Lateral epicondylitis (Tennis Elbow) refers to the pain derived from loading the common extensor origin. It was thought that the pain was due to tendinitis, but this is now seen as inaccurate. The pathology represents overuse of the ECRB tendon at its attachment, with subsequent non inflammatory degenerative change at this site.

The outcome is that the tendon has weakened, making it more prone to further injury. This vicious cycle needs to be broken, by preventing injury, addressing the factors that are contributing to the problem and working on strengthening the affected tendon.

Treatments to date involve reducing the pain of tendinopathy, reducing the load on the tendon and assisting the healing process. Rest, Ice and massage will help relieve some of the pain locally. Elbow bracing and change in ergonomics will reduce the load on the tendon.

The breakthrough comes with injecting of blood and blood products around the tendon to help with regeneration of collagen and strengthening the collagen fibres. There are now numerous studies showing that injection of 2-3ml of autologous blood under ultrasound guidance helps with repair of the tendon and subsequent decrease in pain and increase in function. The thought is that platelet derived growth factors (and other growth factors) are released from the blood sample and help repair collagen. These various growth factors are all found in the alpha granules in platelets. Further to this, Platelet Rich Plasma (PRP) has been shown to have 500% more platelets in concentrated form, and can easily be harvested with a centrifuge in 15-20 min. While other tendon treatments such as corticosteroid injections may provide temporary relief and reduce symptoms, PRP injections potentially heal the tendon over time.

The doctors at Sydney Sports Medicine Centre have successfully treated a number of recalcitrant cases of lateral epicondylitis with these methods. Patients generally return to full activities at 8-12 weeks after injection. Strength work and physiotherapy can begin at 10 days. This treatment is widely used in Europe and has been used in the USA since the 1980’s. It is commonly used in tendinopathies involving high Hamstring, Achilles and Patella tendons. Autologous blood injections and Platelet Rich Plasma injections can all be performed at our clinics under ultrasound guidance.

Further reading is available with a review article available online free of charge. Visit:

www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=19468902

Please call us if you think you or your patient may benefit from this procedure and wish to discuss.