“Most tendon related pain is due to degeneration,” says Nathan Wei, MD, board-certified rheumatologist specializing in regenerative medicine like platelet rich plasma injections to treat conditions including tendonitis.
“Platelet-rich plasma is a concentrate of blood containing a number of platelets that is at least ten times baseline.”
Platelet-rich plasma is also known as PRP.
“Platelets are blood cells that contain a large amount of healing and growth factors,” says Dr. Wei.
“The best method for using PRP is to induce an inflammatory response by performing a tenotomy — poking small holes in the damaged tendon tissue using ultrasound guidance and then injecting the platelet-rich plasma into that area.”
Dr. Wei explains about tendonitis: “At a microscopic level there is a change in the cellular arrangement with subsequent disarray of tendon fibers.
“Small tears in the substance of tendon tissue appear. Proper stretching techniques might help prevent or at least delay some of these changes; however, repetitive motion and aging eventually will win out.”
Tendonitis or tendon pain can also result when younger people overwork their chest and shoulders at the gym, or from repetitive throwing in the ball field.
What are some conditions that platelet-rich plasma injections are very effective with, that normally might require surgery?
Dr. Wei: Alan Mishra at Stanford published a prospective non-blinded study on lateral epicondylitis (tennis elbow) that showed significant improvements with PRP compared with patients who did not receive PRP.
Platelet-rich plasma appears to be effective for most chronic forms of tendonopathy. In particular, we’ve found it to be effective for rotator cuff problems, Achilles tendonopathy, epicondylitis, and plantar fasciitis.
Unless there is a significant tear, platelet-rich plasma appears to occupy a niche where patients who’ve failed other types of conservative treatments and where surgery is being considered, it is, in my opinion, the treatment of choice.
Where do these platelets come from; the patient’s own platelets?
Dr. Wei: The platelets are obtained from peripheral blood. A 60 cc blood collection is centrifuged and the platelets are collected.
How long would a platelet-rich plasma treatment last?
Dr. Wei: Platelet-rich plasma is usually good for at least a year and usually longer. Most patients get permanent relief. Some may require more than one treatment.
If they haven’t responded to two treatments, they probably won’t respond. Some patients will need to go on to stem cell treatment, particularly if they have a tear in the tendon.
How widespread is the platelet-rich plasma treatment?
Dr. Wei: It’s been in the news quite a bit. Hines Ward, the Steeler’s wide receiver, received PRP for a collateral ligament knee injury that helped him play in the Super Bowl.
Dara Torres (rotator cuff), Troy Polamalu (MCL), and Tiger Woods also received platelet-rich plasma.
In fact, most professional sports teams, and many major college athletic squads, have been using PRP for at least two to three years.
If you are facing possible surgery to repair tears in a tendon, or if conservative treatments have failed to alleviate tendonitis pain, ask your orthopedic doctor about PRP: platelet-rich plasma injections.
Dr. Wei passed away after a valiant fight with cancer in March 2018. His practice had become extremely successful in general rheumatology, having offered patients a variety of skillfully done procedures.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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