When Is PRP a Great Option — And When Is It Not?

Platelet-Rich Plasma (PRP) injections may be the single biggest game-changing treatment I’ve seen in nearly 25 years as a Sports Medicine and Orthopedic physician. The role of PRP is constantly expanding, and the results we see today are more exciting than ever.

But like any treatment in medicine, PRP isn’t the right answer for every situation. There are times when it can be life-changing, and other times when a different approach is more effective.

Here are some common examples we see in practice:

When PRP Is a Great Option

✅ Advanced Tennis or Golfer’s Elbow

When ultrasound shows moderate to severe tendon damage and patients are experiencing significant pain and loss of function, PRP can be an excellent choice. In these cases, PRP helps heal tears that we can clearly see on imaging.

✅ Mild to Moderate Knee Osteoarthritis

This is one of PRP’s true strengths. PRP not only reduces pain and inflammation, but also helps improve function and may even slow or stop further deterioration of the joint.

✅ Partial Rotator Cuff Tears

For patients with mild pain, good strength, and preserved motion, PRP can support healing and help avoid surgery.

✅ Insertional Gluteal Tendinopathy (Often Miscalled “Hip Bursitis”)

This common condition—especially in middle-aged to older women—causes pain on the outside of the hip, difficulty sleeping on that side, and pain with stairs or longer walks. PRP is often a great option here.

✅ Chronic Plantar Fasciitis (Lasting 3+ Months)

When rest, therapy, footwear adjustments, and medications haven’t helped, PRP can provide real relief—often avoiding the need for more invasive surgery.

When PRP May Not Be the Best Choice

❌ Early/Mild Tennis or Golfer’s Elbow

If ultrasound only shows minimal tendon changes and pain is mild, conservative options like therapy, rest, bracing, and medications usually work well without the need for PRP.

❌ Severe Knee Osteoarthritis With Significant Misalignment

If the knee is badly worn down with severe pain, bowing, or disability, knee replacement is usually the best option. PRP won’t reverse severe structural damage.

❌ Full-Thickness Rotator Cuff Tears in Younger or Middle-Aged Patients

If there’s significant loss of strength and motion, surgical repair is the better route—PRP won’t replace the benefits of fixing the tendon directly.

❌ Advanced Hip Osteoarthritis

When the hip joint is severely damaged, total hip replacement remains the gold standard.

Our Approach at Impact Sports Medicine

At Impact Sports Medicine, our goal is simple: to help you get the best possible outcome—even if that means recommending a treatment we don’t provide ourselves. We want every patient to be cared for as if you were part of our own family.

PRP is a powerful tool, but like all tools, it works best when used at the right time, in the right situation. If you’re struggling with joint, tendon, or ligament pain, we’d be glad to help you figure out whether PRP—or another treatment—will get you back to doing what you love.

A New Option for Stubborn Tendon Pain: Meet TendoNova

At Impact Sports Medicine, we know how frustrating it can be when tendon pain just won’t go away. Whether it’s tennis elbow, golfer’s elbow, plantar fasciitis, Achilles tendon pain, or even rotator cuff calcific tendinopathy, these problems can linger for months—and often don’t respond well to rest, therapy, steroid injections or medications.

That’s why we’re excited to offer TendoNova, our newest in-office, minimally invasive procedure designed specifically for chronic tendon injuries.

What is TendoNova?

TendoNova is a needle-only system that requires no incision and is performed with just a small lidocaine injection for comfort. Using an oscillating needle, we carefully break up unhealthy tendon tissue under ultrasound guidance—kickstarting your body’s natural healing process.

Here’s the best part: the treatment itself takes only 20–60 seconds.

Combining TendoNova with PRP: A Powerful Duo

On its own, TendoNova stimulates healing. But when combined with platelet-rich plasma (PRP) injections—using your body’s own concentrated platelets and growth factors—the results can be even stronger.

Think of it this way:

• TendoNova = aerating your lawn (breaking up the tough, unhealthy tissue)

• PRP = planting fresh seed (delivering growth factors directly where they’re needed)

Together, they give your tendon the “best of both worlds” for long-term recovery.

Why Choose TendoNova?

• Minimally invasive – no incision, no stitches

• Quick recovery – the procedure itself is done in under a minute

• Natural healing – enhanced when paired with your own PRP

• Cutting-edge care – we’re one of the only practices in Middle Tennessee offering this option

At Impact Sports Medicine and Orthopedics, our mission is simple: to bring you safe, effective, and innovative treatments that reduce pain and help you stay active. TendoNova is just one more way we’re doing exactly that.

F. Clarke Holmes, M.D.

PRP: The Gift of Health

As we near the major holiday gift-giving season of the year, consider one the best gifts you can give to yourself: the gift of health! Platelet-Rich Plasma (PRP) injections are a great option for you in 2024 if you are looking to boost your orthopedic health and longevity. Here are 5 great adjectives that apply to PRP injections:

1) Safe: adverse effects and complications associated with PRP injections are exceedingly rare.

