PRP injection for tennis elbow - successful or not?

sovertennis

Professional
Aussie, good luck with your rehab. I, too, suffered with acute TE for several months (though not for nine months, as you did) and finally opted for surgery. After some diligent rehab, I was playing again, part time, in 6 weeks. Now, nearly two years later, I've not had a moment of pain. I hope your recovery goes just as well.
 

Chas Tennis

G.O.A.T.
..................I, too, suffered with acute TE for several months (though not for nine months, as you did) and finally opted for surgery. After some diligent rehab, I was playing again, part time, in 6 weeks. Now, nearly two years later, I've not had a moment of pain. ........................................

Don't know much about this type of surgery and have not researched very well. Are there two main types of surgical treatment?

1) Remove damaged part of tendon (s) and re-attach tendons to the bone.

2) Make some cuts that do not involve re-attaching the tendon but free up the tendon somehow for some kind of remodeling.

Do you know if your surgery could be characterized as one of the above procedures?
 

aussie

Professional
Don't know much about this type of surgery and have not researched very well. Are there two main types of surgical treatment?

1) Remove damaged part of tendon (s) and re-attach tendons to the bone.

2) Make some cuts that do not involve re-attaching the tendon but free up the tendon somehow for some kind of remodeling.

Do you know if your surgery could be characterized as one of the above procedures?

Yes Chas my procedure was no. 1 above. The damaged portion is removed and the tendon (ECRB) is reattached to the lateral epicondyle. The lateral epicondyle is also roughed up to make a bleeding bed to accelerate the tendon healing process.

When you read what the repair involves it's no wonder that there is a fair degree of pain and stiffness following the op. At 3.5 weeks after surgery I have full flexion with slight pain in the elbow and near full extension with a bit more pain. I have pain free suppination (turning palm up) with elbow flexed but substantial pain when suppinating with elbow in extension.

I also have difficulty in making a fist because of pain and stiffness in mostly my middle finger. Not sure what has caused that but hopefully that will resolve over next few weeks. Next appointment with surgeon is in 2 weeks so my progress and way forward will be clearer after that.

My understanding is that there are a number of procedures that surgeons employ to release/repair the ECRB. One is to cut the tendon to allow it to stretch thus releasing tension on the attachment to the epicondyle so that pain is resolved and healing can re-start. There are other techniques as well some using arthroscopies rather than the full incision method my surgeon employed. In the end you are in the hands of the surgeon and need to put your trust in him/her. Hopefully mine has done a great job!
 

Chas Tennis

G.O.A.T.
........................At 3.5 weeks after surgery I have full flexion with slight pain in the elbow and near full extension with a bit more pain. I have pain free suppination (turning palm up) with elbow flexed but substantial pain when suppinating with elbow in extension.

I also have difficulty in making a fist because of pain and stiffness in mostly my middle finger. Not sure what has caused that but hopefully that will resolve over next few weeks. Next appointment with surgeon is in 2 weeks so my progress and way forward will be clearer after that.

My understanding is that there are a number of procedures that surgeons employ to release/repair the ECRB. One is to cut the tendon to allow it to stretch thus releasing tension on the attachment to the epicondyle so that pain is resolved and healing can re-start. There are other techniques as well some using arthroscopies rather than the full incision method my surgeon employed. In the end you are in the hands of the surgeon and need to put your trust in him/her. Hopefully mine has done a great job!

Why you might get pain with finger movements. The wrist extensors are probably most directly involved in Tennis Elbow. (?) As the video below shows, underneath the forearm wrist extensor muscles are the muscles that control the fingers. Several of these forearm tendons all attach together at the lateral epicondyle.

This video describes the muscles of the forearm-
http://www.youtube.com/watch?v=BjIab-huqgU&list=PLA42AC7FBC0B31765&index=18

The subject of tendon attachment gets extremely complicated. As I understand it, the tendons may not each attach to the bone individually ("locally") but come together first in a structure some researchers call an "enthesis". I think that those researchers are viewing the enthesis as it's own structure with special pathology. Don't take my interpretation.

Complex "Enthesis" description of tendons near the bone. Not easy reading....
http://tt.tennis-warehouse.com/showpost.php?p=7779254&postcount=11

Did they examine the removed tissue and provide any information to you on its condition, degree of tendinosis, etc. ?
 
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aussie

Professional
Why you might get pain with finger movements. The wrist extensors are probably most directly involved in Tennis Elbow. (?) As the video below shows, underneath the forearm wrist extensor muscles are the muscles that control the fingers. Several of these forearm tendons all attach together at the lateral epicondyle.

This video describes the muscles of the forearm-
http://www.youtube.com/watch?v=BjIab-huqgU&list=PLA42AC7FBC0B31765&index=18

The subject of tendon attachment gets extremely complicated. As I understand it, the tendons may not each attach to the bone individually ("locally") but come together first in a structure some researchers call an "enthesis". I think that those researchers are viewing the enthesis as it's own structure with special pathology. Don't take my interpretation.

Complex "Enthesis" description of tendons near the bone. Not easy reading....
http://tt.tennis-warehouse.com/showpost.php?p=7779254&postcount=11

Did they examine the removed tissue and provide any information to you on its condition, degree of tendinosis, etc. ?

Thanks for posting the links Chas. very interesting viewing and reading and I'll need to replay and re-read to get my head around the information. First impressions leave you shaking your head at the complexity of the muscle and tendon anatomical construction just to be able to flex the fingers. Why we don't all suffer a myriad of finger, wrist, arm and elbow problems given the complexity is simply amazing. And this is just one relatively isolated part of our anatomy!

