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Case Report | DOI: https://doi.org/10.31579/2768-0487/067
1Associate Professor, Dental and Oral Research Center, Department of Oral and Maxillofacial Surgery, School of Dentistry, Qom University of Medical
Sciences, Qom 37131, Iran.
2Iranian Tissue Bank & Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran 1419733133, Iran.
3Iranian Tissue Bank & Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran 1419733133, Iran.
4Iranian Tissue Bank & Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran 1419733133, Iran.
*Corresponding Author: Mahdieh Ghiasi, Iranian Tissue Bank & Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran 1419733133, Iran.
Citation: M Mehdizadeh, M Ghiasi, Liela k shad, H Madani. (2022). PRP Injection versus Surgical Method for Treatment of Tennis Elbow: Case Report. Journal of Clinical and Laboratory Research. 5(2); DOI:10.31579/2768-0487/067
Copyright: © 2022 Mahdieh Ghiasi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 06 December 2021 | Accepted: 29 December 2021 | Published: 07 January 2022
Keywords: tennis elbow, PRP injection, tendinopathy
Objective: Tennis elbow is damage of tendon fibers that happens in any age group. It appears with severe pain and inflammation and functional limitations. Now days, none operative methods have been considered. PRP (platelet rich plasma) injections are helpful in treating tennis elbow.
Methods: In this method, whole blood obtained and concentrated the platelets, and injected into elbow. After that, patient should wear splint for month.
Results: it leads one month to see the evidence of recovery in pain and range of motion in patient.
Conclusion: We found that PRP injection can be considered as a safe and effective tool for intractable lateral epicondylitis of the elbow and eliminated the need for surgical intervention.
Tennis elbow also determined as degenerative disorder of the tendon fibers of the lateral humeral epicondyle that are responsible for anchoring the muscles. The tendons extend or lift the wrist and hand [1]. Despite its name, the disease affects a wide range of people with different occupations that associated with hand movements.
In the first phase of treatment, conservative management includes physical therapies, orthotics [2], and extracorporeal shock wave therapy (ESWT) [3] and non steroidal anti-infammatory drugs, and injections [4]. The main injectable treatment is corticosteroid injection. Recently, other injections have been introduced, including PRP, autologous whole blood and botulinum toxin [1]. Platelet-rich plasma has been used in regenerative medicine for many kinds of growth factors [5]. It is a safe biological tool for treatment of tendon, ligament, and certain muscle injuries [6].
One of the key growth factors at PRP is Platelet-derived growth factor (PDGF) that involve involved in angiogenesis processes, also activating mesenchymal differentiation and osteogenesis [7].
Many studies have reported that PRP has capability of tendon regeneration, increase in the vascularity and improved tendon morphology on ultrasound scans. [8, 9] At Meta-analysis of Randomized Controlled Clinical Trials, Fitzpatrick and et al have shown that single injection of Leukocyte-poor PRP (LR-PRP) under ultrasound guidance can improve tendinopathy [10].
At the present study, we designed to evaluate the role of PRP in improvement of tendinopathy. Does it mean that PRP can be used as an alternative treatment for tennis elbow?
In this practice, a patient presented with symptoms of tendonopathy. She had received all the common treatments but still complained because of the lack of recovery. According to patient selection criteria, this patient was selected for PRP injections for 3 times every 3 weeks.
PRP preparation
For this, we obtained from peripheral blood (20 ml for each time) and transferred to the silicone tubes containing sodium citrate 3.8%. Briefly, the tubes were centrifuged at 1800 rpm for 15 min and the top layer (Plasma) was centrifuged at 1800 rpm for 12 min. The final solution was activated by a 10% solution of CaCl2 during injection [11].
The injection is performed by in the elbow area by a specialist physician and supported by splint for one month. (Figure1).
The results revealed that PRP injection could improve tendonopathy in the studied patient.
The follow up was done at 6 months after the last injection. This procedure relieved pain and inflammation in the elbow area after the first injection.
Tendonopathy is the most common diseases in patients between the ages of 30 years to 50 years.
There are many types of treatment such as injection as a non operative technique. Based on the current knowledge, PRP is considered as adjuvant therapy in this type of patients.
It has shown that PRP injections can reduce pain and functional symptoms and revealed long-term improvement according to previous studies [12].
In one study, Mos and et al stated that the improvement was due to the presence of growth factors in the blood such as; platelet derived growth factor (PDGF); transforming growth factor (TGF)-β; insulin-like growth factor (IGF); epidermal growth factor (EGF); vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF) [13]. It means that the release of growth factors developed collagen production and cell viability and stimulate angiogenesis.
After injury, alpha granules release growth factors and bind to target cells (e.g. mesenchymal stem cells, osteoblasts, fibroblasts, endothelial cells, and epidermal cells) and cause the expression of a
gene sequence by activation of an intracellular signal protein. They lead cellular proliferation, matrix formation, osteoid production or collagen synthesis [14].
Multiple studies determined that PRP can be substituted as a supportive treatment in tendinopathies [15-17]. In the present study, Patient satisfied for PRP injections due to none invasive method with favorable response.
The results of our study confirm that PRP can be considered as an effective method to improve tennis elbow disorder.
None.
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