There are currently no conventional long term solutions for tennis elbow.(1) Doctors usually offer NSAIDS (Ibuprofen, Diclofenac), exercise therapy and corticosteroid injections, which all offer short term benefits only and high recurrence. Patients who undergo corticosteroid injections fare worse than placebo injections after 1 year with a 54% recurrence rate vs 12%.(2)
PRP injections are a long term solution for tennis elbow which has an effect that lasts more than 6 months.(3) This is in stark contrast to the commonly used corticosteroid injections which tends to have an effect than lasts around 3 months.(4) Corticosteroid injections when compared head to head with PRP demonstrate superior improvements at 15 days and 1 month in pain, grip strength and function in patients with lateral epicondylitis, but at 3 months follow-up PRP showed significantly superior benefits in pain, grip strength and function compared to corticosteroid injections.(4) Corticosteroids also have been shown in a 2014 systematic review to have a wide range of side effects that are detrimental to long term tendon health such as; loss of collagen organisation, collagen necrosis, reduction in the proliferation and viability of fibroblasts, collagen synthesis was decreased, increase in inflammatory cell infiltrate and an increased cellular toxicity.(5) The meta-analysis revealed a significant deterioration in mechanical properties of tendons leading the authors to conclude their paper with the following statements.
Overall it is clear that the local administration of glucocorticoid has significant negative effects on tendon cells in vitro, including reduced cell viability, cell proliferation and collagen synthesis. There is increased collagen disorganisation and necrosis as shown by in vivo studies. The mechanical properties of tendon are also significantly reduced. This review supports the emerging clinical evidence that shows significant long-term harms to tendon tissue and cells associated with glucocorticoid injections. - Dean et al 2014(5)
References
- Orchard, J. “The Management of Tennis Elbow” in BMJ 342:d2687 (May 2011). Accessed April 5, 2016 at http://www.bmj.com/content/342/bmj.d2687
- Coombes, BK. “Effect of Corticosteroid Injection, Physiotherapy, or Both on Clinical Outcomes in Patients With Unilateral Lateral Epicondylalgia” in JAMA 309 Issue 5 (February 2013), pp.461-469. Accessed April 5, 2016 at http://jama.jamanetwork.com/article.aspx?articleid=1568252
- Omar, AS. “Local injection of autologous platelet rich plasma and corticosteroid in treatment of lateral epicondylitis and plantar fasciitis: Randomized clinical trial” in The Egyptian Rheumatologist 34, Issue 2 (April 2012), pp. 43-49. Accessed April 5, 2016 at http://www.sciencedirect.com/science/article/pii/S1110116411000792
- Yadav R. “Comparison of Local Injection of Platelet Rich Plasma and Corticosteroids in the Treatment of Lateral Epicondylitis of Humerus” in Journal of Clinical and Diagnostic Research 9, Issue 7 (July 2015), RC05–RC07. Accessed April 5, 2016 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573006/
- Dean BJ. "The risks and benefits of glucocorticoid treatment for tendinopathy: A systematic review of the effects of local glucocorticoid on tendon" in Seminars in Arthritis and Rheumatism 43, Issue 4 (February 2014) pp. 570-576. Accessed April 5, 2016 at http://www.semarthritisrheumatism.com/article/S0049-0172(13)00173-X/fulltext