PRP (Platelet Rich Plasma) Ultrasound-guided injection of the Shoulder: Dr. Marc Darrow, M.D., J.D.

PRP (Platelet Rich Plasma) Ultrasound-guided injection of the Knee: Dr. Marc Darrow, M.D., J.D.

Dodgers Pitcher uses PRP Treatment

Dodgers Pitcher uses PRP Treatment

October 03, 2008
Dylan Hernandez, Times Staff Writer

CHICAGO — Takashi Saito is the Dodgers’ closer again — at least that’s what Saito said he was told by pitching coach Rick Honeycutt at the start of the National League division series.

Saito didn’t fool the Cubs in the ninth inning of Game 2, giving up two runs on two doubles and a single, but for him to pitch at all is almost a medical miracle.

“For me to be here with my teammates at this time of the year,” Saito said, “I really can only think that I had luck on my side.”

Saito credited his unlikely recovery from a partially torn ulnar collateral ligament in his elbow that he suffered in July to a cutting-edge medical procedure, which, to his knowledge, had never been tried on a major league pitcher.

To this day, team physician Dr. Neal El-Attrache can’t definitively say that injecting platelet-rich plasma into Saito’s elbow is what allowed him to avoid Tommy John surgery. ElAttrache also won’t guarantee how long the elbow will hold up or that Saito won’t have to have surgery in the future.

What matters to Saito is that he’s back.

Trainer Stan Conte said he estimated that Saito had a 20% chance of pitching again this season and told management not to count on him being back. So when ElAttrache offered using PRP as an option, Conte was open to the idea.

So was Saito, who, at 38, didn’t want to spend nine months to a year recovering from surgery.

“I was willing to do anything,” Saito said. “The only promise they made me is that it wouldn’t make it worse. That was enough for me.”

Within a week of hurting his elbow, Saito had blood drawn and spun to isolate the platelets, which clot and promote healing. The platelets, 10 times more concentrated than in normal blood, were injected into the site of the tear in the elbow. ElAttrache said he used PRP in the past to repair tendons, but never ligaments. All in all, we will devote a full article to PRP or Platelet Rich Plasma Therapy soon.

ElAttrache admitted if that Saito were 25 or 26, he would have recommend surgery.

“It was the perfect scenario with the perfect guy,” ElAttrache said. “We don’t have enough experience with this to say that we can prevent an x number of surgeries. But this is the cutting edge.”

· This article last accessed September 23, 2010
http://articles.latimes.com/2008/oct/03/sports/sp-dodfyi3

Treating Hip Pain with Platelet Rich Plasma Therapy

The platelets contain growth factors that will stimulate the immune system to bring cells to the area that will grow back new tissue, stabilize the area, and eliminate painMuch like Prolotherapy, PRP can be used anywhere in ligaments, tendons, muscles, joints from the head to the toe.I use ultrasound guidance to insure that the maximum number of platelets are delivered to the exact injury area. Ultrasound is very safe in guiding the needle to the exact area where the solution is needed.

 

A medical assistant is withdrawing blood from a patient’s arm, you can see the syring that the blood is being withdrawn into – here the blood is placed into the PRP kit and it is going to be centrafused, the platelets are going to be spun down, The platelet poor solution is removed and a small portion is mixed with the platelets to create a platelet rich plasma solution

You are looking at me injecting this patient’s hip under ultrasound guidance, you can see the needle coming into the area of the joint, I have turned on the dopler to look for blood vessels which indicates that there is a nerve nearby, that is the fermoral artery that is pulsating in red.

Ultrasound is very safe in guiding needles to the exact area the solution is needed.

In this image you can see the hip joint and the hip capsule
where you will see a needle being placed depositing solution

This patient is a 31 one year old female who has a preexisting history of juvenile rheumatoid arthritis, she has been in remission for several years but as a result she has severe osteoarthritis of both hips, what we call bone on bone arthritis, she is an excellent candidate for PRP because of her condition.

Hip pain and PRP

One of the most commonly used joints in the human body sits in the seat of your pants. The hip is a “ball and socket” joint, meaning it’s formed by the pelvic bone: acetabulum (the socket) and the end of the femur bone (the ball or head of the femur). Both bones are covered with a smooth layer of slippery cartilage.

