I have been suffering for the past several months with the 3rd episode of tendonitis in my right elbow in 3 years. The first episode occured in November 2004 after excessive raking – I spent every waking moment for 2 consecutive dry days raking the wet leaves that had fallen over several rainy weeks from the Bigleaf Maple trees in our yard. After waiting several weeks for the pain to go away, I started several weeks of physical therapy, eventually coupled with several weeks of acupuncture – neither of which had significant effect (I was told that 30% of people have neuroreceptors that are not receptive to accupuncuture treatment, and I was likely a member of that minority); a cortisone shot finally resolved the problem in the summer of 2005.
The next episode occured in February 2006, when I joined some other fathers in running an informal baseball training clinic for our boys, who would be soon trying out for Minors in Woodinville Little League. I threw pitches in a batting cage for over an hour, after which my right arm felt like rubber … after which my right elbow felt a great deal of familiar pain. This time, I thought I’d cut to the chase, and started with the cortisone shot. Unfortunately, this has no effect, so I tried physical therapy, but that had little effect, either. Finally, I went to see Becky Beveridge, of Feel the Knead Massage Therapy in Duvall, WA, who practices a rather unique style of massage she somewhat uneuphemistically calls "search and destroy" (as contrasted with the school of "fluff and buff" massage) – and in one session, the pain was gone.
The latest episode started in October 2006, shortly after joining Nokia Research Center Palo Alto. I suspect that the trigger was some combination of a new computer (IBM Thinkpad with a TrackPoint), a new physical workplace environment (Steelcase furniture with Herman Miller Aeron chair), and the inevitable stress that accompanies any significant life event, even one that is positive and welcome – actually, all of these were welcome developments, as I’d missed the ThinkPad + TrackPoint, Steelcase furniture and Aeron chairs I’d enjoyed at Accenture Technology Labs, as well as the opportunity to actually earn money while doing work that I love. Perhaps the stress of the long commute was a factor.
In any case, this time, I started with Becky, but despite three treatments, there was little change. I’ve been so engaged in my work during the weekdays, that it took me a long while to find – or make – the time to find a new doctor (now that I was spending weekdays in Palo Alto). I wasn’t sure how to find a good doctor, but I’d walked by the Agile Physical Therapy office many a time on my way to / from lunch on California Avenue, and figured they would probably be able to recommend good doctors.
As it turns out, one of the doctors they recommended was Allan Mishra, an orthopedic surgeon at the Menlo Clinic who specializes in tendon disorders, and who is pioneering a new, relatively non-invasive, treatment for chronic tendonitis, using Platement Rich Plasma (PRP). The treatment involves withdrawing blood, separating the platelet rich plasma from the platelet poor plasma, and injecting the PRP into the injured area, which stimulates growth factors in the blood to help regenerate and repair the tissue in that area. More details can be seen in a 5-minute video that Dr. Mishra has posted on YouTube (!):
[He also has a blog (!!)]
The new treatment is not [yet?] FDA-approved, and I’ll be paying for it out-of-pocket (and, unfortunately, we’ve never played the HSA game). However, the level of expected disability is lower than surgery, and the expected recovery time is shorter, and so I’ll be able to type two-handed again sooner … and avoid some of the other risks inherent in surgery (not that the PRP treatment is without attendant risks).
I’ll be undergoing the procedure at noon today, and there will still be a period of at least a few weeks where I’ll be avoiding or significantly reducing the use of my right arm, and so I’ll likely be reducing the frequency and length of blog posts (and other forms of written or typed communication) for a while. Perhaps this will give me a chance to catch up on some reading…
Comments
18 responses to “Mending Tendonitis via Platelet Rich Plasma (I hope)”
I am an advocate and reg. autologous blood therapist as well as an BSN-RN. It is great to see the therapy is working for many people. Someday, I hope it will be a treatment option for everyone with the proper reimburstment codes so that those healthcare providers that understand the benefits and want it to be available to everyone can.
Sincerely,
Riki Helms
Thanks Riki; having just paid US$1500 for the procedure, with no prospect of health insurance coverage or reimbursement, I ardently share this desire!
Progress Report on Platelet Rich Plasma (PRP): Week 1
It’s been a little over a week since my platelet rich plasma (PRP) injection for chronic tendonitis; as with my [blog posts about] my wife’s anal cancer treatment (which was successful, as far as we can tell, having recently passed
Joe,
I am in the same boat regarding my elbows (both) and even have had surgery on one of them. I am in discussions with Dr. Mishra office and my fly to CA to receive treatment. I’d be happy to share my experience with you regarding my other treatments and would love to hear your comments about how the plasma injections are working. Please feel free to contact me directly at MarkBunting1@aol.com
Thanks and best of luck to you,
Mark
An update on my elbow, one month after Platelet Rich Plasma (PRP) treatment
I had my one-month followup visit with Dr. Mishra today, to review progress since undergoing a platelet rich plasma (PRP) treatment for chronic elbow tendonitis (or, based on an earlier comment, tendonosis) on July 12. I’d posted an update at
Three month update on my elbow Platelet Rich Plasma (PRP) treatment
On Monday, I had a followup visit with Dr. Mishra to evaluate and discuss progress and prospects for the restored health of my right elbow, three months after my treatment with Platelet Rich Plasma (PRP). One week after treatment, things
Thanks for your feedback on Platelet Rich Plasma Injections. I am a physician in Santa Monica working with PRP. I injured myself with a surfing lesson, and received a PRP injection to my MCL (knee ligament that was sprained/torn). I learned first-hand the importance of post injection rehabilitation.
