Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

New biologic treatment for tennis elbow may replace surgery for chronic sufferers

24.10.2006
One-time injection with patient's own platelets reduces pain, allows return to activity

A person suffering from tennis elbow may not have to look any further than his or her own body for the most effective treatment, according to a study published in the November issue of The American Journal of Sports Medicine.

Specially-prepared platelets taken from the patient which are then re-injected into the tendon of the affected elbow provides more relief than more commonly-used therapies which have failed to yield results, often resulting in surgery, concludes study authors Allan Mishra MD and Terri Pavelko, PAC, PT, of the Menlo Medical Clinic, Stanford University Medical Center, Menlo Park, Calif.

"Ours is the first in vivo human investigation of this novel biologic treatment for chronic severe elbow tendonitis in patients who have simply 'flunked out' of other treatments," says Dr. Mishra. "Ninety-three percent of patients in our study did well, which is as good a result as patients who have tendon surgery."

"There is very little risk here; we are using the patient's own blood taken right in the doctor's office, and the whole procedure takes less than an hour," Mishra says. "The results of our pilot study indicate this therapy is as effective as surgery, with sustained and significant improvement over time, no side effects, and high patient acceptance."

Tennis elbow (lateral epicondylitis or tendonitis) isn't restricted to those who frequent tennis courts, but is a common problem for people whose activities require strong gripping or repetitive wrist motions. It is a degeneration of the tendon above the elbow that controls the movements of the wrist and hand. Treatments such as rest, nonsteroidal anti-inflammatory drugs, bracing, physical therapy, and injections of corticosteroids (cortisone shots) are often used but recent studies have called into question their efficacy. Those who suffer longest resort to surgical repair of the tendon when all other therapies have failed.

Mishra and Pavelko evaluated 140 patients who had tennis elbow for longer than 3 months and had scored at least a 60 of 100 using a visual analog scale (a continuum on which a person rates the severity of his/her pain: 0 = no pain; 100 = maximum pain). They all had completed a course of physical therapy and had tried some combination of anti-inflammatory medicines, bracing or cortisone shots, all without relief of symptoms. Twenty of the original 140 patients evaluated met these strict criteria and were enrolled in the study. These 20 represented the most severe tendonitis patients who had not improved with time or nonsurgical treatment.

Fifteen patients received a one-time injection of platelet-rich plasma (PRP) into their affected elbow. (Platelets are blood components responsible for the formation of clots in response to injury, but also contain powerful growth factors; plasma is the liquid portion of the blood.) Blood was drawn from a patient's unaffected arm and spun down in the physician's office lab to separate the blood's components. Approximately a half-teaspoon (2 to 3 mL) of this material – over 500% richer in platelets than whole blood – was then injected into the tendon of the sore elbow. These 15 patients had tennis elbow for 15 months and the average patient age was 48 years. Their baseline score on the pain scale was 80.3.

Five patients served as a control (non-PRP) group and received a 2 to 3 mL injection of a local anesthetic (bupivacaine with epinephrine) into the affected elbow. The mean duration of symptoms in this group was 12 months and average patient age was 42 years. Their baseline score on the pain scale was 86.

Twenty-four hours post-treatment both groups began a 2-week standardized stretching program and at 4 weeks patients were allowed to return to normal sporting and recreational activities. Follow-up visits were planned at 4 weeks, 8 weeks and 6 months post-treatment, with a final overall evaluation. Using the visual analog scale, at 4 weeks post-treatment the PRP-treated group reported a mean 46 percent improvement versus a mean 17 percent improvement in the control group. Eight weeks after treatment, the PRP patients reported a mean 60 percent improvement while the control group reported a mean 16 percent improvement. At eight weeks, 3 of the 5 control patients had either sought other treatment for their condition or had left the study, limiting further analysis to the PRP-treated patients.

At 6 months post-treatment, the PRP-treated patients' visual analog pain scores had improved 81 percent over their baseline scores. At a 2-year evaluation, 93 percent of these patients reported "complete satisfaction" with the treatment and 7 percent were "partially satisfied." Nearly all of the PRP-treated patients had returned to the activities of daily living and over 90 percent had returned to work or sporting activities.

Platelet-rich plasma contains powerful growth factors that initiate healing in the tendon, but may also send signals to other cells in the body drawing them to the injured area to help in repair, Mishra theorizes. Early studies have shown PRP therapy to be useful in maxillofacial surgery, wound healing, microfracture repair, and in the treatment of plantar faciitis. Treatment with PRP is still considered investigational and further research is needed before it can be made available to the general population.

"The body has an extraordinary ability to heal itself," says Mishra. "All we did was speed the process by taking blood from a different area, concentrating it, and putting it back into an area where there was relatively poor blood supply to help repair the damage."

Patti Davis | EurekAlert!
Further information:
http://www.sportsmed.org
http://www.aossm.org

More articles from Health and Medicine:

nachricht Researchers release the brakes on the immune system
18.10.2017 | Rheinische Friedrich-Wilhelms-Universität Bonn

nachricht Norovirus evades immune system by hiding out in rare gut cells
12.10.2017 | University of Pennsylvania School of Medicine

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Neutron star merger directly observed for the first time

University of Maryland researchers contribute to historic detection of gravitational waves and light created by event

On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...

Im Focus: Breaking: the first light from two neutron stars merging

Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.

Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....

Im Focus: Smart sensors for efficient processes

Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).

When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...

Im Focus: Cold molecules on collision course

Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.

How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...

Im Focus: Shrinking the proton again!

Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.

It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ASEAN Member States discuss the future role of renewable energy

17.10.2017 | Event News

World Health Summit 2017: International experts set the course for the future of Global Health

10.10.2017 | Event News

Climate Engineering Conference 2017 Opens in Berlin

10.10.2017 | Event News

 
Latest News

Osaka university researchers make the slipperiest surfaces adhesive

18.10.2017 | Materials Sciences

Space radiation won't stop NASA's human exploration

18.10.2017 | Physics and Astronomy

Los Alamos researchers and supercomputers help interpret the latest LIGO findings

18.10.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>