At NMPI, we frequently see patients in our office with pain in their elbow. Most often it's tennis players who complain of persistent pain in the forearm as the result of overuse from racquet sports but other sports and non-athletic activities can also put you at risk for this condition known as tennis elbow (TE), or lateral epicondylitis. Strain related changes in the tendons that join the forearm muscles to the outside of the elbow can be very painful.
I was not surprised to read in the British Journal of sports medicine, that a recent study (Strong Evidence Against Platelet-rich Plasma Injections for Chronic Lateral Epicondylar Tendinopathy: A Systematic Review) reported that prp, which I recently reported as not being effective for hamstring injuries, is now found to be ineffective for persistent Tennis Elbow as well. PRP has been increasingly used for many painful conditions that athletes experience. This is based on the finding that in laboratory animals healing can be induced in damaged tissue if platelets are injected into the injured area. The popularity of PRP for TE has grown despite no strong evidence that it actually works. Sir William Osler, a renowned physician once said “use every new treatment as quickly as possible before it stops working.” At NMPI, we do not rush to use a “new” approach just because it is new. We are committed to eliminating our patients' pain and preventing its recurrence.
TE is commonly diagnosed by producing pain when pressing on the tendons that attach to the lateral epicondyle along with pain when the wrist is pulled upward (dorsiflexion) against resistance. TE is generally self-limiting but in some patients it may take more than a year to get better with no treatment. When the pain and tenderness persist various treatments have been tried.
Here's what works:
- In a 2010 paper, an exercise treatment was found to be very effective in relieving TE pain and tenderness.
- At NMPI, we treat these tender muscles successfully with a laser or with muscle injections.
Here's what doesn't work:
- Steroids are not recommended since there is no inflammation in TE and steroids can actually damage the tendon.
- PRP for tennis elbow has been found to not be effective
Newer treatments are often not better. It is always best to first treat any lasting pain problem with the least invasive, safest, and least expensive interventions. This is called the step-care model and the approach you will receive at the Norman Marcus Pain Institute.
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