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INITIAL TREATMENT
1) Rest from aggravating activities.
2) Deep friction massage (2-3 minutes at a time twice per day).
3) Ice massage with ice cubes (5 minutes twice per day).
4) Stretching (30 seconds for 5 repetitions, 3 times per day).
• Elbow flexion and extension.
• Wrist flexion and extension.
• Forearm pronation and supination.
5) Grip strengthening (2-3 minutes twice per day).
• Rubber bands for finger extension.
• 1-5 pound weights for wrist flexion and wrist extension.
6) Tennis elbow strap or infrequent wrist brace.
7) Anti-inflammatory medication.
8) Possible physical therapy for phonophoresis and iontophoresis.
9) If continued pain, possible Cortisone injection.
SECOND PHASE
1) Continue stretching, medication, and bracing.
2) Progressive pain-free strengthening (3 sets of 15, 2 times per day).
• Wrist curls 1-5 pounds.
• Elbow flexion/extension 2-3 pounds
• Forearm pronation/supination (0-2 pounds progressing to 3-5 pounds).
3) Shoulder strengthening to prevent disuse atrophy.
4) Resume previous aggravating activities.
FINAL PHASE
1) Continue stretching and strengthening.
2) Functional training and correct mechanics (consider taking a golf or tennis lesson).
3) Ice after activity.
4) Gradual return to sports.
5) If tennis aggravates, consider enlarging the grip and decreasing the tension on the strings. Also avoid the longer rackets. May consider changing the
backhand grip technique.
6) Maintenance stretching and strengthening (3 times a week).
REFRACTORY EPICONDYLITIS:
PRP (Platelet Rich Plasma):
When conservative treatment fails to resolve the symptoms of chronic elbow tendinosis another treatment options is buffered platelet rich plasma (PRP).
Treatment with platelet-rich plasma (PRP) can reduce pain and increase function in patients suffering from epicondylitis. PRP consists of a more concentrated
solution of platelets than that of whole blood. Platelets contain potent growth factors that behave like osteoblast-like cells, increasing healing in a given area.
The procedure involves blood being drawn from the patient's arm and then concentrated. The PRP is then injected back into the patient at the area of inflammation.
The goal is to optimize the healing environment with stem cells, thereby healing the chronically inflamed and damaged tissue. [1]
In 2006 a study was done with a population of 140 patients with elbow epicondlyar pain. These patients were injected with PRP and then followed. At the 8 week follow
up, 60% had improvement in their pain. At the 6 month follow up, 81% had an improvement in their pain. At the final follow up, 25 months later, 93% of the patients
had a reduction in their pain. [2]
ESWT (Electric Shock Wave Therapy):
This treatment utilizes shock wave therapy to treatment refractory epicondylitis. There is no need for immobilization. Early studies have shown up to a 70% success rate.
Surgical Options:
1) Open -
The damaged tissue is taken down and the tendon reattached.
2) Arthroscopic -
The tendon is released. This option provides a faster recovery with minimal scarring. However, the patient may experience weakness.
3) Topaz -
This treatment consists of microabrasion to stimulate healing. Early studies have shown promise. This option provides a faster recovery.
[1] Dines, MD, Josh, and Rock Positano, MD. "Platelet Rich Plasma Works to Heal Tendonitis: New Non Surgical Treatment Horizon." Joe Dimaggio
Sports Foot and Ankle Center. 22 July 2008. Hospital for Special Surgery. 16 Oct. 200
http://http://www.huffingtonpost.com/dr-rock-positano-and-dr-joshua-s-dines/platelet-rich-plasma-work_b_114258.html.
[2] Mishra, MD, Allan, and Terri Pavelko, PAC PT. "Treatment of Chronic Elbow Tendinosis with Buffered Platelet Rich Plasma (PRP)." American Journal of
Sports Medicine 34 (2006): 1774-778.
Treatment with platelet-rich plasma (PRP) can reduce pain and increase function in patients suffering from epicondylitis. PRP consists of a more
concentrated solution of platelets than that of whole blood. Platelets contain potent growth factors that behave like osteoblast-like cells, increasing
healing in a given area.
The procedure involves blood being drawn from the patient's arm and then concentrated. The PRP is then injected back into the patient at the area of
inflammation. The goal is to optimize the healing environment with stem cells, thereby healing the chronically inflamed and damaged tissue. [1]
In 2006 a study was done with a population of 140 patients with elbow epicondlyar pain. These patients were injected with PRP and then followed. At
the 8 week follow up, 60% had improvement in their pain. At the 6 month follow up, 81% had an improvement in their pain. At the final follow up, 25
months later, 93% of the patients had a reduction in their pain. [2]
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[1] Dines, MD, Josh, and Rock Positano, MD. "Platelet Rich Plasma Works to Heal Tendonitis: New Non Surgical Treatment Horizon." Joe Dimaggio Sports Foot
and Ankle Center. 22 July 2008. Hospital for Special Surgery. 16 Oct. 2008
http://http://www.huffingtonpost.com/dr-rock-positano-and-dr-joshua-s-dines/platelet-rich-plasma-work_b_114258.html.
[2] Mishra, MD, Allan, and Terri Pavelko, PAC PT. "Treatment of Chronic Elbow Tendinosis with Buffered Platelet Rich Plasma (PRP)." American Journal of
Sports Medicine 34 (2006): 1774-778.
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