The elbow is a complex joint essential for upper limb function. Its bony anatomy consists of the distal humerus, proximal radius, and proximal ulna. The distal humerus includes the medial and lateral epicondyles, capitellum, and trochlea. The proximal radius comprises the radial head and neck, while the proximal ulna features the olecranon process, coronoid process, trochlear notch, and radial notch.
Three main articulations form the elbow joint: the humeroulnar joint (a uniaxial hinge joint allowing flexion and extension), the humeroradial joint (a ball-and-socket joint permitting flexion, extension, and rotation), and the proximal radioulnar joint (a pivot joint enabling pronation and supination).
Lateral epicondylitis, also known as tennis elbow, is a common condition that causes pain and tenderness on the outside of the elbow. It’s an overuse injury that happens when the tendons that attach to the bony bump on the outside of the elbow become damaged from repetitive stress. This usually occurs due to activities that involve repeated wrist extension, like playing tennis, hence the name “tennis elbow.”
The condition is most often seen in people between the ages of 30 and 50, and it tends to affect the dominant arm. While it’s frequently associated with tennis players, lateral epicondylitis can also occur in people who participate in other sports or have occupations that involve repetitive wrist movements.
The main symptom of tennis elbow is pain on the outside of the elbow that gets worse with activity, especially with wrist extension and gripping. There may also be tenderness when pressing on the affected area, weakness in grip strength, and pain when trying to extend the wrist against resistance.
Fortunately, most cases of lateral epicondylitis can be treated successfully with conservative measures. This typically involves a combination of rest, ice, physical therapy, and medications like NSAIDs to help with pain and inflammation. In some cases, additional treatments like braces, injections, or even surgery may be necessary.
With proper treatment and activity modification, the vast majority of people with tennis elbow will see their symptoms improve within several months. However, the condition does have a tendency to recur, especially if the aggravating activities are resumed too quickly. That’s why it’s important to give the elbow adequate time to heal and to make gradual changes in activity levels to prevent the injury from coming back.
Three main articulations form the elbow joint: the humeroulnar joint (a uniaxial hinge joint allowing flexion and extension), the humeroradial joint (a ball-and-socket joint permitting flexion, extension, and rotation), and the proximal radioulnar joint (a pivot joint enabling pronation and supination).
The elbow’s stability is maintained by several ligaments. The medial collateral ligament (MCL) consists of anterior, posterior, and transverse bundles. The lateral collateral ligament (LCL) includes the radial collateral ligament, lateral ulnar collateral ligament, and annular ligament. Additional ligaments include the quadrate ligament and oblique cord.
Elbow disorders such as lateral epicondylitis (tennis elbow), medial epicondylitis (golfer’s elbow), and ulnar collateral ligament (UCL) injuries are common conditions, especially in athletes. While traditional treatments like rest, physical therapy, bracing, and surgery are often used, there is growing interest in orthobiologics as less invasive options. This review will discuss the current evidence for platelet-rich plasma (PRP) and stem cell therapies in managing elbow pathology.
PRP is an autologous blood product that contains high concentrations of growth factors which may enhance tissue healing. Several small studies have evaluated PRP injections for lateral epicondylitis. A 2014 systematic review found PRP may provide short-term benefits in pain and function compared to placebo, but the evidence was limited by low quality studies. For medial epicondylitis, a small 2013 study showed PRP and autologous blood injections provided similar improvements in pain and disability. In UCL injuries, evidence for PRP is limited to small case series suggesting potential benefit, but controlled trials are lacking.
Mesenchymal stem cells (MSCs) derived from bone marrow or adipose tissue have the capacity to differentiate into various cell types involved in tissue repair. However, the use of stem cells for elbow disorders is still in early stages. A 2016 case report described good outcomes with bone marrow-derived MSCs for a partial UCL tear in a professional baseball pitcher. Another small 2017 case series reported improvements in pain and MRI appearance after ultrasound-guided injection of bone marrow aspirate concentrate for lateral epicondylitis. Large controlled studies are needed though to establish the efficacy and safety of stem cell therapies.
Current evidence for orthobiologics in elbow disorders is limited by small sample sizes, lack of control groups, and short-term follow-up. Optimal preparation methods, composition, and dosing still need to be determined. Long-term safety, especially of stem cell therapies, remains unknown. Standardized outcome measures are also needed to allow comparison across studies. Ultimately, randomized controlled trials with larger sample sizes and longer follow-up are required to guide treatment decisions.
In summary, orthobiologics such as PRP and stem cells are promising options for common elbow pathologies like lateral epicondylitis, medial epicondylitis, and UCL injuries. Some small studies show potential short-term benefits of PRP for epicondylitis, but overall evidence is limited. Stem cell therapy for elbow disorders is still investigational with only case reports/series available so far. Further high-quality research is necessary to establish the appropriate role of orthobiologics in managing elbow conditions. They should not be considered first-line treatments at this time, but may be an option for patients who fail