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PRP Alternative Injections under Ultrasound Guidance

Professional, college, and other athletes stay in the game with the healing powers of PRP. PRP injections performed with ultrasound guidance by Dr. Anderson enhance accuracy and safety. Dr. Anderson trained with pro-football, pro-soccer, NCAA basketball and elite university medical center physicians to perfect her technique. We use growth factors and stem cells found in platelet rich plasma to regenerate ligament, tendons, muscles, and joints under ultrasound guidance.

The National Football League (NFL), Major League Baseball (MLB), Professional Golfers Association (PGA), Women’s Tennis Association (WTA), Association of Tennis Professionals, and Olympic Athletes use PRP to heal injuries quickly, extend their careers, and avoid surgery.

Athletes and Weekend warriors benefit from the procedure. PRP makes it possible for people to rejuvenate injuries, compete, and participate in activities with friends, instead of being sidelined.

PRP has been used by the NFL, NCAA, and professional sports for years to avoid surgery and to keep athletes in the game. Dr. Anderson injects with ultrasound guidance. Ultrasound guidance is used as a “stealth bomber” to accurately target the area, as well as for safety.

Platelet Rich Plasma (PRP) Injection – Information and Instructions for Sports and Pain Medicine Patients

Background on PRP
PRP is derived from your own blood by taking a sample of venous blood, placing it in a special tube, and spinning the blood in a centrifuge for about 5-10 min. This separates whole blood into its components including red blood cells, platelets, and plasma. The middle layer constitutes PRP, which contains highly concentrated platelets, the cells that normally promote blood clotting. These cells also contain a number of specialized chemicals called growth factors and stem cells. These include platelet derived growth factor, transforming growth factor beta, and vascular endothelial growth factor. These factors interact with the local cells and send signals that initiate a variety of events such as cell division and migration. The basic idea behind PRP injection is to deliver high concentrations of growth factors and stem cells to an area of injury, with the hope of stimulating a healing response and reducing inflammation in the tissue.

PRP has been used since about 1987 to help promote healing in dental, orthopedic, and plastic surgery procedures. Over about the past 5 years, PRP has been recognized for its potential in treating both chronic and acute musculoskeletal injuries involving tendons, ligaments, and muscles. This procedure is gaining wide media attention as it has been used in professional athletes in attempts to return them to competition as soon as possible.

Potential Benefits and Risks
While PRP has been injected for many musculoskeletal disorders (see Further Reading below), carefully controlled studies are not available for the majority of musculoskeletal injuries. Injection of PRP into degenerated or partially torn tendons in tennis elbow has been shown to be effective in the majority of patients, however these results may not translate directly to other tendons or conditions. Most PRP injections are being done in areas of tendon degeneration or tendinopathy, as well as ligament damage which are causing pain for the patient. These areas include the achilles tendon, elbow tendons, rotator cuff, and hamstring tendons. PRP may also be beneficial in treatment of muscle strain injuries.

Because PRP is derived from your own blood (“autologous” transplantation), there is NO chance of having an allergy or immune reaction. Indeed in the literature, side effects or complications of PRP injection are extremely rare. The main risks include local infection ( < 1 % chance) and pain at the site of injection.

Pre-Procedure Planning, and What to Expect During the Procedure
You should stop taking any non-steroidal anti-inflammatory medications 7 days before the procedure, and should not take these medications again for 7 days after the procedure. Common examples of these medications include Ibuprofen, Naproxyn, and Indomethacin or as well as aspirin. Non-steroidal medications work by blocking the action of some of the growth factors present in PRP, thus may render the injection ineffective. You may use acetaminophen (Tylenol) before or after the procedure. For lower extremity injections, we strongly recommend having someone else with you to drive you home. In some cases, your referring physician may want you to be on crutches for 1-2 days after the injection and this should be arranged ahead of time. Crutches are mainly useful if pain is severe in when standing or walking after lower extremity injections. If you had an MRI scan performed it is critical that you bring these images to the procedure either on disk or on film.

The following steps will occur when you arrive to the clinic:

  • Staff will draw approximately 15 cc of blood from an arm vein and place it in the centrifuge to concentrate the PRP.
  • Ultrasound of the affected area will be done to help localize areas of injury, and to determine if the procedure can be safely performed.
  • Under sterile technique, local anesthetic will be used to numb the skin and the area of injection, followed by PRP injection. This may include needling of the adjacent bony attachment of a tendon, which can contribute to procedural and postprocedural pain.
  • Following needle removal, you will rest for 15 minutes in the exam room Discharge home, the entire procedure typically taking about 1 hour.

What to Do and What NOT to Do after the Procedure
You can ice the area for 20 minutes every 2-3 hours for the first 24-48 hours after the procedure. About 1 in 10 patients experience a “flare” reaction beginning the day after the procedure, manifested by intense pain. Tylenol for pain is recommended. Other nonsteroidal anti-inflammatories will make the PRP less effective.

Activity Level and Followup
For the day of the procedure and the day after, limit the activity related to the injection site to activities of daily living. Depending on the injection site a you may be on crutches for 1-2 days until pain is not increased with weight bearing. Return to higher level activities such as running, cycling, golf, weight training, etc, as tolerated. It will take up to 6-8 weeks to adequately assess your response to the therapy.

Will My Insurance Pay for PRP?
Currently, PRP is not approved by the FDA for many of the musculoskeletal injuries being performed. It is likely that your carrier will deny part or all of the reimbursement related to the procedure. In particular, the companies that make the special centrifuge tubes to prepare PRP charge around $800 for this piece of equipment. Our hope is to give you information so your expectations are realistic.

Further Reading
Results of preliminary scientific studies and review articles are also available, listed here.

Mishra A, Pavelko T “Treatment of chronic elbow tendinosis with buffered platelet-rich plasma”. The American Journal of Sports Medicine 34 (11 ): 177 4-8, 2006.

Sampson S, Gerhardt M, Mandelbaum, B “Platelet rich plasma injection grafts for musculoskeletal injuries: a review” Curr Rev Musculoskelet Med 1 :165-174, 2008.

Mishra A, Woodall J, Vieira A “Treatment of tendon and muscle using platelet-rich plasma”. Clinics in Sports Medicine 28 (1 ): 113-25, 2009.