Lateral epicondylosis (tennis elbow) causes pain at the outside part of the elbow, due to degeneration and disorganization of the collagen fibers of the tendon. Traditional treatments include the use of braces and splints, rest, activity modification, physical therapy, corticosteroid injection and surgery. Even with treatment some may experience long-term pain and disability. The intention of alternate therapies is to interrupt the cycle of degeneration and augment the body's own healing response.
Prolotherapy
Prolotherapy is a term derived from the word proliferant. It is performed by injecting a proliferent in and around the diseased tendon. Hyperosmolar dextrose is one of the most commonly used proliferants. When injected, it causes inflammation with the intent to induce a healing response.
Polidocanol
Polidocanol is a vascular sclerosant, or irritant, that was originally used to treat varicose veins. In lateral epicondylosis, there is increased blood flow with very small abnormal vessels called "neovessels." Polidocanol is used to sclerose neovessels, breaking the cycle of degeneration and pain.
Autologous Whole Blood Injections
Whole blood injections are performed by injecting the patient's own blood into the painful tendon. The intention is to directly inject growth factors, cell mediators and platelets contained in the blood into the area of degeneration. This is thought to promote tendon healing.
Platelet-Rich Plasma
Platelet-rich plasma injections are like whole blood injections taken to another level. In this treatment the whole blood is spun in a centrifuge and the growth factors and platelets are separated out. This concentrated platelet-rich substance is thought to augment the native healing process through growth factors found in platelets themselves.
References
- "British Journal of Sports Medicine"; A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma; David Rabago et al; July 2009.
