Turmeric for Tendonitis, Arthritis, and Cancer

The golden spice turmeric, commonly found in many tasty Indian dishes, contains an interesting and potentially valuable therapeutic component.  Curcumin, found in turmeric, modulates several  cellular pathways and has been used as a nutraceutical supplement to combat inflammation.  Importantly, turmeric has been found to have a high safety profile.  This is consistent with its use for thousands of years in India and China.

Research studies have shown turmeric can modify tendon inflammatory pathways.  (Ref)  One study found "curcumin can improve the quality of tendon rupture healing, and thus represents a promising strategy in the management of injured tendon tissue."  (Ref)

Tumeric / Curcumin may also be of value in the treatment of osteoarthritis by decreasing inflammatory pathways.  "Short-term supplementation with curcuminoids attenuates the systemic oxidative stress in patients with osteoarthritis.  These antioxidant effects may account for the reported therapuetic effects of curcuminoids in relieving osteoarthritis symptoms.  (Ref)  Some clinical studies suggest using Tumeric / Curcumin may result in better improvements in pain and walking when compared to using chondroitin and glucosamine supplements alone.  (Ref)  Finally, some formulations of curcumin have been specifically found to reduce the pain associated with knee arthritis.  (Ref)  (See chart below)




Recently, curcumin has also been studied as a cancer treatment.  It has been shown to inhibit a variety of pathways connected to cancer cell growth.  It may also enhance the cytotoxic effects of chemotherapy thereby enhancing its efficacy.  Much more work needs to be done but these early cancer studies have confirmed cucurmin's excellent safety profile.  I started to wonder if we should consider taking curcumin to prevent cancer.

Bloodcure's take home message for turmeric is to consider it for tendonitis and arthritis symptoms.  The data suggest the supplement is safe and it may be a natural way to treat these very common disorders.  Consider a dose of 500 mg to 1500 mg per day that contains black pepper extract.  The black pepper helps with absorption of the turmeric.

As always, check with your personal physician prior to initiating any new supplement as each of us is unique.

AM
TotalTendon

Platelet Rich Plasma beats Surgery for Tennis Elbow

Treatment of tennis elbow using platelet rich plasma (PRP) resulted in an average of 83% improvement in pain scores at one year compared to baseline in a recently published study of 110 patients by Karaduman et al.  The surgery group had 46% improvement in pain scores.   Mayo elbow scores were also higher in the PRP group.  (See graphs below)  

The study used the Biomet GPS PRP device and the Nirschl surgical technique

This is an interesting study comparing the value of PRP versus a commonly recommended surgical procedure.  The data suggest PRP is a safe and effective alternative to the much more invasive and expensive surgical procedure.

AM

@bloodcure

Total Tendon

See abstract and reference below:

Karaduman et el 2016

Abstract

Purpose

To compare short and mid-term results in the treatment of chronic elbow tendinosis with platelet-rich plasma (PRP) or Nirschl surgical technique.

Method

A retrospective study was conducted on patients with chronic lateral epicondylitis, treated by Nirschl surgical technique (50 elbows) or PRP (60 elbows). Outcome was evaluated with Visual Analog Score (VAS), Mayo Elbow Scores and grip strength measurements.

Results

VAS and Mayo Elbow Scores of the PRP group had improved as a mean of 83% (p = 0.0001), 74% (p = 0.0001) over baseline and 34.2 pounds gain of grip strength.

Conclusion

The PRP seems to be better for pain relief and functionality in the short and mid-term periods.

Keywords

• Nirschl surgical technique; 
• Platelet rich plasma (PRP); 
• Chronic elbow tendinosis

Tennis Elbow Stretches

Tennis elbow is a very common problem.  Most often it can be treated with rest, activity modification and some simple exercises.

Check out the TotalTendon Tennis Elbow Stretching Protocol.



In future posts, I will demonstrate a strengthening protocol and discuss other treatment options.

AM
TotalTendon

Why patients are seeking out platelet rich plasma and other biologic treatments.

Platelet rich plasma (PRP) and adult stem cell treatments derived from bone marrow are rapidly evolving into the mainstream of medicine.  As you can see from the chart above, the number of hits for "platelet rich plasma" is rising dramatically.  There are also over 7400 PRP references on PubMed.org.  Let's explore why.

