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PRP in Lateral Elbow Pain

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Elbow and Sport

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Abstract

The lateral elbow pain is a common condition that usually affects young active patients and used to be related either to labor or sport repetitive movements involving the forearm extensors. The differential diagnosis is mandatory and should distinguish among lateral tendinopathy, intra-articular problems, and even neuropathies that could present with lateral elbow pain. In those cases in which rest and avoidance or modification of the causative activities do not lead to a remission in symptoms, different nonoperative treatment could be useful. In case of absence of response to conservative therapies, surgery could be needed. In the last decade the interest in regenerative therapies has increased extraordinarily. Thus, different studies on the utility and efficiency of platelet-rich plasma (preparation rich in patient’s own blood growth factors) in the treatment of lateral elbow tendinopathy have been performed with confusing results.

Probably the differences among the different systems of platelet-rich plasma and the variety of application protocols do not help in clarifying the real efficacy of this therapy.

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References

  1. Runge F. Zur Genese und Behandlung des schreibe Kranfes. Bed Klin Worchenschr. 1873;10:245–8 (in German).

    Google Scholar 

  2. Major HP. Lawn-tennis elbow. BMJ. 1883;2:557. letter.

    Google Scholar 

  3. Luk J, Tsang R, Leung HB. Lateral epicondylalgia: midlife crisis of a tendón. Hong Kong Med J. 2014;20:145–51.

    PubMed  Google Scholar 

  4. Nirschl RP. Tennis elbow. Orthop Clin North Am. 1973;4:787–800.

    CAS  PubMed  Google Scholar 

  5. Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med. 1992;11:851–70.

    CAS  PubMed  Google Scholar 

  6. Bishai SK, Plancher KD. The basic science of lateral epicondylosis: update for the future. Technol Orthop. 2006;21:250–5.

    Article  Google Scholar 

  7. Kannus P, Józsa L. Histopathological changes preceding spontaneous rupture of a tendon: a controlled study of 891 patients. J Bone Joint Surg Am. 1991;73-A:1507–25.

    Google Scholar 

  8. Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am. 1999;81:259–78.

    Article  CAS  PubMed  Google Scholar 

  9. Baker CL, Nirschl RP. Lateral tendon injury: open and arthroscopic treatment. In: Altchek DW, Andrews JR, editors. The Athlete’s elbow. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 91–103.

    Google Scholar 

  10. Schulze-Tanzil G, Al-Sadi O, Wiegand E, Ertel W, Busch C, Kohl B, Pufe T. The role of pro- inflammatory and immunoregulatory cytokines in tendon healing and rupture: new insights. Scand J Med Sci Sports. 2011;21(3):337–51.

    Article  CAS  PubMed  Google Scholar 

  11. Rees JD, et al. Tendons – time to revisit inflammation. Br J Sports Med. 2014;48:1553–7.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cyriax JH. The pathology and treatment of tennis elbow. J Bone Joint Surg. 1936;18:921–40.

    Google Scholar 

  13. Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum. 2004;51:642–51.

    Article  PubMed  Google Scholar 

  14. Sanders TL et al. The epidemiology and health care burden of tennis elbow. A population- based study. Am J Sports Med. 2015; pii: 0363546514568087. [Epub ahead of print].

    Google Scholar 

  15. Shiri R, Viikari-Juntara E. Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol. 2011;25:43–57.

    Article  PubMed  Google Scholar 

  16. Shiri R, Viikari-Juntura E, Varonen H, et al. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006;164:1065–74.

    Article  PubMed  Google Scholar 

  17. Shiri R, Varonen H, Heliövaara M, Viikari-Juntura E. Hand dominance in upper extremity musculoskeletal disorders. J Rheumatol. 2007;34(5):1076–82.

    PubMed  Google Scholar 

  18. Hamilton PG. The prevalence of humeral epicondylitis: a survey in general practice. J R Coll Gen Pract. 1986;36(291):464–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Boyer MI, Hastings II H. Lateral tennis elbow: “Is there any science out there?”. J Shoulder Elbow Surg. 1999;8:481–91.

