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It is released from the extracellular matrix during tissue injury specifically cleaved from SPARC (Secreted Protein Acidic and Rich in Cysteine) and the alpha 2(I) chain of type I collagen.[2] Age-related decline: Plasma concentration declines from approximately 200 ng/mL (10 M) at age 20 to roughly 80 ng/mL by age 60

In resistant cases of golfers elbow, it is important to rule out the presence of a tear within the tendon, as this might require surgical treatment and further referral to a specialist elbow surgeon