I have been treating many patients with promising results. I created a blog to provide an open forum for patients & health professionals to learn more about PRP.
Most interesting, there are links to PRP possibly helping those with knee arthritis and cartilage defects.
Thank you,
Dr Steve
http://www.prpinjection.blogspot.com
Steve: thanks for sharing your story and the link to your blog. I wanted to include a direct link to your post on Doctor Heal Thyself, which provides more details about your own experience with being on the receiving end of the treatment. I note that you describe the injection as being similar in some ways to a new injury, and stress the importance of rest and rehabilitation. I also note that your post is dated August 19 (2007), but does not list the date of the injection. I hope your recovery is proceeding – or has proceeded – in a positive way, and if you are still recovering, I hope that you will post more updates on your recovery experience on your blog.
Joe,
Thanks for the feedback. I posted a follow up at 8 wks. Please see the sight.
http://prpinjection.blogspot.com/2007/10/prp-knee-injection-8-wks-post-injection.html
I am running, swimming, biking without limitations. I am publishing a case report documenting MRI’s and ultrasounds done at 1wk, 4wk, and 8wks. Also, I am in talks with some organizations to do a large knee arthritis study on PRP. This October there was research presented in Warsaw Poland at the International Cartilage Repair Society supporting it’s use in knee cartilage/arthritis. Again, further studies are needed.
Dr Steve
Dr Steve
Steve: thanks for the update! I’m glad that your recovering is progressing positively. I’m adding a direct link to the post on your blog, so anyone reading this thread (here) can click through (there) to read more about it.
Six month update on my elbow Platelet Rich Plasma (PRP) treatment
Amid the broad range of emotions and activities in which I’m engaging this week – a sad last week at Nokia before an exciting new start at MyStrands – I was able to schedule an appointment for my 6-month followup
20551 is an acceptable code I have found.
This is just a code for the injection, but par for the course of healthcare does not cover the disposables used.
I hope this can help.
Wow, this is great news – thanks for sharing your discovery!
Searching around for more information about the USA CPT [Current Procedural Terminology] code 20551 revealed a number of articles. Here’s one, from the AccuChecker healthcare reimbursement site, on Injection of Tendon Sheath, Ligament, Trigger Points, or Ganglion Cysts.
16 month update on my elbow Platelet Rich Plasma (PRP) treatment
In November, I visited Dr. Allan Mishra’s office for a belated followup on the platelet rich plasma (PRP) treatment for elbow tendonitis he’d administered in July 2007. As was the case before my six month followup visit, I was feeling…
This is a good blog! I hope more informative blogs such as these will posted.
I’m in the process of appealing for insurance coverage, so to chime in as far as CPT codes go:
CPT code 20550 defines an injection to the tendon sheath; CPT code 20551 defines an injection to the origin/insertion site of a tendon
I was initially billed for 20551 for my medial epicondylosis (golfer’s elbow), which was accepted and paid, but later re-coded to 0232T, which the American Medical Association just released a few months ago specifically for PRP. This is just one of the charge codes used, as there can also be an ultrasound guidance component and the pricey PRP-prep kit itself.
Just for reference as far as pricing goes, having just visited Dr Mishra for a second opinion in September 2010, he/Menlo Clinic currently charges $1800, and with appropriate indications (i.e. tendinopathies), he estimates efficacy rates of >85%. The procedure is slowly gaining more recognition and acceptance as far insurance coverage goes, as workers compensation covers it fully these days, even if private insurances are still spotty.
It’s now been four months since my first injection, and seven weeks since my second, and I’m definitely appreciating the improvement. I’m still doing eccentric strengthening with a Thera-band, almost nightly, but pain at idle and during most daily activities is gone.
I still encounter flare-ups here and there, for example, activities including a strong grip like weight training, but brief icing helps tremendously in those instances.
@Nick: thanks for the additional context about the different CPT codes that apply to PRP, the current costs charged by Dr. Mishra and the way that acceptance by the insurance industry is evolving. I’m glad to read that you are experiencing improvement with the treatment, and hope that trend continues.
Platelet therapy is a new innovation in medical technology and yes it does wonder sometimes, although it may be a few years to get patients reimbursed for their out of pocket payments for this type of procedure. I do hope that your representatives will hear your voices and pass a bill regarding this issue, so that it will be included in your health benefits.