Also I never thought to ask the surgeon regarding the condition of the tendonosis when I last saw him. If I remember when I see him in 2 weeks I'll ask but there is always so much info being absorbed during those appointments.
 

Junkie74

New User
Hello!

I did this procedure a couple of years ago, prior to that 10 years ago I had golfer's elbow surgery and the problems came back by over playing and a couple of stiff racquets along with some techniques flaws of course. To this day, i can't tell for sure if it helped me, It was painful I can tell you that and I had to rest for like 2 months along with physical therapy and maybe the rest time was all i needed to get cured and not the procedure ( I was desperate at the time ). bottom line for me, I don't think it worked like I had thought.

Good luck!
 

aussie

Professional
Guys I intend to give a complete update when I do get back to playing. In short, there have been complications following the surgery such as a minor frozen shoulder which I have 80% beaten which has impacted on my post TE surgery rehab. I still have more swelling in the lateral epicondyle region than the surgeon or I would like, so my recovery is taking more time than I would like. Hopefully though, still on track to play easy tennis by 6 months post surgery- around May/June. But, I will expand on this in the future once I am through all this and back on the court. Aussie
 

ccmtennis

Semi-Pro
Things you wish your doctor told you

Guys I intend to give a complete update when I do get back to playing. In short, there have been complications following the surgery such as a minor frozen shoulder which I have 80% beaten which has impacted on my post TE surgery rehab. I still have more swelling in the lateral epicondyle region than the surgeon or I would like, so my recovery is taking more time than I would like. Hopefully though, still on track to play easy tennis by 6 months post surgery- around May/June. But, I will expand on this in the future once I am through all this and back on the court. Aussie

I have just discovered this thread and read through it. First of I want to thank you for documenting your experience here for all to see and I hope this finds you well. I have been a TT member for a while but have not been very active due to work. I am moved by all that you went through and it reminds me of why we do what we do for patients.

I wanted to share a few things with you as well as other TT members here who may read this. I am a physician scientist at a leading research university in the US, although not in sports medicine. More importantly my area of research is stem cells. This actually allows me to look at things critically and also as a tennis fanatic, a TE patient and most of all I do NOT have financial gain from any of this. I consider this an escape and love these boards. I am writing this in part because I am also upset on some amount of misinformation here provided by some physicians. Let's call this the "things that you wish your doctor told you" . I hope the mods don't delete this...

First of PRP is not for everyone. It does clearly work for some including me, however it was very clear early in your description that it would not likely work for you. There is a lot of debate in the medical literature on this and for every study there is another to refute it. Most studies are flawed by lack of specifics in patient selection as well as a lack of a control i.e placebo (fake medication such as saline). A recent large study was finally attempted here
http://www.ncbi.nlm.nih.gov/pubmed/23825183

There were methological and statistical flaws but it appears that there may have been some benefit seen at a latter stage. For me, like most of you I experienced a lot more pain initially and had success 2-6 months later as seen in the literature. In addition to TE I had a sharp radiating pain with full extension and the MRI showed a partial tear along the common extensor tendon at the insertion. When I saw a colleague of mine well known in the field we had a long talk about it... details if you wish. I had 3 months rest followed by PRP twive at no charge at all so there is my disclaimer. 2 months later the pain is now an ache and it still allows me to play at a high level 2-3 times a week but likely not more. However I am no where at the severity of the OP.

I wanted to clarify a few things if some of you are considering this. First of all there is still no conclusive evidence that PRP works for every case. It is an attempt to isolate healing cells (stem cells) which are scare in plasma but are still present. There was a poster here that mentions his doc gave him PRP as well as stem cells. I am sorry to say but this is no more than a placebo in science. We do NOT have the resources or technology to isolate stem cells that would work for your condition and I would not propose this to anyone except in the lab setting. Also there was a lot of mention about repeat ultrasounds and monitoring "neovascularization" i.e new vessel formation. I am sad to say that if your doctor promotes this, he is likely in private practice and gaining financially from you and I would consider looking elsewhere. Neovascilarization with a doppler ultrasound is highly controversial except with a tissue biopsy and lastly it has NO correlation with how patients heal and feel about their progress when blinded to it. Abundant data have shown this as well.

Overall I hope that everyone who reads this understands that this is an evolving field even for those at the "cutting edge". There is very limited data but and anyone who claims to be an expert on this, you would need to look at what they have to back up their claims. What I am saying is that the best docs in this field always give options. There is no "one size fits all" unfortunately for us.
 

aussie

Professional
Thanks ccmtennis for your well thought out post. I agree that PRP injections are not the "magic cure" for all tendonitis/tendonosis issues and certainly what works for one sufferer may not work for another.

When I am asked by others whether having a PRP injection is a successful course of action to take for these types of issues my response is that it was not successful for me, but there have been too many sufferers of tennis elbow in particular who have experienced accelerated healing responses following the injection/s to discount it. For me, it was worth the time, discomfort and expense ($600 for the 2 injections) in a last ditch attempt to fix my TE before I went down the surgical repair path. I also believe that this is an evolving field of medical science that has a long way to go and there is much to learn.

For me personally, my progress since surgery nearly 6 months ago has been much slower than I would like and was certainly hampered by a case of frozen shoulder I developed following the surgery. The frozen shoulder (adhesive capsulitis) is just about beaten and my elbow continues to improve. With my elbow flexed I can lift a lot of weight using my extensors (muscles on the back of my arm connecting to the lateral epicondyle - the site of the TE pain) without pain. I can grip with full strength anything with my elbow flexed without pain. For example, when I string racquets, I can squeeze the flying clamps without any pain - this was not possible before the surgery, I had to use my left hand or both to avoid pain. However, with my elbow in extension I still have some minor pain when lifting palm down or squeezing. Until I rid my elbow of this pain I do not consider myself ready for tennis.

