Disclosures: Michael Appeadu, MD: No financial relationships or conflicts of interest

Case Diagnosis: Medial epicondylitis

Case Description: A 52-year-old male veteran presented to clinic with left elbow pain over the last month with no initial trauma. The pain worsened with activities such as lifting objects and washing his car and was refractory to physical therapy, ice, elbow bracing, and medial epicondyle corticosteroid injection. Examination revealed left medial elbow tenderness and pain with resisted wrist flexion. Radiographs demonstrated no acute fracture. The patient was diagnosed with medial epicondylitis and underwent leukocyte-poor platelet-rich plasma (LP-PRP) injection.

Setting: Outpatient PM&R clinicAssessment/

Results: At follow-up, the patient reported 100% pain relief for 4 months after PRP injection with full return of left upper extremity function. At six-month follow-up, he had gradually returning pain and tenderness. He was treated with a second PRP injection. After one week, he reported 100% relief of left elbow pain with no adverse events.

Discussion: Medial epicondylitis, or “golfer’s elbow” is a condition that typically results from repetitive microtrauma to wrist flexors at the insertion at the medial epicondyle, resulting in tissue degeneration and tendinopathy. It affects less than 1% of the general population. PRP has been shown to benefit patients presenting with medial epicondylitis who failed other conservative measures such as occupational therapy and corticosteroid injection; however, there is a lack of well-designed studies in this area. It has been suggested that LP-PRP may be more helpful for chronic tendon injuries while leukocyte-rich-PRP for acute tendon injuries. Two LP-PRP injections, at 6-month intervals, provided complete pain resolution and full functional recovery of pain in our patient. The success of this treatment method may have more widespread implications for a veteran population, which is more likely than the general population to have joint pain.

Conclusion: Our case demonstrates that LP-PRP may be a valuable and safe intervention for patients with medial epicondylitis who fail to respond to other conservative measures.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/leukocyte-poor-platelet-rich-plasma-prp-injection-for-management-of-refractory-medial-epicondylitis-in-an-army-veteran/