ECU/TFCC Injury and PRP Injection

standardgirl

New User
I've been lurking around the forum for long enough that I finally registered an account as I want to be able to help others by sharing my recent experience. :)

Background:
Racquet: Head Instinct MP strung with Babolat RPM Blast.
When I first changed to RPM Blast in February 2014, I had wrist pain after 2 hrs of play. I didn't associate the pain with the string though and simply thought that perhaps I've done something wrong with my stroke. I rested for about 2 months and started playing again after the pain went away. Never had the pain again until around September/October 2015 – basically after a whole summer season of playing much more than I did before. The pain was on the outside of my wrist and was particularly bad with anti-clockwise turning action (key, left turn driving, etc.) and also whenever I dropped the racquet head trying to spin the ball. I didn't take any action until December 2015.

Had an ultrasound done in December 2015 where the results came back negative. The doctor said that everything's fine and that perhaps I'd just need to strengthen my forearm muscle. He prescribed me with some strengthening exercises. However, I did so much research online, spoke to my dad (who's a doctor) and had self-diagnosed me with TFCC injury. I followed the weight bearing test as suggested by the wrist widget website and I was on less than 45lbs on my right compared to 75+ on my left! Anyhow, I bought a couple wrist widgets and was wearing it whilst playing which helped a lot. I also switched my string to synthetic gut.

I continued playing 4+ hours a week during the winter season. In February, I had a 2-week holiday where I didn't play at all; yet the pain didn't go away. The pain was getting worse – before it was only painful after play, but by February, I was feeling pain even when I didn't play. The pain didn't go away during the 2-week holiday without tennis. Whilst on holiday in February, I saw another orthopedic who is a very close family friend (I'm from a family of doctors) and was told that it's just a repetitive stress problem, probably with inflammation and that I can opt for cortisone or PRP if I so desire. I didn't get anything done as I was away from home. Upon returning home, I went to my doctor again around end of March (the same one I saw in December).

Diagnosis:
The ultrasound end of March shows a clear partial tear of the ECU tendon. The ECU tendon is the only wrist motor tendon that connects with the TFCC. Even though the doctor did not mention anything about a TFCC injury and I didn't bother asking, I was and am still convinced that I had more than just an ECU tear since one of the primary differentiators between an ECU injury vs. a TFCC injury is the weight bearing test. Anyhow, it doesn't really matter that much with the PRP treatment.

Treatment:
I had my first PRP injection the same day of my ultrasound diagnosis. This is partially because I was already aware of the treatment and have done enough research about it, and partially because there really isn't any reason to wait. In fact, I was already considering either a cortisone injection or a PRP shot before I booked the appointment for the check-up (i.e. before the diagnosis of the ECU tear). The family friend orthopedic told me that if cost is no concern, than the PRP injection would be the better option. In fact, he had a patient who did cortisone on one arm and PRP on another. The patient began feeling improvement much faster with cortisone and only after 2 weeks with PRP; yet the cortisone treated arm needed another treatment in one year whilst the PRP one didn't. Granted that it's just one sample, but I figured PRP would in any event be a more "natural" treatment than cortisone! And since my private insurance covers 90% of the PRP cost, cost wasn't really an issue.

The PRP injection into the ECU tendon and surrounding area (which covers area of TFCC and hence why I said earlier it didn't really matter that the doctor didn't mention anything about TFCC injury) was the most painful shot that I've ever gotten in my life and my pain threshold is generally high! I had 5.5cc injected to my wrist. The doctor told me that this is more than usual as they managed to get more plasma from me than usual (usually about 4ml, but they got 5.5ml from me). That's good news! The pain stayed for the rest of the afternoon though I was still able to work out in the gym that evening, 4 hours after the injection by doing only a lower body workout. By the time I went to bed (8hrs post injection), there was very little pain left. The site stay swollen for about 2 days. By day 3 (48hrs after injection), there was only minimal swollenness. I was given a metal splint to wear at all time which I did and I also started with physical therapy.