    Article  CAS  PubMed  Google Scholar 

  20. Priest JD, Braden V, Gerberich JG. The elbow and tennis. Part 1. Phys Sports Med. 1980;8:80.

    Google Scholar 

  21. Fichez O. Epicondylite: histoire naturelle et etude critique des differents traitements. J Traumatol Sport. 1998;15(3):163–72.

    Google Scholar 

  22. De Smedt T, de Jong A, Leemput WV, et al. Lateral epicondylitis in tennis: update on aetiology, biomechanics, and treatment. Br J Sports Med. 2007;41:816–9.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Eygendaal D, Rahussen FTG, Diercks RL. Biomechanics of the elbow joint in tennis players and relation to pathology. Br J Sports Med. 2007;41:820–3.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Tosti R, Jennings J, Sewards JM. Lateral epicondylitis of the elbow. Am J Med. 2013;126(357):357. e1-357.e6.

    PubMed  Google Scholar 

  25. Hume PA, Reid D, Edwards T. Epicondylar injury in sport. Epidemiology, type, mechanisms, assessment, management and prevention. Sports Med. 2006;36(2):151–70.

    Article  PubMed  Google Scholar 

  26. Sánchez M, Anitua E. A new biological approach to orthopedic surgery and sports medicine. 1st ed. Vitoria: Team Work Media; 2013. Chapter 144–58.

    Google Scholar 

  27. Behzad H, Sharma A, Mousavizadeh R, et al. Mast cells exert pro-inflammatory effects of relevance to the pathophysiology of tendinopathy. Arthritis Res Ther. 2013;15(6):R184.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am. 2005;87:187–202.

    Article  PubMed  Google Scholar 

  29. Alfredson H, Bjur D, Thorsen K, Lorentzon R, Sandstrom P. High intratendinous lactate levels in painful chronic Achilles tendinosis. An investigation using microdialysis technique. J Orthop Res. 2002;20:934–8.

    Article  CAS  PubMed  Google Scholar 

  30. Alfredson H, Ohberg L. Sclerosing injections to areas of neo-vascularisation reduce pain in chronic Achilles tendinopathy: a double blind randomised controlled trial. Knee Surg Sports Traumatol Arthrosc. 2005;13:338–44.

    Article  PubMed  Google Scholar 

  31. Goldie I. Epicondylitis lateralis humeri (epicondylagia or tennis elbow). A pathogenetical study. Acta Chir Scand Suppl. 1964;57 suppl 339:1.

    PubMed  Google Scholar 

  32. Coonrad RW, Hooper WR. Tennis elbow: its courses, natural history, conservative and surgical management. J Bone Joint Surg Am. 1973;55:1177–82.

    CAS  PubMed  Google Scholar 

  33. Ahmad Z. Lateral epicondylitis. A review of pathology and management. Bone Joint J. 2013;95-B:1158–64.

    Article  CAS  PubMed  Google Scholar 

  34. Chen J, Wang A, Xu J, et al. In chronic lateral epicondylitis, apoptosis and autophagic cell death occur in the extensor carpi radialis brevis tendon. J Shoulder Elbow Surg. 2010;19:355–62.

    Article  PubMed  Google Scholar 

  35. Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 1979;61(6A):832–9.

    CAS  PubMed  Google Scholar 

  36. Brummel J, et al. Epicondylitis: lateral. Sports Med Arthrosc Rev. 2014;22:e1–6.

    Article  Google Scholar 

  37. Connell D, Burke F, Coombes P, et al. Sonographic examination of lateral epicondylitis. Am J Roentgenol. 2001;176:777–82.

    Article  CAS  Google Scholar 

  38. Van Hofwegen C, Baker 3rd CL, Baker Jr CL. Epicondylitis in the athlete’s elbow. Clin Sports Med. 2010;29:577–97.

    Article  PubMed  Google Scholar 

  39. Buckup K. Clinical tests for the musculoskeletal system: examinations-sign-phenomena. 2nd ed. Stuttgart: Thieme; 2008. p. 129–33.

