Houston Methodist. Leading Medicine

Elbow FAQ

Question:

I saw a brief segment on the news about a new treatment using my own blood for chronic tennis elbow. I would love to try it. It's been months since I played a game without pain. My doctor didn't seem to know anything about it. I said I would research it and get back to him. What can you tell me about this?

Answer:

Don't be surprised if your physician hasn't heard of platelet-rich plasma (PRP) to treat sports injuries. It is a relatively new treatment development in the area of musculoskeletal injuries. It hasn't been tested fully to prove its effectiveness. There aren't many studies published just yet. Most of the studies presented so far have been with animals or small numbers of people. Some folks are asking: what is platelet-rich plasma? Platelets are part of the blood that circulate around the body ready to help with blood clotting should you have a cut, broken bone, injury that bleeds internally, or any other type of injury. Besides containing clotting factors, the platelets release growth factors that help start the healing sequence. Plasma is the clear portion of the blood in which all the other blood particles such as platelets, red blood cells, and white blood cells travel. Platelet-rich plasma refers to a sample of plasma that has more than the normal amount of platelets. To get this substance, a portion of the blood is removed from a patient and placed in a machine called a centrifuge. The centrifuge spins the blood fast enough to separate it into layers based on weight. Heavier parts (e.g., red blood cells) stay on the bottom. Platelets and white blood cells spin out just above the red blood cell layer. Lighter particles (plasma without platelets or blood cells) make up the top layer in the test tube. The platelet-rich portion of the plasma is then injected into the damaged area (e.g., tendon, joint, bone). This treatment technique isn't entirely new -- just new to the realm of sports medicine. It's been used for years after plastic surgery and surgery on the mouth, jaw, and neck. It seems to promote bone graft healing and wound healing. Researchers have found a way to combine this substance with other chemicals to make it into a putty or gel that can be painted on a surgical site to speed up healing. There is no clear direction on when, how, or why PRP should be used. In this experimental phase, surgeons have used it for patients who failed conservative (nonoperative) care for chronic tennis elbow and chronic patellar tendinosis (knee tendon damage). There was one study where it was used for acute (recent) muscle injuries in professional athletes. The results of that study really made the rounds: these high-level athletes recovered in half the expected time and with no bad side effects and no scar tissue or adhesions. Similar findings have been observed when PRP was used during surgery to repair ruptured Achilles tendons and rotator cuff tears in a small number of patients participating in a pilot study. Once again, wound healing was much faster with fewer problems and less scar tissue. And the list of improvements with this treatment continues: patients use less pain medication, patients gain greater joint motion over a shorter period of time, patients get back to regular daily activities with greater speed and ease, and so on. You can expect to see an increase in studies reporting results over the next months to years. Right now, there are clinical trials being carried out in a number of places with a wide range of conditions. While that's being sorted out, physical therapists are turning their attention to the proper rehab protocol to follow for these patients. Developing optimal tendon healing and muscle strength, especially in high-level professional athletes who are eager to get back into the game will be a priority. Michael P. Hall, MD, et al. Platelet-rich Plasma: Current Concepts and Application in Sports Medicine. In Journal of the American Academy of Orthopaedic Surgeons. October 2009. Vol. 17. No. 10. Pp. 602-608.

*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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