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Platelet-Rich Plasma

Platelet-Rich Plasma (PRP) is the component of blood after the red blood cells are removed. PRP contains numerous biologic factors that have been shown to enhance healing in animal and human studies. Over the last decade, the use of PRP has been a major focus in the sports medicine community. The FDA has approved the use of PRP in orthopedic surgery. There is growing evidence that the biological factors in PRP are effective in treating tendinosis (chronic tendinitis), chronic muscle strains and injuries, osteoarthritis, and other musculoskeletal injuries. Early results are promising. At the current time FDA approval is pending and these injections are considered "off label use". Because of this, insurance companies are not covering the use of PRP for these injuries at this time.

With PRP, the body's own healing properties are used to treat these areas of injury. The PRP is taken from each patient's own blood. Nothing is added and only the red blood cells are removed. Because of this, there is little, if any risk in the use of PRP.

Candidates for PRP injection

Patients who have long-standing problems with:

  • Tendinosis
  • Tendinitis
  • Partial ligament tears
  • Chronic muscle strains

Patients must have completed a vigorous course of non-surgical treatment such as rest, physical therapy, and cortisone injection. These candidates should have sufficient symptoms to be considering surgery or repeated injections. Patients who are on blood thinning medications, are unable to comply with the post procedure instructions, are unable to remain off of aspirin and other anti-inflammatory medications or who will not allow removal or injection blood products into their bodies are NOT candidates for PRP injections.

PRP Injection Procedure
  • Injection of PRP is an office-based procedure.
  • Before the injection, 10-20 mL of blood is drawn from the patient's arm.
  • The blood is "conditioned" in the centrifuge for 5 minutes while the patient waits.
  • This "conditioned" plasma (PRP) is drawn off into a syringe.
  • The area to be injected this prepared using standard sterile technique.
  • The area is anesthetized with local lidocaine or bupivicaine.
  • 2-5 ml of PRP is injected under ultrasound guidance into the affected area.
Outcomes & Results

There can be no guarantees of success with PRP injections. Generally, this is a single injection but occasionally a second injection is preformed after a few months. Most patients who experience benefit will see improvement within 1-2 months. Patients will often then continue to see steady gradual improvement for 6-12 months. In numerous studies going on presently in United States and around the world, the success rate for PRP injections seems to be better than cortisone and often more successful with less risk than surgery. Surgery remains an option for patient's who did not respond to PRP injections.

Preparation for PRP Injection
  • Patients who are scheduled for PRP injection should stop all anti-inflammatory medications for 2 weeks prior to injection. This includes: Aspirin, ibuprofen, Motrin , Advil, Aleve, Celebrex, Naprosyn, Arthrotec, Mobic, diclofenac, etc. (Note: If you're taking any of these medications for heart and/or vascular disease, you must first check with your primary care physician before discontinuing the medication.)
  • Patients should be prepared to “take it easy” for about 2-3 days after the injection. For lower extremity injections, crutches and a brace may be needed for the first few days. For elbow and shoulder injections, a sling may be worn.
After-care
  • Following the procedure, the patient will be asked to remain for 15 minutes to ensure the procedure was well tolerated.
  • Ice should be applied to the area of injection for about 15-20 minutes, 3-4 times a day for the next 48 hours.
  • Do not take anti-inflammatory medication for the next 2 weeks
  • Often there is mild to moderate post-procedure pain. Pain medication will be prescribed during the office visit. Normally, significant post-injection pain "flare" will resolve in the first few days.
  • After 2-3 days of rest, normal activities are allowed as tolerated. Typically, most patients are able to return to pre-injections level of activity within 7-10 days
  • A follow-up post-procedure clinic visit will be scheduled for 2-4 weeks.
  • Formal physical therapy will be started approximately one week after the injection.