    Google Scholar 

  40. Gardner RC. Tennis elbow: diagnosis, pathology and treatment: nine severe cases treated by a new reconstructive operation. Clin Orthop. 1970;72:248–53.

    CAS  PubMed  Google Scholar 

  41. Edelson G, Kunos CA, Vigder F, Obed E. Bony changes at the lateral epicondyle of possible significance in tennis elbow syndrome. J Shoulder Elbow Surg. 2001;10:158–63.

    Article  CAS  PubMed  Google Scholar 

  42. Miller TT, Shapiro MA, Schultz E, et al. Comparison of sonography and MRI for diagnosing epicondylitis. J Clin Ultrasound. 2002;30:193–202.

    Article  PubMed  Google Scholar 

  43. Naam NH, Nemani S. Radial tunnel syndrome. Orthop Clin North Am. 2012;43:529–36.

    Article  PubMed  Google Scholar 

  44. Rajeev A, Pooley J. Lateral compartment cartilage changes and lateral elbow pain. Acta Orthop Belg. 2009;75:37–40.

    PubMed  Google Scholar 

  45. Smidt N, Lewis M, van der Windt DAWM, Hay EM, Bouter LM, Croft P. Lateral epicondylitis in general practice: course and prognostic indicators of outcome. J Rheumatol. 2006;33:2053–9.

    PubMed  Google Scholar 

  46. Sayegh ET, Strauch RJ. Does nonsurgical treatment improve longitudinal outcomes of lateral epicondylitis over no treatment? A meta-analysis. Clin Orthop Relat Res. 2015;473:1093–107.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Bisset L, et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006. doi:10.1136/bmj.38961.584653.AE.

    Google Scholar 

  48. Coombes BK, et al. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia a randomized controlled trial. JAMA. 2013;309(5):461–9.

    Article  CAS  PubMed  Google Scholar 

  49. Mardani-Kivi M, Karimi-Mobarakeh M, Karimi A, et al. The effects of corticosteroid injection versus local anesthetic injection in the treatment of lateral epicondylitis: a randomized single-blinded clinical trial. Arch Orthop Trauma Surg. 2013;133:757–63.

    Article  PubMed  Google Scholar 

  50. Buchbinder R, Johnston RV, Barnsley L, Assendelft WJ, Bell SN, Smidt N. Surgery for lateral elbow pain. Cochrane Database Syst Rev. 2011;3:CD003525.

    PubMed  Google Scholar 

  51. Hall MP, Band PA, Meislin RJ, Jazrawi LM, Cardone DA. Platelet-rich plasma: current concepts and application in sports medicine. J Am Acad Orthop Surg. 2009;17(10):602–8.

    PubMed  Google Scholar 

  52. Sánchez M, Azofra J, Anitua E, et al. Plasma rich in growth factors to treat an articular cartilage avulsion: a case report. Med Sci Sports Exerc. 2003;35:1648–52.

    Article  PubMed  Google Scholar 

  53. Sánchez M, Anitua E, Orive G, et al. Platelet-rich therapies in the treatment of orthopaedic sport injuries. Sports Med. 2009;39:345–54.

    Article  PubMed  Google Scholar 

  54. Mishra A, Harmon K, Woodall Jr J, Vieira A. Sports medicine applications of platelet rich plasma. Curr Pharm Biotechnol. 2012;13(7):1185–95.

    Article  CAS  PubMed  Google Scholar 

  55. Hsu WK, Mishra A, Rodeo SR, et al. Platelet-rich plasma in orthopaedic applications: evidence-based recommendations for treatment. J Am Acad Orthop Surg. 2013;21(12):739–48.

    Article  PubMed  Google Scholar 

  56. Sánchez M, Albillos J, Angulo F, et al. Platelet-rich plasma in muscle and tendon healing. Oper Technol Orthop. 2012;22:16–24.

    Article  Google Scholar 

  57. Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol. 2009;27:158–67.

