Platelet Rich Plasma Therapy: 2007

Tuesday, December 18, 2007

New Platelet Rich Plasma Web Site

I recently launched a web site on PRP. It is another resource for health professionals & patients to learn more about this emerging therapy. Additionally, I will be hosting a conference in early May 2008, in Los Angeles to train other physicians on the use of PRP along with musculoskeletal ultrasound guidance.

www.PRPinjection.com

The site will include testimonials as well as promote further communication amongst patients.

Platelet Rich Plasma Cartilage/Arthritis Study in Rabbits

In a recent study from October 2007, a group from China was the first to document platelet rich plasma's ability to support chondrogenesis (cartilage cell growth). They took cartilage from the rabbit's ear, & mixed it with PRP and calcium chloride & thrombin (to form a matrix). Two months later, hard knobbles were found and seen on MRI, as well as histological analysis (cellular) and staining confirmed cartilage growth. Interestingly, there was no cartilage growth with the control group that received PRP alone. This study demonstrated successful formation of new cartilage with an injectable graft using PRP and cultured chondrocytes.

http://www.joms.org/article/PIIS0278239106021070/abstract

Sunday, December 9, 2007

Santa Monica Orthopaedic Group Awarded FIFA Center of Excellence

Our practice was awarded the title of a FIFA Medical Center of Excellence. The Fédération Internationale de Football Association (FIFA) is an association governed by Swiss law founded in 1904 and based in Zurich. They oversee one of the world's largest international sporting events, The World Cup. FIFA hopes to reach out and touch the world, using football(soccer) as a symbol of hope and integration.

Our practice was selected after demonstration of clinical education, research, and injury prevention. Other centers chosen include St Marianna University School of Medicine in Kawasaki, Japan, The Adidas Sports Medicine Centre in Auckland, New Zealand, the Centre for Exercise Science and Sports Medicine at the University of Witwatersrand in Johannesburg, South Africa, and the Orthocentre of the Technical University, Munich.

There will be a ceremony at our facility Monday December 10th, 2007.
These designated centers are open to every soccer player looking for therapy or a second opinion on a specific injury.

http://www.fifa.com/aboutfifa/developing/releases/newsid=653724.html

My Colleagues, Bert Mandelbaum MD & Michael Gerhardt MD are team physicians for the US National Soccer team.

We have used platelet rich plasma on professional soccer athletes to accelerate recovery.

http://prpinjection.blogspot.com/2007/10/cbs-news-with-katie-kouric-prp-feature.html

Sunday, December 2, 2007

Extracorporeal Shockwave Therapy to Encourage Natural Healing in Tendon Injuries?

After immersing myself in the study of Platelet Rich Plasma Therapy and the larger scope of "biologics," I have been drawn to the concept of maximizing the body's natural ability to heal itself. PRP does not create a new injury, to stimulate healing, but rather takes the body's normal reaction to an area & places it at the site of limited healing. After injection patients experience discomfort above baseline anywhere from 2-5 days. Clinical benefits are often not immediate, as the cellular changes take up to months. However, we have seen dramatic improvements in most cases.

Perhaps an earlier generation in the philosophy of promoting natural healing lies in shockwave therapy. Shockwaves are administered in an office setting for a series of 3treatments at one week intervals , lasting 3 minutes each. The concept is that by alternating positive & negative pressure, shockwaves induce microtrauma (minor injury) that sends a signal to the brain to stimulate healing to an area previously dormant & injured.

We know that after a few weeks, tendons are not inflammed, but rather form a scarred & thickened structure, with blood flow changes. This new understanding has flipped our approach to tendon injuries, now termed "tendonopathies." Treating a chronic tendon injury with cortisone or anti-anflammatory medications not only has adverse side effects, but doesn't make sense.

Shockwave therapy was initially developed to break up kidney stones. However, the Europeans have been using this treatment on tendon injuries for years. It is now FDA approved for use in the U.S.

