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A New Treatment For An Old Problem

By Luga Podesta, MD Originally published in the March 2008 issue of DRUM! Magazine<

Acute and chronic forearm pain is a very common condition in musicians, particularly drummers, requiring them to seek medical care. The repetitive wrist and elbow motion involved in playing drums predisposes us to develop forearm muscle/tendon overuse injuries.

Tennis elbow, or lateral epicondylitis, is the most common of these entities. It encompasses a variety of disorders involving the muscle and tendons that lift or extend your wrist. It had been assumed that these injuries were due to an inflammatory response in the tendons themselves. However, it is now believed to be due to tendinosis, a degeneration of the tendon tissue, which most commonly develops in our forties or fifties, but can occur at much younger ages.

Treatment is typically conservative, relying on oral anti-inflammatory medication, ice application, physical therapy, relative rest from the activity believed to have caused the injury, exercise, stretching, and corticosteroid injections. Surgical repair of the tendon would be considered for more chronic painful conditions that do not respond to conservative care.

An alternative treatment for chronic tendinosis has recently been developed that may give the same or better results than surgical treatment, with a single simple injection of the patient’s own blood. Dr. Allan Mishra and orthopedic surgeons at Stanford University are leading the research of utilizing buffered platelet-rich plasma injections for the treatment of chronic painful tendosis.

Plasma is the liquid portion of the blood comprised of 90-percent water, and the platelets, or thrombocytes, are the irregularly shaped bodies in the blood responsible for blood clotting. Within platelets are powerful growth factors that, when injected in concentrated form, are believed to promote the healing process by acting on the cellular components of the tendon.

The process is straightforward and simple. A small amount of blood is drawn from the patient and then spun at a very high speed in a special cartridge for 15 minutes. The layered blood containing the platelet-rich plasma component is removed and injected into the injured tendon. Preliminary results have shown that platelet-rich plasma injections had success rates similar to those treated surgically for chronic tennis elbow, with less pain and the immediate ability to resume normal activities after a single injection.

Further research will help determine whether this exciting new treatment will give lasting relief for this chronic and common problem.

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