This anatomic design allows for incredible movement, form, and function, but it also allows for wear and tear, which can result in incredible pain. Many people think that the hip bones are just those bones that jut out on either side of the body below and around the abdomen; however, the hip actually extends from your thigh and into the groin. Meaning an injury in this area can have a far-reaching affect.

Hip pain is common, and its causes are many, although not all come from the joint but can masquerade as joint pain.

Arthritis: One of the most frequent causes of hip pain is caused by loss of cartilage from wear and tear, inflammation, or injury.

Pyriformis Syndrome: This syndrome may cause pain in the buttocks, lower back, or down the leg. Your hip has some very powerful muscles. Among them is the piriformis, which is in the back of the hip and helps rotate the leg outwards. The sciatic nerve is just underneath it; in some people, the nerve is impinged under the piriformis muscle. When the muscle contracts, it acts like a pincer on the nerve, which causes the discomfort.

Lumbar Pain: Many back or spine issues can radiate to areas around the hips. Most common are herniated discs and sciatica.

Greater trochanteric Bursitis & Ischial bursitis: The hip joint and the large muscles that cover it are protected by several bursal sacs. There is also a small amount of fluid contained in the hip joint. Each bursa produces lubricating fluid and functions to reduce pressure and friction around the joint. These bursa sacs can become irritated from injury, excessive pressure, and overuse. Inflammation of a bursa is called bursitis.

Hip tendonitis or tears: Tendinitis occurs when a muscle is overused and pulls on the tendon that attaches it to the bone. In your hip, tendons perform an important role by keeping strong muscles attached to the femur (thigh bone) as your legs move. One kind of tendinitis that occurs as a result of overuse is called iliacus tendinitis or iliopsoas tendinitis. The iliac muscle, which starts at your hip bone, and the psoas muscle, which starts in your lower spine, are used when lifting the leg toward the chest to keep you stable. They come together in a tendon at the top of the femur, and that is the point where tendinitis occurs.

PRP for Tendon Treatment

PRP Stanford Football Player

Carolyn Johnson ABC News

Accessed 9/23/2010

PALO ALTO, CA (KGO) — Researchers at Stanford are working on a new treatment for damaged tendons to help them heal without surgery. And the key agent comes from the patient’s own body.

Watching James McGillicuddy fly through drills with the Stanford football team, it’s hard to imagine him on the verge of never playing again. The tendon in his right knee was literally torn from the bone.

“I couldn’t run, I was limping when I was walking. It would cramp up, felt like someone was stabbing me with a knife, it was terrible,” said McGillicuddy.

In James’ second surgery in as many years, doctors reattached the tendon. But eight months later, after countless hours of rehab, they confirmed the bad news, the tendon wasn’t healing.

That’s when James turned to a Stanford researcher, who’s experimenting with a treatment to help heal human tissue, not by using drugs, but the patient’s own blood.

Dr. Allan Mishra of Stanford’s Menlo Clinic is helping to pioneer the use of platelet rich plasma, or “PRP” to coax the body into healing.

“The easiest way to think of how PRP works is to think of cutting yourself. The platelets stop the bleeding, but then they release the growth factors that start the healing response,” said Dr. Mishra.

After drawing the patient’s own blood, Dr. Mishra places it in a centrifuge which divides the sample into three layers, leaving the platelet rich plasma in the middle, ready to be injected back into the patient’s knee or elbow at the point of the tear.

The injections raise the concentration of platelets to about five times normal.

“That’s when we put the injections, right underneath where the tendon beneath where the tendon attaches, because that’s typically where they get the problem,” said Dr. Mishra.

He says evidence suggests the platelets carry growth factor proteins, which in turn stimulate cell regeneration.

Some researchers also believe the platelets may recruit other types of cells, which can help repair the damaged tissue.

“There’s a study in Japan that shows when you inject the tendon with PRP, it helps bring circulating or bone marrow derivative cells to that area, and it’s like a signal fire to bring in reparative cells,” said Dr. Mishra.

Back on the practice field, McGillicuddy says his knee showed dramatic improvement after the PRP injections.

