Elbow Arthritis & Osteoarthritis

Can Regenerative Therapy Provide Permanent Elbow Pain Relief Without Surgery?

Does your elbow pain keep worsening day by day? Are you unable to do your routine activities? Luckily, you can get long-term relief from pain and come back to normalcy without any surgery, by utilising regenerative therapy. Before we go through the elbow injuries and elbow osteoarthritis treatment in Ireland, let us understand the anatomy of your elbow.

Elbow anatomy

Elbow, one of the most used joints in the body, is located at the centre of the arm. An elbow joint is composed of three bones:
  • Humerus – upper arm bone
  • Radius – forearm bone
  • Ulna – forearm bone
These three bones create two joints, such as:
  • Humeroradial joint: The meeting point of the radius and humerus that allows the arm to bend and straighten.
  • Proximal radioulnar joint: The meeting place of the ulna and radius that allows the arm to rotate.
The two joints are held together by ligaments such as:
  • Ulnar collateral ligament (UCL) on the inner side of the joint
  • Radial collateral ligament on the outer side of the joint responsible for the joint extension.
  • Annular ligament keeps the radius in contact with the radial notch of the ulna.
A bony bump at the bottom of the humerus is called epicondyle. There are two types of epicondyles, namely:
  • Lateral epicondyle – A bony bump on the outer side of the elbow
  • Medial epicondyle – A bony bump on the inner side of the elbow
Elbow also includes tendons, ligaments, and muscles that hold the joint together, which helps in providing stability and mobility.
Elbow-Osteoarthritis

As people use their elbows constantly throughout the day, therefore they are always prone to injury. If injured, people will experience the following symptoms:

  • Pain
  • Radiation of pain to forearm/wrist
  • Tenderness
  • Swelling
  • Loss of motion
  • Stiffness
  • Numbness
  • Weakness
  • Tingling

Common elbow injuries include:

  • UCL injury
  • Tendon tears
  • Tennis elbow/lateral epicondylitis
  • Golfer’s elbow/ medial epicondylitis
  • Elbow arthritis (osteoarthritis and Rheumatoid arthritis)
  • Trauma or accidental injury

During the physical examination, your doctor performs various tests to detect the level of pain and grip strength. He may further recommend X-rays and an MRI to detect any elbow injury or recommend a blood test to rule out rheumatoid arthritis.

The conventional treatment for elbow damage includes non-surgical procedures and surgical procedures to improve the strength and function of elbow joints by controlling the symptoms and avoid further joint damage. Non-surgical procedures include R.I.C.E. Formula (Rest, Ice, Compression, Elevation), activity modification (bracing) and physical therapy. Administration of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections provide temporary relief, but they have local and systemic adverse side effects.

Lastly, your doctor may recommend elbow arthroscopy to treat some elbow injuries. In the case of osteoarthritis, your doctor may recommend elbow joint replacement surgery. But they have a few disadvantages:

You may experience elbow pain, swelling, and discomfort after the completion of the operation. So, the doctor recommends that you should follow post-operative rehabilitation protocols for the complete recovery of your elbow joint. Hence you will have to take rest, apply ice packs to the affected areas and undergo physical therapy to strengthen the arms and increase range of motion. Finally, you will return to your normal routine between six months to one year after the surgery. Although joint replacement can be a treatment option for elbow osteoarthritis, there are patients with continuing pain and an increased rate of bone erosion with weakness as they grow older. Hence, they are forced to opt for surgery again.

Here comes the innovation in the medical field. Fortunately, regenerative cellular treatments have evolved as an alternative to elbow surgery, where your body can heal by itself. For instance, if you cut your finger, it bleeds and forms a scab like structure. Later, the healing cells beneath the scab seal the injury and stop the bleeding. Similarly, your body can also examine the signs of damage and repair them using its healing cells.

Regenerative treatments are non-surgical procedures that provide long-lasting relief from the symptoms with minimal downtime and enhances recovery within a short period. It has no side effects since the injection involves your blood or regenerative cells. So, there is no chance of rejection or cross-transmission of disease.

    1. Regenerative cellular therapeutic options such as PRP (Platelet-Rich Plasma) therapy, prolotherapy, SVF (Stromal Vascular fraction) therapy and mesenchymal cell therapy proves to be efficient for treating several types of arthritis.Bone Marrow Aspirate Concentrate (BMAC) regenerative cell injections can manage all kinds of elbow injuries and osteoarthritis.
    2. PRP injection does not have potential complications associated with a corticosteroid injection such as secondary tendon tears, skin atrophy, etc. [1] 
    3. PRP therapy is considered as a safe and effective therapy for tennis elbow, compared to steroid injections. PRP reduced elbow pain and increased function significantly, exceeding the effect of corticosteroid injection even after a follow-up of 2 years [2]. 
    4. Since PRP injections significantly reduce pain and improve functions during the treatment of patients with chronic elbow tendinosis, doctors can consider PRP therapy before surgical intervention [3]. 
    5. Even a single injection of BMA containing plasma rich in growth factors and mesenchymal stem cells showed a significant improvement in symptoms while treating tennis elbow patients [4].
    6. The formation of scar tissue due to conservative management creates a tendon lacking the biomechanical properties and mechanical strength of the normal tendon. Regenerative cellular treatments, including BMAC, PRP injection, and collagen-producing cell injection help to regenerate tendon and regain function in patients with epicondylitis. They also alleviate pain, enhance functioning, and improve healing [5].

Regenerative Therapy for Knee Pain may help patients who don’t respond to typical drug treatment, want to reduce their reliance on medication, or are looking for safe knee replacement alternatives. Regenerative Treatments are not suitable for all conditions and all patients. The consultant will be able to advise if you are a suitable candidate.

Your first step to exploring your elbow osteoarthritis treatment in Ireland  is scheduling a consultation with our Consultant. To do so call us on 020 8168 2000 or alternatively book a consultation online or request a call back today!

References
  1. Kwapisz A, Prabhakar S, Compagnoni R, Sibilska A, Randelli P. Platelet-Rich Plasma for Elbow Pathologies: a Descriptive Review of Current Literature. Curr Rev Musculoskelet Med. 2018;11(4):598‐ doi:10.1007/s12178-018-9520-1
  2. Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up.Am J Sports Med. 2011 Jun;39(6):1200-8
  3. Mishra, A., &Pavelko, T. (2006). Treatment of Chronic Elbow Tendinosis with Buffered Platelet-Rich Plasma. The American Journal of Sports Medicine, 34(11), 1774–1778.
  4. Singh A, Gangwar DS, Singh S. Bone marrow injection: A novel treatment for tennis elbow. J Nat SciBiol Med. 2014;5(2):389‐ doi:10.4103/0976-9668.136198