SECOND IN A SERIES OF ARTICLES FOLLOWING TREATMENT RESULTS  Part One       Part Two     Part Three    Part Four
Several years ago, Beth Musick had surgery to repair carpal tunnel syndrome in her right hand and wrist.  That surgery went well, and she has been playing tennis 3-4 times a week for awhile.  Only now she has a very chronic case of tennis elbow. Tennis elbow, also known as lateral epicondylitis or tendonitis, is a degeneration of the tendon above the elbow that controls the movements of the wrist and hand.    In tennis elbow, the tendons - the elastic connective tissues that attach muscles to bones - have been injured or stretched, resulting in a reduced blood supply.  And pain.	Beth Musick's  arm is prepped by marking the specific sites where the injection will be placed

Current Treatments for tennis elbow include rest (sometimes for as long as six months)  nonsteroidal anti-inflammatory drugs such as Aleve and Advil, bracing, physical therapy, and injections of cortisone (corticosteroids) at the point of pain

Recent studies have shown that steroid injections do not provide long-term relief from tennis elbow.  In fact, according to an article in the British Medical Journal (Oct. 2006),  physiotherapy or a 'wait and see' approach are both more effective in tackling tennis elbow than steroid injections.   

Avid tennis players tend to be an impatient group, which may account for the amount of injections undertaken in surgeon's offices.  However, while cortisone shots may seem to offer short-term relief, according to the British study, after 52 weeks the study participants who had received injections had rates of improvement that were significantly worse than those of the physiotherapy (wait, rest and see) group.

Those who received steroid injections also had the most reported recurrences, with 72% of participants' conditions deteriorating after 3-6 weeks.   This could be in part to a patients' quicker initial recovery and re-use which over-taxes the elbow, as well as to their lack of changing the problem which may have caused the issue in the first place (i.e. poor stroke method, overuse, wrong equipment).

Those who continue to suffer from tennis elbow sometimes choose surgical repair, which is called a "release".  The tendon is cut and repaired at the point where it is frayed or torn, which alleviates the pain. 

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The theory behind Platelet Therapy is fairly similar to Prolotherapy, another current technique used in the treatment of conditions related to over-stretched or weakened connective tissues.  Prolotherapy and Platelet Therapy both utilize the body's ability to heal itself.  During prolotherapy, a solution of dextrose (sugar water)  is injected into the ligament or tendon where it attaches to the bone.  

In Platelet Therapy, a patient's own blood is used instead of sugar water or another irritant.  Both procedures trigger a reaction to inflammation in the injected area.   Prolotherapy in a way seeks to cause more injury to the tissue, to irritate it so the body sends more blood cells to the area, with an increased supply of nutrients, thereby increasing circulation and eventually strengthening the tendon over time.  Platelet Therapy provides a ready, nutrient rich supply of platelets at the site, eager to speed the process of recovery immediately.

The source of this know-how comes from no one other than Socrates, the Greek philosopher.  He determined, along with Hippocrates, that if you took a spear throwing Greek Warrior burdened with shoulder issues, and shoved a hot iron poker through his armpit, it would tend to cause rebellion within the shoulder tissue.  The resulting "anger" within the region would cause lots of blood cells to be sent to help with repair (never mind what was going on in the poor guy's brain at the time).  Ultimately, the area would form scar tissue which helped stabilize the shoulder.

The downside to Prolotherapy is that most people require 6-8 treatments every 2-3 weeks to reap its full benefits.  Recent investigational treatments using Platelet Therapy for tennis elbow showed that many patients (but not all) only needed one or two injections before feeling much better.

The Injection

After the initial assessments, Beth signed a short consent form.  Blood was then drawn from her arm, and transferred to a sterile container that was placed in the centrifuge to separate the platelets from the plasma.  This part of the  process took about 15-20 minutes.  

When the specially prepared platelet solution was ready, Beth was moved to another treatment room equipped with two ultrasound monitors.  Using the ultrasound wand, Dr. Wardell was able to find the exact spot(s) of concern.  That is where approximately 1/2 a teaspoon of the platelet material - nearly 500% richer in platelets than normal blood- was then injected back into the sore area of Beth's elbow.

The centrifuge spins the blood and separates the components

"That part was easy," said Beth, who said she refrained from watching the monitor while the needle took care of business. 

Then it was done.  

Dr. Wardell gave Beth a short set of instructions: - Ice the area for the first few days to help with the increased pain that might occur (the first 24 hours usually being the worst).   - Limit activity the first day of the procedure and no tennis for two weeks.   - No anti-inflammatory medications such as Motrin, Advil or Aleve for SIX WEEKS following the injection.  Use of these medicines could counter-act the inflammatory response that is sought in the healing process.

Beth was asked to notify the doctor of her status in two weeks. 

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The afternoon of the injection (following the ninety minute drive home),  the compliant patient took a long walk and did some gentle stretching.   She filled her prescription for the pain killer Vicodin.  Beth reported that her arm was very sore, and she couldn't straighten it completely.  She took a pain pill, and used ice, then switched to heat before she went to bed.  "I was very sore, and very tired."

The first 48 hours after

On Thursday, the day after the procedure, she went for a bike ride and did some light weight work.  "I'm still a little sore when rolling the wrist, although up and down movement (like a bicep curl) is no problem," she reported at the time.

Beth's energy level returned as well, once she figured out what was causing her sleepiness.   It was the prescription medication, so she nixed it.

However, she already missed her anti-inflammatory meds.  "You never think about it, but I used to take that stuff all the time.....Doing without it calls your attention to how much we all rely on it!"

Unfortunately, as she started to feel better, on Friday she overdid it in the garden, pulling weeds.  She vowed to rest the remainder of the day and over the weekend.  "He (Dr. Wardell) should have said, 'No Tennis and No Golf and No weed pulling for two weeks!....So I was a little sore and took a pain pill (bad idea) and then had to take a nap."

Beth said she felt better compared to when she had the cortisone shots.  "It (the injection site) is still a little swollen, but feels OK now."

How Did Things Go When Beth Returned to Tennis?  Find out in Part 3

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**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.  .