I perform strengthening exercises every day for the extensors and flexors using dumbells which I prefer over the Flexbar as I have more precise control over the amount of weight used. I incorporate a range of stretches as well as weights and though the improvement has been slow, there is still measurable improvement which is what keeps me positive.

Finally, it so happens that I have an appointment with my upper limb surgeon this coming week so I may well have a clearer idea of what the future holds following that. Cheers for now, aussie.
 

ccmtennis

Semi-Pro
Thanks ccmtennis for your well thought out post. I agree that PRP injections are not the "magic cure" for all tendonitis/tendonosis issues and certainly what works for one sufferer may not work for another.

When I am asked by others whether having a PRP injection is a successful course of action to take for these types of issues my response is that it was not successful for me, but there have been too many sufferers of tennis elbow in particular who have experienced accelerated healing responses following the injection/s to discount it. For me, it was worth the time, discomfort and expense ($600 for the 2 injections) in a last ditch attempt to fix my TE before I went down the surgical repair path. I also believe that this is an evolving field of medical science that has a long way to go and there is much to learn.

For me personally, my progress since surgery nearly 6 months ago has been much slower than I would like and was certainly hampered by a case of frozen shoulder I developed following the surgery. The frozen shoulder (adhesive capsulitis) is just about beaten and my elbow continues to improve. With my elbow flexed I can lift a lot of weight using my extensors (muscles on the back of my arm connecting to the lateral epicondyle - the site of the TE pain) without pain. I can grip with full strength anything with my elbow flexed without pain. For example, when I string racquets, I can squeeze the flying clamps without any pain - this was not possible before the surgery, I had to use my left hand or both to avoid pain. However, with my elbow in extension I still have some minor pain when lifting palm down or squeezing. Until I rid my elbow of this pain I do not consider myself ready for tennis.

I perform strengthening exercises every day for the extensors and flexors using dumbells which I prefer over the Flexbar as I have more precise control over the amount of weight used. I incorporate a range of stretches as well as weights and though the improvement has been slow, there is still measurable improvement which is what keeps me positive.

Finally, it so happens that I have an appointment with my upper limb surgeon this coming week so I may well have a clearer idea of what the future holds following that. Cheers for now, aussie.

Thanks for the update, it was good to hear certainly about your progress and please updates us on your progress. I'm sorry to hear about your shoulder but rest assured that I think the most important part of your healing is that your grip strength is great. That is one of the most critical part of the insertion tendon anatomy and I think the extensors will come along soon. All the best to you
 

doctennis

New User
Prp

PRP can work for tennis elbow. Typically, it is used after stretching, strengthening, some rest and steroid shots have failed. Nothing is 100%, but PRP has been a nice addition to the treatment. Sometimes a second injection 6 weeks after the first can increase positive results. You need to shut down the tennis for 2-4 weeks following injection. We have obtained good results with PRP for tennis elbow but not all have succeeded. Did it to myself and received about 50% relief. Luckily not my racquet hand. PRP has no down sides based on current research so it is always worth a try. Surgery is a last resort option, but new techniques over the past 10 years do not require releasing or cutting any muscle or tendon. Return to play is quicker than in the past. Hope this helps, Aussie!
 

aussie

Professional
A quick update. I am back to playing hard tennis one night a week even though my TE is not completely resolved. If I had to put a percentage on my elbow health, I would say it is about 80% right with 100% being absolutely no elbow pain.

My accepting that my elbow may never be 100% and managing it with the right stretching regime, the right frame and string combo, some physical supports and some changes in how I play certain strokes have enabled me to get back on the court and play close to the competitive level I was playing 2 years ago.

I will when I have a chance commence a new thread detailing how I have been able to manage the condition well enough to hit the court again.
 

mikeler

Moderator
A quick update. I am back to playing hard tennis one night a week even though my TE is not completely resolved. If I had to put a percentage on my elbow health, I would say it is about 80% right with 100% being absolutely no elbow pain.

My accepting that my elbow may never be 100% and managing it with the right stretching regime, the right frame and string combo, some physical supports and some changes in how I play certain strokes have enabled me to get back on the court and play close to the competitive level I was playing 2 years ago.

I will when I have a chance commence a new thread detailing how I have been able to manage the condition well enough to hit the court again.

Since you are using some already arm friendly Prince frames, let me suggest you buy the king of arm friendly Prince rackets. I can use full poly in this frame with no arm issues (coming from someone who struggled for years):

http://www.tennis-warehouse.com/Prince_Tour_100T_ESP_Racquets/descpageRCPRINCE-PT100T.html
 

aussie

Professional
Since you are using some already arm friendly Prince frames, let me suggest you buy the king of arm friendly Prince rackets. I can use full poly in this frame with no arm issues (coming from someone who struggled for years):

http://www.tennis-warehouse.com/Prince_Tour_100T_ESP_Racquets/descpageRCPRINCE-PT100T.html

Yes Mikeler I remember reading your many posts detailing your struggles against TE over the years and search for the most arm friendly frame possible. If I remember correctly you used the PK 7G for some time and felt it helped. I tried the 5G and while it was a great stick to play with I felt the kinetic bearings did little (at least for me) to soften shock and vibration to my elbow.

Interesting you place the Tour 100T ESP above both the EXO3 Tour 100 models and Tour 100 models for arm friendliness as it ranks/rates below (worse in other words) those frames in vibration frequency, stiffness and weight which are 3 of the key indicators in determining arm comfort of a racquet.