    Article  CAS  PubMed  Google Scholar 

  58. DeLong JM, Russell RP, Mazzocca AD. Platelet-rich plasma: the PAW classification system. Arthroscopy. 2012;28(7):998–1009.

    Article  PubMed  Google Scholar 

  59. Mastrangelo AN, Vavken P, Fleming BC, et al. Reduced platelet concentration does not harm PRP effectiveness for ACL repair in a porcine in vivo model. J Orthop Res. 2011;29:1002–7.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Wiegerinck JI, Reilingh ML, de Jonge MC, et al. Injection techniques of platelet-rich plasma into and around the Achilles tendon: a cadaveric study. Am J Sports Med. 2011;39:1681–168.

    Article  PubMed  Google Scholar 

  61. Dragoo JL, Braun HJ, Durham JL, et al. Comparison of the acute inflammatory response of two commercial platelet-rich plasma systems in healthy rabbit tendons. Am J Sports Med. 2012;40:1274–81.

    Article  PubMed  Google Scholar 

  62. Sundman EA, Cole BJ, Fortier LA. Growth factor and catabolic cytokine concentrations are influenced by the cellular composition of platelet-rich plasma. Am J Sports Med. 2011;39:2135–40.

    Article  PubMed  Google Scholar 

  63. Filardo G, Kon E, Pereira Ruiz MT, Vaccaro F, Guitaldi R, Di Martino A, Cenacchi A, Fornasari PM, Marcacci M. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc. 2012;20:2082–91.

    Article  PubMed  Google Scholar 

  64. Carofino B, et al. Corticosteroids and local anesthetics decrease positive effects of platelet-rich plasma: an in vitro study on human tendon cells. Arthroscopy. 2012;28(5):711–9.

    Article  PubMed  Google Scholar 

  65. Martin JI, et al. Platelet-rich plasma (PRP) in chronic epicondylitis: study protocol for a randomized controlled trial. Trials. 2013;14:410.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Anitua E, Alkhraisat MH, Orive G. Perspectives and challenges in regenerative medicine using plasma rich in growth factors. J Control Release. 2012;157:29–38.

    Article  CAS  PubMed  Google Scholar 

  67. Anitua E, Sanchez M, Orive G. Potential of endogenous regenerative technology for in situ regenerative medicine. Adv Drug Deliv Rev. 2010;62(7–8):741–52.

    Article  CAS  PubMed  Google Scholar 

  68. Nurden AT. Platelets, inflammation and tissue regeneration. Thromb Haemost. 2011;105(Suppl1):S13–33.

    Article  CAS  PubMed  Google Scholar 

  69. Discher DE, Mooney DJ, Zandstra PW. Growth factors, matrices, and forces combine and control stem cells. Science. 2009;324(5935):1673–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Martino MM, Briquez PS, Ranga A, et al. Heparin-binding domain of fibrin(ogen) binds growth factors and promotes tissue repair when incorporated within a synthetic matrix. Proc Natl Acad Sci U S A. 2013;110(12):4563–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Anitua E, Zalduendo M, Prado R, et al. Morphogen and pro‐inflammatory cytokine release kinetics from PRGF‐Endoret fibrin scaffolds: evaluation of the effect of leukocyte inclusion. J Biomed Mater Res A. 2015;103(3):1011–20.

    Article  CAS  PubMed  Google Scholar 

  72. Anitua E, Orive G. Endogenous regenerative technology using plasma- and platelet-derived growth factors. J Control Release. 2012;157(3):317–20.

    Article  CAS  PubMed  Google Scholar 

  73. Zhang J, Wang JHC. Platelet–rich plasma releasate promotes differentiation of tendon stem cells into active tenocytes. Am J Sports Med. 2010;38:2477–86.

    Article  PubMed  Google Scholar 

  74. Schnabel LV, Mohammed HO, Miller BJ, et al. Platelet rich plasma (PRP) enhances the anabolic gene expression pattern in flexor digitorum superficialis tendons. J Orthop Res. 2007;25:230–40.

