Tennis Elbow and Elbow Tendinopathies

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Tennis Elbow is a common problem invloving the elbow.  Regenerative Medicine and the use of Platelet Rich Plasma offers a revolutionary new way to treat this common problem.


Tennis Elbow and Elbow Tendinopathies


Tennis Elbow (Lateral Epicondylitis) and Golfer’s Elbow (Medial Epicondylitis) are common problems affecting the elbow.  The Elbow depends upon all the structures to work properly in order to be pain-free and without other symptoms.  Part of the thing that makes us human is the way we are able to use our hands.  The effective use of our hands requires a painless, stable elbow.

Tennis Elbow begins to develop most often with some type of overuse that causes damage to the tendons and muscles around the elbow. The body can often heal these on its own; however, at times the structures are not able to heal on their own and then the symptoms persists.  The symptoms then continue and can worsen despite various traditional treatments.


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Elbow pain caused by lateral or medial epicondylitis is quite common



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The Elbow is a complex joint with various important surrounding structures

The Normal Elbow

The elbow is a complex area.  Important structures of the elbow include various bones, joints, tendons, ligaments, muscles, nerves, and blood vessels.  The bones of the elbow include the humerus (arm bone) and the radius and ulan (the forearm bones).  The muscles on the outer or lateral part of the elbow help extend the wrist and fingers.  The muscles on the inner or medial part of the elbow help to flex the wrist and fingers.  There are also very important ligaments on both sides of the elbow that allow it to move properly and remain stable.  

With normal use there are often small “injuries” to some of these structures, but the body is able to heal these smaller injuries quickly with its special healing mechanisms.  The symptoms then quickly resolve.  Unfortunately the body sometimes is not able to stay caught up for various reasons, and then the symptoms start to worsen and persist.  Now the problem becomes chronic.


Elbow Joint Anatomy Video



Tennis Elbow

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Tennis Elbow is caused by damage to the tendinous insertion of the extensor muscles onto the bone

Tennis Elbow is a problem that involves the tendons that help extend the wrist, the forearm extensor tendons, where they insert into the bone on the humerus.  This area is called the lateral epicondyle of the humerus.  That is how tennis elbow, or lateral epicondylitis, gets its name.  It used to be thought that the problem was an “inflammation” of these structures.  That is why it has been traditionally called at “-itis” or an inflammation.  In reality that is not true at all.  The problem is that the tendons become damaged in the area where they insert into the bone.  This problem in generally called an enthesopathy.  The tendonous portion of the muscle where it inserts into bone often does not have a very good blood supply; therefore, healing is often slow or cannot ever completely heal.  This then causes the area to become painful and the muscles are not able to work properly.  The area remains abnormal and is often not able to heal on its own.  This problem is more accurately called a tendinopathy. 

Tennis Elbow involves the muscle on the lateral side of the elbow, the extensor muscles.  Golfer’s Elbow is a similar problem that involves the muscles on the medial side of the elbow, the flexor muscles.  

In many situations the tendon is able to heal itself and symptoms quicky disappear.  Occasionally that healing does not occur on its own, and then the symptoms persist.

The most ideal treatment would be to have something that would stimulate the body’s own healing mechanism to repair the damaged tendons.


The Problem With Traditional Treatment for Tennis Elbow

Traditional treatment options for Tennis Elbow include rest, splinting, icing, heat, physical therapy, non-steroidal anti-inflammatory drugs (NSAIDS), corticosteroid injection, and surgery. 

Rest, splinting (tennis elbow band), icing, and physical therapy are always useful to try in the early stages of the problem, and often the problem will resolve on its own.  If the symptoms persists then additional treatment would be warranted.  And this is where the problems come into play with the other traditional treatments.  They all have significant side effects and do address the real underlying problem.

NSAIDS are taken by mouth and reduce inflammation around your whole body, and very little get to the site of the injury since the tendon that is injured has a relatively poor blood supply.  The NSAIDS have various complications including ulcers, internal bleeding, heart attack, and stroke.  So these medicines are taken, barely get to where the problem is, and cause significant side effects.

