doi:10.1016/j.rboe.2015.03.014.

S

SELF CARE: 0/5

You won’t be doing this on your own!

C

COST: 2/5

There are many ads online and in the paper touting PRP treatments. Costs apparently vary widely, but some online sites quote fees from $500-$1500, and others of $300 per injection, and usually more than one is required. PRP is still considered “investigational” and therefore not covered by most insurance carriers.

U

USEFULNESS (overall rating): 3/5

PRP injections involve drawing some of your own blood (usually 1-2 tubes) which is then spun down to yield increased concentrations of platelets. Platelets are a crucial component of blood important in healing, and they contain growth enhancing factors thought to increase healing. The plasma is then injected into the area of damage at the lateral epicondyle.

PRP is being used on a wide variety of joint, tendon, and muscle conditions. There are various types of products, and more recent research suggests the type with leukocyte rich PRP appears to be more effective.

Krogh TP, Bartels EM, Ellingsen T, Stengaard-Pedersen K, Buchbinder R, Fredberg U, Bliddal H, Christensen R. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med. 2013 Jun;41(6):1435-46. doi: 10.1177/0363546512458237.

Studies suggest that PRP injections can be helpful, but should be tried after more conservative approaches have been tried first, and some authorities believe it should be reserved for severe chronic cases before surgery is considered. Effects are usually not apparent at 12 weeks, but are more significant at 24 weeks.

Mishra AK, Skrepnik NV, Edwards SG, Jones GL, Sampson S, Vermillion DA, Ramsey ML, Karli DC, Rettig AC. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med. 2014 Feb;42(2):463-71. doi: 10.1177/0363546513494359.

Sanders TL, Kremers HM, Bryan AJ, Ransom JE, Smith J, Morrey BF. The Epidemiology and Health Care Burden of Tennis Elbow: A Population-Based Study. The American journal of sports medicine. 2015;43(5):1066-1071. doi:10.1177/0363546514568087.

Lateral Elbow Tendinopathy Development of a Pathophysiology-Based Treatment Algorithm Gev Bhabra,*† MD, FRCS(Orth), Allan Wang,†‡ FRACS, PhD, Jay R. Ebert,§ PhD, Peter Edwards,§ BSc, Monica Zheng,|| BPodM, and Ming H. Zheng,†{ PhD, MD, FRCPath. The Orthopaedic Journal of Sports Medicine, 4(11)

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