Prolotherapy With Platelet Rich Plasma Case History: Bilateral Elbow Tendinosis With Underlying Joint Degeneration

Ross Hauser, MDRoss Hauser, MD

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 prolotherapy treatments 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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