الفهرس 
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Abstract
Tennis elbow (lateral epicondylitis) is a common problem that causes many symptoms such as pain in lateral aspect of the elbow, restriction of movement and impaired activities of daily life. There are a lot of theories that explain the causes of that symptoms such as the Tendinogenic theory which relate the symptoms to degen-eration of the origin of the extensor carpi radialis brevis, the articular theory which relate the symptoms to irritation of synovial membrane secondary to weakened fibers of common tendon due to trauma, stress or aging process, bursitis, traumatic periostitis and chondromalacia of the capitulum lastly the neurogenic theory which suggests an association between tennis elbow and entrapment of the posterior interosseous nerve by a fibrous arch in the superficial head of the supinator muscle (the arcade of Frohse) and the anterior aspect of the deep aponeurosis of the extensor carpi radialis brevis.
Many modalities of treatment were prescribed to relieve the symptoms such as rest, nonsteroidal anti-inflammatory drugs (NSAIDs), bracing, physical therapy and corticosteroid injection. Newer treatment modalities have been tried, such as extracor-poreal shock wave treatment, iontophoresis, and injection of botulism toxin.
In case of lack of response to conservative treatment, the last resort is surgery with the primary objective of relieving pain. One novel treatment strategy is the use of local injection of platelet rich plasma.
Preparation of platelet-rich plasma involves centrifugation of autologous blood to separate and concentrate platelets. The platelet- rich plasma fraction may then be activated prior to injection by addition of excess calcium to saturate all platelet recep-tors. Alternatively, the platelet-rich plasma fraction may be naturally activated after injection when coming in contact with local tissues
These activated platelets then secrete a variety of growth factors and other sig-naling molecules, including leukocyte-derived catabolic cytokines and fibrinogen, which collectively influence the tissue- healing processes.
In the present study 50 patient with lateral epicondylitis were considered to be injected locally by platelets rich plasma (PRP. The youngest was 25 years old, and the oldest was 58 years old with average of (40 years). The dominant side was affected in 40 patients (30) right side and (10) left side) and only ten patient had tennis elbow in the non- dominant side (10 patients in the left side).
Patients were categorized into two groups according to number of local injec-tions:
• group A: included 38 cases (76 %) who received only a single injection of PRP.
• group B: included 12 cases (24%) who received double injection of PRP, those who showed minimal improvement in their pain 4 weeks after first in-jection with, so they received the second injection one month after the first one.
Patients were evaluated pre and post injection clinically. visual analogue scale of pain (VAS) and Modified Mayo clinic score of the elbow (MEPS) were also evalu-ated pre and post injection at one, two and six months.
All patients were successfully followed up for 6 months. At the end of follow up period, all patients in group A had satisfactory results (16 patients with excellent results & 22 patient with good results). In group B, 8 patients ended with satisfactory results (4 patients with excellent results & four patients with good results), 4 patients ended with un-satisfactory results (two patients with a fair result and the others with a poor result). So, the final end results were satisfactory in 46 patients out of 50 and only four patients ended by unsatisfactory results.