Beth Musick wants to play tennis.  However, she is suffering from tennis elbow, a condition that has left her with "constant moderate" pain since last October.	Beth Musick with Dr. Wardell & Staff at Harbourview  in Suffolk

"It hurts to do simple things, like blow drying my hair or pulling up the sheets," said Beth, who recently retired from a job she held for 18 years. Now with lots of time on her hands, she'd like to spend plenty of it playing her favorite sport.  But, even with an arm brace that she wears all day, her injury won't let her. 

She tried cortisone shots, two of them;  the first on the bone and a second right below.  Neither helped.  So, when a friend mentioned an article she had read about Platelet Therapy for chronic tennis elbow sufferers, Beth was very interested.  But it was a chance encounter on vacation with someone who had undertaken the procedure in Massachusetts that piqued her curiosity and sent her searching for more information.

"The guy I talked to said it worked great, and he was back to playing tennis quickly," said Beth.  "In his case, it only took one injection."

Beth located the company that has developed a treatment protocol for Platelet Enhanced Plasma Therapy, which can be used to treat injured, torn or inflamed tissue, tendons, and ligaments.  The Massachusetts company, Harvest Technologies, has an FDA cleared device that produces high levels of platelet concentrations in a small value of blood plasma using a patient's own blood.

The use of autologous platelet concentrate in the operating room is not a new treatment.  Platelets are carriers of proteins specifically involved in the regeneration and growth of injured tissue.  However, being able to develop platelet-rich plasma (PRP) in an office setting, and within a relatively short amount of time,  is somewhat new.  In the past, critics have said that the amount of active platelets required to produce a healing enhancement cannot be done in an office setting.

Beth's thorough research left her with the impression that it was at least worth a try.   However, attempts to find doctors who offered the procedure locally  proved futile.  After many calls,  she located an orthopedic office in Suffolk who would be performing the injections starting June 1st.

"All the research seemed to make sense," Beth explained.  "Of course, my friends were grilling me about it:  Who has had it done?  What about the doctor? How did I know it was perfectly safe.  That sort of thing."

On Wednesday, June 6th, Beth headed off to Suffolk, VA to meet with Dr. Arthur Wardell, a well-known Orthopedic Surgeon who has been the President of the medical staff at Portsmouth General Hospital. Now in private practice, Wardell is the only physician in Virginia, according to Harvest Technologies, who has performed office-based PRP injections utilizing the company's centrifuge and delivery system.

After filling out the required paperwork, Beth was taken into an exam room where staff members and the doctor made a thorough inspection of her painful elbow.  "Many diseases or problems mimic tennis elbow," he told Beth. "We need to rule out other issues first."

Part of the routine included an x-ray of the site.  In Beth's case, beyond a small bone spur, (which, as Dr. Wardell explained, is a bony reaction to a tissue injury) all symptoms led to a diagnosis of tennis elbow.

"Tennis elbow can be chronic and hard to deal with," said Dr. Wardell, who typically recommends steroid injections and physical therapy to persons who are just starting to suffer its painful symptoms.  "PRP Therapy is for patients who haven't responded to steroidal injections or physical therapy, and who aren't ready for standard surgical treatment."

Dr. Wardell believes that the technology can speed up the body's ability to heal itself using just a few tablespoons of a patient's own blood, separating out the platelets. 

"Platelets are packed full of growth factors," said Dr. Wardell.  "When you inject them into a very specific area, it promotes faster healing."  Because of Dr. Wardells office based ultrasonography team, he says he can offer not only the delivery system, but the ability to determine the specific site  where the injection should be placed, using ultrasound.

He was very thorough in responding to Beth's questions, and pointed out that although the treatment may be new to the orthopedic world, it has been around some time for other medical areas.  "There is a road that a new treatment takes before it becomes a 'standard of care'.

"First, it's labeled experimental.  Then investigational, then accepted and widely accepted, " he explained.  

"One thing that you can look at is whether insurance companies will pay for the procedure.  So far, it has been no problem."  (Which was true in Beth's case).

"The concept really can't be faulted," said Dr. Wardell.  "We know how wounds repair; that's simple hematology.  And many athletes are using the technology in professional sports:  for the achilles tendon, rotator cuff, patella tendon.  It makes sense to use it here as well."

Side effects reportedly have been minor, according to published papers.  So far, one of the biggest complaints is that the procedure itself is kind of painful.  Actually, not even the injection -- but the needles used to insert the numbing medication.

"I did my yoga breathing," said Beth.

Next:  The procedure itself, and Beth's first 48 hours afterwards.
So far, so good........Part 2

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*References:
Platelet Rich Plasma Treatment for Tendonitis, Schnabel, LV; Jacobson, MS; Miller, BJ; McDermott; WG; Fortier, LA;  Cornell University

Platelet Rich Plasma:  Evidence to Support Its Use, Robert E. Marx DDS, Oral and Maxillofacial Surgery, 2004

Developing Technologies for Accelerating Healing, Naturally, Harvest Technologies Group, Plymouth, MA 2002

**This article is provided for informational purposes only and does  not  constitute medical advice, a recommendation or endorsement of any particular procedure or product and should not be used as a substitute for medical advise from your physician.  Please consult your physician for a specific treatment plan for tennis elbow or any other procedure.