Patients are seeking out less invasive treatments.  When presented with the option of surgery or an office procedure, patients typically will choose the office procedure.  Surgery often carries significant more risk and certainly more cost.

Patients want to return to sports, work or life as quickly as possible.
Botox and Lasik eye surgery provide patients with almost immediate improvement for wrinkles and vision.  Patients now expect other specialities to deliver similar almost instantaneous success.   Elite athletes are especially interested in returning to the highest level of function as quickly as possible.  They have been one of the primary drivers of PRP and other biologic treatments.

Patients are dissatisfied with the surgical treatments we have been offering them.
This is particularly true when it comes to knee arthritis.  Presently, there is very little definitive evidence supporting the use of many common treatments and there is a Grand Canyon size hole in our ability to effectively manage tens of millions of patients.  Biologic therapies will likely fill this void within the next five years.

Patients intuitively understand the regenerative abilities of your own blood and bone marrow.  Evidence is mounting across a several specialties supporting the use of blood and bone marrow to treat a variety of conditions.  A new study will begin this fall evaluating the utility of giving Alzheimer's patients blood transfusions from healthy volunteers under 30.  (Stanford Blood-Alzheimer's study)

Patients are willing to be treated without perfect supporting data.

Patients do not often understand the need for large clinical trials and are impatient with the time and effort it takes to generate meaningful clinical data.  The use of their own blood (PRP) or bone marrow simply make sense to them and they are willing and often eager to try a new treatment instead of undergo surgery.

We are presently scrambling to figure out how to develop, execute and pay for the clinical trials needed to best understand how to utilize biologic orthopedic therapies.  The good news is:  hundreds of clinicians, researchers and medical device professionals are working diligently on dozens of new treatment options.

Please post any comments about why you may think patients and clinicians are using PRP, stem cells or other biologic treatments.

AM   (@BloodCure on Twitter)
TotalTendon

Platelet Rich Plasma Significantly Improves Outcomes for Tennis Elbow in a 230 Patient Study

The American Journal of Sports Medicine (AJSM) has just published the largest study evaluating platelet-rich plasma.  The 230 patient study was conducted over the course of more than five years and represents the work of dozens of clinicians and researchers.  Overall, it is clear from the data that the use of PRP to treat chronic tennis elbow results in significant reductions in pain and elbow tenderness compared to an active control of needling of the elbow without PRP.  It is also safe and cost effective compared to cortisone and surgery.  This type of study is time consuming and expensive but will help guide patient and physicians decisions about how to best treat chronic tennis elbow.

Here is a lay press article on the article from Healio.

Read the full AJSM Abstract below.

AM
Total Tendon


Platelet-Rich Plasma Significantly Improves Clinical Outcomes in Patients With Chronic Tennis Elbow
A Double-Blind, Prospective, Multicenter, Controlled Trial of 230 Patients

1. Allan K. Mishra, MD*,†, 
2. Nebojsa V. Skrepnik, MD, PhD‡,
3. Scott G. Edwards, MD§, 
4. Grant L. Jones, MD‖, 
5. Steven Sampson, DO¶,
6. Doug A. Vermillion, MD#, 
7. Matthew L. Ramsey, MD**, 
8. David C. Karli, MD, MBA†† and 
9. Arthur C. Rettig, MD‡‡

1. ^†Department of Orthopedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, Menlo Park, California
2. ^‡Tucson Orthopaedic Institute, Tucson, Arizona
3. ^§Division of Hand and Elbow Surgery, Georgetown University Hospital, Washington, District of Columbia
4. ^‖Department of Orthopaedic Surgery, The Ohio State University, Columbus, Ohio
5. ^¶The Orthohealing Center and The Orthobiologic Institute, Los Angeles, California
6. ^#Orthopaedic Research Clinic, Anchorage, Alaska
7. ^**Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
8. ^††The Steadman Clinic, Vail, Colorado
9. ^‡‡Methodist Sports Medicine, Indianapolis, Indiana
10. Investigation performed at Department of Orthopaedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, Menlo Park, California

1. *Allan K. Mishra, MD, Department of Orthopedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, 1300 Crane Street, Menlo Park, CA 94025 (e-mail: am@totaltendon.com).