“I was on crutches about six weeks. Five to six days started to feel better. I was running two months later, which is pretty phenomenal,” said McGillicuddy.

So is his ability to squat close to 500 pounds. It’s evidence he believes, that his days stuck on the sidelines could soon be coming to an end.

“I can squat, power clean, run. I’ve played spring football. I’m basically 100 percent,” said McGillicuddy.

Dr. Mishra is now working with other Stanford researchers to develop clinical trials. He believes the platelet rich plasma therapy may ultimately be combined with surgery to produce the best results.

(Copyright ©2010 KGO-TV/DT. All Rights Reserved.)

PRP Therapy (Platelet-Rich Plasma)

Although PRP (Platelet-Rich Plasma) Therapy has been around since the mid-1990s many people are still unaware of this beneficial treatment.

Various fields of medicine, including dentistry, neurosurgery, wound healing, and orthopedics, have only just begun to scrape the surface of the long-term and ongoing benefits that can result from employing this valuable therapy.

What is it? A Quick Lesson on Blood
In a nutshell, a PRP injection delivers a high concentration of endogenous (your own “home-grown”) platelets to an area of injury.

To understand the therapeutic value of PRP injections, you need to have a basic understanding of the make-up of blood. Blood is composed of plasma, red blood cells, white blood cells, and platelets. It’s these platelets that are the injury’s “first-responders” and help revascularize an injured area, construct new tissue, and stop the bleeding.

Because platelets play a significant role in the healing of tissue, reintroducing a high concentration of platelets directly into the injured area may enhance the healing process.

The physiological effects include:

• Increase tissue regeneration (tendon, ligament, soft tissue)
• Decrease inflammation
• Decrease pain
• Increase collagen (base component of connective tissue)
• Increase bone density
• Increase angiogenesis (development of new blood cells)

In the world of high-stakes sports, many stars swear by it. Tiger Woods received PRP injections in his left knee following surgery, and L.A. Dodger’s pitcher, Takashi Saito was able to return to the mound for the 2008 playoffs as a result of this little-known therapy.

Studies have seconded these testimonials. A recent study published in the American Journal of Sports Medicine (2006) reviewed the effectiveness of PRP therapy in patients with chronic elbow pain. Fifteen patients were treated with PRP therapy. The results documented a 60% improvement at eight weeks, 81% at six months, and 93% at final follow-up (12-38 months). There were no side effects or complications reported.

The Trouble with Tendons
Tendon injuries often become chronic because of the poor blood supply to these areas. Athletes and active people tend to have these issues and sometimes a whole career or hobby can be ruined by this ongoing complication. A PRP injection allows a quick and focused action to the area of injury, which allows it to heal more effectively and rapidly.

The Procedure
A patient’s blood is drawn and placed in a centrifuge which separates the platelet-rich plasma from the rest of the blood. This plasma is then injected into the area of injury. It’s a quick procedure with little, if any, downtime. It’s also safe because the platelets are derived from the patient’s own blood, so there is no risk of rejection or reaction.

Not every patient is treated with PRP.
We do not treat every patient with PRP, most often, Dextrose Prolotherapy is used instead of PRP, because of the extra step in drawing your blood, the extra expense in purchasing the PRP kit, and extra time it takes to prepare the platelets. The injections are exactly the same way, but the proliferant, or solution injected is different. For many years we have had great success in healing 1000’s of patients’ and having them avoid surgery with dextrose Prolotherapy.

Your decision to have PRP should be discussed with us to determine which type of Prolotherapy, (Dextrose, platelets, or another proliferant) is best for you.

Not every doctor is proficient in PRP Therapy
Platelet Rich Plasma Therapy has become very popular. Physicians who do not do traditional Prolotherapy are now offering PRP. Unfortunately, these untrained doctors are injecting the platelets in a way that is often painful, debilitating for weeks, and can leave hematomas (collections of clotted blood) in the area injected. We believe that PRP is best delivered by a physician already experienced and well versed in Prolotherapy.

