Say the examination points somewhere we can help. Here's what the rest of it looks like:
The first move is not an injection. Instead, it’s working out where this came from. If the cause turns out to be one exercise being done wrong, and correcting it settles the elbow down, that’s the full treatment, and there’s nothing else to do. Where we can identify the aggravating activity but modifying it is not enough on its own, counterforce bracing and occupational or physical therapy come next.

When that still isn't enough, it's time to talk about treating the tendon directly. There are two ways we do that here. Sometimes we use one, sometimes both, and the scan is what decides.

 

The first is PRP. For an elbow that needs an injection, that's the bread and butter here. PRP deserves an honest description, because it asks more of you than the phrase “an injection” suggests. Your body is the pharmacy. The material comes from you, so if you have health conditions that aren't controlled, the preparation you produce won't be as good, and neither will the result. It involves a needle, and any time a needle goes anywhere, something can go wrong, even when everything is done correctly. And the injection into the tendon for tennis elbow is genuinely painful. We numb the area and can perform a nerve block, but this is not a pain-free procedure, and it would be dishonest to describe it as one.

When it works, people tend to report pain relief within days to weeks, and function returning over weeks to a few months. As a rule of thumb, 80 percent of the final outcome from a PRP injection is known by the three-month mark. That’s roughly how long the healing, regeneration, and tissue remodelling take.

The second is percutaneous needle tenotomy. Instead of delivering something into the tendon, it uses ultrasound to guide a fine needle into the degenerated part of it and break that tissue up directly. It's done here, in the office, under local anesthetic. Like PRP, it attempts to harness the body’s innate healing capacity by debriding the damaged area and giving the healing response a second chance to get the job done.

PRP and needle tenotomy can also  be combined, and the clearest case for it is a calcification in the tendon. If a calcification is extensive enough to be part of what's driving the pain, PRP alone won't clear it, no matter how good the PRP is. In this case, the needle goes first to break up the calcification, and the PRP follows.

Either way, recovery takes a while, and it has to be paired with physical or occupational therapy. That part is not optional. Tendons respond to load. Therapy loads the tendon in a controlled way that will not undo what the injection did, while giving the tissue the signal it needs to heal in the right direction. Without it, you will not get the result you came for.

Where this is unlikely to help: an elbow attached to a body that is not currently in a position to heal. The clearest example from this practice was a patient with badly uncontrolled diabetes, in enough misery that she wanted to go ahead regardless. It did not work, and for a few weeks afterwards she was worse off than before we started. Your body is the pharmacy, and hers was not in a state to supply what the treatment needed. The right sequence in that situation is to get the underlying condition under control first, and then try. That’s not a referral somewhere else: OASIS runs its own GLP-1 program, and where getting the metabolic picture under control is what stands between you and a result worth having, it becomes part of the same plan, with the same physician. Uncontrolled diabetes, an untreated thyroid or inflammatory condition, and smoking all narrow what is possible, and none of that is unique to regenerative medicine. The same factors limit how well anyone does after surgery.

Learn more about PRP and tenotomy.