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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 a bit disheartened at the condition of my right elbow. And fortunately, as was the case after that visit, I was once again heartened (reheartened?) at both my current condition and future prospects.

Despite over 16 months having elapsed since the PRP injection, I was still feeling pain after any kind of even moderate exertion, e.g., giving my wife a neck massage while sitting together on the couch. Although the pain was relatively minor, it was still recurring regularly (I like to give Amy neck massages), at a time when I had hoped that everything would finally be back to normal.

I was supposed to return to the Menlo Sports Medicine clinic for a 12-month followup visit, but due to a job change, I hadn't been in the Bay area since last January. Amy had mentioned the ongoing lack of full resolution to a local orthopedic surgeon who was treating my son's broken knee in July, who suggested we may want to consider surgery. Around that time, I had a paper accepted to the CSCW 2008 conference in San Diego (held in November), so I decided I'd stop off in San Francisco on my return to visit Dr. Mishra and see what he had to say.

After describing the persisting symptoms to Dr. Mishra, he examined my elbow, performed a few tests, and asked me where exactly the pain was located. The tests revealed that my grip strength was holding steady at 135 psi, with a pain level of [at most] 1 out of 10 (compared with a pre-injection grip strength of 65 with pain level 5), my wrist extension was a full 5 out of 5 with a pain level less than 1 (vs. pre-injection levels of 4 / 5 and a pain level of 9), and palpation - level of tenderness in my elbow - had decreased from 8 or 9 down to 1. I pointed to the the outer part of my forearm, about an inch or two below the elbow, as the area with the pain. When he asked whether there was any pain in the elbow itself, I realized that there was none (doh!).

Dr. Mishra told me that however long a joint has been in a state of injury or disrepair, it typically takes twice as long - after [successful] treatment - for it, and the surrounding area, to fully heal. This is, in part, due to atrophy in the affiliated muscles that occurs after long periods of reduced use or disuse. Given that my elbow was in a compromised state for a large portion of the nearly 3 years prior to the injection, it could take 5-6 years for the elbow - and the upper forearm - to fully return to normal :-(

Despite this rather sobering news, he told me he considered me a "poster child" for PRP treatments for the elbow. My elbow had been in the worst shape of any person he's yet treated solely with PRP; typically, he would have combined the PRP injection with surgery for someone who had suffered so long. The progress I've made thus far has been very encouraging to him, which offers further encouragement to me, and he thinks that it likely that I - or, at least, my elbow - will eventually return to normal.

We then talked about the theraband exercises he'd prescribed, I admitted I'd not been very diligent in doing them (probably around once every several weeks, rather than several times per week). I also told him that the exercises often triggered elbow pain (and pain in the upper forearm), and so he asked me to show him how I was performing them. He noted that I was going overboard in the exercises - bending at the elbow rather than the wrist, and thus placing unnecessary (and counteproductive) stress on the elbow joint. He said this was a common misapplication of the exercises, and after showing me how to do them correctly - bending slowly at the wrist - I suggested that maybe I could create and post a video of the right (and wrong) ways.

So, after some delay, I've created and posted my first public YouTube video, Elbow Exercises, post-PRP treatment:

As I note in the video narration, I'm hoping that this public posting of the video will both help others perform the exercises correctly, and provide additional motivation for me to perform them more regularly. And hopefully, sometime in the next few years, I'll be able to post yet another update, reporting that my elbow has completely healed.

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