Platelet Rich Plasma (PRP) Injections

Platelet Rich Plasma (PRP) is an innovative treatment of musculoskeletal injury that utilizes patient’s own blood to stimulate healing and regeneration of soft tissues and bony structures.
What is PRP?

In 1999, the first autologous PRP prepared from a small quantity of blood was described. (Anitua E. Plasma rich in growth factors: preliminary results of use in the preparation of future sites for implants. Int J Oral Maxillofac Implants 1999;14:529–35). The use of PRP in many fields of medical practice has recently expanded rapidly, with many articles being published. In particular, in athletes with sporting injuries, especially in elite athletes where there is a relative urgency to facilitate a quick return to competition, the use of PRP has expanded rapidly.

PRP is a plasma with a super-physiologic concentration of platelets. The platelets are best known for their importance in clotting blood. However, platelets also contain growth factors essential for cellular recruitment, multiplication and specialization that are vital in initiating and accelerating tissue repair and regeneration in the healing process. These growth factors contained in PRP increase stem cell production to initiate connective tissue healing, bone regeneration and repair, promote development of new blood vessels and stimulate the wound healing process (Bachl N, Derman W, Engebretsen L, et al.Therapeutic use of growth factors in the musculoskeletal system in sports-related injuries. J Sports Med Phys Fitness2009;49:346–57).

Success of procedure depends on:

  • Accuracy of placement. It is recommended that the injections are administered under ultrasound guidance, thus ensuring the exact location of the product placements.
  • Method of preparation.
  • Composition of PRP.

The Benefits

PRP is a natural remedy that induces body healing. The procedure is safe with virtually no complications and side effects. The treatment may eliminate the need for surgery and may decrease/alleviate chronic pain.

Animal studies have confirmed the usefulness of platelet concentrate in acute musculoskeletal injury, but this benefit of PRP is negated if the injury site is immobilized, and hence mechanical stimuli should be applied during the critical healing period.

Muscle strain and contusion injuries are common in sports, and result in time loss from training and competition. PRP is being widely used in elite sport, and the use of PRP for acute muscle injuries has some scientific support. Overall, there is paucity of evidence for use of PRP in muscle-strain injury in either animals or athletes, however the rationale is to promote muscle regeneration while minimizing muscle scarring.

Intervertebral disc degeneration (IDD) is a complex process with the mechanism not fully elucidated. The current clinical treatments for IDD are mainly focused on providing symptomatic relief (epidural steroid injections, or facet injections/rhizotomy) without addressing the underlying cause of the IDD. Biological therapeutic strategies to repair and regenerate the degenerated discs are drawing more attention. Growth factor therapy is one of the biological strategies and holds promising prospects. As a promising bioactive substance, PRP is considered to be an ideal growth factor "cocktail" for intervertebral disc restoration. Results from many in vitro and in vivo studies have confirmed the efficacy of growth factors and PRP in intervertebral disc repair and regeneration.

Conditions Treated

Most frequently treated acute and chronic injuries include:

  • Tennis & golf elbow
  • Rotator cuff partial tears and other shoulder injuries
  • Knee - meniscal tears & osteoarthritis
  • Hip bursitis or trochanteric pain syndrome
  • IT band syndrome
  • Achilles tendonitis
  • Plantar fasciitis
  • Medial collateral ligament (MCL) tears
  • Acute and chronic tendon problems
  • Chronic low back and neck pain from injured facet joints, sacroiliac joints, ligaments, tendons, and muscles
For detailed information on conditions treated see PRP/Stem Cell Treatments.

Side Effects

Side effects are minimal, mostly risks associated with needle puncture into tissue; local infection secondary to unsterile technique; pain at injection site. With joints PRP procedures – post injection pain flare; tenotomy procedure – painful, if overly aggressive may cause rupture.

Note - because the product is derived from the patients’ own blood, there are no risks usually associated with blood products like transfusion reaction, allergic or immune reaction.

How is it Administered?

During a PRP procedure a small amount of whole blood is drawn from the patient. Once the platelets are collected there are two steps taken to prepare the PRP to be injected into the patient:

  • Extract platelets and plasma via first “spin” in the centrifuge
  • Harder centrifugal spin that separates platelet-rich plasma (PRP) from platelet-poor plasma

PRP is injected then, using ultrasound guidance if needed, into the injured area. It causes mild inflammation that triggers the healing reaction. As a result, a new collagen begins to develop. As this collagen matures it begins to shrink causing the tightening and strengthening of the damaged area.

Ketamine Infusions

What are Ketamine Infusions?

Ketamine is a prescription, controlled drug primarily used as a rapid-onset, short-acting anesthetic in surgical anesthesia protocols. Infusions with Ketamine have been used in the outpatient setting to treat acute/chronic pain. Ketamine infusions involve release of Ketamine directly into the bloodstream in a series of injections to help alleviate symptoms.

While pain relief can happen immediately after infusion cycle, its effect is temporary – in some cases up to 12 weeks. Booster single injections might be needed to maintain therapy’s efficacy over the time.

Conditions Treated

Ketamine infusions have shown effective control of acute pain, neuropathic pain, oncology-related pain and complex regional pain syndrome. Ketamine infusions are also being successfully used in the treatment of severe depressions where conventional treatment proved ineffective.

For detailed information on conditions treated see Ketamine Infusions.

