Sprains, Strains and Muscular Gains - Get Relief with Platelet Rich Plasma Therapy
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Transcript of Sprains, Strains and Muscular Gains - Get Relief with Platelet Rich Plasma Therapy
Advances in the Treatment of Tendon InjuriesRishi Sharma, MD, Sports Medicine
www.SpringfieldClinic.comwww.SpringfieldClinic.com
Common Tendon Problems
• Shoulder
• Elbow
• Wrist
• Hip
• Knee
• Ankle & Foot
Tendon: What is it?
• Fibrous connective tissue that connects muscle to bone
Tendon: What is the function?
• Acts as a spring to collect and release force
Common Names for Tendinopathy
• Tendonitis
• Peritendonitis
• Tendinopathy
• Tenosynovitis
• Apophysitis
• Insertitis
• Bursitis
• Enthesopathy
How is it injured?
• Tendinopathy– Degeneration of
the tendon
• Tendinitis– Overuse
• Tendon Tears– Injury
Microscopic Tendon
RUPTURED TENDON
ACHILLES TENDINOPATHY
NORMAL TENDON
ROTATOR CUFF TENDINOPATHY
Can the tendon heal itself?
• Depends– Full-thickness
• usually no
– Tendinopathy• usually yes
How does tendinopathy heal?
• Inflammation
• Repair
• Remodeling
How does tendinopathy heal?
• Inflammation
• Repair
• Remodeling
How does tendinopathy heal?
• Inflammation
• Repair
• Remodeling
What is the problem with the tendon?
• Tendinopathy
• Full-thickness tear
Etiology of Tendon Disorders
• Repetitive and prolonged exertion
• Sudden increase in training
• Pre-existing tendinosis
• Acute trauma
Shoulder
• Rotator Cuff Tendon– Continuum from:
• Tendinopathy to Full-thickness Rotator Cuff Tear
• Biceps Tendon
Rotator Cuff Pain
• Insidious onset of pain
• Middle aged
• Increasing pain with activity
• Can have decreased range of motion or weakness
Elbow
Elbow
• Tennis Elbow– Lateral Epicondylitis
• Golfer’s Elbow– Medial Epicondylitis
Tennis Elbow
Tennis Elbow
• Common extensor tendon
Golfer’s Elbow
Wrist
• DeQuervain’s tenosynovitis
Hip
• Trochanteric Bursitis
Hip
• Hamstring
• Hip Flexors
Knee
• Quadriceps tendon
• Patellar tendon
Foot & Ankle
• Achilles tendon
• Peroneal tendon
• Tibialis posterior tendon
• Tibialis anterior tendon
Medications
Bracing
Physical Rehabilitation
Corticosteroid Injections
Topaz - Radiocoblation
Surgical Treatment
• Achilles Tendinopathy
Emerging Treatments
• Topical Glycerol Trinitrate
• Proliferation Therapy
• Botulinium Toxin A
• Acupuncture
• Low Level Laser Therapy
• Platelet Rich Plasma
Platelet-Rich Plasma
• Sample of blood with a platelet concentration of at least 1,000,000 platelets/micromLin 5 mL of plasma
Platelet-Rich Plasma
Types of Platelet Rich Plasma
• Tier One– Arteriocyte Magellan– Harvest SmartPRep– Biomet GPS II
• 4-5 x’s baseline platelet concentration
• Tier Two– Arthrex– Cascade
• 2-3 x’s baseline concentration
Tier One: PRP
• Arteriocyte Magellan
Tier Two
• Arthrex
Platelet-Rich Plasma
• What do platelets contain?– alpha granules
• PDGF • VEGF• EGF• IGF-1
How do we know where to inject?
Ultrasound
• Patellar tendinopathy
Ultrasound
• Achilles tendinopathy
Rotator Cuff Disorders
• Diagnostic Ultrasound– Partial and Full thickness tears– Tendinopathy
Evidence of PRP
• Double blind randomized study showed PRP better than corticosteroid at 26 and 52 weeks
– AJSM Feb 2010
PRP Evidence
• Mishra, et. al; in a pilot study; has had success in the management of chronic elbow tendinosis with PRP
• Scarpone, et. al; showed statistical significance in pain scores for the management of rotator cuff tendonipathy with PRP
• Barret, et. al. had found significant symptom relief in patients with plantar facciitis who underwent PRP therapy.
May not work for everyone