Chiropractor Chandler AZ

Platelet-Rich Plasma Prolotherapy for Elbow Pain

Platelet-rich plasma Prolotherapy is a non-surgical, minimally invasive technique which accelerates the body's own healing system to treat a chronic pain.

Plasma is the liquid part of the blood which acts as a medium for blood cells and platelets to travel in throughout the body. Almost 93% of the blood cells consist of red blood cells. Around 1% of the blood cells consist of white blood cells, and platelets make about 6% of the total blood cells. Platelets are small in size but very multipurpose cells. Since connective tissue repair is the function of the platelets, that's why it is used in the platelet-rich plasma Prolotherapy.

How Does Platelet-rich Plasma Prolotherapy Work?

The platelet-rich plasma Prolotherapy works on a very simple principle: when the platelet concentration is injected into a certain area of the body, it accelerates the healing process.

Platelets contain many chemicals, such as:

1. Glycogen
2. Lysosomes
3. Alpha granules
4. Beta granules

Alpha granules contain growth factors and they are the main focus of platelet-rich plasma therapy. There are three stages of healing after platelet-rich plasma Prolotherapy injections and different types of growth factors are involved in driving different stages:

1. Inflammation phase: It lasts for 2-3 days. In this phase, growth factors are released.
2. Proliferation phase: It lasts for 2-4 weeks. It is vital for musculoskeletal regeneration.
3. Remodelling phase: It lasts over a year. In this phase, collagen is matured and strengthened while the injury is healed.

Preparation for Platelet-Rich Plasma Prolotherapy

Around 20-30 mL of the patient's own blood is used to make platelet-rich plasma. The blood is spun for 15 minutes at 3,200 rpm in a centrifuge machine. This step separates platelet-rich plasma from platelet-poor plasma. About 3 mL of platelet-rich plasma is obtained from 20 mL of blood. The platelet-rich plasma is combined with half mL of sodium bicarbonate to neutralise the pH.

Platelet-Rich Plasma Injection Procedure

The injection is administered with the help of a dynamic musculoskeletal ultrasound with a transducer of 6–13 Hz to maximise the location accuracy for the injection. The injection is administered directly at the site of injury.

Safety of Platelet-Rich Plasma Prolotherapy

As platelet-rich plasma Prolotherapy technique uses the patient's own blood, the chances of immunogenic reaction or the transfer of blood borne diseases are completely eliminated.

The growth factors attach to the cell surface and not the nucleus of the cell, thus the chances of tumour growth are also eliminated.

Risks associated with Platelet-Rich Plasma Prolotherapy

As the platelet-rich plasma Prolotherapy is an injection-based procedure, the risks involved in the procedure are:

1. Anaesthesia allergy
2. Infection
3. Neural trauma
4. Organ trauma
5. Needle breakage

Platelet-Rich Plasma Prolotherapy for Elbow pain

Elbow pain is any discomfort in the elbow. It is one of the most common pain disorders. It can either be due to:

1. Aging
2. Sports injury
3. Over-use
4. Trauma

Structure of Elbow

The elbow is a hinge joint between the radius and ulna bones of forearm, and the humerus bone of the upper arm. These bones are held together by many ligaments. The movement of the elbow is due to several muscles attached across the bones. Muscles are attached to the bone through tendons. Cartilages protect the ends of the bone and bursa sacs provide lubrication around the joint.

Causes of Elbow Pain

There are different causes of elbow pain. Some of the most common causes of elbow pain are the following:

1. Arthritis: Arthritis is a chronic condition that is caused by the loss of cartilage around the bone. Signs and symptoms of arthritis include stiffness, pain, and swelling in the elbow region.
2. Sprains and Strains: A sprain is an injury to the ligament and a strain is the injury to the muscle. Sprains are common in athletes. Symptoms of sprains are point tenderness, looseness in the joint, joint pain, and swelling. The strain is caused by putting too much pressure on the elbow muscles during weight lifting, work activities, and sports. Symptoms of strain are pain, swelling, bruises, and weakness.
3. Dislocation: Dislocation is when one of the bones in the elbow joint moves or is pushed out of place due to trauma. It can be due to a car accident or a fall. Symptoms of dislocation are disfigurement, pain, swelling, and loss of motion.
4. Elbow fracture: A fracture can affect any of the bones around the elbow. The cause of the elbow fracture is a direct hit to the elbow or by falling on the arm. The symptoms of elbow fracture are loss of motion, deformation, pain, and swelling.
5. Tennis elbow (lateral epicondylitis): Tennis elbow is a general term which may or may not be associated with playing tennis. This is caused by overuse of the forearm muscles which leads to muscle damage. Symptom includes pain on the outside of your arm that goes on the back on your arm and hand. It usually starts slowly. The pain gets worse when shaking a hand or squeezing objects.
6. Golfer's elbow (medial epicondylitis): It is the condition similar to the tennis elbow. In this condition, wear and tear of tendons occur that are attached to the inside of the elbow. Symptoms include pain on the inside of the elbow and tenderness.
7. Olecranon bursitis: In this condition, bursa, which is a fluid-filled sac that provides the lubrication to the elbow, is inflamed. This condition is also known as popeye elbow. This condition is caused by a direct hit to the elbow, infection, or due to continuous pressure on the bursa. Symptoms include pain, tenderness, swelling, redness, and warmth at the elbow.
8. Cubital tunnel syndrome: it is a musculoskeletal disorder, caused by too much pressure on the ulnar nerve. It is caused by putting long-term pressure on the ulnar nerve either due to sleeping on the arm or bending the arm for a longer period of time. Symptoms include burning sensation or numbness in the elbow.

