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Kia ora Joe,
Glad to read the elbow has improved and will continue to do so. I remember dislocating my elbow at Ripon College and the pt I had to endure was both boring and painful but I stuck it out, even to this day it causes me some problems so i may get one of those therabands and give it a go.
On another note just said farewell to Jeff, who should be back in wintry Madison by now. We spent 5 days in the mountains playing and roaming around a bit. So great to reconnect in that sort of environment. We thought of you. You mentioned your camping trip with him as being an adventure but I also recall you, Jeff, and I doing a canoe trip down the Wisconsin river for a few days which was pretty cool. Check out the blog for a few photos and thoughts. My best New Years wishes to you and your family. Rangimarie.
Noho ora mai ra e hoa,


Thank you for creating this blog. I have been recommended to try PRP and just needed excactly something like this, to make a descision Thank you Reini


Just stumbled upon your blog...I just had elbow prp 2 days ago. Had a much different experience than you did. Had the most excrutiating pain during and post injection, that I nearly passed out. Felt like someone hit my elbow and wrist with a sledgehammer. Had to stay at the hospital and have a hypo of morphine. Have had to rely on vicodin for 2 more days and I'm no baby...I'd rather have had my appendix, gallbladder and tonsils all out at the same time, than have another of these injections! I was so excited to try this therapy and still remain very hopeful after suffering for 7 years now. I was my surgeons first patient for this therapy and I trust him thoroughly, to be his first patient. I just wonder what type of experience others are having and whether it's typical to be nearly pain free during the injection, like you were, or to be wracked with unbearable pain, like me. Also, it's hard to find any real information about what the risks are, on the internet or with local doctors. You mention that you were told not to fly during the first week, due to risk of blood clots? I was not told of any risks. If you feel inclined to answer by question about what the risks are, that would be great. Interesting side note, my brother and his family live in Woodinville...originally from North Dakota, where I still live. Thank you for your blog. Wish I had found it before the treatment, but nonetheless, it's been very helpful to me. Thanks!

Joe McCarthy

LaRayne: I just reread the 1-week "progress report" post on my PRP treatment that I wrote almost 3 years ago, and it appears that I had some pain during the first day or two following the injection, but nothing like the level that you describe. I did not experience any significant pain during the injection itself.

I don't know much about others' experiences, but Dr. Mishra, who treated my elbow, has established an online information network and support group for those interested or involved in PRP treatment, the Total Tendon Network, that might offer a broader range of experiences.

I remember that at the time, Dr. Mishra said that there were a few variables in the experimental treatment whose values were not widely agreed to yet, so there was considerable variation in the injections given by different doctors and in the overall treatment procedures. I don't know whether things have become more standardized since then, but you may want to get more details about your own treatment, e.g., volume of platelets, injection target site (muscle, tissue, etc.) ... and actual site.

I believe that the recommendation not to fly was based on the potential risk of clotting, but I cannot say for sure.

As for other risks, it seems to me that the primary risk was that the PRP treatment [alone] might not work, and so there could be further delay in the recovery of full, pain-free functioning of my elbow. At the time, Dr. Mishra says that my condition was the worst he had yet treated with PRP, and I was right on the border of where he would normally recommend surgery or PRP + surgery. I tend to prefer non-invasive treatments - as does Dr. Mishra - and so we decided that we would try PRP alone, and if that did not work, we could followup with surgery, likely accompanied with a second PRP injection. Fortunately, the first treatment worked.

Best wishes for similar success with your treatment!


Thanks for the quick response! I'll definately check out the Total Tendon Network and see if I can learn more there. It was great finding such a detailed personal accounting of the process from someone who actually went through it. Thanks for sharing!

D Kent

I had PRP done a little over two weeks ago. My doc used an ultrasound and found tears and holes in my elbow. They first did a fat graft, taking some fat from my love-handle area of my side and then injected that fat into the holes. After that, they injected the PRP. The pain was excruciating during the procedure. I felt very sick and I'm sure would have passed out if the doc had not stopped for a while.