I was given a free machine for a 6 wk trial. I treated 14 patients last Tuesday. Apparently, patients may experience an improvement following the second treatment. This modality is appealing, because it is less invasive than an injection, and results are more immediate (if they occur) than PRP.

Ultimately shockwave therapy may be uses along with PRP in a protocol to maximize therapy. My colleague, a podiatrist has seen terrific results in patients that have failed conservative treatments for heel pain(achilles tendonosis & plantar fasciitis). The procedure is generally well tolerated.

Attached is the web site to learn further. I will continue to post my experiences with this new treatment. There are only 60 machines in the U.S.

www.dolorclastmethod.com

Cigarette Smoking May Limit Platelet Activity in PRP

A study from Istanbul, Turkey looked at the effects of cigarette smoking on the viability of platelets. Platelets are very fragile and special care must be taken in preparing them for injection after increasing their concentration. However, research suggests that smokers may have increased free radicals that affect the oxidant/anti-oxidant balance, thus reducing platelet activity.

www.blackwell-synergy.com/doi/abs/10.1080/13556210020077046

Future research should compare the platelet concentration & clinical effects of PRP in non-smokers Vs smokers.

Wednesday, November 28, 2007

Superkids Charity

A friend of mine back in NY told me about a wonderful charity. Her brother and sister in law (Stephen and Janet Fink) started this organization after they adopted their daughter from China.

Superkids is a non-profit organization that sends physical therapists and volunteers to the Shanghai Children’s Home. They work directly with the children, donate equipment to the orphanage, and work in partnership with the orphanage staff to incorporate easy, fun therapeutic exercise games in the children’s daily routines. These kids range in age from infant to teen and their medical problems range from minor to serious. Most of the children have mild and routinely correctable problems such as club feet and cleft palate. More serious problems include cerebral palsy and spina bifida. Because of their medical conditions, most of these children show delays in motor and/or speech development.

Special needs orphans are also called "waiting children." Their age and medical conditions make them difficult to place. They wait longer to find homes. Many are never adopted.

Janet and a group of occupational therapists returned from Shanghai 3 weeks ago and met four teen orphans with spinal cord injuries. She has been trying for months to get them the appropriate wheelchairs.

Wheelchair companies will not donate or give discounts. Charities that can donate wheelchairs do not have the appropriate type of chair. These teens are already starting to develop scoliosis and breathing problems because they are not in good chairs. They have found a company that will make good, pediatric wheelchairs for only $3,000.

They are trying to raise money to purchase chairs for all four teens. If they can raise the money and have the chairs shipped to the orphanage, Janet will go to the orphanage in china with the therapists to make sure that the chairs are fitted properly to these children.

Please spread the word about these terrific kids and their need for good wheelchairs. If anyone is interested in making a donation, log on to the Superkids website http://www.superkidscharity.org/

Sunday, November 18, 2007

New Article on Osteoarthritis and Platelet Rich Plasma

A European Study from Oct 07' by Anitua & Sanchez et al. injected 10 osteoarthritic patients with PRP & studied the cellular effects of PRP. They found an increase in hyaluronic acid concentration, balancing cell proliferation (angiogenesis). However, there was no effect on IL 1-B, which generally plays a role in osteoarthritis. This information gives us insight into how PRP may potentially benefit arthritis.

Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kem234v1

It's important that we better understand the mechanism that PRP may potentially benefit arthritis. New insights may direct more specific treatments in the exciting realm of Biologics.

Autologous Blood Use in Horse Osteoarthritis

Another subset in "biologics" is the use a (ACS) Autologous Conditioned Serum. This treatment primarily used in Europe, invlolves production of a substance known as IL-1Ra that attacks the effects of arthritis. While this specific treatment is not approved in the U.S., similar treatments using PRP (Platelet rich Plasma) are being used here to address knee arthritis.

