59-year-old engineering company managing director, Richard came to see Mr Ali Noorani in March 2019, presenting with tennis elbow (lateral epicondylar tendinopathy) in his left arm. Despite his managerial status, his job still required significant physical manual activity, and therefore his condition was impacting on his work life. His elbow had been hurting for over a year, but the pain had worsened in the six weeks prior to seeing Mr Noorani and he was experiencing problems with gripping or twisting.
When Richard initially came for treatment, he was concerned about putting himself into the hands of an unfamiliar medical professional, but his worries were soon allayed on meeting Mr Noorani, whose confidence and experience impressed him. Following the relevant scans and examination of his elbow, it was agreed that Richard would begin a programme of rehabilitation with a local osteopath and also consider undergoing a course of injections of PRP (Platelet Rich Plasma) to promote healing.
Once agreed, the course of three PRP injections was administered over June and July with ultrasound scans taken simultaneously on each occasion to monitor the extent of his injury and the condition of the underlying ligament.
In October, Richard saw Mr Noorani again regarding his ongoing left elbow problems and raised concerns over pain in his left shoulder too. On examination, Mr Noorani diagnosed the shoulder pain as an impingement and, having informed Richard of the risks and benefits, injected his left shoulder with steroids to manage his symptoms.
From the outset, Richard was impressed by Mr Noorani’s conviction that they would be able to find a solution for his problems, even when the condition of his left shoulder unexpectedly became an issue.
Richard’s left arm and shoulder are now pain-free, and he is expecting further improvement in their condition to result from his programme of exercises. As it is still early days in terms of the PRP treatment, which can take up to a year to be fully effective, Mr Noorani is confident that with time and exercise, Richard’s tennis elbow will heal completely, particularly as there is no ligament damage, saying that “with time and rehabilitation, the effects of PRP will resolve the symptoms.” Regarding Richard’s shoulder impingement, at their latest appointment, his shoulder was injected with both steroids and local anaesthetic to bring long-term relief for the pain and inflammation.
Richard concludes: “Mr Noorani has shown nothing but concern, care and attention towards me, which has proved his original comment that ‘we can sort it’ to be true, because he has.”
Mr Noorani explains: “Richard was an interesting case, his elbow had classic tennis elbow and we know that some activity with modification with rehab is the best way forward and then in addition, PRP can be useful. There is an algorithm on how best to manage this and in this case considering the ligaments were intact, PRP is as good as surgery according to all the research, with no risks associated with surgery. What is interesting is how long PRP takes to work. In some cases there is a quick response, but in most cases it takes 3 to 6 months and it was clear that when Richard had seen me 6 to 8 weeks down the line he was still sore, which is completely to be expected. However at the six-month appointment he was completely pain-free after being in pain for many years. Most studies show that PRP takes time to start working because of it induces a healing response which, unlike steroids, gives a more permanent solution. As far as Richard’s shoulder is concerned, the problem here was slightly different. Here he had more of a mechanical impingement with acute inflammation, and steroids are still safe to inject in a large subacromial bursa as long as they’re not repeated too often.”