I lift weights and I'm a competitive handgun shooters. For several years I would get tennis elbow but I would use one of those tennis-elbow bands and that would normally prevent the pain from getting worse. This year the band didn't work and the pain increased. The pain got so bad that I could not shake hands, hold my gun during competition without pain, or lift any weight. It even hurt when picking up a glass of water.

Currently I don't feel much pain if I keep my arm close to my body. However, if I extend my arm out, like I do when I shoot my handgun, it hurts like hell...especially when trying to grip something.

My insurance didn't pay for any of this since they consider it to still be experimental and because they don't have a procedure code assigned to it. So I paid about $1000 out of my own pocket. My doc said it might take 2 or 3 sessions...I sure hope not since I couldn't even afford one session (I put it on the credit card).

I'm currently sitting at home when I could be out shooting or lifting weights. Not being able to do the things I love is really disheartening.

Thanks for your blog. Hope we all get better!

Joe McCarthy

@D Kent: For me, the daily / recurring pain prior to my treatment was associated with lifting my 22-ounce mug of coffee rather than a handgun (or a glass of water).

FWIW, one of the people who posted a comment on my initial post on mending tendinitis with platelet rich plasma suggested that medical code 20551 might be used to seek insurance reimbursement for the procedure. I posted a followup comment on that post containing some additional information I found about that code.

Your comment reminds me that I'd meant to post a new update at the 36-month (3 year) mark) this past July, so perhaps I'll post one at the 40-month mark. I guess I don't even think about my elbow anymore, except when someone comments on one of my elbow PRP posts, which is a good sign.

I hope you also reach a stage in the not-too-distant future where you no longer think about your elbow!


Hi again Joe...thought I'd post my own update since my injection July 8th, 2010...four months out, I am now where you are, completely forgetting that I ever had a problem with my elbow! I'll be doing quite physical work and it will just hit me, like, "Wow, I have no elbow pain". It's been just awesome, after suffering for so long. All the pain of the initial injection was well worth it. I would do it again in a heartbeat. Continued success and healing to everyone.

Joe McCarthy

@LaRayne: I'm glad to read that you have experienced such success with the PRP injection, and in such a relatively short period of time. Thanks for taking the time to loop back with an update, and I hope your elbow remains free and clear of pain.


I hope you, and all the people commenting here are doing well. I am scheduled to undergo the same procedure in couple weeks and I am getting a little nervous reading about the pain that most of you have suffered during and after the injection ( I'm no baby either). My question is for all of you and specially Joe and LaRayne, did the doctor use ultrasound to guide the needle and did he give you a local anesthesia before the actual injection and if he did, which one hurt more?
I am actually kind of familiar with the pain, but I wander if I'll be able to withstand the injection. Back in May I went to a different doctor and he gave me cortisone shot (big mistake). The actual injection was OK - unpleasant but not extremely painful. Couple days after that I was in probably 5-6 level of pain and then nothing for 4 months. After that the pain gradually become so bad that one night I had to go to the ER because I couldn't stand it. Now I'm kind of OK and waiting for the PRP.
Please if you can, answer the question above and please share if you had similar experience with cortisone shots.

Thank you!

Joe McCarthy

Theo: here is what I wrote in an earlier blog post, a progress report on my platelet rich plasma treatment (week 1):

The treatment itself was relatively painless - I felt a little burning when the local anaesthetic (Lidocaine) was injected, and a little pressure when the PRP was injected, but that was all. The main problem I had was that I often get lightheaded whenever a needle pierces my skin - I'm not conscious of any fear, but it happens every time - so I had to lie down for the procedure.

In my update one month after my elbow PRP treatment, I wrote a bit about Cortisone:

Mark sent me a note detailing extensive experiences with various treatments that included an overuse of Cortisone; he now urges people to avoid the use of Cortisone. Fortunately, the doctor's I've seen about my elbow problems over the years have all been averse to using Cortisone, but I did have two Cortisone injections, and one of them was effective (for a while). I wanted to pass along Mark's (and my doctors') recommendations to avoid using Cortisone, as it is a complicating factor in the potential efficacy of PRP.