Just goes to show that our bodies are all unique as indeed our health issues can be and what works for one in terms of comfort, rehab etc may not be a perfect fit for another.
 

sadowsk2

Rookie
Aussie- glad to hear you're back playing. From someone who is a little further along than you post-PRP, (I had mine done in Sept 2012 if memory serves), my elbow I would say is about 90%. It was 80% or so a year ago. I can now play all out 2-3 days a week... By all out I mean 2-2.5 hours a day, 3 sets of singles. It will generally be pretty sore for the following 24 hours and then go away. It is always there despite me doing 2 hours of physical therapy twice a week on it. I've become resigned that as long as I play tennis it will probably always be there... As long as I can maintain my current level of effort I'm more or less content.
 

aussie

Professional
Aussie- glad to hear you're back playing. From someone who is a little further along than you post-PRP, (I had mine done in Sept 2012 if memory serves), my elbow I would say is about 90%. It was 80% or so a year ago. I can now play all out 2-3 days a week... By all out I mean 2-2.5 hours a day, 3 sets of singles. It will generally be pretty sore for the following 24 hours and then go away. It is always there despite me doing 2 hours of physical therapy twice a week on it. I've become resigned that as long as I play tennis it will probably always be there... As long as I can maintain my current level of effort I'm more or less content.

Thanks for the encouraging words. Yes I find that it is a matter of accepting that the elbow will never be 100% pain free and also that certain actions and positions will cause aggravation and pain. For example shaving and cleaning teeth still aggravates my elbow and causes some pain but with the appropriate massaging, stretching and bracing, tennis including one handed backhands causes less pain and is certainly within my acceptable pain tolerance level.

I still feel that my elbow is improving, but the improvement is not in days or weeks but more in 3 monthly periods. And I do find that massaging the extensor muscles with a roller allied with stretching and range of movement exercises but NO STRENGTHENING EXERCISES is sufficient for my elbow to remain almost pain free. Flexbar and other eccentric exercises still irritate and cause some pain.

As an aside, do you often wonder as I do, that we'd be in the same position with our elbows even if we had not undergone repair surgery? In other words, without surgical intervention, would rest and nature have healed our elbows to the same levels they are now?
 

Mac33

Professional
Around 10 years ago I developed tennis elbow playing squash.

I turned up at the club one night and realised I had forgot my 180g Wilson Hamer frame.

I borrowed another racquet,very light around 140g that had been strung much,much tighter.

It wasn't till the next time on the court that I felt pain--- though the considerable impact of the super tight string and light frame was very noticeable at the time.

Anyway,it took me 3 months to get rid of it. A few days off,then I would play.

If I tried to play on consecutive days pain was too much.

By accident I served a ball with more of a cutting technique one day and felt no pain. I continued using this technique on serve and pain went away!

I understand your frustrations about not being able to pay the game you love so much---- but for me anyway,I would have waited quite a bit longer.

Years ago,all this surgery was not so prevalent.

Cutting into your body runs a considerable risk of damage.

Directly injecting substances into the body,for one thing it's bypassing the body's own defence mechanism(of these substances).Just like with vaccinations,the side effects are considerable. Unfortunately many of these side effects are not seen till later in life. Auto-immune diseases are linked to direct injection.

I'm a big believer the body can heal itself. With such a serious injury,more time is needed for the body to repair.

Failing reasonable improvement from long term rest I would try using different techniques of hitting the ball. Perhaps flatter with a shorter swing etc.

I would experiment with very loose string too,around 35 perhaps.

TE---is an impact injury I believe. Loose string will put more energy back into the ball.

A heavy frame,especially a head heavy frame should help too.

A flexible frame seems to muffle the impact more.

If little improvement resulted from long term rest----- I probably would give the game away.

Understand for you that is not really a option.

Best of luck healing.
 

mikeler

Moderator
Yes Mikeler I remember reading your many posts detailing your struggles against TE over the years and search for the most arm friendly frame possible. If I remember correctly you used the PK 7G for some time and felt it helped. I tried the 5G and while it was a great stick to play with I felt the kinetic bearings did little (at least for me) to soften shock and vibration to my elbow.

Interesting you place the Tour 100T ESP above both the EXO3 Tour 100 models and Tour 100 models for arm friendliness as it ranks/rates below (worse in other words) those frames in vibration frequency, stiffness and weight which are 3 of the key indicators in determining arm comfort of a racquet.

Just goes to show that our bodies are all unique as indeed our health issues can be and what works for one in terms of comfort, rehab etc may not be a perfect fit for another.

The problem with all the measurements you mentioned is that it does not take into account the super open 16x16 pattern. I could not handle full poly in the 16x18 Exo3 Tour but I don't like anything but full poly in the Tour 100T ESP.
 

the hack

New User
Got the torn epicondle from a stiff racket that hit so nice I didn't want to switch. Had the surgery, couldn't play for 6 months, came back using Kennex 5G. Have used several arm friendly rackets since, now use Kennex Blackace 98 with Babolat gut in mains and synthetic gut in crosses. I promise you that gut strings are easier on your arm then any synthetic. My elbow feels the shock immediately if I hit with all synthetic string at the 55# tension that I like. Thank goodness for gut strings. Still playing. Still hacking. Still working on my game.
 

speedysteve

Legend
I have followed your tale of woe and am so glad to read your more recent update on improvement Aussie.
Great that you are able to play again, even if at currently reduced capacity.
I do hope you continue to recover and really beat it, and can play to your hearts content - every tennis players dream:)

I have a minor (by comparison) battle with golfers elbow.
Arm friendly racquets, nat gut and lower tensions are seeing me right tennis wise. Also changing my serve has been essential.

I also use my arm for my other hobby - wood and metal turning and generally fabricating things, so I have had to re-learn doing some of those things and I recognise the clever left hand use when stringing racquets etc.