Side Effects

The short-term side effects of ketamine noted in clinical studies include psychedelic symptoms (hallucinations, memory defects, panic attacks), nausea/vomiting, drowsiness, cardiovascular stimulation There are no reported long term side effects from the procedure, however in some patients with preexisting conditions and/or pharma-interactions may lead to serious renal, liver and cardio damage.

How is it Administered?

Ketamine infusions are given in our offices in a series of IV infusions. Ketamine dosage is very low (up to 200 mg daily) so no major side effects are expected. The injections will be administered daily, approximately an hour long, during the period of 4-10 consecutive days. Every day, upon completion of IV, the patient will stay under close observation in the office for about an hour, before being released to a family member. Patients won’t be able to drive and operate heavy machinery during that day.

The Benefits

It is expected that patients who receive ketamine infusion therapy would enjoy immediate pain relief and comfort that are not usually achieved in traditional pharmacological-based pain management. We see significant improvement in patients with depression. With depression/suicidal/bipolar conditions, ketamine treatments proved to be extremely effective with minimal side effects compared to pharmacological treatments (Lithium and others).

Stem Cell Injections

Stem cell therapy has some of the most exciting treatment potential in medicine today.
What are Stem Cell Injections?

Stem cells are the body’s master cells, mostly concentrated in bone marrow, adipose tissue (fat) and placenta. They are undifferentiated cells which allow them to develop into other types of cells that are required to repair or replace damaged tissue. Through a process called differentiation, stem cells can become cartilage, ligaments, tendons, muscles and just about any other types of cells they come into contact with. Stem cells have been clinically and scientifically proven to effectively treat most chronic pain conditions, accelerate the healing, and reduce scarring. As a key component of regenerative medicine, stem cell therapies are opening the door to many and varied new clinical applications.

Conditions Treated

Stem cell injections are a regenerative cell-based therapy that can be used for the management of inflammatory conditions such as tendonitis, joint pain associated with early arthritis and cartilage damage. These injections have been shown to help treat conditions that were unresponsive to alternate therapies such as PRP injections or Viscosupplements. There is evidence that the benefits may include dramatic anti-inflammatory effects and the potential to aid tissue repair.

We also offer stem cell treatment for arthritis. Stem cell treatment for arthritis is one of the latest therapies providing completely new ways to treat and manage degenerative joint and bone conditions. In addition to osteoarthritis treatment, stem cells can provide meniscus tear treatment, plantar fasciitis treatment, knee cartilage repair etc.

For detailed information on conditions treated see PRP/Stem Cell Treatments

How is it Administered?

Stem cell injection is an outpatient office procedure. A high volume of stem cells is obtained from the patient’s own bone marrow or fat tissue (adipose) by bone marrow aspiration. Then the material is processed through centrifugal spin and additional purification process at the bedside.

Once the stem cells have been concentrated, they are injected into damaged areas of the body using ultrasound guidance. It is a safe, nonsurgical treatment option for most chronic pain conditions, wound care, and aesthetic abnormalities.

Side Effects

Side effects are minimal, mostly risks associated with needle puncture into tissue; local infection secondary to unsterile technique; pain at injection site. With joints PRP procedures – post injection pain flare; tenotomy procedure – painful, if overly aggressive may cause rupture.

The Benefits

These non-surgical stem cell injection procedures may offer a viable alternative to surgery or even joint replacement. Patients are typically able to return to normal activity following the procedure and to avoid the painful and lengthy rehabilitation periods that are typically required to help restore strength, mobility, and range of motion following invasive joint surgeries. Lastly, patients are far less vulnerable to the risks of surgeries, such as infection and blood clots.

Regenerative medicine therapy is an innovative way to use stem cells to treat chronic painful orthopedic issues in the elbows, knees, hips, shoulders, or feet/ankles and conditions that have not improved following conservative, nonsurgical treatments. Many of our patients visit us after exhausting other treatment options, wanting to explore an alternative to an invasive surgery.

Steroid Injections

What are Steroid Injections?

Injections of corticosteroids are used to deliver high dosage of steroids in attempt to treat inflammation and pain in joints, tendons, muscles and/or soft tissues.

Corticosteroids, or steroids, are a synthetic drug that resembles human hormone cortisol. While the injection can provide rapid pain relief, sometimes it can cause serious side effects and

Conditions Treated

Cortisone injections may be most effective in treating arthritis.
They are also often used in:

  • Bursitis
  • Gout
  • Plantar fasciitis
  • Tendinitis

For detailed information on types of injections provided, see “Steroid Injections”

Side Effects

Frequent steroid injections may cause weakening of the tissues, hence there should be no more than three to four injections per year. The damage can be quite substantial that might include:

  • Tendon rupture
  • Infection
  • Nerve damage
  • Osteoporosis
  • Osteonecrosis
The above side effects would rarely occur in a patient that doesn’t administer steroid injections often.

How are they Administered?

Steroid injections are given in the outpatient setting in our offices. The injection might be preceded with administration of local anesthetic and may be performed under ultrasound guidance for the safety and precision sake.

The Benefits

It is expected that patients who receive steroid injection would enjoy immediate pain relief and comfort that are not usually achieved in traditional pharmacological-based pain management. We see significant improvement in patients with arthritis, and otherwise healthy people with chronic joint pain.