Tennis Elbow Treatment - PRP Injections

by Dr. Bruce Steinberg, Chairman of the Board, Jacksonville Orthopaedic Institute, Jacksonville, Florida

Commonly asked question: Since PRP (platelet-rich plasma) is not covered by insurance, is it worth the out-of-pocket cash expense?

Tennis elbow is a very common condition which causes pain along the outside portion of the elbow. Gripping, torqueing, pinching and lifting of even light objects such as a coffee cup can become exquisitely painful. The lay press has reported on a treatment that has been used for tendinopathies including tennis elbow, PRP (platelet-rich plasma). PRP is a technique in which blood is drawn from the patient and spun down extracting the serum portion of the blood that includes the platelets. The theory is that this portion of the blood, when injected back into the area of the injured, inflamed tendon, will lead to its healing. The question is whether or not this particular treatment is any better than the standard treatment of corticosteroid injection . The theory certainly seems to make sense.

There are many types of reports in medicine when it comes to a treatment and evaluation of a procedure. The best peer review scientific reports have not yet proven that PRP works any better than the accepted treatment of corticosteroid injection. The studies which doctors most rely upon are those that are performed for a group of patients with the same condition, where both the doctor and the patient are “blinded” to the treatment. A “blinded” study means that the doctor and the patient do not know if they are receiving the old treatment of corticosteroids versus a new treatment of PRP. Finally, these studies re-evaluate the patients over time to see if one treatment was better than the other. The largest most recent studies to look at this question have not found that one treatment is better than another. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial; 
Effects of platelet-rich plasma on lateral epicondylitis of the elbow: prospective randomized controlled trial;

In fact, in one large “systemic” review of the entire literature demonstrated strong statistical evidence against platelet-rich plasma injections. Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review

Tennis elbow can be a very frustrating painful condition. Patients are even willing to pay for treatments such as PRP, which are not covered by insurance, with out-of-pocket funds. It is the job of the physician to review the scientific literature and make recommendations to the patient based on the best studies available. While one can certainly seek to undergo PRP treatment, to date there is no evidence that this treatment is better than the standard treatment. If further evidence becomes available that should change this opinion, then PRP would become one of the initial treatment options most likely also covered by insurance. The literature overwhelmingly demonstrates that corticosteroid injection has an 80-95% success rate curing the condition of tennis elbow (lateral epicondylitis). This treatment with activity modification and specific stretching and strengthening exercises usually resolves the problem. Surgical intervention in a small group of patients for failed conservative treatment has a greater than 90% success rate. Surgical treatment for lateral epicondylitis: a long-term follow-up of results

If you are interested in the treatment of tennis elbow (lateral epicondylitis), please contact Jacksonville Orthopaedic Institute at (904) JOI-2000 or for online scheduling.