Ice, rest and tens machine (electric shocks) are what helped me most in the beginning. I do like the Flexibar as it seems to get at the golfers elbow side of things more than wrist flexes with weights.

Once again, great to hear of your progress and do let us know how you fair in the long run.
 

JeffKang

New User
Err.. gonna repost my PRP comment here, instead of the “tennis elbow rehab article” thread.
Didn’t know about this thread that specifically discusses PRP.

**PRP evidence**

> found a paucity of evidence from unbiased trials

Comparative Effectiveness of Injection Therapies in Lateral Epicondylitis
doi:10.1177/0363546512458237. PMID 22972856. Epub 2012 Sep 12.

> but the apparent benefit of PRP dissipates over time

Platelet-Rich Plasma as a Treatment for Patellar Tendinopathy
A Double-Blind, Randomized Controlled Trial. January 30, 2014

ajs.sagepub/com/content/early/2014/01/29/0363546513518416.abstract

**Nonbulbar dermal sheath cells**

Yahoo sports did an article a few months ago on the tendinosis (usually starts as tendinitis before becoming chronic) in soccer star Cristiano Ronaldo's patellar region/knees.

The Yahoo journalist interviewed the CEO of a Vancouver company called RepliCel.

They are working on a tendon treatment that will involve taking fibroblasts isolated from nonbulbar dermal sheath cells of a patient's own hair follicles, and injecting it into the damaged area.

sports.yahoo/com/news/cristiano-ronaldo-s-obscure-injury-could-open-door-for-u-s-031401309-soccer.html

> “Having spent much of his career researching treatments for tendinosis, Dr. Jack Taunton, professor at the University of British Columbia faculty of medicine’s CCV sports medicine division, says regenerative therapy holds great promise when dealing with chronic, long-term injuries.
> “We’ve dealt with a number of these types of injuries caused by overuse or
repetitive strain in thousands of patients.
> Typically treatments have included physiotherapy, ice, anti-inflammatory’s, dextrose and **PRP [platelet-rich plasma]** injections.
> Yet, we still have a significant population of patients that do not get better.”
> He is hopeful that the upcoming RepliCel trials will improve those numbers given that hair follicle fibroblasts produce the amount of Type 1 collagen needed for fundamental repair of the tendon.

business.financialpost/com/2014/09/09/new-technology-puts-your-own-cells-to-work-to-repair-and-rejuvenate-your-body/

PRP might have a purpose, but once you have damaged tissue, or scar tissue, I don't think that supposed increased blood circulation is going to all of a sudden convert the scar tissue (e.g. for tendons, type 3 collagen) into healthy tissue (for tendons, type 1 collagen).

>Replicel will initiate a Phase 1/2 clinical trial investigating the use of RCT-01 to treat patients suffering from chronic Achilles tendinosis.
>NBDS cells are rich in of collagen-producing dermal fibroblasts necessary for tendon healing.
>Chronic Achilles tendinosis is a degenerative disease of the tendon caused by a cycle of injury, improper healing and re-injury resulting in ongoing pain and loss of function.
>Healthy functioning tendon is comprised largely of highly structured type 1 collagen wherein resident fibroblasts play a significant role in repair and maintenance.
>In chronic tendinosis, it is believed that the resident fibroblast population is insufficient to complete the healing cycle.
>These particular fibroblasts are easily isolated and expanded and are highly expressive of type 1 collagen and other extracellular proteins which are needed to reignite the healing process and support the regeneration of tendon for patients suffering from chronic tendinosis.

Obaid, H.; Clarke, A.; Rosenfeld, P.; Leach, C.; Connell, D. (2012). "Skin-Derived Fibroblasts for the Treatment of Refractory Achilles Tendinosis: Preliminary Short-Term Results". The Journal of Bone & Joint Surgery 94 (3): 193–200. doi:10.2106/JBJS.J.00781. ISSN 0021-9355. Jbjs/org/content/94/3/193

**EchoSoft ultrasound software, and reevaluating platelet-rich plasma**

There's now a new ultrasound technology and software from the University of Wisconsin-Madison (Wisconsin Alumni Research Foundation), and Echometrix that not only uses waves for vision (conventional B-mode ultrasound), but the waves give quantitative data about functional characteristics, like stiffness (acoustoelasticity).

echo-metrix/com/products.php

It’s like looking at those heat maps on the Weather Channel.

> Called EchoSoft, that technology analyzes previously unused information carried by ultrasound waves to **quantify** the extent of muscle and ligament injuries or a patient's progress in the healing process.
> This technology applies the theory of acoustoelasticity to measure biological materials.
> “EchoSoft is the first ultrasound-based product to provide a **quantitative analysis** of ligaments, tendons, and muscles as they naturally function,’” says Sam Adams, chief executive officer of Echometrix.
> “The result is a clear, quantitative measurement that surpasses the diagnostic capabilities of a traditional ultrasound image.

New Products". Journal of Orthopaedic & Sports Physical Therapy 40 (9): 598–601. 2010. doi:10.2519/jospt.2010.40.9.598. ISSN 0190-6011.

While waiting for RepliCel, I might consider PRP for my tennis elbow (lateral epicondylitis) and wrist tendinosis if they do a proper trial with the Echosoft ultrasound software.
No subjective reporting.
I’d like to see data with numbers.
 

aussie

Professional
Just to revert back to topic, I have a work college who is currently suffering TE bought on by a lot of motorcycle use. His wrist being constantly in an extended (bent backwards) position supporting his weight while undergoing the shock and vibration when riding has given him the dreaded TE. His girlfriends brother is an orthopedic surgeon here in Brisbane and says that there is just not enough evidence to recommend PRP injections. He is undergoing intensive physio and is now making progress after 6 months but once again shows that there is just no one definitive fix for this condition.
 

aussie

Professional
Just an update to inform those who read through this litany of TE woe that I continue to play with no pain. My ohb is absolutely pain free and find that I am hitting it as well as I ever have. I continue to be cautious with everyday activities though - I always, without exception lift anything heavy with my palm up or with my other hand and when I do physical activities such as mowing the yard, washing the car etc wear a tennis elbow (counterforce) brace.

