Category Archives: Ultrasound guidance for injections

Another excellent study showing PRP works for tennis elbow!

Tara Haelle writing in Rheumatology News reported on a 24 week randomized controlled and double blind study looked at the effectiveness of platelet-rich plasma –PRP in treating tennis elbow. prp

The study  involved 230 patients who had failed physical therapy, non-steroidal anti-inflammatory drugs, and/or cortisone shots and was conducted at the Rothman Institute of Thomas Jefferson University.  The PRP group showed a 71.5% improvement in pain scores while the control group showed a 56.1% improvement.

tennis-elbow-on-fire

Comment: The differences weren’t huge but this still indicates PRP is the treatment of choice for this extremely painful disorder.

Cortisone shots should be avoided since they actually damage soft tissue and lead to more recurrence of tennis elbow and other forms of tendinopathy.

PRP should be administered using ultrasound guided needle tenotomy technique.

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Steroid injections for tennis elbow make it worse

Genevra Pittman writing in Reuters reported that in an Australian study published in the Journal of the American Medical Association, researchers evaluated 165 adults with tennis elbow.

tennis-elbowThe participants were divided into four treatment groups: cortisone shots without physical therapy, cortisone shots with physical therapy, placebo shots without physical therapy, and placebo shots with physical therapy. After one year, 83% of the participants who received a cortisone shot reported that they had completely recovered, compared to 96% of those who received a placebo shot.

Steroid shots weaken tendons over the long haul.  A much more physiologic approach is to use ultrasound guided needle tenotomy and platelet-rich plasma (PRP).

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Radiation Therapy Provides Relief For Plantar Fasciitis

Helen Albert writing in Medwire reported on a study of 62 patients, published in the International Journal of Radiation Oncology, which showed that “external beam radiation therapy, similar to that used in treating cancer, provided effective pain relief for patients with plantar fasciitis.” plantar-fasciitis

For the study, “researchers found that 80% of those who received standard-dose therapy experienced complete pain relief, 64% of whom maintained this relief for up to 48 weeks.”

Comment: I would be concerned that radiation would bring along its own potential risks.  There are better and safer options for this condition. It’s like using a bazooka to kill a mouse.

One option we’ve used is ultrasound-guided injections of platelet-rich plasma (PRP). Another is ultrasound-guided injection of Botox.  Both of these are far safer than radiation.  Another treatment that seems to work and is safe is shock wave therapy.

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Why is PRP being used by athletes?

The use of regenerative treatments such as PRP and autologous stem cells have revolutionized our approach to athletic injuries and also to tendinopathies involving Boomer athletes.

PRP is an ultraconcentrate of blood that contains a large number of platelets, prpcells packed with growth and healing factors.

PRP ideally is administered using an ultrasound guided needle tenotomy injectingprptoankle-mmiller-13technique.  What this entails is using a small gauge needle to “pepper” the area of tendon damage to induce an acute inflammatory response.  Inflammation is the first step in healing. Inflammation causes the platelets to release their growth factors and initiate the healing of the damaged tendon.  The inflammatory phase lasts roughly about a week.  The healing phase lasts about 3-04 weeks.  The final stage is the reorganization phase where the tendon fibers are organized into a normal fiber pattern.  This can take up to a year.

Nonetheless, the ability to heal tendon damage withour having to resort to surgery is exciting.  In those patients who don’t respond to two PRP treatments, autologous stem cells are indicated.

 

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A new use for Botox?

First reported in Singapore, then confirmed by a number of studies elsewhere, the popular cosmetic drug, Botox, has another novel use.botox

For sufferers of chronic plantar fasciitis, it appears to not only relieve pain but actually reduces the thickness of the plantar fascia, as measured by diagnostic ultrasound.

I found out about this from a physician in our community who wanted me to try the treatment for his chronic plantar fasciitis.  Using our standard ultrasound-ultrasound-guided-plantar-fascia-injectionguided technique, I did so.  Not only have his symptoms resolved, the serial measurement of plantar fascial thickness has shown improvement as well.

Botox is also being studied as a symptomatic treatment for knee osteoarthritis.

It apparently has an effect on nocioceptive receptors (pain receptors.)

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Do lubricants work for knee osteoarthritis?

A recent meta-analysis study indicated that lubricant injections for knee osteoarthritis (OA)are no more effective than placebo.

Hogwash!

Lubricants, known as hyaluronic acid (HA), have been used in the United States since 1997 for the treatment of symptomatic knee OA.viscosupplement

A very large meta-analysis study showed that these substances provided pain relief within 5 to 13 weeks after injection.  Improvement was 28-54% for pain and 9-32% for function.

The efficacy was comparable to that achieved with non-steroidal anti-inflammatory drugs and longer term than that seen with injections of steroids.  Steroids do work quicker though.

HA is a major component of normal synovial fluid and provides help with load absorption and also helps with lubrication.  HA may also have anti-inflammatory properties.  There are some hypotheses that suggest HA stimulates synovial cells to produce synovial fluid, stimulates the growth of cartilage cells, and prevents cartilage degradation.

HA should be administered using ultrasound guidance for the best results.

In our practice, we use Supartz.  It seems to work well with very few if any side-effects.

 

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