It is now accepted that tennis elbow, golfers' elbow and distal biceps tendinopathy (as well as patella tendinopathy, Achilles tendinopathy..) are not inflammatory, but degenerative conditions, with aborted healing in the tendon. A historic mainstay of treatment was cortisone injections. While these masked the pain effectively for 6 weeks or so, there is good evidence that steroid injection prolongs the problem of tennis elbow and that physiotherapy, or even nothing is better beyond three months. Other studies have shown that steroid within tendons is toxic to the tendon cells. Mr Granville-Chapman does not therefore recommend cortisone injections for elbow tendinopathy.
More recent data has demonstrated a positive treatment effect of autologous blood and PRP injections. These treatments harness your own blood cells' growth factors to encourage healing of your degenerate tendon. They have been shown to be superior to cortisone injection and to physiotherapy alone.
Platelets are cells in our blood that harbour many growth factors. Platelet rich plasma (PRP) describes a layer of centrifuged blood that is rich in platelet cells. Many medical manufacturers produce kits that separate PRP from whole blood, but not all work as well as each other in tendinopathy. Mr Granville-Chapman uses either the Arthrex ACP system or the Biomet GPS system as he feels the evidence supporting their efficacy is robust.
The process is simple and well tolerated with you awake. A blood sample is taken from a vein in your arm (between 15 and 30ml) into a special syringe. The blood is then spun in a centrifuge for 5-15min (depending on which kit is being used). During this time Mr Granville-Chapman will inject a very small volume of local anaesthetic over your injection site. Once the spinning process is complete, the desired platelet-rich layer of the blood is drawn off and 2-3ml of this is injected into your affected tendon. Depending on which tendon is being treated, Mr Granville-Chapman may target your injection using an ultrasound machine. You can go home after the injection is complete.
You will need to do the eccentric strengthening and stretching physiotherapy programme and it will take up to three months for the benefits to be realised. It is important that you do not take any anti-inflammatories (Aspirin, Ibuprofen, Naproxen, Diclofenac) for 10 days before and 4 weeks after your treatment. The reason for this is that these drugs disable your platelets.
In a recent series of patients with un-resolved tennis elbow, 70% of patients who received PRP injection avoided the need for surgical intervention of their tennis elbow.