A recent study from Colorado State University published in The American Journal of Veterinary Research; demonstrated significant clinical improvements of Horse osteoarthritis affected joints with ACS compared to placebo.

http://avmajournals.avma.org/doi/abs/10.2460/ajvr.68.3.290?prevSearch=allfield%3A%28autologous+conditioned+serum%29

The process like PRP, involves drawing blood and spinning it down in a machine called a centrifuge. However, afterwards the blood is incubated at 37 degrees Celsius for 24 hours. The serum is then frozen until use.

This system, is used throughout Europe in professional race horses to treat arthritis. Also, it is used in Dusseldorf Germany on humans for osteoarthritis.

We are using a modified treatment performing a series of 3 PRP injections into the human knee joint under ultrasound guidance at 3 week intervals. We will be reporting on our findings.

Thursday, November 8, 2007

U.S. Professional Soccer Athlete Injected with Platelet Rich Plasma

In addition to chronic (long term) injuries, Platelet Rich Plasma is being applied to the high level athlete to accelerate recovery. Numerous professional athletes have received PRP for a common knee injury, an MCL (medial Collateral Ligament) sprain. While I'm not an elite athlete by any means, I received a similar injection following a surfing accident. I just ran full speed tonight without any limitations, now appx 9 wks post injection. http://prpinjection.blogspot.com/2007/10/prp-knee-injection-8-wks-post-injection.html

http://www.latimes.com/sports/soccer/chivas/la-sp-chivas15oct15,1,3735874.story?coll=la-sports-chivas
Another athlete was injected by myself & my colleague Mike Gerhadt MD. This positive outcome was reported on CBS Evening news with Katie Kouric.

http://prpinjection.blogspot.com/2007/10/cbs-news-with-katie-kouric-prp-feature.html

Bone Marrow Aspirate, Using Adult Stem Cells To Treat Osteoarthritis

Platelet Rich Plasma provides a potent delivery of the body's healing properties, called growth factors. However in some patients with severe cartilage loss and less viable cells, a stronger pool of healing properties lies in obtaining adult "mesenchymal stem cells" from the hip (iliac crest). In this procedure, Bone marrow is taken from the hip and like PRP is prepared for injection into an arthritic hip or knee. While further studies are needed, preliminary reports are encouraging. PRP is probably a more reasonable first line treatment, given it's ease of use. However particularly challenging cases may consider the marrow application. A blog on bone marrow aspirate is: http://www.autologousadultstemcells.org/blogs.html

Thursday, November 1, 2007

American Academy of Orthopedic Surgeons New Article on Biologics

"Orthobiologics" or "biologics" are quickly becoming recognized amongst the sports medicine/orthopaedic community as one of the fastest growing industries with tremendous potential. Merging our understanding of how the body heals itself with cutting edge modern technology, we are developing exciting alternatives to standard care.

In the Sept 07 AAOS (American Academy of Orthopedic Surgeons) Now Magazine, there was an article discussing this very subject matter. "Biologics in sports medicine: from BMPs to bone formation."

http://www.aaos.org/news/bulletin/sep07/clinical5.asp

The article describes this Field of "biologics" and cell based therapies to create new approaches to treating old injuries. Tems introduced include BMP (bone Morphogenic Protein and mesenchymal stem cells). These may be paramount to facilitating healing in various injuries including rotator cuff cuff tears in the shoulder and knee arthritis and meniscal tears. As the community of "babyboomers" and recreational ahletes grow, we are seeing younger patients with cartilage injuries that are too young (<60) years for knee replacements. Thus biologic solutions provide promise in this population base.

