Houston Methodist. Leading Medicine

Elbow FAQ

Question:

I had chronic tennis elbow for months and months. After trying everything else, I decided to go for the new whole blood injection therapy. The pain was much, much worse right away and then got better after about a week. Can you explain why this treatment makes you worse before better?

Answer:

Blood as a healing agent is a fairly new approach to problems like chronic tennis elbow. It was first used in the 1990s for facial and plastic surgery and has since expanded in its application to include orthopedic treatments as well. There are two different types of blood injection currently being used and studied. The first is platelet-rich plasma or (PRP). PRP is the plasma (clear) portion of the blood with eight times the number of platelets as regular whole blood. Platelets contain special growth factors that are normally released during a healing or tendon reparative process. Depending on how the platelet-rich plasma is prepared, there can be up to 25 times the normal number of growth factors available. The second form of blood injection is the use of autologous whole blood. Autologous tells us that the patient's own blood was used in the procedure. It sounds like this is the type of blood injection you may have had. Both types of blood treatment have been shown to increase the number of cells needed to stimulate collagen production but without creating scar tissue. Collagen is the basic building material of tendons. Paatients receiving the whole blood injection report more pain after their injection. This may be because the white blood cells contained within the blood sample signal an intense inflammatory response. Studies comparing platelet-rich plasma (PRP) with whole blood suggest that platelet-rich plasma (PRP) injection is superior to autologous whole blood in the treatment of chronic tennis elbow. Patients receiving the platelet-rich plasma (PRP) (with the higher concentration of growth factors) have better results at first (during the first six weeks). But after that, the results are about the same between the two groups. So PRP treatment gives earlier pain relief but no greater function in the end. Pain relief is still welcomed by anyone with chronic elbow pain. Researchers in this field suggest that the influence of white blood cells with and without platelets should also be investigated more closely. Christos Thanasas, MD, et al. Platelet-Rich Plasma Versus Autologous Whole Blood for the Treatment of Chronic Lateral Elbow Epicondylitis. In The American Journal of Sports Medicine. October 2011. Vol. 39. No. 10. Pp. 2130-2134.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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