    Article  CAS  PubMed  Google Scholar 

  75. Anitua E, Sanchez M, Zalduendo MM, et al. Fibroblastic response to treatment with different preparations rich in growth factors. Cell Prolif. 2009;41:162–70.

    Article  Google Scholar 

  76. Anitua E, Sanchez M, De la Fuente M, et al. Plasma rich in growth factors (PRGF-Endoret) stimulates tendon and synovial fibroblasts migration and improves the biological properties of hyaluronic acid. Knee Surg Sports Traumatol Arthrosc. 2012;20:1657–65.

    Article  CAS  PubMed  Google Scholar 

  77. Anitua E, Sánchez M, Nurden AT, et al. Autologous fibrin matrices: a potential source of biological mediators that modulate tendon cell activities. J Biomed Mater Res. 2006;77:285–93.

    Article  Google Scholar 

  78. Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet rich plasma. Am J Sports Med. 2006;34:1774–8.

    Article  PubMed  Google Scholar 

  79. Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: Platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med. 2010;38:255–62.

    Article  PubMed  Google Scholar 

  80. Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double- blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2011;39:1200–8.

    Article  PubMed  Google Scholar 

  81. Creaney L, Walla A, Curtis M, Connell D. Growth factor- based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, double-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med. 2011;45:966–71.

    Article  PubMed  Google Scholar 

  82. Thanasas C, Papadimitriou G, Charalambidis C, Paraskevopoulos I, Papanikolaou A. Platelet- rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. Am J Sports Med. 2011;39:2130–4.

    Article  PubMed  Google Scholar 

  83. Omar Aziza S, Maha EI, Amal SA, Mahmoud S. Local injection of autologous platelet rich plasma and corticosteroid in treatment of lateral epicondylitis and plantar fasciitis: randomized clinical trial. Egypt Rheumatol. 2012;34:43–9.

    Article  Google Scholar 

  84. Krogh TP, Fredberg U, Stengaard-Pedersen K, et al. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial. Am J Sports Med. 2013;41:625–35.

    Article  PubMed  Google Scholar 

  85. 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;42:463–71.

    Article  PubMed  Google Scholar 

  86. Raeissadat SA, Rayegani SM, Hassanabadi H, et al. Is platelet-rich plasma superior to whole blood in the management of chronic tennis elbow: one year randomized clinical trial. BMC Sports Sci Med Rehabil. 2014;6:12.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Chaudhury S, de La Lama M, Adler RS, et al. Platelet-rich plasma for the treatment of lateral epicondylitis: sonographic assessment of tendon morphology and vascularity (pilot study). Skeletal Radiol. 2013;42:91–7.

    Article  PubMed  Google Scholar 

  88. Hechtman KS, Uribe JW, Botto-vanDemden A, Kiebzak GM. Platelet-rich plasma injection reduces pain in patients with recalcitrant epicondylitis. Orthopedics. 2011;34:92.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Unidad de Cirugia Artroscopica, VItoria, Spain

    Jorge Guadilla, Sabino Padilla, Diego Delgado & Mikel Sanchez

  2. Traumatology, Department at Ibermutuamur Sevilla, ISMEC. International Sports Medicine Clinic, Arjona 10. Bajo, Sevilla, 41001, Spain

    Emilio Lopez-Vidriero MD, PhD (Chief)

  3. ISMEC. International Sports Medicine Clinic, Arjona 10. Bajo, Sevilla, 41001, Spain

    Rosa Lopez-Vidriero

  4. Arriaza Asociados, La Coruña, Spain

    Rafael Arriaza

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  1. Jorge Guadilla
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Correspondence to Emilio Lopez-Vidriero MD, PhD .

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  1. Nuovo Ospedale di Sassuolo, Sassuolo, Italy

    Luigi Adriano Pederzini

  2. Dept of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands

    Denise Eygendaal

  3. Istituto Clinico Humanitas, Rozzano, Milan, Italy

    Matteo Denti

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Guadilla, J. et al. (2016). PRP in Lateral Elbow Pain. In: Pederzini, L., Eygendaal, D., Denti, M. (eds) Elbow and Sport. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48742-6_10

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