Tenniswise, I always wear the brace plus a Tenex shock absorber. I will never use a stick other than the low flex Prince Tour O port range strung with multis at low tension. I'm not saying that there are not any sticks that are as arm friendly as the Prince range, but I am not willing to change and go through TE hell ever again.

Strangely, the only discomfort I experience with the elbow is an occasional ache in the lateral epicondyle region where the surgery was performed. The surgery was quite invasive and given the surgical procedure involved it is only to be expected that there would be long lasting but relatively minor aches.

In my more than 2 years since my 2 PRP injections I have not read of any advancements in the procedure and would be interested if any readers have recently undergone the procedure and can report on results. For me it did nothing but made me come to the realisation that surgery was probably my only chance of playing tennis again and so it transpired. But it is the final option to choose and other means of intervention including PRP should be considered first.

But I do want to give hope to all TE sufferers that there are various modalities and interventions that will allow you to play again, but be prepared to find the right one that works for you as there is just not one method that works for all TE sufferers. And it can take a frustrating amount of time as well and even that differs from person to person.

Good luck to you all and be assured that if I can come back from TE pain that stopped me from using a knife, flossing my teeth, shaving and countless other daily tasks as well as not even being able to hold my racquet because the weight hurt my elbow, then you all can. aussie
 
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mikeler

Moderator
aussie, great news! The battle with TE/GE for many of us was/is a long one. I'm in a slump now but I'm not upset. I'd rather be getting exercise without pain on the court than sitting on the sidelines.
 

njboy

Rookie
Just an update to inform those who read through this litany of TE woe that I continue to play with no pain. My ohb is absolutely pain free and find that I am hitting it as well as I ever have. I continue to be cautious with everyday activities though - I always, without exception lift anything heavy with my palm up or with my other hand and when I do physical activities such as mowing the yard, washing the car etc wear a tennis elbow (counterforce) brace.

Tenniswise, I always wear the brace plus a Tenex shock absorber. I will never use a stick other than the low flex Prince Tour O port range strung with multis at low tension. I'm not saying that there are not any sticks that are as arm friendly as the Prince range, but I am not willing to change and go through TE hell ever again.

Strangely, the only discomfort I experience with the elbow is an occasional ache in the lateral epicondyle region where the surgery was performed. The surgery was quite invasive and given the surgical procedure involved it is only to be expected that there would be long lasting but relatively minor aches.

In my more than 2 years since my 2 PRP injections I have not read of any advancements in the procedure and would be interested if any readers have recently undergone the procedure and can report on results. For me it did nothing but made me come to the realisation that surgery was probably my only chance of playing tennis again and so it transpired. But it is the final option to choose and other means of intervention including PRP should be considered first.

But I do want to give hope to all TE sufferers that there are various modalities and interventions that will allow you to play again, but be prepared to find the right one that works for you as there is just not one method that works for all TE sufferers. And it can take a frustrating amount of time as well and even that differs from person to person.

Good luck to you all and be assured that if I can come back from TE pain that stopped me from using a knife, flossing my teeth, shaving and countless other daily tasks as well as not even being able to hold my racquet because the weight hurt my elbow, then you all can. aussie
Just an update to inform those who read through this litany of TE woe that I continue to play with no pain. My ohb is absolutely pain free and find that I am hitting it as well as I ever have. I continue to be cautious with everyday activities though - I always, without exception lift anything heavy with my palm up or with my other hand and when I do physical activities such as mowing the yard, washing the car etc wear a tennis elbow (counterforce) brace.

Tenniswise, I always wear the brace plus a Tenex shock absorber. I will never use a stick other than the low flex Prince Tour O port range strung with multis at low tension. I'm not saying that there are not any sticks that are as arm friendly as the Prince range, but I am not willing to change and go through TE hell ever again.

Strangely, the only discomfort I experience with the elbow is an occasional ache in the lateral epicondyle region where the surgery was performed. The surgery was quite invasive and given the surgical procedure involved it is only to be expected that there would be long lasting but relatively minor aches.

In my more than 2 years since my 2 PRP injections I have not read of any advancements in the procedure and would be interested if any readers have recently undergone the procedure and can report on results. For me it did nothing but made me come to the realisation that surgery was probably my only chance of playing tennis again and so it transpired. But it is the final option to choose and other means of intervention including PRP should be considered first.

But I do want to give hope to all TE sufferers that there are various modalities and interventions that will allow you to play again, but be prepared to find the right one that works for you as there is just not one method that works for all TE sufferers. And it can take a frustrating amount of time as well and even that differs from person to person.

Good luck to you all and be assured that if I can come back from TE pain that stopped me from using a knife, flossing my teeth, shaving and countless other daily tasks as well as not even being able to hold my racquet because the weight hurt my elbow, then you all can. aussie


It is a long thread. Can you please give a summary what you did to fix ur TE? Many thanks.
 
PRP was very helpful to me. However, I would go to a chiropractor and make sure your elbow and arm are aligned. My golfers elbow did not fully go away until I did so.
 
What does that mean - aligned? Was your elbow dislocated?