At my practice, Santa Monica Orthopaedic & Sports Medicine Group we are beginning to treat patients with knee arthritis with a series of PRP injections. I have been corresponding with Physicians from Bologna Italy to learn from their early experiences as well. There is a link to their data on my blog. We are conducting outcome studies on the many patients we have injected for various injuries. Furthermore we hope to perform a knee arthritis PRP study in the near future. In general we are seeing tremendous outcomes in patients that have failed conservative treatments and were considering surgery or activity modification.

http://prpinjection.blogspot.com/2007/10/new-studies-on-platelet-rich-plasma-and.html

New Platelet Rich Plasma Article in the American Academy of Orthopaedic Surgeons Now Magazine

As PRP use is increasing, we are seeing more articles surfacing discussing it's potential benefits. In a monthly publication for orthopaedists, the AAOS (Amer Academy of Orthopaedic Surgeons) released an article titled "Clinical use of Platelet-rich plasma in orthopaedics."

http://www.aaos.org/news/bulletin/sep07/research2.asp

In general, the article familiarizes the reader with the science behind it's uses and advocates is use in soft tissue and wound repair, while cautioning it's application in bone grafting. Once again, further research is encouraged.

Monday, October 29, 2007

New Acupuncture Literature Supports Acupuncture in Low Back Pain

Although acupuncture has been used for thousands of years, it is difficult to study under or western system of evaluating research. However a large study from Germany needled over 1100 patients and found favorable results. 47% improved with acupuncture versus 27% in conventional treatments (Physical Therapy Meds etc.). Interestingly, 42% of sham acupuncture (fake acupuncture where the needles were placed in the skin at random non-acupuncture points had relief as well. This insn't too suprising to acupuncturists, as the needling itself stimulates a natural reaction in the body releasing endorphins, increasing blood flow, and temperature.

Acupuncture is appealing because it is safe and focuses on treating the patient as a whole, rather than just a knee or a hip etc. For example when we treat a patient with knee arthritis we place needles & electricity around the knee, but also around the hands, ear, feet, scalp etc to address the whole person to adress other issues like fatigue and anxiety. This invloves some unorthodox interviewing of the patient inquiring about childhood illness & personality details.

The East believe that illness is a result of blocked Qi (chi) that normally flows from teh feet up to the head, and back down to the feet in a cycle. Acupuncture promotes the flow of qi.

Electroacupuncture with a knee arthritis may be combined in a PRP protocol to maximize benefits.

Heading to PRP Ultrasound Conference Nov-2nd-3rd, 2007

On Nov 2nd & 3rd, I will be at a PRP course in Ohio. To my knowledge it is the first of it's kind in the US. Several field leaders and those Physicians interested in learning about PRP will gather there to exchange ideas and further our understanding of PRP. Also, there will be needle guided ultrasound tutorials. Musculoskeletal ultrasound is being used increasingly by docs performing PRP injections. I have performed some injections under ultrasound with enhanced ability to guide the needle to precise areas of injury. I will post info following the course.

Tuesday, October 23, 2007

New Spine article on biologics "Orthokine" Use in Lumbar Epidurals for Sciatica

A common treatment for a herniated Disc or "Sciatica" that fails physical therapy and conservative treatment is an epidural steroid injection. Nowadays they are performed under an x-ray machine, called fluroscopy which ensures proper needle placement and safety.

A study from Spine compared steroids/cortisone which is commonly used in epidurals to decrease nerve inflammation with Orthokine. http://www.orthokine.com/Orthokine is a biologic agent known as a Cytokine. It specifically blocks Interlukin-1, which plays a role in inflammation and pathology. Similar to PRP, whole blood is drawn from a patient and placed in a centrifuge aftrewards. However there is an additional step with incubation of the processed blood for 24hrs which creates IL1-RA an antagonist that blocks pain/inflammation.

The study suggests that after 3 months of receiving a series of 3 injections, those with Orthokine injections had more dramatic decreased pain scores than those with cortisone. Furthermore, there are less adverse effects associated with autologous blood versus steroids.

http://www.spinejournal.com/pt/re/spine/abstract.00007632-200708010-00002.htm;jsessionid=HflXqpy0GQGZYyvc3GpvY1NQ4QYjnk1xjNGmlLqmQpXN1BmjGKZV!1071114923!181195629!8091!-1

Orthokine and PRP are part of an emerging industry that combine modern technology while maximiizing the body's natural ability to heal itself. This field is known as Orthobiologics.