Abstract

Background: Elbow tenderness and pain with resisted wrist extension are common manifestations of lateral epicondylar tendinopathy, also known as tennis elbow. Previous studies have suggested platelet-rich plasma (PRP) to be a safe and effective therapy for tennis elbow.

Purpose: To evaluate the clinical value of tendon needling with PRP in patients with chronic tennis elbow compared with an active control group.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 230 patients with chronic lateral epicondylar tendinopathy were treated at 12 centers over 5 years. All patients had at least 3 months of symptoms and had failed conventional therapy. There were no differences in patients randomized to receive PRP (n = 116) or active controls (n = 114). The PRP was prepared from venous whole blood at the point of care and contained both concentrated platelets and leukocytes. After receiving a local anesthetic, all patients had their extensor tendons needled with or without PRP. Patients and investigators remained blinded to the treatment group throughout the study.

Results: Patient outcomes were followed for up to 24 weeks. At 12 weeks (n = 192), the PRP-treated patients reported an improvement of 55.1% in their pain scores compared with 47.4% in the active control group (P = .094). At 24 weeks (n = 119), the PRP-treated patients reported an improvement of 71.5% in their pain scores compared with 56.1% in the control group (P = .027). The percentage of patients reporting significant elbow tenderness at 12 weeks was 37.4% in the PRP group versus 48.4% in the control group (P = .036). At 24 weeks, 29.1% of the PRP-treated patients reported significant elbow tenderness versus 54.0% in the control group (P < .001). Success rates for patients with 24 weeks of follow-up were 83.9% in the PRP group compared with 68.3% in the control group (P= .012). No significant complications occurred in either group.

Conclusion: Treatment of chronic tennis elbow with leukocyte-enriched PRP is safe and results in clinically meaningful improvements compared with an active control group.

The Biomet Biologics GPS device was used to prepare the PRP for this study.

Platelet Rich Plasma Update, JBJS Webinar

Worldwide interest in Platelet-Rich Plasma is increasing significantly.  471 new publications have appeared on PubMed about platelet-rich plasma in just the last year, making it quite challenging to keep up with the published literature.  There has also been a dramatic rise in Google "hits" for PRP to over 1.3 million.  (See the graphs below)   New data recently accepted for publication to the American Journal of Sports Medicine confirms the value of PRP in the treatment of chronic tennis elbow.  See American College of Surgeons Report on the paper.

Tonight the Journal of Bone and Joint Surgery will be holding a webinar on the topic.  Over 1000 professionals have already signed up for the event.  This is totally unprecedented for a major, elite journal to sponsor a discussion on a single specific biologic orthopedic topic.  Follow Dr. Mishra:  @BloodCure for real time updates about tonight's webinar.

Or, consider joining the Biologic Orthopedic Society Group on LinkedIN to participate in a discussion about the webinar and other biologic orthopedic topics.

AM

TotalTendon

Platelet Rich Plasma useful for Chronic Tennis Elbow

For more than a decade now, platelet rich plasma has been used to treat chronic tennis elbow.   A recently published review article in Hand Clinics reviewed the literature for the use of PRP in the upper extremity.  It was concluded that multiple controlled trials support the use of PRP for tennis elbow.  The literature supporting the its use for rotator cuff tears, however, was not yet conclusive.  (See Abstract Below)

PRP Injection into left elbow

Hand Clin. 2012 Nov;28(4):481-91. doi: 10.1016/j.hcl.2012.08.008.

Platelet-rich plasma and the upper extremity.

Mishra A, Randelli P, Barr C, Talamonti T, Ragone V, Cabitza P.

Source

Department of Orthopaedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, 1300 Crane Street, Menlo Park, CA 94025, USA. 

Abstract

Platelet-rich plasma (PRP) is a fraction of whole blood containing powerful growth factors and cytokines. Preclinical studies suggest PRP may be useful for tendon repair or regeneration. Clinical investigations have focused on the treatment of chronic lateral epicondylar tendinopathy and rotator cuff pathology. Multiple controlled studies support the use of PRP for chronic tennis elbow. Rotator cuff studies, however, have produced conflicting results based on PRP formulation, surgical technique, and size of tendon tear. This article explores the scientific rational for using PRP, its various formulations, and the emerging clinical data. Future potential applications are also explored.

AM

Total Tendon

For more information about Platelet Rich Plasma, visit:  ApexPRP.com