No, but a vertebra (sp) in my neck was pinching the nerve that runs all the way down your right arm. This caused my shoulder to essentially "slouch." Like, you could look at my right shoulder and see that it was not in the same position that my left shoulder was in. The pinching of the nerve was contributing to my golfer's elbow by irritating the nerve. Once I got this fixed, my golfer's elbow disappeared. Granted, this is not the case for most people, but your bones can still be out of line without being dislocated, and a good chiropractor can help a lot.
 

hray4clay

Rookie
Sadowsk2,

First, you have my sympathy to your current condition.

If you didn't see my Reply #5, I'd suggest you look that over for questions to ask yourself.

Supplementing my response that soft tissue restrictions can reach down to the cellular level. Meaning that if there is a significant restriction in the area, it will not allow for proper "flow" in the area, disrupting the normal healing process. Medicine will not be able to reach into the region, it'd be like pouring water over a stone.

I wish you luck in your current course of action. Just make sure you question yourself that if your previous actions didn't result in a satisfactory result, and you repeat those same actions expecting a different result....hmmm? Third time's a charm maybe?


Exactly! I have been suffering with this since April of 2014, now nearly 18 months later I am playing again. My orthopedic surgeon insisted upon cortisol injection directly into the site of soreness and then rest for SEVERAL weeks and then therapy for 4 weeks and then I played again and hurt it badly on the very first backhand volley against a very hard shot. More rest (12 weeks) then more PT (6 weeks) and then more tennis and more pain and injury. This time, I rested for 6 weeks and then played golf because it did not hurt my tennis elbow site, only my wallet and my psyche! What a miserable pastime compared to tennis! Finally, after not hitting a tennis ball for 8 months, I went back to playing even though I could still feel some pain at the epicondylitis site. I'm using Vokyl V1 Classics, one strung with multifilament and one with gut in the mains and the "softest" (oxymoronic) poly I could find (Tourna BHB7) in the crosses at 6 pounds lighter tension than the gut. I ice my elbow after EVERY time I play for 15 minutes. It is still a little sore always but not like before. I can actually unscrew jar tops and wash my hair and lift things with my palm facing down if I have to but I am always mindful of it and I do not think it will ever completely go away. I think the only reason I did not have to have surgery which my ortho DID in fact recommend is that I laid off of tennis for 8 months and gave it a chance to heal a little. I am convinced that a severe case of tendonitis like I had requires a minimum of one year with NO tennis ball hitting whatsoever to heal sufficiently and then you must pay close attention to technique (2hbh) and equipment and ice the elbow after every session of playing.
 

hray4clay

Rookie
IMO, I wouldnt touch any Babolat racquet. I hate to say that because its a great company....

Yep. That's what did me in. Got two Nadal racquets, hybrid gut/poly, played great for several weeks and then boom. Done for 1 1/2 years with tendonitis, tendon damage, tendonosis, etc. Back to Vokyl and gut.....
 

HouTex

Rookie
Exactly! I have been suffering with this since April of 2014, now nearly 18 months later I am playing again. My orthopedic surgeon insisted upon cortisol injection directly into the site of soreness and then rest for SEVERAL weeks and then therapy for 4 weeks and then I played again and hurt it badly on the very first backhand volley against a very hard shot. More rest (12 weeks) then more PT (6 weeks) and then more tennis and more pain and injury. This time, I rested for 6 weeks and then played golf because it did not hurt my tennis elbow site, only my wallet and my psyche! What a miserable pastime compared to tennis! Finally, after not hitting a tennis ball for 8 months, I went back to playing even though I could still feel some pain at the epicondylitis site. I'm using Vokyl V1 Classics, one strung with multifilament and one with gut in the mains and the "softest" (oxymoronic) poly I could find (Tourna BHB7) in the crosses at 6 pounds lighter tension than the gut. I ice my elbow after EVERY time I play for 15 minutes. It is still a little sore always but not like before. I can actually unscrew jar tops and wash my hair and lift things with my palm facing down if I have to but I am always mindful of it and I do not think it will ever completely go away. I think the only reason I did not have to have surgery which my ortho DID in fact recommend is that I laid off of tennis for 8 months and gave it a chance to heal a little. I am convinced that a severe case of tendonitis like I had requires a minimum of one year with NO tennis ball hitting whatsoever to heal sufficiently and then you must pay close attention to technique (2hbh) and equipment and ice the elbow after every session of playing.

Completely agree--although ice does not help me--heat seems to work better. I'm using the Volkl V1 as well. I also like the Prince EXO 100. I'm limiting my play to once every 6 weeks or so.

edit: But I don't agree about golf!! Been playing a lot of golf with this condition. It's a little sore afterward but nothing like playing tennis.
 

hray4clay

Rookie
Completely agree--although ice does not help me--heat seems to work better. I'm using the Volkl V1 as well. I also like the Prince EXO 100. I'm limiting my play to once every 6 weeks or so.

edit: But I don't agree about golf!! Been playing a lot of golf with this condition. It's a little sore afterward but nothing like playing tennis.


That's right, golf does not hurt the tennis elbow pain site but the game itself SUCKS.
 

hray4clay

Rookie
Hi guys, have been somewhat slack in updates. I felt you guys may tire of me never having any positive news on my progress. Well in short, there has been no progress. Some days I feel a little progress but that is then followed by days when the pain around the lateral epicondyle returns. The upshot is that some 8 weeks after the PRP injection, I am no better.

However, I am not a quitter and I will be getting a second PRP Injection on Tues 27th. I read in many accounts of PRP injections that a lot of people only respond to the second injection. I am obviously hoping that I will be in that category!

I'll have some questions to ask of the physician when he ultrasounds the elbow to guide the injection. Such as can he notice any improvement in the tendon with better collagen alignment, less scarring, less calcification etc. I'll be interested to hear his views on the state of the tendon attachment following that first injection.

