High Dose PRP, Platelet Rich Plasma, as a Treatment for Epicondylitis

by Katy

Differing locations and levels of pain throughout the body can be perplexing to the average person who is experiencing or learning about their pain. One minute, a patient might be experiencing pain in one location of their body and the next their pain has vanished or relocated. Typically, Orthagenex works to help patients treat chronic conditions by non-invasive means. However, there are some conditions that can be both chronic long-term issues that present routinely as short-term repeat episodes of inflammation and pain. Epicondylitis, both lateral and medial, is one such condition that perplexes patients who suffer from it. However, regardless of a patient’s history or constancy with the condition, Orthagenex understands that effective pain relief can be difficult to find– especially when the condition needing treatment is not easily understood. So, what is lateral/medial epicondylitis and how can Orthagenex help?

In 2013, Dr. Ahmad and his associates in The Bone & Joint Journal conducted an extensive study on the nature of epicondylitis and first determined that, “[l]ateral epicondylitis, or ’tennis elbow’, is a common condition that usually affects patients between 35 and 55 years of age. It is generally self-limiting, but in some patients, it may continue to cause persistent symptoms, which can be refractory [stubborn] to treatment” (Ahmad, 2013). Because of the condition’s sporadic influence on a patient and symptoms that prevent regular treatment, patients are often left frustrated and confused. However, learning more about the condition and its vagaries can help.

Dr Ahmad continued to pursue the elusive condition and its effects on patients and determined that epicondylitis, “ . . . affects between 1% and 3% of the population, mainly those aged from 35 to 55 years, with an equal gender distribution. It is generally self-limiting, and most cases require no more than treatment with simple analgesia . . . Although popularly associated with tennis, lateral epicondylitis may develop from a variety of activities that involve excessive and repetitive use of the forearm extensors,18 such as typing, playing the piano and various types of manual work. When affected, any movement that puts force on the extended wrist may be painful, as it increases the load on the diseased common extensor tendon”. When understanding that epicondylitis can result from activities as innocuous as playing the piano, patients can begin to understand why the condition is so sporadic in nature; they may not realize the various activities they perform every day could trigger and inflame the condition.

However, as Ahmad previously mentioned, epicondylitis is commonly referred to as “tennis elbow” and this is for a very good reason. Dr. Ahmad, in a summary of the relation between tennis and epicondylitis concluded that, “racquet sports may cause the condition due to a combination of factors: 1) incorrect technique (snapping the wrist in a backhand play, incorrect positioning of the feet, and hitting the ball late or with a bent elbow all result in power generation from the forearm extensors rather than core muscles or the rotator cuff); 2) extended duration of play; 3) frequency of play; 4) size of the racquet handle (affecting the lever arm of the force applied through the forearm); and 5) racquet weight”. While it is likely and obvious that many patients who suffer from “tennis elbow” are involved in some form of racquet sport, there are of course other contributing factors.

Dr. Ahmad in studying the origin of epicondylitis also concludes that, “[w]ork-related lateral epicondylitis may be linked to handling tools heavier than 1 kg, loads heavier than 20 kg more than ten times per day, and repetitive movements for more than two hours”. In general, it may be assumed that anyone who does repetitive motion with their arms and/or lifts heavy loads regularly may experience some level of pain from epicondylitis. With this being the case, it is no surprise that many who suffer from the condition will ask what they can to decrease the pain and increase mobility in their arms.

While many seek treatment for epicondylitis, others maintain that the condition– in its ephemeral nature– will eventually dissipate. In 2019, Dr. Lenoir and his associates in the journal of Orthopaedics & Traumatology: Surgery & Research determined that, “LE usually resolves spontaneously without treatment within 1–2 years. Very few studies have compared outcomes with and without treatment. As a result, whether a favourable outcome should be ascribed to the treatments used or to the natural history of the disorder is unclear . . . Overall, the available data suggest that LE often resolves spontaneously. Therefore, considerable circumspection is in order before embarking on a course of treatment, regardless of the modality chosen. Studies comparing specific types of treatment versus placebo are needed”. However, while patients often experience the pain of epicondylitis spontaneously resolve without treatment, many will experience the pain for extended periods of time and won’t necessarily appreciate being told to wait until the pain subsides. For patients who want to be proactive in treating their epicondylitis, there is a recommended treatment offered by Orthagenex.

In Dr. Ahmad’s same study mentioned previously in The Bone & Joint Journal, he and his associates found that, “[p]latelet-rich plasma (PRP) is a concentrate of platelets derived from the patient’s own blood and is known to contain a high content of growth factors that have the potential to enhance the healing process of the tendon [related to epicondylitis]. A blood sample is taken and centrifuged to extract the plasma content, and the blood is then re-injected around the lateral epicondyle. A number of RCTs have shown that PRP is superior to autologous blood and bupivacaine injections” (2013). With an understanding of the procedure and hope that it could be an effective treatment for epicondylitis, patients may wonder how Orthagenex uses high dose PRP treatments and what studies prove that it is an effective treatment.

In separate trials focusing on the efficacy of platelet rich plasma versus other methods in treating epicondylitis, Dr. Ahmad explains that, “[t]wo cohort studies showed that PRP improved clinical satisfaction scores. One case-control study showed that PRP yielded a significantly greater improvement in symptoms compared with bupivacaine [a local anesthetic]. Two randomized controlled trials compared the effect of injections of PRP and blood. Only 1 of the studies noted a significant difference at the 6-week time point. Three randomized controlled trials compared corticosteroids with PRP. Two of the smaller trials, which had follow-up periods of 6 weeks and 3 months, showed no significant difference between treatment groups. The largest randomized controlled trial found that PRP had significant benefit compared with corticosteroids with regard to pain and Disabilities of the Arm, Shoulder and Hand scores at 1- and 2-year time points” (2013). As we can clearly see, patients undergoing high dose PRP treatments with Orthagenex have a high likelihood of treating the pain symptoms of epicondylitis. Dr. Ahmad concludes that these clinical trials are “. . . limited but evolving evidence for the use of PRP in lateral epicondylitis”.

As the use of High Dose PRP treatment has increased, the trials and understanding of the treatment has only provided further advocacy for its recommendation in treating epicondylitis. In a more recent 2019 study, Dr. Boden determined that, “ME and LE [Medial and Lateral Epicondylitis] are common conditions that affect between 1% and 3% of the population, mainly in persons aged 35 to 55 years . . . Although a multitude of treatment options are available, there is currently no clear gold-standard treatment for patients with chronic pain. With the aging population, successful, less invasive treatment modalities are essential” With the necessity for less invasive treatment options, Dr. Boden determined that, “PRP . . . procedures are effective, minimally invasive, nonsurgical options for treating recalcitrant [again, stubborn] ME or LE. “. . . showed a clinically and statistically significant improvement in pain and function”. As our understanding of this condition continues to evolve, Orthagenex offers the premier solution for patients with epicondylitis through high dose PRP treatment.

Patients who undergo these high dose PRP treatments for their epicondylitis pain will not only experience a safe and effective way to mitigate the pain but become further educated in the nature of their condition. The more a patient understands the nature of their pain condition, even a condition as unpredictable as epicondylitis, the more they will come to understand how Orthagenex High Dose PRP treatments may work for them. Improving one’s understanding of painful conditions not only educates patients to help them seek effective treatments like high dose PRP but gives them the confidence they need to make informed and productive decisions. Throughout this process, Orthagenex is here to help– all with the aim of improving a patient’s quality of life and reducing irritating pain.

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