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Prolotherapy with Platelet Rich Plasma
Case History: bilateral elbow tendinosis
with underlying joint
degeneration
Ross Hauser,
M.D.
Cynthia is a 45 year old formerly active woman who came to Caring
Medical on April 18, 2006 with complaints of bilateral forearm and
elbow pain.
The pain in the left elbow was present since July 2004 and in the right
elbow since February 2003. She had tried many treatments such as
cortisone
shots, acupuncture, and
surgeries (repair of a ruptured tendon in the right arm, radial tunnel
decompression and lateral extensor fasciotomy in the left arm) without
relief.
MRI’s have shown
tendinopathy in the both elbows and osteitis in
the left elbow. She ranked her pain as a 10 almost 24-7 and she was
basically completely disabled in both arms and hands due to the pain.
She had 5-10 degrees of limited extension in the left elbow.
No treatment was performed at her first visit, but a 3 phase bone scan
was ordered along with a Sed Rate, C reactive protein level, and CBC.
All labs came back normal with no evidence of systemic inflammation. The
bone scan lit up bilaterally in the elbows and showed increased uptake
laterally on the left elbow on all 3 phases of the scan, which made her
suspect for osteomyelitis post surgery.
On April 25, 2006, she received her first treatments of Prolotherapy to
both elbows. Her working diagnosis was bilateral elbow tendinosis with
underlying joint degeneration. On July 13, 2006, she returned for her
4th treatment and reported 40% improvement in the right elbow and 20%
pain improvement in the left. She also reported 100% improvement in
function of the left elbow. On December 14, 2006, Cynthia felt she had
plateau’d at 50 and 60% in both elbows, so she received her first
treatment of Prolotherapy with PRP (Platelet
Rich Plasma) to try to further repair her painful elbows.
We did not see Cynthia again until May 10, 2007 where she reported 60
and 70% improvement respectively in her right and left elbows, so she
was treated again. A repeat MRI of her left elbow at this time compared
to her previous MRI was reported as “…previously identified interstitial
partial tears not seen on today’s examination… Compared to MRI 10/05
there has been interval improved signal characteristics of the common
extensor tendon.”
On August 31, 2007, we received an email from Cynthia stating that this
was the first time that she could honestly say she believed she would be
healed and that she could do many activities pain free and that her 24-7
pain was completely gone.
As of December 18, 2007, Cynthia stated she experienced 90% overall
improvement and no longer had the severe pain of the past. She was now
able to grip items easier with very little pain. She is grateful that
she is able to do activities with her family and complete tasks in her
daily routines without assistance, which may seem simple, but to her,
are extraordinary accomplishments.
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