Epicondylitis: this is a misnomer, as there is no inflammation! First some basic anatomy. Tendons that move the wrist and fingers attach at the elbow into the ‘epicondyle’ of the arm bone (humerus). This is the anchor point for wrist movement. In other words the reason you have elbow pain from epicondylitis is because of wrist movement (not elbow movement- hence the need to rest the wrist!).There are two epicondyles, hence golfers and tennis elbow depending on the inner or the outer epicondyle being affected.
Reasons for damage? repetitive movement, age, genetic factors, known or unknown injury and various other factors contribute to “wear and tear” . Structural damage may or may not be seen on ultrasound or even MRI scans. Recently we have become increasingly aware that this is a degenerative and NOT an inflammatory disorder. However this fact was published about two decades ago! This lack of understanding may partly explain the widespread use of steroid injections for epicondylitis.
How does this heal? Natural healing is limited as tendons do not possess good inherent blood supply. I think of tendons and ligaments as slaves who slog away in our body without rest, food or water and slowly ‘ degenerate’ over time. Known or unknown injury accelerate this process. Repair of tendons is usually slow and can take several months or even few years. Repair can also be inadequate. These limitations are further worsened with repeated steroid injections.
How to treat epicondylitis? Once the correct diagnosis is established I “rest the wrist” for about ten days, paracetamol (if not allergic), ice and elevation. I work closely with occupational or physiotherapistfodor rehab. If this doesn’t work PRP or ABI is offered. ABI is not offered if there is a large tendon tear.
What is ABI? This is your blood from a vein draw and injected under ultrasound image control into the tendon or ligament.
What is PRP? Again this is your blood from a vein draw into a special tube and spun to separate the cells that heal (platelets) (hence the extra cost!) and injected as explained above.The unwanted part of the blood is discarded.
Why PRP? Platelets contain various growth factors that stimulate the healing process of tendons. The restoration of structure improves function.
What happens after PRP treatment for epicondylitis? I ” rest the wrist” with a splint for 10 days, ice, and paracetamol for pain only works if taken every 6 hours (check the dose with ur doctor- usually 1 gram every 6 hours for 3 to 5 days). After the first ten days, avoid activity that increases pain. Try to achieve a balance of pain free activity and gradual build up of strength under a good rehab program. I use the 20% rule of intensity and frequency increased in increments of 20% every 4 to 6 weeks until 100 % (your normal activity) and it seems to work in most cases. Remember to go straight back to baseline (splint for 10 days, ice paracetamol etc). If this doesnt work a second course of PRP is offered.
What to expect after PRP? pain crisis – is very severe pain due to the natural healing response after PRP In about 10 to 20 % of patients and last typically for 5 days. Some pain can persist for many weeks. Do not expect magic in the first several weeks. Healing is gradual and can be delayed. This realization is important.
The above post is a guest post done by our specialty expert, Dr. Doss of Nedlands Ultrasound.
