MEDIAL EPICONDYLITIS PROTOCOLS
Patients with golfers elbow (medial epicondylitis) are ideal candidates for PRP.
Visual Analog Scale (VAS) is an assessment scale of pain. VAS uses a numerical scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the highest level of pain. I recommend Patients with VAS scores of 4 or higher and patients that have failed conservative therapy.
First line of treatment is rest and NSAIDs, if the patient fails this conservative management and also fails exercises listed below I usually suggest PRP prior to corticosteroids as I find corticosteroids may further injure the torn or damaged tendon.
The medial epicondyle gives attachment to the ulnar collateral ligament of elbow joint, to the pronator teres, and to a common tendon of origin (the common flexor tendon) of some of the flexor muscles of the forearm: the flexor carpi radialis, the flexor carpi ulnaris, the flexor digitorum superficialis, and the palmaris longus.
A low-volume, single-spin Leukocyte poor PRP kit is ideal for this treatment.
• Ultrasound guided, high-frequency linear transducer at 9 mhz or greater
• 10 cc Syringe
• 20 gauge spinal needle for injection
• 5-7 cc of Leukocyte poor PRP
Please carefully read and have your patient follow these instructions prior to their PRP treatment.
AVOID: Aspirin, Motrin, ibuprofen, Aleve (all non-steroidal and steroidal anti-inflammatory agents), curcumin, turmeric, Gingko biloba, garlic, flax oil, cod liver oil, vitamin A, vitamin E, or any other essential fatty acids at least 1 week prior to and after their treatment. Remember, we are creating inflammation, so any drugs or foods that have anti-inflammatory properties must be avoided, including pain gels such as Voltaren and Salonpas, etc.
DO NOT TAKE systemic steroids such as; Prednisone, Hydrocortisone, etc. for at least 2 weeks prior to the procedure.
If the patient has had epidurals or steroid injections, please wait 6 weeks before administering any PRP procedures.
AVOID: Vigorous exercise, sun, and heat exposure for at least 3 days prior to their treatment.
AVOID: Alcohol, caffeine, and cigarettes for 3 days before and after their treatment.
DIET AND FLUID INTAKE: Patient should increase their intake of fluid the day before the procedure by drinking 2 glasses of water in the morning before their PRP session, 2 glasses at lunch and 2 glasses at dinner.
The patient should eat a normal breakfast or lunch the day of the PRP session. However, they should not eat for 3 hours prior to the procedure. The patient may take routine morning medications as long as they are not anti-inflammatory, or blood thinners (see list above).
Please carefully read and have your patient follow these instructions after their PRP treatment. There are minimal restrictions after PRP injections allowing the patient to return to daily activities almost immediately.
The patient should NOT touch, press, rub or manipulate the treated area(s) for at least 12 hours after the treatment.
AVOID: Aspirin, Motrin, ibuprofen, Aleve (all non-steroidal and steroidal anti-inflammatory agents), curcumin, turmeric, Gingko biloba, garlic, flax oil, cod liver oil, vitamin A, vitamin E, or any other essential fatty acids at least 1 week prior to and after their treatment. Remember, we are creating inflammation, so any drugs or foods that have anti-inflammatory properties must be avoided, including pain gels such as Voltaren and Salonpas, etc.
If the patient experiences discomfort or pain, they may take Tylenol or other acetaminophen products.
Heat may be applied, to the injected area for 20-30 minutes after the procedure, but it would preferable if they can refrain from this. Ice or cold packs should never be applied to the treated area!
The patient should not wash or take a shower for at least 6 hours after their treatment.
They should not use any lotions, creams, or make-up for at least 6 hours after their treatment.
AVOID: Vigorous exercise, sun, and heat exposure for at least 3 days after your treatment.
AVOID: Alcohol, caffeine, and cigarettes for 3 days before and after your treatment.
Smokers do not heal well, problems recur earlier, and results may take longer.
Patients should drink plenty of water for 2 weeks (10 cups per day).
They can return to physical therapy 7 days after treatment.
They may return to the gym 10 days after treatment.
It is normal to experience: bruising, redness, itching, soreness, and swelling that may last from 3-10 days following their procedure. Important reminder: There should be no fever or purulent discharge (pus) from the site. If there is, have the patient contact you immediately.