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Corticosteroid Injection for Tennis Elbow can be damaging

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Tennis Elbow Surgery is quite invasive

Corticosteroids are often used to treat lateral epicondylitis.  These medicines are injected around the area of the injury.  Corticosteroids are used to reduce inflammation.  However, inflammation is not the underlying problem in Tennis Elbow.  The problem is the injured non-healing tendon.  Corticosteroids inhibit the healing mechanisms and slow down the healing process.  They can also cause damage to important ligaments, tendons, joints, and the surrounding fat and skin.  The effects that corticosteroids have on the area of injury in Tennis or Golfer’s Elbow is totally contrary or opposite to what is really needed for the structures to heal.

Surgery for Tennis Elbow bascially consists of removing the non-healing part of the tendons that are injured.  Essentially it removes parts that are necessary for the body to function normally.  The surgery is quite invasive.  Often the important ligaments of the elbow can be injured during the surgery and this can cause an additional problem of instability.  The surgery is often followed by immobilization and stiffness can become a significant problem as well.  Part of the surgery also can consist of partial removal of the bone.  Some people believe that removing part of the bone, or drillig holes into the bone, stimulates the healing process and may be a reason for the surgery’s occasional success.  There are other ways to stimulate this healing process, and that is where Platelet Rich Plasma and Regenerative Medicine come into the picture.



Stem Cell and Platelet Rich Plasma (PRP) Treatment for Tennis Elbow


Platelet Rich Plasma (PRP) is an autologous purified portion of your own blood that can effectively treat Tennis Elbow and Golfer’s Elbow.  Regenerative Injection Therapy with PRP stimulates the healing of the damaged tendons.  The various molecules and factors in the PRP help to reduce pain and any abnormal inflammation in the area as well.

PRP can also help in the healing of injured ligaments or cartilage in the elbow.


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PRP Injection for Lateral Epicondylitis stimulates the healing process


The Orthobiological activity of Platelet RIch Plasma (PRP):

     - naturally “kick start” and stimulate the healing mechanisms in the body to heal the damaged tissues

     - stimulates the healing of the damaged tendos by activating tendon cells and encouraging the ingrowth of new blood vessels

     - inhibits the catabolic (breaking down) processes that would otherwise continue and cause continued damage 

     - stimulates the anabolic (building up) processes that naturally accelerates the healing of the damaged tendons

The specially prepared autologous Platelet Rich Plasma is injected in to the affected tendon to stimulate it to heal.  Additional PRP can be injected into damaged ligaments and the joint, in order to promoted healing of the elbow and reduce symptoms.

Studies have shown that Platelet Rich Plasma is a very effective treatment for Lateral Epicondylitis, providing better results that other methods of treatment.   (Am J Sports Med Nov. 2006) (Am J Sports Med Feb. 2014) (J Clin Diag Res July 2015) (J Hand Microsurg dec 2015)

There are also new studies (JOrthopaedics 13:1 10-14 March 2016) that are showing that PRP injection results are better than results from surgery for Tennis Elbow.  This study showed that treatment with Platelet Rich Plasma (PRP) resulted in an average of 83% improvement in pain score at one year, and the surgery group only had an average 46% improvement.  The PRP improved pain twice as much as the surgery.  So why are we still doing surgery for this problem?


Platelet Rich Plasma is 2X more effective than surgery for relieving pain caused by chronic lateral epicondylitis.



The use of Platelet RIch Plasma for elbow tendinopathies has distinct advantages over the other traditional treatments.  PRP is safe and does not have the typical side effects of the other traditional treatments.  Platelet RIch Plasma treatment stimulates the natural healing process, allowing the injured area to heal back to normal.  This is very different from the traditional treatment that can cause damage and permanent alterations to the normal structures of the elbow.

PRP can also sometimes be used if a surgery has been performed and significant symptoms persist.  Surgery can sometimes alter the environment of the elbow to the point where the body is no longer able to continue the healing process.  PRP can then be used to help “kickstart” the healing mechanisms and reduce symptoms.

Platelet Rich Plasma Injection Therapy should be strongly considered for the treatment of Tennis Elbow and Golfer’s Elbow.

This new treatment option is now available to treat these elbow problems.  Regenerative Medicine and the use of Platelet Rich Plasma Injection is a game-changing treatment option that is offered at the Regenerative Medicine and Joint Preservation Center of Santa Rosa.


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Regenerative Injection Therapy with Platelet Rich Plasma for your elbow can get you back to what you love to do.


©         Regenerative Medicine and Joint Preservation Center of Santa Rosa    2017