Exactly one week later, I went for a second PRP injection which was somehow a lot less painful. The pain also went away quicker after the injection. During the one week between the first and the second injection, I didn't really feel much of an improvement. I continued wearing a splint 24/7 after the second injection but now a less restrictive one – elastic one with a plastic support.

Two weeks later, I went for my third appointment, this time, I was performing much better – had much more strength in my wrist with the tests the doctor did. The ultrasound also revealed some initial closing of the tear at the top. During the 2 weeks after the second injection, I wasn't feeling much pain at all in my day to day life. The doctor suggested that we not do a third injection but rather see how the wrist progresses. He told me that about 50% of people need 3 injections; others only need 2. The doctor gave a very hesitant clearance for me to resume playing; however, my physical therapist had already suggested that I should be able to resume playing lightly – quoting that "it'd be best if you start to play with some kids!" My weight bearing test was showing 55lbs on my right side at this point, still below the recommended 60lbs before resuming tennis. With wrist widget, the weight bearing is well above the recommended 60lbs though.

Returning to play:
3.5 weeks after the first PRP injection, I played (fairly tentatively) for just under one hour in a private lesson with nice controlled ball fed to me. I was taped up in my forearm and wrist and was also wearing wrist widget fairly tightly. We played for about 20min of forehands and spent most of the remaining time on backhands so as not to over stressed my right wrist. Serves didn't actually bother me. There were maybe a few shots where I felt something in my right wrist, but overall, it was quite alright – no pain. I iced the wrist for half an hour afterwards just to be safe. The wrist didn't feel any worse after play nor did it feel any worse in the next days.

1 week later (4.5 weeks post the first PRP injection), I played again for one hour in a lesson, wrist taped and with wrist widget. And with a new racquet – Wilson Blade 98 20x18 much more arm friendly. The hour felt very very nice, no pain and actually quite comfortable. I played more or less full out and it worked well. I iced my wrist for another half an hour afterwards just to be safe.

4 days later (5 weeks post the first PRP injection), I was off to a training weekend that was booked way ahead of the March diagnosis. I already had flights and hotels booked, so went anyway and figured I'd just play as much as possible. It turned out that I was able to play the full program of 2 hours in the morning and 1 hour in the afternoon with my wrist taped and wearing the wrist widget. No pain. I iced the wrist each and every time after play.

In Conclusion:
I'm very thankful of the PRP shots – these are probably the best things that happened! Tendon injuries usually take a long time to heal (easily more than half a year) due to the minimal blood flow into the area which is needed for healing purposes. In essence, I was able to return back to play, albeit with taped wrist and wrist widget, after 5 weeks of rest. The change of racquet made a difference too. I'm not (yet) living completely pain free at the moment – i.e. a couple times a week if I do something funny with my wrist, I would feel a very slight pain, but otoh, I'm able to play pain free now. My weight bearing number is now about 70lbs on my right arm. Very glad with the recovery process.

I'll have another follow-up ultrasound appointment end of this month to check the healing process. :)
 

scotus

G.O.A.T.
I've been lurking around the forum for long enough that I finally registered an account as I want to be able to help others by sharing my recent experience. :)

Background:
Racquet: Head Instinct MP strung with Babolat RPM Blast.
When I first changed to RPM Blast in February 2014, I had wrist pain after 2 hrs of play. I didn't associate the pain with the string though and simply thought that perhaps I've done something wrong with my stroke. I rested for about 2 months and started playing again after the pain went away. Never had the pain again until around September/October 2015 – basically after a whole summer season of playing much more than I did before. The pain was on the outside of my wrist and was particularly bad with anti-clockwise turning action (key, left turn driving, etc.) and also whenever I dropped the racquet head trying to spin the ball. I didn't take any action until December 2015.