Everything I've since heard or read suggests that Cortisone should be avoided, as it has a deleterious effect on the tissue into which it's injected (I still have a "flat spot" on my elbow at the site of the previous Cortisone injections). That said, I don't recall my pain getting substantially worse after the second Cortisone injection (or at least not in any way that led me to suspect it was due to the Cortisone). I wonder if the increased pain you experienced was due to other factors that might have been stressing your elbow.

In any case, I wish you all the best on your treatment and recovery!


Thanks for the answers. I suspect after the cortisone you started back with the anti-inflammatory meds? I think my pain got so bad because after I read that those meds have similar negative effects as the cortisone, I refused to take them.
One last question - did the doctor use an ultrasound to guide the needle?

Joe McCarthy

Theo: I don't recall ultrasound being used to guide the PRP injection or at any point during my treatment by Dr. Mishra. It was used for physical therapy during my two earlier treatments. Regarding anti-inflammatory meds, I took Celebrex during those first two treatments (which both included Coritisone), but after reports of Vioxx complications surfaced in 2004, I shifted to Ibuprofen for periodic pain relief.


Hello Theo....for my injection, ultrasound was not used to guide the needle. I was my surgeons first patient for this procedure, but I trusted him fully, since he had given me 4-5 cortisone injections through the years, in that elbow.

The cortisone injections were very tolerable. But, the PRP injection was the worst pain I have ever had. And, it did not subside after taking the needle out. It felt like he had broken my arm. I layed on a gurney for 10 minutes to see if it would subside and finally took a shot or morphine as the doctor had suggested. I was finally comfortable enough to go home about an hour later. My doctor commented that for his future patients, he was going to offer the narcotic BEFORE the injection.

Although it was so painful, it was worth it, because after suffering for so many years, not being able to garden, shovel snow or other activities without causing the elbow to was worth all the pain of the injection.

Also, I do not recall getting a shot of novocaine first, before the PRP injection and I did think that was weird. I think that's why my injection was so incredibly painful.

This same doctor gave me bi-lateral knee injections of Synvisc earlier this year and those injections were preceded by novocaine injections which were VERY painful. Then, when he went on to inject the Synvisc, all I felt was pressure. Although the novocaine in the knees was very painful, it was nowhere near as painsful as the PRP in my elbow.

After reading a lot of personal stories about PRP it seems that these injections are only mildly discomforting to most patients, but excrutiating for others. Guess I was just one of the "lucky" ones.

You've probably had your PRP by the time I post this, so I'd be curious how your procedure went!?

Hope it went well!


Thanks LaRayne,

The procedure is scheduled for this Wednesday. I will definitely post my experience when able to type again. According to my doctor, he has done around 200 PRPs and he uses ultrasound and gives Novocain, so I hope it won’t be that painful. I suspect your doctor hit a nerve (apparently there are plenty nerves passing and ending around the elbow), hence the excruciating pain – imagine a root canal without plenty of Novocain. The good news for you is that your pain free. How long did it take to recover and go back to normal functioning?
Same question goes to Kent, how are you feeling after your November procedure? I guess is a little too early, but it will be great if you share your experience.

Thank you all.


Theo---to answer your question about how long it took to recover and go back to normal functioning...I had moderate to severe pain for about 2 days. I took Vicoden. After that, the pain improved day by day for about a week or so. Then,for about 5 weeks it seemed that I would never improve, as the pain stayed relatively the same. I wasn't even back to pre-injection pain levels. It was a little discouraging and left me wondering if the injection actually worked. The pain gradually reduced after that, over the course of the next 2 months, until it just kind of hit me one day, doing some physical work, that I no longer had pain.

I babied my elbow for about a month, but after that I just kept using it, testing it, to see how much I could do. My elbow told me how much I could do and I would stop short of re-injury. If what I was doing re-produced mild pain, I would stop whatever I was doing.

Prior to injection, it was impossible for me to even lift a coffee cup with my right arm or comb my hair. Now, about the only thing that causes me pain is snow shoveling, so I have to be really careful about that. I have had a couple of episodes of pain for 2-3 days after over-exerting recently, but thankfully the elbow returns to normal more quickly than prior to the injection. Think I'll always have to be a bit cautious with it. Hope your procedure went well and you enjoy the holiday!


Hello all.

