At Complete we carry out a variety of ultrasound guided procedures for a selection of conditions. These include steroid injections, hyaluronic acid and PRP injections.
Tennis elbow is one of the most common conditions that we see in the clinic.
The classic symptoms of tennis elbow are pain on the outside of the elbow (see below) alongside pain with gripping and lifting. It is also very painful if you ‘knock’ the elbow.
What is the best treatment for tennis elbow ?
There are currently a variety of treatment options available for those suffering from symptoms of tennis elbow. At Complete we will always consider the least invasive treatment options first; these include physiotherapy and shockwave.
Who is a good candidate for ultrasound-guided injection therapy?
Ultrasound-guided injections are considered for patients with:
- severe pain, particularly pain waking you at night caused by tennis elbow
- those with manual jobs who are struggling or unable to go to work due to the pain
- pain that is not improving despite comprehensive physiotherapy and/or shockwave treatment
- pain that is significantly affecting your daily activities and or preventing you from playing sport or carrying out your hobbies
Which injections are effective for the treatment of a tennis elbow?
For tennis elbow (also known as common extensor tendinopathy or lateral epicondylitis) there are two main treatment options available if symptoms of pain are not improving;
- Steroid injections (also known as corticosteroid or cortisone injections)
- PRP (Platelet-rich plasma) injections.
For many years steroid injections have been used as a treatment for tennis elbow with good short-term success resulting in relief of painful symptoms. They provide rapid (often almost immediate) pain relief. A steroid injection treatment for tennis elbow should always be followed up with a comprehensive course of physiotherapy to help prevent re-occurrence.
Steroid injections however, can be relatively short-lasting, which occasionally means a second or even a third, injection is required. At Complete we limit the number of steroid injections we carry out for each condition, as steroid has been shown to have a diminishing effect and will also reduce the strength of the tendon.
It has also been indicated that if the pain returns following a steroid injection it may be worse than prior to the injection. This will be discussed with you before we carry out an injection to ensure you are fully informed about the pros and cons of steroid injections vs Platelet-rich plasma injections.
Consequently, this is one of the main reasons for the rise in popularity of PRP injections as a treatment for tennis elbow, especially in long term, stubborn cases.
What is PRP?
PRP is a novel, safe and effective treatment for tennis elbow pain. PRP is when we take blood from your arm, spin it in a centrifuge to separate the different elements within the blood.
It separates the blood into your red blood cells (RBC), white blood cells (WBC) and the “Platelet Rich Plasma” (hence the term PRP).
At Complete Physio, we use a system called the Athrex ACP double syringe system, which is considered the market leader. Unlike steroid, PRP is not a drug and has few side effects and has no negative effects to the strength of the tendon, which is one of its main benefits over steroid.
The main indications to use PRP as a treatment for tennis elbow are;
- If there is significant tendinopathy (also known as degeneration or sometimes described as ‘wear and tear’)
- Or a tear in the tendon.
Both of these will be visualised clearly on a diagnostic ultrasound scan. At Complete Physio we carry out an ultrasound (there is no extra charge for the scan – see image below) before carrying out any injection to ensure the most appropriate course of treatment for you.
If there is significant tendinopathy or a tear in the tendon, we will often suggest a Platelet Rich Plasma injection to help facilitate the healing process. PRP should also be considered is if you have had a poor outcome or only short term pain relief from a steroid injection.
How does PRP work as a treatment for tennis elbow?
Platelet-rich plasma (PRP) therapy uses the body’s own natural healing processes to repair damaged tissue. Platelets are blood cells that promote blood clotting and help wounds to heal. PRP contains many proteins called growth factors (more than normal blood) which helps the tendon to heal and consequently reduce your pain.
Does PRP work for tennis elbow pain?
There are multiple trials in the scientific literature (see references below) that support the use of PRP in chronic cases of tennis elbow that have not improved with physiotherapy. It is acknowledged that PRP is a promising and safe treatment modality for tennis elbow pain, with few side effects and good outcomes.
Many studies demonstrate improved outcomes with PRP when compared to steroid injections, in the medium and long term.
In one long term study, treatment of patients with PRP, reduced elbow pain and increased function significantly, exceeding the effect of corticosteroid injection even after a follow-up of 2 years (Gosens et al, 2011).
The results of surgery for tennis elbow are unpredictable and vary significantly. PRP should certainly be considered before surgical options are contemplated.
How long should you rest after PRP injections for tennis elbow?
It is not uncommon that following a PRP injection you experience more pain for 2-3 days after the procedure, as the injection starts to work. This is normal, expected and nothing to worry about. The region of the injection will be tender and there maybe some mild swelling of the tendon for a few days. We discourage you from using anti-inflammatories as these can reduce the healing effect of the PRP.
How long is the recovery for a tennis elbow following PRP injections?
Many of our clients start to experience pain relief after 3-4 weeks, but we would expect significant improvements at 6 weeks. However, it is important to note that patients heal at different rates and some patients respond to PRP better than others. It will also depend on how long you have had the pain and the severity of the condition.
The research suggests that for a full recovery it is likely to take 3-6 months. Tendons do take time to improve, because they have a relatively poor blood supply compared to a muscle for example.
PRP is certainly a very promising treatment for tennis elbow and has resulted in a positive outcome for many of our clients to resolve their pain and return them back to full function.
How many PRP injections do you need?
The majority of the research studies use a three injection protocol. We have discovered that three injections achieve superior results compared to just one or two injections.
Consequently we would therefore recommend three injections, two weeks apart. However, every case is different and it can depend on the severity of your case.
Why choose Complete?
At Complete we have been using PRP for tennis elbow for many years and have had some excellent results. The results are certainly more effective in those patients who have more severe structural change on the ultrasound, such as a tear in the tendon, and for those that have chronic unresolving symptoms.
What next?
If you would like to book an appointment or discuss PRP with one of our clinical specialists please do not hesitate to contact us at info@complete-physio.co.uk or call 0207 482 3875.