Had an ultrasound done in December 2015 where the results came back negative. The doctor said that everything's fine and that perhaps I'd just need to strengthen my forearm muscle. He prescribed me with some strengthening exercises. However, I did so much research online, spoke to my dad (who's a doctor) and had self-diagnosed me with TFCC injury. I followed the weight bearing test as suggested by the wrist widget website and I was on less than 45lbs on my right compared to 75+ on my left! Anyhow, I bought a couple wrist widgets and was wearing it whilst playing which helped a lot. I also switched my string to synthetic gut.

I continued playing 4+ hours a week during the winter season. In February, I had a 2-week holiday where I didn't play at all; yet the pain didn't go away. The pain was getting worse – before it was only painful after play, but by February, I was feeling pain even when I didn't play. The pain didn't go away during the 2-week holiday without tennis. Whilst on holiday in February, I saw another orthopedic who is a very close family friend (I'm from a family of doctors) and was told that it's just a repetitive stress problem, probably with inflammation and that I can opt for cortisone or PRP if I so desire. I didn't get anything done as I was away from home. Upon returning home, I went to my doctor again around end of March (the same one I saw in December).

Diagnosis:
The ultrasound end of March shows a clear partial tear of the ECU tendon. The ECU tendon is the only wrist motor tendon that connects with the TFCC. Even though the doctor did not mention anything about a TFCC injury and I didn't bother asking, I was and am still convinced that I had more than just an ECU tear since one of the primary differentiators between an ECU injury vs. a TFCC injury is the weight bearing test. Anyhow, it doesn't really matter that much with the PRP treatment.

Treatment:
I had my first PRP injection the same day of my ultrasound diagnosis. This is partially because I was already aware of the treatment and have done enough research about it, and partially because there really isn't any reason to wait. In fact, I was already considering either a cortisone injection or a PRP shot before I booked the appointment for the check-up (i.e. before the diagnosis of the ECU tear). The family friend orthopedic told me that if cost is no concern, than the PRP injection would be the better option. In fact, he had a patient who did cortisone on one arm and PRP on another. The patient began feeling improvement much faster with cortisone and only after 2 weeks with PRP; yet the cortisone treated arm needed another treatment in one year whilst the PRP one didn't. Granted that it's just one sample, but I figured PRP would in any event be a more "natural" treatment than cortisone! And since my private insurance covers 90% of the PRP cost, cost wasn't really an issue.

The PRP injection into the ECU tendon and surrounding area (which covers area of TFCC and hence why I said earlier it didn't really matter that the doctor didn't mention anything about TFCC injury) was the most painful shot that I've ever gotten in my life and my pain threshold is generally high! I had 5.5cc injected to my wrist. The doctor told me that this is more than usual as they managed to get more plasma from me than usual (usually about 4ml, but they got 5.5ml from me). That's good news! The pain stayed for the rest of the afternoon though I was still able to work out in the gym that evening, 4 hours after the injection by doing only a lower body workout. By the time I went to bed (8hrs post injection), there was very little pain left. The site stay swollen for about 2 days. By day 3 (48hrs after injection), there was only minimal swollenness. I was given a metal splint to wear at all time which I did and I also started with physical therapy.

Exactly one week later, I went for a second PRP injection which was somehow a lot less painful. The pain also went away quicker after the injection. During the one week between the first and the second injection, I didn't really feel much of an improvement. I continued wearing a splint 24/7 after the second injection but now a less restrictive one – elastic one with a plastic support.

Two weeks later, I went for my third appointment, this time, I was performing much better – had much more strength in my wrist with the tests the doctor did. The ultrasound also revealed some initial closing of the tear at the top. During the 2 weeks after the second injection, I wasn't feeling much pain at all in my day to day life. The doctor suggested that we not do a third injection but rather see how the wrist progresses. He told me that about 50% of people need 3 injections; others only need 2. The doctor gave a very hesitant clearance for me to resume playing; however, my physical therapist had already suggested that I should be able to resume playing lightly – quoting that "it'd be best if you start to play with some kids!" My weight bearing test was showing 55lbs on my right side at this point, still below the recommended 60lbs before resuming tennis. With wrist widget, the weight bearing is well above the recommended 60lbs though.

