By Dennis O. Sagini, MD
In the evolving landscape of regenerative medicine, platelet-rich plasma (PRP) has emerged as one of the most widely studied and clinically applied biologic therapies for musculoskeletal conditions. PRP is an autologous blood product derived from a patient’s own blood, concentrated to contain a significantly higher platelet count than baseline levels. These platelets are rich in growth factors—including platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF), and insulin-like growth factor (IGF)—that play essential roles in tissue repair and regeneration. For patients suffering from tendinitis, ligament injuries, and early arthritis of the upper extremity, PRP therapy offers a minimally invasive treatment option that harnesses the body’s own healing mechanisms.
How PRP Works
The preparation of PRP begins with a simple blood draw, typically between 15 and 60 milliliters depending on the system used. The blood is then processed through centrifugation, which separates the components and concentrates the platelets into a small volume of plasma. The resulting PRP preparation can contain three to seven times the normal concentration of platelets. Once prepared, the PRP is injected directly into the site of injury under ultrasound guidance to ensure precise placement. Upon activation, the concentrated platelets release their growth factors, initiating and accelerating the cascade of tissue healing, reducing inflammation, and promoting the formation of new collagen and blood vessels.
PRP for Upper Extremity Tendinitis
Tendinitis and tendinopathy are among the most common indications for PRP in the upper extremity. Conditions such as lateral epicondylitis (tennis elbow), medial epicondylitis (golfer’s elbow), and rotator cuff tendinitis often become chronic and resistant to conventional treatments like rest, physical therapy, and corticosteroid injections. PRP has shown particular promise in lateral epicondylitis, where multiple randomized controlled trials have demonstrated superior outcomes compared to corticosteroid injections at follow-up periods beyond three months. While corticosteroids may provide rapid short-term relief, PRP addresses the underlying degenerative process by stimulating tendon repair at the cellular level. For rotator cuff tendinopathy, PRP injections have been associated with improvements in pain and functional scores, and some evidence suggests that PRP may also enhance healing when used as an adjunct during surgical rotator cuff repair.
PRP for Ligament Injuries
Ligament injuries of the upper extremity, including ulnar collateral ligament (UCL) sprains in overhead athletes, scapholunate ligament injuries of the wrist, and acromioclavicular joint sprains, represent another area where PRP is gaining traction. Ligaments have an inherently limited blood supply, which contributes to slow and often incomplete healing. By delivering a concentrated dose of growth factors directly to the injured ligament, PRP can enhance the local biological environment and promote more robust tissue repair. In the case of UCL injuries in throwing athletes, PRP injections combined with structured rehabilitation programs have allowed some patients to return to sport without surgical reconstruction. Although the evidence for ligament applications is still growing, early clinical results and case series support PRP as a reasonable non-operative treatment strategy for partial ligament tears and sprains.
PRP for Early Upper Extremity Arthritis
Early osteoarthritis of the shoulder, elbow, and hand joints is an increasingly recognized application for PRP therapy. In joints affected by mild to moderate cartilage loss, PRP injections have demonstrated anti-inflammatory effects and the potential to slow cartilage degradation. The growth factors released by platelets can modulate the inflammatory environment within the joint, reduce the production of destructive enzymes, and support the activity of chondrocytes—the cells responsible for maintaining cartilage health. For glenohumeral arthritis, basal joint arthritis of the thumb, and early degenerative changes in the elbow, PRP offers an alternative for patients seeking to delay or avoid joint replacement surgery. Studies in knee osteoarthritis have provided the strongest evidence base, and emerging data suggest similar benefits can be expected in upper extremity joints.
Looking Ahead
While PRP therapy holds significant promise, it is important to acknowledge that not all PRP preparations are identical. Variations in platelet concentration, leukocyte content, and activation methods can influence clinical outcomes, and standardization across protocols remains an ongoing challenge.
Patients should seek evaluation from a qualified physician who can determine whether PRP is appropriate for their specific condition and severity. As research continues to refine preparation techniques and identify the patients most likely to benefit, PRP is poised to play an increasingly important role in the non-surgical management of upper extremity tendinitis, ligament injuries, and early arthritis—offering patients a safe, biologically driven path toward healing and restored function.
Dennis O. Sagini, MD
Dr. Sagini is an orthopedic surgeon with specialization in hand and upper extremity surgery. He specializes in arthritis of the hand, nerve compression, muscle and tendon injury, fracture care, and upper extremity dysfunction.
He completed his Bachelors of Science in Microbiology from the University of Oklahoma in Norman, Oklahoma in 1998 and his Doctor of Medicine at Temple University in Philadelphia, PA in 2002. It was during medical school training that Dr. Sagini developed an interest in orthopaedic surgery. His residency in orthopaedic surgery was completed at Howard University Hospital, Washington, DC. Dr. Sagini completed his fellowship training in Hand and Upper Extremity surgery at the University of Pittsburgh Medical Center in Pittsburgh, PA.
Dr. Sagini is a member of the American Academy of Orthopaedic Surgeons, the American Medical Association, the Florida Medical Association, and the American Society for Surgery of the Hand.
Dr. Sagini is active in research and community service and has a passion for overseas medical mission work. He also enjoys running, traveling, listening to music, cooking, tennis, and spending time with his family and friends.
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