Joe asked me to post an update and said Theo had a question for me?? I assume it's the question regarding the ultrasound? Anyway, I'll answer a few of the questions I saw above.

My doctor first injected some kind of local anesthetic first. She also used something extremely cold on the surface (I imagine it was liquid nitrogen).

Regarding the ultrasound, yes my doc use the ultrasound to guide the needle.

For me, the needle from the fat graft hurt the worse. However, I had the advertised adrenalin/endorphin/whatever-they-call-it rush going (thanks to the two fat graft injections) when she inserted the PRP needle.

I have a friend who had the PRP injections done in her leg and she told me she passed out from the pain.

I think the worse the injury, the worse the pain will be from the injection...after all, they are sticking a needle directly into the injured area.

Chances are it's going to hurt like a !#!#$@#....just be aware of it but don't dwell on it. The biggest, most helpful, thing you can do is the BREATHE before and during the injection. It's natural for the body to clench up...that's what I did...and that will cause you to pass out or feel like you're going to pass out. Take deep breaths!

As far as my update:
I'm about 8 weeks out from my PRP injection. The PRP provided some relief of the pain in my forearm, but I still have a lot of pain in my elbow. Due to this I went to see a orthepedic sports doc and was referred to Dr. George Paletta (who is famous for being the StLouis Cardinals and StL Rams surgeon). Doc Paletta thought that I did the right thing by trying PRP first, however, since I didn't see at least a 60% improvement, he thought surgery was the way to go. At one point he asked me if I had tingling in my hands (which I said yes I have had tingling in my pinky, ring finger, palm, and thumb) so he scheduled a nerve conductivity test. It appears the thinking was that the elbow injury could have been pushing on the nerves, causing the tingling.

I got the results of the nerve conductivity test two days ago and it turns out that my elbow injury is NOT causing the tingling, however, it is a separate problem related to deterioration of the sheath around my nerve (I think the ulner nerve). He called it "cubital tunnel". He also said I had mild carpal tunnel.

So here's the deal...I'm schedule for surgery this coming Monday (3 days from now). They are going to open up my elbow and supposedly clean out the damaged tendon tissue in my elbow and do something else with the tendon. While they are in there, they are going to relocate my ulner nerve. There was some discussion about splitting my muscle and tucking the nerve in there or something....It's really hard to follow the discussion when they are throwing out words like demylinating, ulner nerve transposition, cubital tunnel, carpal tunnel...etc, etc.

So that's it dudes. Having surgery on Monday (my Christmas present to myself), will be in a sling for a while, then be healing and physical therapy for 3 months. Hopefully I will be good to go by spring.

Joe McCarthy

@Darren: thanks for the update, and best wishes for the surgery tomorrow. I know that when Dr. Mishra was talking about the prospect of surgery for me - which was a strong probability in my case at the outset - he'd mentioned the idea of giving a second PRP injection along with the surgery. I don't know if that's an option - or advisable - for you (or others), but I wanted to at least mention it.

@LaRayne: thank you for the update, too. It sounds like your experience is similar to mine, and I hope that your recovery continues to go well.

@theo: I hope your procedure went well and that you, too, will experience a good recovery.

Eric S

This is all of interest to me, as a person who is considering PRP for chronic lateral epicondIlytis. I am afraid of surgery, because I had it almost two years ago on the medial side, and never fully recovered. The elbow is still stiff, too.

I have tried four sessions of Prolotherapy over the past five months on the lateral epcondiliytis. It really hasn't seemed to help. The Doc said that if there was no progress after four sessions, we should try PRP, that's why I'm considering it some time in the next month.

A few questions

1. Has anyone heard of and/or done this? PRP after a few prolotherapy sessions that weren't working (or were working too slowly). If so, did the PRP actually make a better (or worse) impact than the prolotherapy?

2. Those of you who've had success, did you also suffer from elbow stiffness in addition to pain prior the PRP; and, did the PRP help alleviate any of the stiffness, in addition to the pain? And yes, I have been doing PT to try tackling the stiffness....

Thanks for any info,

Joe McCarthy

@Eric: I have no experience nor knowledge about PRP treatment following [other] prolotherapy treatment. My understanding is that PRP is a type or subclass of a prolotherapy treatment, but I am not an expert.