Returning to play:
3.5 weeks after the first PRP injection, I played (fairly tentatively) for just under one hour in a private lesson with nice controlled ball fed to me. I was taped up in my forearm and wrist and was also wearing wrist widget fairly tightly. We played for about 20min of forehands and spent most of the remaining time on backhands so as not to over stressed my right wrist. Serves didn't actually bother me. There were maybe a few shots where I felt something in my right wrist, but overall, it was quite alright – no pain. I iced the wrist for half an hour afterwards just to be safe. The wrist didn't feel any worse after play nor did it feel any worse in the next days.

1 week later (4.5 weeks post the first PRP injection), I played again for one hour in a lesson, wrist taped and with wrist widget. And with a new racquet – Wilson Blade 98 20x18 much more arm friendly. The hour felt very very nice, no pain and actually quite comfortable. I played more or less full out and it worked well. I iced my wrist for another half an hour afterwards just to be safe.

4 days later (5 weeks post the first PRP injection), I was off to a training weekend that was booked way ahead of the March diagnosis. I already had flights and hotels booked, so went anyway and figured I'd just play as much as possible. It turned out that I was able to play the full program of 2 hours in the morning and 1 hour in the afternoon with my wrist taped and wearing the wrist widget. No pain. I iced the wrist each and every time after play.

In Conclusion:
I'm very thankful of the PRP shots – these are probably the best things that happened! Tendon injuries usually take a long time to heal (easily more than half a year) due to the minimal blood flow into the area which is needed for healing purposes. In essence, I was able to return back to play, albeit with taped wrist and wrist widget, after 5 weeks of rest. The change of racquet made a difference too. I'm not (yet) living completely pain free at the moment – i.e. a couple times a week if I do something funny with my wrist, I would feel a very slight pain, but otoh, I'm able to play pain free now. My weight bearing number is now about 70lbs on my right arm. Very glad with the recovery process.

I'll have another follow-up ultrasound appointment end of this month to check the healing process. :)

Thank you for the very thoughtful and helpful post.

Welcome to Talk Tennis and I wish you a speedy full recovery.
 

Raul_SJ

G.O.A.T.
Treatment:
I had my first PRP injection the same day of my ultrasound diagnosis. This is partially because I was already aware of the treatment and have done enough research about it, and partially because there really isn't any reason to wait. In fact, I was already considering either a cortisone injection or a PRP shot before I booked the appointment for the check-up (i.e. before the diagnosis of the ECU tear). The family friend orthopedic told me that if cost is no concern, than the PRP injection would be the better option. In fact, he had a patient who did cortisone on one arm and PRP on another. The patient began feeling improvement much faster with cortisone and only after 2 weeks with PRP; yet the cortisone treated arm needed another treatment in one year whilst the PRP one didn't. Granted that it's just one sample, but I figured PRP would in any event be a more "natural" treatment than cortisone! And since my private insurance covers 90% of the PRP cost, cost wasn't really an issue.

Is insurance starting to cover PRP injections now? My Podiatrist said he was getting good results using PRP on patients with retro-calcanael bursitis. When he submitted the request, my insurance denied it saying it was an experimental treatment.

That was a year ago. I think there have been recent positive studies with PRP since then,
 

standardgirl

New User
Is insurance starting to cover PRP injections now? My Podiatrist said he was getting good results using PRP on patients with retro-calcanael bursitis. When he submitted the request, my insurance denied it saying it was an experimental treatment.

That was a year ago. I think there have been recent positive studies with PRP since then,

I no longer live in the US, so unfortunately can't comment on the insurance coverage in the states :(
Where I am (Switzerland), it's not universally covered by insurance. My doctor had recommended either PRP or Shockwave Therapy. We clarified with the insurance first and my insurance company said that they would cover 90% of cost for PRP injections but not Shockwave. I was anyway leaning towards PRP so went with it. Very please with the results so far :)

Hope that more insurance companies will cover the procedure in the states!!! But it's actually fairly cheap to do it in Switzerland - so maybe you can just fly here :rolleyes: The cost was ca. USD 120 per injection + normal cost of the doctor visit. The doctor visit part is anyhow covered by health insurance, so the additional part was really just 120 per injection.
 

