It is now accepted that tennis elbow, golfers' elbow and distal biceps tendinopathy (as well as patella tendinopathy, Achilles tendinopathy..) are not inflammatory, but degenerative conditions, with aborted healing in the tendon. A historic mainstay of treatment was cortisone injections. While these masked the pain effectively for 6 weeks or so, there is good evidence that steroid injection prolongs the problem of tennis elbow and that physiotherapy, or even nothing is better beyond three months. Other studies have shown that steroid within tendons is toxic to the tendon cells. Mr Granville-Chapman does not therefore recommend cortisone injections for elbow tendinopathy.
More recent data has demonstrated a positive treatment effect of autologous blood and PRP injections. These treatments harness your own blood cells' growth factors to encourage healing of your degenerate tendon. They have been shown to be superior to cortisone injection and to physiotherapy alone.
Platelets are cells in our blood that harbour many growth factors. Platelet rich plasma (PRP) describes a layer of centrifuged blood that is rich in platelet cells. Many medical manufacturers produce kits that separate PRP from whole blood, but not all work as well as each other in tendinopathy. Mr Granville-Chapman uses either the Arthrex ACP system or the Biomet GPS system as he feels the evidence supporting their efficacy is robust.
The process is simple and well tolerated with you awake. A blood sample is taken from a vein in your arm (between 15 and 30ml) into a special syringe. The blood is then spun in a centrifuge for 5-15min (depending on which kit is being used). During this time Mr Granville-Chapman will inject a very small volume of local anaesthetic over your injection site. Once the spinning process is complete, the desired platelet-rich layer of the blood is drawn off and 2-3ml of this is injected into your affected tendon. Depending on which tendon is being treated, Mr Granville-Chapman may target your injection using an ultrasound machine. You can go home after the injection is complete.
You will need to do the eccentric strengthening and stretching physiotherapy programme and it will take up to three months for the benefits to be realised. It is important that you do not take any anti-inflammatories (Aspirin, Ibuprofen, Naproxen, Diclofenac) for 10 days before and 4 weeks after your treatment. The reason for this is that these drugs disable your platelets.
In a recent series of patients with un-resolved tennis elbow, 70% of patients who received PRP injection avoided the need for surgical intervention of their tennis elbow.
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
BMI The Princess Margaret Hospital
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