Anyway, I'll post the results of my visit for injection number 2. I know that many of us are searching for that gold standard treatment for tennis elbow - around a half of all recreational players suffer from this debilitating problem so any information is readily devoured.


Hope springs eternal....... Only total avoidance of the offending movements (hitting tennis balls) is going to cure your problem. I hope I am wrong and that you will miraculously heal and become a tennis tour pro but let's be realistic, shall we.....Rest up for several months, you'll be fine after that.
 

hray4clay

Rookie
The length it takes is exactly why some surgeons in Sweden have more or less stopped doing TE surgery, motiviating it with that it would be healed in that time even without surgery. This seems to be the problem with all remedies for tendon issues.

If it takes 12 months after treatment chances are that the healing had little or nothing to do with the treatment, alas. Time seems to be the only thing that definitivly has a chance to fix a damaged tendon.


A M E N
 

hray4clay

Rookie
Just an update to inform those who read through this litany of TE woe that I continue to play with no pain. My ohb is absolutely pain free and find that I am hitting it as well as I ever have. I continue to be cautious with everyday activities though - I always, without exception lift anything heavy with my palm up or with my other hand and when I do physical activities such as mowing the yard, washing the car etc wear a tennis elbow (counterforce) brace.

Tenniswise, I always wear the brace plus a Tenex shock absorber. I will never use a stick other than the low flex Prince Tour O port range strung with multis at low tension. I'm not saying that there are not any sticks that are as arm friendly as the Prince range, but I am not willing to change and go through TE hell ever again.

Strangely, the only discomfort I experience with the elbow is an occasional ache in the lateral epicondyle region where the surgery was performed. The surgery was quite invasive and given the surgical procedure involved it is only to be expected that there would be long lasting but relatively minor aches.

In my more than 2 years since my 2 PRP injections I have not read of any advancements in the procedure and would be interested if any readers have recently undergone the procedure and can report on results. For me it did nothing but made me come to the realisation that surgery was probably my only chance of playing tennis again and so it transpired. But it is the final option to choose and other means of intervention including PRP should be considered first.

But I do want to give hope to all TE sufferers that there are various modalities and interventions that will allow you to play again, but be prepared to find the right one that works for you as there is just not one method that works for all TE sufferers. And it can take a frustrating amount of time as well and even that differs from person to person.

Good luck to you all and be assured that if I can come back from TE pain that stopped me from using a knife, flossing my teeth, shaving and countless other daily tasks as well as not even being able to hold my racquet because the weight hurt my elbow, then you all can. aussie


I am so happy that you have had a successful outcome from the surgery and I hope your condition continues to improve. This thread by you has been magnificent and an inspiration to all of us that suffer from similar ailments. I have hope now that if my TE gets worse that surgery is a viable option. Thank you very very much, Aussie!!
 

Crocodile

G.O.A.T.
I've heard mixed results from people who have had PRP treatment. It seems to respond to some joints better than others.
The thing that I've noticed for people trying to fix their elbows is dealing with the time factor and matters of inflammation. No treatment will work until the inflammation has subsided and that takes time. The second thing is that PRP alone won't do it. You still have to rest it for a while and then gradually rehab the joint.
I know one guy who has been through it and the thing that made it worse for him was getting back on court too soon, particularly serving.
I think there is an exact process to it which you must follow religiously and be prepared for a 15 to 18 month period if need be (Not saying that this is actual time but as you get older it may well be the case).
Once you get back playing you may need to look at some technical and strategic changes to ease the load on your arm.
As far as racquets are concerned, most people with really bad arm problems have done well with the Pro Kennex kinetic series and the Volkl V1 Pro and 10 series. Using a larger grip size also helps and natural gut like Pacific bull gut in a 1.3 gauge strung low (50 lbs or even in the 40's) is the way to go and under no circumstances use poly or Kevlar. Tecnifibre X One bi phase is Ok but Pacific gut is way better.
 

aussie

Professional
Just a quick update these many years on after reading some other threads about PRP injections for shoulders, knees etc. After a relatively minor (compared to my severe TE anyway) GE issue with the elbow which I manage well following acupuncture and regular massaging, I continue to play absolute TE pain free. I am always, and I mean always, mindful that I had severe TE that took me out of tennis for close to 2 years, and I always wear a counterforce brace to protect against both TE and GE while playing. The evidence is strong that if you have had TE once, you will be susceptible to it again. So I am always conscious of protecting the extensor muscles and tendon that attach to the lateral epicondyle and always lift heavy objects with my palm up or use the other hand. In fact, the lifting of heavy objects palm up probably contributed to the GE so I try to lift objects with my arm in a more in between position - with the thumb up so to speak.

Without visiting all the previous comments I have made, I continue to play using either a Prince Tour 100 18x20 or 16x18 with the O-ports and string either with syn gut or multis at tensions in the high 40 to low 50. I don't use polys at all as it is just not worth the risk. When you have had severe TE, you will do anything to not go down that path again.

One final comment - while PRP may not have worked for me, it may for others. I know that all the early hype for PRP injections has somewhat evaporated over the last few years which is something of a shame because it seemed so promising. Would I recommend surgical repair of the extensor tendon to beat TE? Maybe I would if more than 6 months has elapsed since the onset and all the regular treatments have not worked. The one question that nags me and I just don't know the answer is - would my TE have healed without me undergoing surgery considering that it took 1 year after surgery to start hitting again? I strongly suspect that it would have based on the evidence of other players who have rested their elbows for 1 - 2 years and have been able to play again pain free. Good luck to all that are trying to beat this insidious condition and my hope is that as more is learned about TE that there will finally be a greater understanding of how to resolve the problem in a quicker timeframe.
 
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