Diagnosis of Elbow Pain

There are different ways to diagnose the cause of elbow pain. The doctor will take the history of the patient to determine the cause of elbow pain. Physical examination is done by using an X-ray, MRI, or CT scan to understand the severity of the injury.

Treatments for Elbow Pain

Depending on the cause of elbow pain, different treatments are proposed to treat the elbow pain such as:

1. Painkillers like acetaminophen or ibuprofen
2. Anti-inflammatory drugs
3. Rest
4. Gentle stretching
5. Applying Ice
6. Applying heat
7. Bracing
8. Cortisone injections
9. Antibiotics
10. Surgery
11. Physical therapy

Alternative therapies such as acupuncture, yoga, platelet-rich plasma Prolotherapy are also used to treat elbow pain.

Platelet-Rich Plasma Prolotherapy for Elbow Pain

When the conventional methods fail to eliminate the elbow pain, alternative methods become the center of attention. Platelet-rich plasma Prolotherapy is an alternative method to eliminate the elbow pain by inducing and accelerating the natural healing process of the body. It is a minimally invasive method which promises long term results.

Preclinical and human cell culture studies support the use of platelet-rich plasma Prolotherapy for the treatment of elbow conditions such as damaged tendons. Studies have shown that platelet-rich plasma Prolotherapy increases the tendon repair without scar formation.

Another study showed a 60% improvement in the patients treated with platelet-rich plasma Prolotherapy for damaged elbow tendons.

Platelet-rich plasma Prolotherapy is also effective in treating muscle damage. Although limited studies are available that show the effectiveness of this technique in muscle damage repair, experiments done in the lab on the human cells have shown the effectiveness of this technique for muscle repair and cell growth.

The role of platelet-rich plasma Prolotherapy in acute ligament damage has not been studied in humans, but there are studies on animals which suggest that platelet-rich plasma Prolotherapy is effective in treating ligament damage. Platelet-rich plasma injections are safe to use for cartilage damage and they have shown to improve the pain in the patients within 6-12 months. This technique has shown positive results in healing bone fractures.

To treat the long-term elbow pain, the cause of the elbow pain is diagnosed. After that, the patient's blood is drawn, centrifuged in sterile conditions, and platelet-rich plasma is separated. This platelet-rich plasma is administered at the elbow where it causes inflammation and starts the healing process. Painkillers are prescribed to eliminate the feeling of discomfort. The injection repairs the damaged tendons, ligaments, muscle or broken bone and eliminates the pain caused by the damage and relieves the patient.

Future research is needed to find the optimal formulation for platelet-rich plasma injections.

Combining Conservative Treatments with PRP

Combing prolotherapy and stem cell treatments with physical therapy, sports therapy, massage therapy, and exercises enhances recovery and pain free function. People have often tried many of these treatments prior to injection therapy. Combining these treatments with PRP and stem cells maximizes recovery and tissue repair.

Low Level Laser Treatments

1. ACCELERATED TISSUE REPAIR AND CELL GROWTH

Photons of light from lasers penetrate into tissue and accelerate cellular growth and reproduction. Laser therapy increases the energy available to the cell so it can work faster, better, and quickly get rid of waste products. When cells of tendons, ligaments, and muscles are exposed to laser light they repair and heal faster.

2. FASTER WOUND HEALING

Laser light increases collagen production by stimulating fibroblasts. Collagen is the building block of tissue repair and healing. Laser therapy increases fibroblast activity and therefore collagen production to speed healing.

3. REDUCED FIBROUS TISSUE FORMATION

Low-level laser therapy decreases scar tissue formation. Scar tissue can be a source of chronic pain and poor healing. By eliminating excessive scar tissue and encouraging proper collagen production, painful scars and chronic pain is reduced.


4. ANTI-INFLAMMATION

Laser therapy causes vasodilatation (increases the size of capillaries) which increases blood flow. The treatments also increases lymphatic drainage to decrease swelling or edema. Therefore, laser therapy reduces swelling caused by bruising or inflammation while speeding the recovery process.

5. PAIN RELIEF

Cold laser therapy decreases pain by blocking pain signals to the brain. Some nerve cells sense pain and send signals to the brain. Chronic pain can be caused by overly active pain nerves. Specific wavelengths help "shut off" the pain signals, thereby eliminating your pain.