I do not recall any elbow stiffness - and in reviewing my very first post on mending tendonitis via platelet rich plasma, I do not see any mention of stiffness - so I can't offer much help on that (either).

I don't know whether or how often some of the other people who have undergone PRP treatment and posted helpful comments here check this or other PRP-related posts on my blog, but you may want to join Dr. Mishra's online support group for PRP, Total Tendon Network as another channel for seeking answers to your questions.

Best wishes for successful treatment and recovery!


Hello everybody, finally I have some time to share my experience. It has been a little over a month after the PRP injection for me.
The procedure was almost pain free. The drawing of the blood was actually more painful since the assistant could not get the blood vessel. The doctor – Kenneth Mautner at Emory Orthopedics used the ultrasound guidance and mixed the plasma with the anesthesia prior to the injection, so there was no separate anesthesia.
Now I’m doing PT and some exercises at home. So far though, I don’t have any significant relief. I hope it will come eventually, but for some reason, I don’t have too much hope. So this is pretty much it, if you have any questions, shoot.
To Eric: I haven’t done the Prolotherapy.

Joe McCarthy

Theo: thanks for the update. I just re-read the post I wrote about an update on my elbow one month after PRP treatment, where I noted that my elbow was feeling like it felt before treatment (though not as bad as during the first few weeks after treatment). It also appears that I was not following the doctor's instructions for optimal rehabilitation at that time.

I also re-read some potentially helpful - and hopeful - insights shared by Dr. Mishra at that time:

Dr. Mishra said it is not at all uncommon for the condition of a PRP-treated elbow to be at the same level - or even slightly worse - at the one-month mark after treatment as it was prior to treatment.

So I hope that your recovery trajectory is similar to mine, i.e., little/no improvement at the one month mark followed by gradual improvement thereafter, and eventually (possibly as long as a few years) resulting in full recovery and no pain.

Dr. K-Orthopedic Surgeon

A very helpful article indeed! Nice work Joe!

Hope that elbow is coming along and hope you'll be back on your way to recovery.

That exercise is actually going to help you rehabilitate your elbow muscles, yes indeed!

S Dingley

I find this article very helpful in my similar experience. I have had tendinitis (Lateral Epicondylitis) for over 15 years. During this time, I have resorted to therapy, NSAID pain relief, and one cortisone shot. I have been experiencing a serious flare up that has lasted for about a year now. I aggravate my condition with computer work, and also years of cake baking/decorating and calligraphy. I went to one orthopedic who did an MRI and found a couple of tears in the ligament/tendons in my elbow and wanted to do surgery right away. After a second opinion with another orthopedic surgeon, he sent me for 4 weeks of therapy to see if there is any improvement, at this time I am in week 3 and the pain and restricted movement shows little change. I am still only at about 48psi of grip strength. He wants to try the PRP therapy but I am a bit anxious about the cost and the "iffy" result prognosis... My only other option is surgery to repair the tears, which will leave me somewhat incapacitated for several weeks. But the more I read about PRP therapy, it seems I will still be on restricted use, and there's really no promise that it will make me feel any better... After fighting this pain on and off for 15 years, I wonder if surgery at this point would be a better option???
Thank you again for sharing your experience!

Joe McCarthy

@S Dingley: I, too, was initially concerned about the financial costs of the treatment, but I'm not aware of any significant physiological costs or risks associated with the procedure. My understanding was that the worst result - with respect to my elbow (vs. wallet) - was that it might further delay the resolution that might be achievable via surgery.

As I mentioned in at least one of my PRP-related posts, Dr. Mishra considered me a borderline case, and had anticipated that I might eventually need surgery even with the PRP treatment. I'm glad that I tried PRP before trying surgery, as it seems to have done the trick for me.

I cannot predict whether or how it might work for you, but please feel free to review my other posts to see if any of the comments posted by others might further inform your decision. I know that someone once posted a comment to share a diagnostic code that might make PRP treatment eligible for insurance coverage in certain contexts (may vary based on state, insurance company, etc.).

Best wishes with whatever course of treatment you embark on!

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