Tendonitis: Cortisone vs. Platelet-Rich Plasma

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Tendonitis: Cortisone vs. Platelet-Rich Plasma

Tendonitis of the elbow, often called “Tennis elbow” is often not an inflammation, as the suffix “itis” leads us to believe, but a degeneration of the tendon fibers from over-use.  For this reason, doctors are now using the term “tendonopathy”  to denote a problem with the tendon.

Cortisone shots are commonly used to treat tendonitis, but may hinder long-term recovery from injury.  A NYT article a few weeks ago cited a large-scale review in the Lancet that showed, while cortisone shots relieved tendonopathy pain in the short-term, there are often significantly slower rates of healing in the long-term.  Cortisone shots may simply mask the pain and hinder the body’s natural healing process, making it easier to re-injure yourself in the long run.

There is another technique, fairly new in western medicine, called Platelet-Rich Plasma injections (PRP).  In preparation for PRP injections, doctors take blood from the patient and separate out the platelets from the red blood cells (RBC).  Blood is normally composed of about 93% RBC and 6% platelets, but with PRP injections, the blood has been reconstituted to have 94% platelets and 5% RBC.  The idea behind these injections is that platelets are responsible for healing the tissue by promoting hemostasis, construction of new connective tissue, and the repair of blood vessels in the area.  They release proteins responsible for attracting macrophages and other cells that promote removal of dead tissue and encourage tissue regeneration and healing (Sampson, et al).  Tendons do not generally receive significant blood flow.  By injecting platelet-rich blood, they are nourishing the tendon more than it would be nourished by the body normally.  It would seem that these PRP injections are a better alternative to troublesome cortisone shots for tendon injuries.

TCM Connection:

In a TCM sense, these types of injuries often result from a yin deficiency not nourishing the muscles or tendons, leaving them less supple and easier to tear. This therapy is injecting a highly Yin substance into the area of injury to facilitate healing.   Although it is in line with TCM philosophy on a local level, systemically the patient may continue to be yin deficient and may have more injuries as a result.  A Chinese medical doctor would treat the person constitutionally as well as locally to bring the body into balance and prevent further injuries.

Sampson, Steven, Michael Gerhardt, and Bert Mandelbaum. Platelet rich plasma injection grafts for musculoskeletal injuries: a reviewCurr Rev Musculoskelet Med. 2008 December; 1(3-4): 165–174.  Published online 2008 July 16. doi: 10.1007/s12178-008-9032-5.

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