PRP for Tennis Elbow

Elbow pain can be debilitating and make simple activities almost impossible.  What is tennis elbow?  What are the treatment options?  What is PRP for tennis elbow?  Let’s dig in.

What is Tennis Elbow?

Tennis elbow, also known as lateral epicondylitis, is a painful condition affecting the outside of the elbow.  The lateral epicondyle is bony prominence on the outside of the elbow to which important ligaments and tendons attach.  The most important structures that attach to the lateral epicondyle are the extensor muscles and tendons.  These include the extensor carpi radialis brevis, extensor carpi ulnaris, extensor digitorum which are illustrated below. Tendons attach muscle to bone.  Repetitive wrist extension, internal rotation of the forearm and gripping cause inflammation of the extensor tendons. Inflammation of the tendon is known as tendonitis and when it becomes chronic it is called tendinosis.  The overall prevalence of lateral epicondylitis is 1-3% (1).  The highest incidence is in individuals 40-60 years of age (2).

Classic symptoms include pain with gripping and wrist extension.  Reduced grip strength may also be present and the lateral epicondyle may be exquisitely sensitive to touch.

Treatment Options for Tennis Elbow

First and foremost is activity modification with reduced gripping and wrist extension.  For tennis players, this may mean playing with a different racket with a larger grip and lower string tension.  Physical therapy with myofascial release of the tight extensor muscles can be helpful. Curcumin and fish oil are effective anti-inflammatory agents that can reduce swelling.

Steroid Injections for Tennis Elbow

Steroid injections can actually damage tendon cells and accelerate damage (3).  Other adverse effects of steroids include muscle atrophy, escalation in pain, and depigmentation. Physical therapy has been shown to be more effective than steroid injections. In a 2002 study, 185 patients with lateral epicondylitis were randomized to 6 weeks of treatment with either steroids or physical therapy.   Outcome measures included pain and function which were measured at 3,6,12,26 and 52 weeks.  Physical therapy was superior to steroid injections (4).

PRP For Tennis Elbow

PRP, which stands for platelet-rich plasma, is a concentration of platelets and growth factors derived from whole blood.  Plasma is the fluid portion of blood. Blood is drawn from a peripheral site most commonly in the arm and then placed into a centrifuge where the platelets are concentrated.   Platelets contain important growth factors that are critical to tissue healing and repair which include vascular endothelial growth factor and platelet-derived growth factor.

PRP has been compared with steroids in the treatment of lateral epicondylitis.  In a 2015 study, 65 patients with lateral epicondylitis were randomized to receive PRP or steroid injections.  Pain, grip strength, and function were measured at 15 days, 1 month, and 3 months.  PRP was the superior treatment at 3 months (5).  A randomized control study (RTC) in 2014 established PRP as the best treatment option. In this study, 230 patients with lateral epicondylitis who failed conservative therapy were randomized into two groups( 6).  One group received PRP injections whereas the other served as controls and received no PRP.  At 24 weeks patients treated with  PRP demonstrated significant clinical improvement in comparison to those who did not receive PRP.

Not all PRP is the same, however.  Most PRP is processed by a bedside centrifuge which has limited flexibility.  At the Centeno-Schultz Clinic, we have extensive experience in the treatment of lateral epicondylitis.  We utilize a state-of-the-art cell laboratory which allows for your PRP to be customized for your specific condition, which is not possible with a bedside centrifuge.  To better understand the important differences in PRP please click on the video below.

PRP for tennis elbow is most effective when injections are performed under ultrasound guidance to ensure accurate placement of the platelets. Injections without ultrasound are not precise and may miss the areas of injury.  To watch an ultrasound-guided injection into the lateral epicondyle please click on the video below.

Related:Tennis Elbow vs. Golfer’s Elbow

Why Regenexx PRP Mixtures Are Superior

In most clinics that offer PRP therapies, the method of developing PRP involves removing a patient’s blood and running it through a simple bedside centrifuge machine to separate the plasma and concentrate the blood platelets, which are then immediately extracted and used as the injectate. These devices are not great at getting rid of unfavorable cells from the resulting mixture. Our lab tests show that white and red blood cells have an inhibiting effect on the same stem cells the platelets are attempting to stimulate and might cause excessive inflammation following the injection.

Our PRP is purer, concentrated, and customizable because it is produced in a laboratory setting by an experienced technician who can separate and concentrate all the blood’s good components and remove the unfavorable ones.

Invented at Centeno-Schultz Clinic, Regenexx’s Super Concentrated PRP procedures are an advanced type of PRP therapy that uses lab-processed PRP mixtures that have been found to provide up to 10 – 40 times more platelet concentrations than the traditional “bloody” PRP. Our PRP, due to its high levels of platelets, has an amber color (see Figure 1).

In Conclusion…

Tennis elbow also known as lateral epicondylitis is a painful condition that involves the outside portion of the elbow with injury and inflammation of the extensor muscles and tendons. Repetitive wrist extension, gripping and internal rotation of the forearm are common risk factors.  Physical activity modification, physical therapy, and anti-inflammatory agents are useful.  Steroids injections are associated with complications and are inferior to physical therapy.  PRP injections are superior to steroid injections in long-term studies in the treatment of lateral epicondylitis and now have become the gold standard.

Doctors Who Perform PRP Injections for Tennis Elbow

PRP injection procedures in Denver and Broomfield, Colorado clinics are performed by the following Interventional Orthopedics doctors:

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

Read more

John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

Read more

John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

Read more

Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

Read more

Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

Read more

1. E. Allander (1974) Prevalence, Incidence, And Remission Rates of Some Common Rheumatic Diseases Or Syndromes, Scandinavian Journal of Rheumatology, 3:3, 145-153, DOI: 10.3109/03009747409097141

2. Olaussen M, Holmedal Ø, Lindbaek M, Brage S. Physiotherapy alone or in combination with corticosteroid injection for acute lateral epicondylitis in general practice: a protocol for a randomised, placebo-controlled study. BMC Musculoskelet Disord. 2009;10:152. doi: 10.1186/1471-2474-10-152
3. Zhang J, Keenan C, Wang JH. The effects of dexamethasone on human patellar tendon stem cells: implications for dexamethasone treatment of tendon injury. J Orthop Res. 2013;31(1):105-10. DOI: 10.1002/jor.22193

4.Smidt N, van der Windt DA, Assendelft WJ, Devillé WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002;359(9307):657-62.DOI: 10.1016/S0140-6736(02)07811-X

5. Yadav R, Kothari SY, Borah D. Comparison of Local Injection of Platelet Rich Plasma and Corticosteroids in the Treatment of Lateral Epicondylitis of Humerus. J Clin Diagn Res. 2015;9(7):RC05-7.DOI: 10.7860/JCDR/2015/14087.6213

6.Mishra AK, Skrepnik NV, Edwards SG, et al. 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;42(2):463-71.DOI: 10.1177/0363546513494359