HouTex

Rookie
I was about to do PRP therapy for my TE in early 2015 and the two orthopedic surgeons in Houston who recommended the procedure if PT and cortisone shots didn't work estimated it would cost about $500. Insurance would not pay because it's still viewed as experimental.
 

hungroger

New User
I've been lurking around the forum for long enough that I finally registered an account as I want to be able to help others by sharing my recent experience. :)

Background:
Racquet: Head Instinct MP strung with Babolat RPM Blast.
When I first changed to RPM Blast in February 2014, I had wrist pain after 2 hrs of play. I didn't associate the pain with the string though and simply thought that perhaps I've done something wrong with my stroke. I rested for about 2 months and started playing again after the pain went away. Never had the pain again until around September/October 2015 – basically after a whole summer season of playing much more than I did before. The pain was on the outside of my wrist and was particularly bad with anti-clockwise turning action (key, left turn driving, etc.) and also whenever I dropped the racquet head trying to spin the ball. I didn't take any action until December 2015.

Had an ultrasound done in December 2015 where the results came back negative. The doctor said that everything's fine and that perhaps I'd just need to strengthen my forearm muscle. He prescribed me with some strengthening exercises. However, I did so much research online, spoke to my dad (who's a doctor) and had self-diagnosed me with TFCC injury. I followed the weight bearing test as suggested by the wrist widget website and I was on less than 45lbs on my right compared to 75+ on my left! Anyhow, I bought a couple wrist widgets and was wearing it whilst playing which helped a lot. I also switched my string to synthetic gut.

I continued playing 4+ hours a week during the winter season. In February, I had a 2-week holiday where I didn't play at all; yet the pain didn't go away. The pain was getting worse – before it was only painful after play, but by February, I was feeling pain even when I didn't play. The pain didn't go away during the 2-week holiday without tennis. Whilst on holiday in February, I saw another orthopedic who is a very close family friend (I'm from a family of doctors) and was told that it's just a repetitive stress problem, probably with inflammation and that I can opt for cortisone or PRP if I so desire. I didn't get anything done as I was away from home. Upon returning home, I went to my doctor again around end of March (the same one I saw in December).

Diagnosis:
The ultrasound end of March shows a clear partial tear of the ECU tendon. The ECU tendon is the only wrist motor tendon that connects with the TFCC. Even though the doctor did not mention anything about a TFCC injury and I didn't bother asking, I was and am still convinced that I had more than just an ECU tear since one of the primary differentiators between an ECU injury vs. a TFCC injury is the weight bearing test. Anyhow, it doesn't really matter that much with the PRP treatment.

Treatment:
I had my first PRP injection the same day of my ultrasound diagnosis. This is partially because I was already aware of the treatment and have done enough research about it, and partially because there really isn't any reason to wait. In fact, I was already considering either a cortisone injection or a PRP shot before I booked the appointment for the check-up (i.e. before the diagnosis of the ECU tear). The family friend orthopedic told me that if cost is no concern, than the PRP injection would be the better option. In fact, he had a patient who did cortisone on one arm and PRP on another. The patient began feeling improvement much faster with cortisone and only after 2 weeks with PRP; yet the cortisone treated arm needed another treatment in one year whilst the PRP one didn't. Granted that it's just one sample, but I figured PRP would in any event be a more "natural" treatment than cortisone! And since my private insurance covers 90% of the PRP cost, cost wasn't really an issue.