Low-level lasers are excellent at decreasing inflammation, which also increases pain nerve activity. Cold laser therapy also increases endorphins and enkephalins, which block pain signals and decrease pain sensation. Overall laser therapy reduces painful nerve signals and reducing your perceived pain.

6. INCREASED BLOOD FLOW

Blood carries nutrients and building blocks to the tissue, and carries waste products away. Increased blood flow to tissues increases and enhances cellular healing. Cold laser therapy increases the formation of capillaries in damaged tissue. Specific laser frequency also increases blood flow to the area treated, to enhance injury repair.

7. INCREASED REPAIR AND REGENERATION

Low-level lasers increases enzyme activity to improve metabolic activity that affects cell repair and regeneration. The enzymes are turned on "high" to speed the healing.

8. NERVE FUNCTION AND REPAIR

Nerves heal very slowly. Lasers speed up this process. Damage to nerves causes numbness, pain, muscle weakness, and altered sensations. Laser therapy treatments enhance nerve function, healing, and reduce pain.

9. INCREASED ENERGY PRODUCTION - ATP

ATP is like gasoline for cells, it is the energy source that cells operate. Injured cells often have low levels of ATP, which decreases their ability to heal and repair. By increasing ATP and "gasoline storage levels," cells have more ATP for healing and repair. Increased mitochondrial production is very important with nerve pain.

10. ACUPRESSURE AND TRIGGER POINTS

Low-level laser therapy decreases trigger points and stimulates acupuncture points to decrease muscle and joint pain.

We combine low-level laser therapy with a variety of techniques and treatments. Cold laser therapy can be used alone as a single treatment modality, or in conjunction with other Chiropractic, Physical Therapy, massage therapy, or medical treatments.

Conservative Treatments

Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique.

These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.

When these treatments are incorporated into a treatment plan, patients heal faster and are less likely to have long-term pain or soft tissue fibrosis or scar tissue in the injured muscle. These soft tissue treatments are incorporated with cold laser, therapeutic exercise, and flexibility programs.

Treatment for shoulder injuries often requires a variety of exercises, stretches, conservative treatments, medical treatments, and home therapies. Shoulder injuries can become chronic if the appropriate steps are not taken.

Elbow injuries often occur in people with severe or chronic shoulder injuries. People begin trying to alter their shoulder motions to protect it. Unfortunately these altered body mechanics tend to overwhelm the muscles and tendons around the elbow. People often develop a secondary cubital tunnel syndrome, lateral epicondylitis, tricep tendonitis, medial epicondylitis, pronator teres syndrome, double crush, carpal sprains, wrist tendinitis, de quervain's tendonitis, finger extensor strains, or carpal tunnel syndrome.

Treatment for elbow injuries can be extensive if the tendinosis is severe. Mild strains can be treated at home with PRICE, home stretches, and exercises. Don't wait for damage to both the shoulder and elbow to seek treatment and therapy.

Many people do have arthritis or degenerative changes in their elbow, wrist, finger, or thumb joints. Arthritis does not mean you will always have pain in the joints. Degenerative arthritis means the structural Integrity of the bones have changed which alters its gliding, sliding, and hinging motions.

The more severe the arthritic changes the easier it becomes to aggravate the joint and produce pain. Low-level laser therapy is excellent at decreasing pain and inflammation in arthritic hand and wrist joints. Especially when cold lasers are combined with prolotherapy or stem cell treatments.

The upper extremity works as a comprehensive unit performing many of the repetitive tasks at home, work, and recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles.

Many therapeutic exercises can help restore proper strength and endurance to the elbow flexor muscles. Isometric exercises are often the initial treatment exercises, followed by single plane rubber band exercises for elbow flexion, extension, pronation, and supination movements. Dynamic exercises involving stability ball push-ups can be performed on the wall or floor. The more unstable the surface, the more effort and stabilization is required of all the upper extremity muscles.

Push-ups on a stability ball enhances neuromuscular learning throughout the neck, scapula, shoulder, upper arm, and lower arm muscles. Additional strength exercises can be found on the arm and shoulder strengthening pages.

Bibliography:

Kahlenberg, C. A., Knesek, M., & Terry, M. A. (2015). New Developments in the Use of Biologics and Other Modalities in the Management of Lateral Epicondylitis. BioMed Research International.

Ko, G. D. (2010). Platelet-Rich Plasma Prolotherapy for low back pain Caused by Sacroiliac Joint Laxity. Practical Pain Management, 55-67.

Mishra, A., Harmon, K., Woodall, J., & Vieira, A. (2012). Sports Medicine Applications of Platelet Rich Plasma. Current Pharmaceutical Biotechnology, 1185-1195.

Scioli, M. W. (2011). Platelet-rich Plasma Injection for Proximal Plantar Fasciitis. Techniques in Foot & Ankle Surgery, 7-10.