Published in January 21st, 2012
Advertisements
There has been much debate about the beneficial effects of platelet-rich plasma (PRP). While a Dutch study stated that PRP was no better than” “placebo” for the treatment of chronic Achilles tendonitis, the “placebo” was a standard tenotomy protocol which is an effective therapy. So the fact that PRP was only a little better than an effective therapy doesn’t say that PRP is not effective.
What was neglected by much of the media was the technique used to administer the PRP- not a technique that is favored by those of us who use PRP a lot. And the type of method used to prepare the PRP. Unless the protocol definitely produced a platelet concentration 4-5 times baseline, the treatment was not going to be effective.
Also, another more recent Dutch study did show PRP was very effective for lateral epicondylitis (tennis elbow) and an Italian study showed favorable results in osteoarthritis of the knee.
So… if you’re a prospective patient with a tendonitis problem, how do you ensure you get the right type of treatment?
First, make sure the physician who administers the PRP has done at least 200 cases.
Second, make sure the physician is skilled in the use of diagnostic ultrasound. Unless ultrasound is used, the PRP is essentially wasted.
Third. What type of protocol is used? Find out the exact machine used and what the platelet concentration above baseline is administered. It must be at least 4-5 times above baseline.
Fourth. Make sure you don’t have any of the conditions that might make a PRP procedure less than effective. These include:
• Anti-platelet / anti-inflammatory medication (i.e. Coumadin, ASA, NSAIDS, heparin, and High dose fish oil)
• Bleeding / clotting disorder
• Anemia / low platelet count
• Cigarette smoking
• Nutritional / Hormonal deficiency
Here is a list of potential areas where PRP has been shown to be effective. This list is provided courtesy of Dr, Jonathan Fenton.
Hip/Pelvis
• Hip osteoarthritis
• Hamstring origin/ischial tuberosity
• Symphysis pubis / pubalgia
• Adductor / gluteal tendinosis
Knee
• Patellar tendinosis
• Quadriceps tendinosis tears
• Collateral / cruciate ligament tears
• Meniscal tears
• Osteoarthritis
• Patellofemoral
• Post ACL repair
• Pes bursitis / tendinosis
• Proximal tibfib joint laxity / OA
Ankle/Foot
• Achilles tendinosis
• Peroneal tendinosis tear
• Tibialis posterior tears tendinosis
• Plantar fasciitis
• Osteochondral defect talus
• Sinus tarsi syndrome
• Ankle ligament tears and laxity
• Bunions
• Osteoarthritis ankle, foot, toes
• Sesamoids
And this is only a partial list.
When PRP is given it should be done after a percutaneous needle tenotomy is performed. This is a procedure where the damaged or diseased tendon is peppered with multiple small holes using ultrasound guidance.
Why?
The procedure helps to breaks up scar tissue, abnormal blood vessels, and degenerative tissue. It also stimulates bleeding and creates a favorable condition for PRP.
Tenotomy also leads to remodeling of tendon in a way that restores many of its normal mechanical properties.
At the Arthritis Treatment Center, we have had enormous success using PRP for the above areas and highly recommend it for patients in whom chronic tendonitis is a problem.
Nathan Wei, MD FACP FACR is a board-certified rheumatologist and nationally known arthritis authority and expert. For more info: Arthritis Treatment and Arthritis Treatment Center
Related posts:
- What is PRP and How Does it Work? Platelet rich plasma (or PRP as it is called) is the “treatment du jour” for many soft tissue injuries since being mentioned as the technique that allowed Hines Ward to play in the Super Bowl. Before stating specifically what PRP is, I will discuss the rationale behind its use. Wound healing is a complex staged [...]...
- Platelet Rich Plasma – PRP For Achilles Tendonitis The Achilles tendon is the largest tendon in the body and connects the gastrocnemius (calf muscle) to the back of the calcaneus (heel bone). The Achilles tendon is what allows a person to stand up on their toes as well as jump up and down. The Achilles tendon is extremely strong and is capable of [...]...
- Doctor… My Shoulder Really Hurts. What Do You Recommend? Patients with inflammatory types of arthritis such as rheumatoid arthritis and psoriatic arthritis often have shoulder problems. However, more often than not, a patient presenting with shoulder pain to the rheumatologist will have another reason besides the arthritis for the discomfort they are feeling. The shoulder is a complicated and complex joint consisting of the [...]...
- Doctor… I Don’t Want a Joint Replacement For my ... Arthritis is a growing health concern. The most common form of arthritis-osteoarthritis (OA)- is increasing in prevalence coincident with the Baby Boomer surge into late middle age. It is estimated that OA affects more than 20-30 million Americans. By the year 2030, that number will probably double. This form of arthritis is also prevalent among [...]...
- How To Treat Plantar Fasciitis Plantar fasciitis is one of the most common causes of heel pain. It is due to inflammation of the plantar fascia, a thick piece of connective tissue that runs from the bottom of the heel to the base of the toes. This is how the condition develops… Repetitive trauma leads to micro tears in the [...]...
- Stem Cells For Osteoarthritis? Yes!!! Osteoarthritis is the most common form of arthritis. It is the type of arthritis that people think about when they talk about arthritis and aging. More than 90 percent of people over the age of 50 will eventually develop some type of arthritis and that type is usually osteoarthritis (OA). OA preferentially attacks the weight [...]...
- My Shoulder Hurts. My Doctor Told Me I Have A “Rotor ... The term “rotor” cuff, actually- the rotator cuff- refers to a group of muscles and associated tendons that connect the scapula (shoulder blade) to the humerus (upper arm bone). The rotator cuff tendons sit on top of the humerus and permit movement in all directions. In fact, the shoulder is the most mobile joint in [...]...
- Radical Prescription For Changing the Treatment of ... The first treatments for osteoarthritis, better known as “rheumatism” in the old days were balms which consisted of menthol and other herbal concoctions. These were applied topically and helped soothe some of the aches and pains. Variations probably included immersion in hot springs, mineral baths, or other forms of hydrotherapy. In the Far East acupuncture [...]...
- My Shoulder Hurts And I’ve Been Diagnosed With ... When patients go to their rheumatologist or orthopedist with aches or pains, they are often told they have tendonitis. The term “tendonitis” means inflammation of a tendon. Tendons are tough fibrous cords of tissue that connect muscles to bones. When muscles contract (tighten) the tendon attachment makes the bone the tendon is attached to move [...]...
- The Many Forms Of Arthritis Arthritis is not just a single type but there are more than one hundred conditions. It is literally known as the inflammation of the joints. Due to various circumstances, the deterioration of the body joints lead to a condition, which we will refer to as arthritis. Arthritis is the foremost cause of senior citizens disability; [...]...
Previous post:
«
Medicines Are Going GreenNext post: Practical Ways of Treating Panic Disorder »