The PRP injection into the ECU tendon and surrounding area (which covers area of TFCC and hence why I said earlier it didn't really matter that the doctor didn't mention anything about TFCC injury) was the most painful shot that I've ever gotten in my life and my pain threshold is generally high! I had 5.5cc injected to my wrist. The doctor told me that this is more than usual as they managed to get more plasma from me than usual (usually about 4ml, but they got 5.5ml from me). That's good news! The pain stayed for the rest of the afternoon though I was still able to work out in the gym that evening, 4 hours after the injection by doing only a lower body workout. By the time I went to bed (8hrs post injection), there was very little pain left. The site stay swollen for about 2 days. By day 3 (48hrs after injection), there was only minimal swollenness. I was given a metal splint to wear at all time which I did and I also started with physical therapy.

Exactly one week later, I went for a second PRP injection which was somehow a lot less painful. The pain also went away quicker after the injection. During the one week between the first and the second injection, I didn't really feel much of an improvement. I continued wearing a splint 24/7 after the second injection but now a less restrictive one – elastic one with a plastic support.

Two weeks later, I went for my third appointment, this time, I was performing much better – had much more strength in my wrist with the tests the doctor did. The ultrasound also revealed some initial closing of the tear at the top. During the 2 weeks after the second injection, I wasn't feeling much pain at all in my day to day life. The doctor suggested that we not do a third injection but rather see how the wrist progresses. He told me that about 50% of people need 3 injections; others only need 2. The doctor gave a very hesitant clearance for me to resume playing; however, my physical therapist had already suggested that I should be able to resume playing lightly – quoting that "it'd be best if you start to play with some kids!" My weight bearing test was showing 55lbs on my right side at this point, still below the recommended 60lbs before resuming tennis. With wrist widget, the weight bearing is well above the recommended 60lbs though.

Returning to play:
3.5 weeks after the first PRP injection, I played (fairly tentatively) for just under one hour in a private lesson with nice controlled ball fed to me. I was taped up in my forearm and wrist and was also wearing wrist widget fairly tightly. We played for about 20min of forehands and spent most of the remaining time on backhands so as not to over stressed my right wrist. Serves didn't actually bother me. There were maybe a few shots where I felt something in my right wrist, but overall, it was quite alright – no pain. I iced the wrist for half an hour afterwards just to be safe. The wrist didn't feel any worse after play nor did it feel any worse in the next days.

1 week later (4.5 weeks post the first PRP injection), I played again for one hour in a lesson, wrist taped and with wrist widget. And with a new racquet – Wilson Blade 98 20x18 much more arm friendly. The hour felt very very nice, no pain and actually quite comfortable. I played more or less full out and it worked well. I iced my wrist for another half an hour afterwards just to be safe.

4 days later (5 weeks post the first PRP injection), I was off to a training weekend that was booked way ahead of the March diagnosis. I already had flights and hotels booked, so went anyway and figured I'd just play as much as possible. It turned out that I was able to play the full program of 2 hours in the morning and 1 hour in the afternoon with my wrist taped and wearing the wrist widget. No pain. I iced the wrist each and every time after play.

In Conclusion:
I'm very thankful of the PRP shots – these are probably the best things that happened! Tendon injuries usually take a long time to heal (easily more than half a year) due to the minimal blood flow into the area which is needed for healing purposes. In essence, I was able to return back to play, albeit with taped wrist and wrist widget, after 5 weeks of rest. The change of racquet made a difference too. I'm not (yet) living completely pain free at the moment – i.e. a couple times a week if I do something funny with my wrist, I would feel a very slight pain, but otoh, I'm able to play pain free now. My weight bearing number is now about 70lbs on my right arm. Very glad with the recovery process.

I'll have another follow-up ultrasound appointment end of this month to check the healing process. :)

I am so glad that I've found this post from you! I'm having the SAME EXACT issue and also considering taking PRP Shot. How is your wrist now? Is it healed completely?
 
In fact, he had a patient who did cortisone on one arm and PRP on another. The patient began feeling improvement much faster with cortisone and only after 2 weeks with PRP; yet the cortisone treated arm needed another treatment in one year whilst the PRP one didn't.

A true scientist who uses his own body as a test case. Bravo!
 
Thanks for posting the detailed chronology.

Personally, I think you should take 2 months away from tennis.
Spend the time focusing on fitness and PT.
 
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