2) Effective: 80-90% of our patients that receive PRP injections have very good outcomes and are satisfied with their results.

3) Natural: these injections use your blood, specifically your platelets and your growth factors to exert their positive effects.

4) Proven: once considered experimental, there are now hundreds of studies that demonstrate clinical benefit with PRP injections.

5) Preventative: PRP injections are touted in their ability to prevent many degenerative joint and soft conditions from further deterioration.

Want to know more? Check out some of our blogs:

Insurance Companies Say PRP Is Experimental…We Sigh — Impact Sports Medicine & Orthopedics (impactsportsnashville.com)

Five Keys to Successful Outcomes with PRP Injections — Impact Sports Medicine & Orthopedics (impactsportsnashville.com)

PRP And The Three "Es" — Impact Sports Medicine & Orthopedics (impactsportsnashville.com)

As always, let us know if we can be of assistance to you!

F. Clarke Holmes, M.D.

TENex for TENnis Elbow

At times, tennis elbow, also known as lateral epicondylitis, can be so stubborn that an advanced procedure is needed to overcome this condition. There are two basic types of surgeries used to treat this condition. The first and by far our favorite is a percutaneous tenotomy under ultrasound guidance, commonly referred to as the Tenex procedure. The other is an open release of the tendon which involves cutting the tendon off the bone.  Let’s briefly highlight the differences between the two:

Anesthesia      

Tenex: Local-lidocaine injection only            

Open: General- patient is put to sleep

Incision Size      

Tenex: 1/4 inch                                  

Open: 1-2 inches

Trauma To Tissue

Tenex: Minimal                                  

Open: Moderate

Infection Risk  

Tenex: Minimal                                  

Open: Mild

Sutures/Stitches

Tenex: None                                        

Open: 1-2 layers required

Recovery Time    

Tenex: 2-6 months                            

Open: 4-12 months

Success Rate

Tenex: 90-95%                                    

Open: 75-90%

Are we biased towards the Tenex? You better believe it! Look at those comparisons above. In our mind, it’s an obvious choice: the Tenex procedure is the better overall option. Why do more physicians not perform the Tenex procedure? Because you are required to have proficiency in musculoskeletal ultrasound to perform this procedure. Not many physicians have taken the time and made the investment in ultrasound-guided procedures, so they tend to revert to the more traditional, sometimes higher-risk and less successful options.

We’ve performed more Tenex procedures in Middle Tennessee than any other physician. So, if you, a loved one or friend has tennis elbow, then come see us!

F. Clarke Holmes, M.D.

Frozen Shoulder: More Than Just a Winter Occurrence

We’ve talked a lot about PIO (Proactive Interventional Orthopedics) recently and this concept really applies when it comes to a frozen shoulder, also known as adhesive capsulitis. This is a condition most commonly seen in middle-aged women around the time of menopause with the average age of a frozen shoulder being 51.

It starts as shoulder pain, often unrelated to a particular injury or overuse situation, and is followed by a very stiff shoulder with loss of motion. Although a frozen shoulder can be a self-limiting condition, with our interventions, we can greatly expedite the recovery process while alleviating pain.

Other risk factors for adhesive capsulitis include thyroid disease, diabetes and recent shoulder surgery. In the early “pain” stage, it’s often difficult to determine whether a patient has a frozen shoulder, osteoarthritis, or rotator cuff and/or biceps tendon problem. An MRI can be helpful, especially to see tendon or joint pathology, but in the presence of isolated adhesive capsulitis, the MRI can be normal or near normal. The next stage is the “stiff” or “frozen” stage, highlighted by the loss of motion both actively (what the patient can do) and passively (how someone else can move the shoulder). The final stage is the “thawing” or “recovery” stage. Each stage typically last 2-6 months, and early treatment often shortens these stages.

Being proactive and interventional often means an ultrasound-guided steroid injection into the joint. Without ultrasound guidance, it is often very difficult to achieve accuracy. This tends to be a very inflammatory condition, and thus, the potent anti-inflammatory effects of the steroid can provide rapid relief of pain. Early treatment within the first few weeks or months of the onset of the shoulder pain is the optimal path to a faster and more complete recovery. After that steroid injection, a rehab program, often made much more effective by the steroid injection, is the mainstay of treatment. 20% of patients with a frozen shoulder develop the same condition on the opposite shoulder within 5 years, so if pain in the other shoulder develops, it’s wise to seek treatment early.

Check out this brief article:

Steroid injection may be the best medicine for frozen shoulder - Harvard Health

If you think you may have a frozen shoulder, let us use PIO to help you!

F. Clarke Holmes, M.D.