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.
Keywords
- Extracorporeal Shock Wave Therapy
- Osteochondritis Dissecans
- Lateral Epicondylitis
- Tendon Cell
- Posterior Interosseous Nerve
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, access via your institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Runge F. Zur Genese und Behandlung des schreibe Kranfes. Bed Klin Worchenschr. 1873;10:245–8 (in German).
Major HP. Lawn-tennis elbow. BMJ. 1883;2:557. letter.
Luk J, Tsang R, Leung HB. Lateral epicondylalgia: midlife crisis of a tendón. Hong Kong Med J. 2014;20:145–51.
Nirschl RP. Tennis elbow. Orthop Clin North Am. 1973;4:787–800.
Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med. 1992;11:851–70.
Bishai SK, Plancher KD. The basic science of lateral epicondylosis: update for the future. Technol Orthop. 2006;21:250–5.
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.
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.
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.
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.
Rees JD, et al. Tendons – time to revisit inflammation. Br J Sports Med. 2014;48:1553–7.
Cyriax JH. The pathology and treatment of tennis elbow. J Bone Joint Surg. 1936;18:921–40.
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.
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].
Shiri R, Viikari-Juntara E. Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol. 2011;25:43–57.
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.
Shiri R, Varonen H, Heliövaara M, Viikari-Juntura E. Hand dominance in upper extremity musculoskeletal disorders. J Rheumatol. 2007;34(5):1076–82.
Hamilton PG. The prevalence of humeral epicondylitis: a survey in general practice. J R Coll Gen Pract. 1986;36(291):464–5.
Boyer MI, Hastings II H. Lateral tennis elbow: “Is there any science out there?”. J Shoulder Elbow Surg. 1999;8:481–91.
Priest JD, Braden V, Gerberich JG. The elbow and tennis. Part 1. Phys Sports Med. 1980;8:80.
Fichez O. Epicondylite: histoire naturelle et etude critique des differents traitements. J Traumatol Sport. 1998;15(3):163–72.
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.
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.
Tosti R, Jennings J, Sewards JM. Lateral epicondylitis of the elbow. Am J Med. 2013;126(357):357. e1-357.e6.
Hume PA, Reid D, Edwards T. Epicondylar injury in sport. Epidemiology, type, mechanisms, assessment, management and prevention. Sports Med. 2006;36(2):151–70.
Sánchez M, Anitua E. A new biological approach to orthopedic surgery and sports medicine. 1st ed. Vitoria: Team Work Media; 2013. Chapter 144–58.
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.
Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am. 2005;87:187–202.
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.
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.
Goldie I. Epicondylitis lateralis humeri (epicondylagia or tennis elbow). A pathogenetical study. Acta Chir Scand Suppl. 1964;57 suppl 339:1.
Coonrad RW, Hooper WR. Tennis elbow: its courses, natural history, conservative and surgical management. J Bone Joint Surg Am. 1973;55:1177–82.
Ahmad Z. Lateral epicondylitis. A review of pathology and management. Bone Joint J. 2013;95-B:1158–64.
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.
Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 1979;61(6A):832–9.
Brummel J, et al. Epicondylitis: lateral. Sports Med Arthrosc Rev. 2014;22:e1–6.
Connell D, Burke F, Coombes P, et al. Sonographic examination of lateral epicondylitis. Am J Roentgenol. 2001;176:777–82.
Van Hofwegen C, Baker 3rd CL, Baker Jr CL. Epicondylitis in the athlete’s elbow. Clin Sports Med. 2010;29:577–97.
Buckup K. Clinical tests for the musculoskeletal system: examinations-sign-phenomena. 2nd ed. Stuttgart: Thieme; 2008. p. 129–33.
Gardner RC. Tennis elbow: diagnosis, pathology and treatment: nine severe cases treated by a new reconstructive operation. Clin Orthop. 1970;72:248–53.
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.
Miller TT, Shapiro MA, Schultz E, et al. Comparison of sonography and MRI for diagnosing epicondylitis. J Clin Ultrasound. 2002;30:193–202.
Naam NH, Nemani S. Radial tunnel syndrome. Orthop Clin North Am. 2012;43:529–36.
Rajeev A, Pooley J. Lateral compartment cartilage changes and lateral elbow pain. Acta Orthop Belg. 2009;75:37–40.
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.
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.
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.
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.
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.
Buchbinder R, Johnston RV, Barnsley L, Assendelft WJ, Bell SN, Smidt N. Surgery for lateral elbow pain. Cochrane Database Syst Rev. 2011;3:CD003525.
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.
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.
Sánchez M, Anitua E, Orive G, et al. Platelet-rich therapies in the treatment of orthopaedic sport injuries. Sports Med. 2009;39:345–54.
Mishra A, Harmon K, Woodall Jr J, Vieira A. Sports medicine applications of platelet rich plasma. Curr Pharm Biotechnol. 2012;13(7):1185–95.
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.
Sánchez M, Albillos J, Angulo F, et al. Platelet-rich plasma in muscle and tendon healing. Oper Technol Orthop. 2012;22:16–24.
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.
DeLong JM, Russell RP, Mazzocca AD. Platelet-rich plasma: the PAW classification system. Arthroscopy. 2012;28(7):998–1009.
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.
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.
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.
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.
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.
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.
Martin JI, et al. Platelet-rich plasma (PRP) in chronic epicondylitis: study protocol for a randomized controlled trial. Trials. 2013;14:410.
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.
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.
Nurden AT. Platelets, inflammation and tissue regeneration. Thromb Haemost. 2011;105(Suppl1):S13–33.
Discher DE, Mooney DJ, Zandstra PW. Growth factors, matrices, and forces combine and control stem cells. Science. 2009;324(5935):1673–7.
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.
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.
Anitua E, Orive G. Endogenous regenerative technology using plasma- and platelet-derived growth factors. J Control Release. 2012;157(3):317–20.
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.
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.
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.
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.
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.
Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet rich plasma. Am J Sports Med. 2006;34:1774–8.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Hechtman KS, Uribe JW, Botto-vanDemden A, Kiebzak GM. Platelet-rich plasma injection reduces pain in patients with recalcitrant epicondylitis. Orthopedics. 2011;34:92.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 ESSKA
About this chapter
Cite this chapter
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
Download citation
DOI: https://doi.org/10.1007/978-3-662-48742-6_10
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-48740-2
Online ISBN: 978-3-662-48742-6
eBook Packages: MedicineMedicine (R0)