Platelet alpha granules contain potent growth factors necessary to begin tissue repair and regeneration at the wound site. Concentrated autologous platelets contain large reservoirs of growth factors that have the potential to greatly accelerate the normal healing process, naturally. The use of concentrated growth factors is considered by many to be a “new frontier” of clinical therapy

Excerpts in this article from Harvest Technologies Corp

1. Marx, R.E. , et al,“Platelet-Rich Plasma Growth Factor Enhancement for Bone Grafts”, Oral Surg Oral Med Oral Patrhol, 1998;85:638-646.

2. Antonaides, H.N., et al,“Human Platelet-Derived Growth Factor: Structure and Functions”, Federation Proceedings, 1983;42:2630-2634.

3. Pierce, G.F., et al,“PDGF-BB,TGF-ß1 and Basic FGF in Dermal Wound Healing: Neovessel and Matrix Formation and Cessation Repair”, Am J Pathology, 1992;140:1375-1388.

Problems With Your Ankle After A Sprain?

It may have never healed properly

It is estimated that 40% of all people who suffer an ankle sprain will suffer chronic pain and weakness in that ankle long-term. The reason? Your ankle never healed properly. Here is why: Our ankles are held together by ligaments and tendons, strong bands of connective tissue. Ligaments hold the ankle bones together while tendons attach the muscles to the bones.

When ankle sprains occur, the ligaments of the ankle are stretched and torn. Most commonly, ankle sprains occur when the athlete lands unevenly from a leap or jump, or has someone fall on their ankle during contact sports. Sprains can also occur when stepping into a hole or divot on a playing field or golf course. The severest of ankle sprains are the extreme or violent twist or “roll-over” of the ankle causing a hyperextended turning in or turning out of the foot. The turning out injury causes a sprain of the anterior talofibular ligament, and this is the most commonly injured part of the ankle.

When ankle sprain is suspected, the severity of the injury is then graded by a medical professional and a treatment suggested.

Grading the sprain

Grade 1 sprain:

A grade 1 sprain is the least severe of ankle sprains. The ligaments are slightly stretched with a minimum of tearing to the ligament fibers. More of a discomfort than pain is felt as the athlete can usually “walk it off.”

Grade 2 sprain:

There is stretching of the ligaments and partial tearing causing an unstable or loose joint. The condition is also referred to as ligament laxity, as the ligament, now stretched beyond its normal range has become weakened or lax, as an overstretched rubber band. There is noticeable swelling and tenderness and depending on extent of injury, instability when walking.

Grade 3 sprain:
A complete tear of the ligament causing extreme instability, swelling, and pain

Grading the treatment:
Grade 3 sprains are not the most common forms of ankle sprains and surgery may be prescribed, but this is rare since the ligament usually scars over during healing.

Is it the treatment at fault?
The “gold” standard of treatment in Grade 1 and Grade 2 sprains is RICE. Rest, ice, compression, and elevation. Recently however this therapy has been debated by some physicians because of the high incidence of chronic or recurrent ankle sprains.

Among the theories put forth questioning the RICE treatment is that it does not fully allow the ligaments to heal because it reduces and impedes inflammation that is needed to stimulate new tissue regeneration.

Creating inflammation to heal the ankle sprain
Basic medicine tells us that the body’s natural healing response is inflammation. Inflammation is the trigger for the immune system to begin the cascade of events in injury repair. When ligaments do not heal completely, they weaken and put the athlete at risk for chronic ankle sprain.

Preventing with Prolotherapy
When there is not enough inflammation to heal a ligament injury, some physicians have turned back to a new “old-fashioned,” treatment to jump start the healing processes. Prolotherapy was first introduced in the 1950′s as a means to cure chronic pain by strengthening the ligaments of weakened, loose joints by creating inflammation – not suppressing it.

Prolotherapy works by introducing a mild irritant through injection to the exact spot of the ligament damage. This irritant is usually something as benign as simple dextrose. What the dextrose does is create a small, controlled inflammation at the spot of injury accelerating healing and returning strength and resiliency to the ligament and stability to the ankle. In remittent cases, PRP (Platelet Rich Plasma) is used as a stronger proliferant.

Prolotherapy is gaining adherents among athletes because it is minimally invasive, does not require long periods of inactivity and in fact, a Prolotherapy doctor will usually recommend supervised activity or a recommend training plan to get the athlete back on the field as fast as possible.

One to six treatments is typical for the competitive athlete, spaced at weekly intervals.