Thursday, October 18, 2007

New Study on PRP use on Rabbit Cartilage

In the Journal of Oral & Maxillofascial Surgery, September 2007, A
Cartilage cells, (chondrocytes) were harvested from a rabbit ear and was added to PRP and injected into rabbits. After 2 months, histological slides and MRI suggested increased cartilage production.

PRP is seeing increased usage in cartilage defects, with many docs reporting promising results. However studies like this may lead to a more refined approach to PRP and knee osteoarthitis. In time, individual growth factors may be filtered out and applied for specific indications. For now, PRP contains a "cocktail" of potent healing properties. This exciting new field is termed, "Orthobiologics."

http://www.joms.org/article/PIIS0278239106021070/abstract

Dental Applications of Platelet Rich Plasma

Early roots of PPR use lie in Dentristy and Plastic Surgery. Initially, it was thought that platelets act exclusively by forming wound clots. However, we have learned that PRP also heals soft tissue.

Below is a link to dental applications.

http://jada.ada.org/cgi/content/abstract/133/10/1383

Furthermore there are few textbooks on PRP. This book was written by Robert E. Marx, a pioneer of PRP usage.

http://www.amazon.com/Dental-Craniofacial-Applications-Platelet-Rich-Plasma/dp/0867154322

Racing Horse Treated with PRP and Hyperbaric Oxygen

PRP has been used in Vetrinary medicine as well. Recent studies have shown that PRP strengthens and heals tendons and ligaments that are frequently injured in race horses. PRP has been modified for horse application.

http://www.equinesite.com/articles/modules.php?name=News&file=article&sid=1178

A case report was just released documenting accelerated recovery of a professional race horse, Wearable Art.

http://www.standardbredcanada.ca/news/iss1007/wearableart1002.html

Monday, October 15, 2007

Platelet Rich Plasma Patient Education Brochure

www.smog-ortho.com/prpguide.pdf

Platelet Rich Plasma on CBS News with Katie Kouric

Our Practice (Santa Monica Orthopaedic Group) was featured on CBS Evening News recently. We treated a professional soccer player, Jonathan Bornstein with PRP to accelerate his MCL knee injury healing. We have treated several athletes with encouraging results. His story was told on CBS News. Also, one of my colleagues, Dr Michael Gerhardt was interviewed.

http://www.cbsnews.com/stories/2007/06/05/eveningnews/main2889125.shtml

Thursday, October 11, 2007

Knee Arthritis Helped with Platelet Rich Plasma, Warsaw, Poland Oct 07'

- Utilization of Platelet-derived growth factors for the treatment of cartilage degenerative pathology Clinical research / Knee (Chondral and Osteochondral defects)

E. Kon, G. Filardo, M. Lo Presti, M. Delcogliano, F. Iacono, C. Montaperto, M. Marcacci; Bologna/IT
Purpose
The influence of the growth factors on cartilage repair is not yet widely studied and its application in clinics is still experimental. PRP (Platelet Rich Plasma) is a natural concentrate of autologous growth factors and actually is widely experimented in different fields of medicine. The method is simple, low cost and minimally invasive. The aim of our study is to determine the short-term effect of PRP in cartilage degenerative pathology.
Methods and Materials
30 symptomatic patients (40 knees) were treated with autologous PRP intra-articular injections for degenerative cartilage pathology. Mean age of the patients was 51 years (range:35y to 80y). 3 injections were performed every 3 weeks. All patients were clinically evaluated at the end of the treatment and at 6 months follow up. IKDC, SF36, EQ-VAS, scores were used for clinical evaluation and patient stisfaction and functional status were also recorded.
Results
Statistically significant improvement of all scores was detected after treatment and was maintained at 6 months. Subjective IKDC evaluation showed a significant score enhancement from 37,9 before the treatment to 59,0 after the treatment. Significant correlation of clinical outcome with patients age was found. While the group of patients less then 60 years old have shown 85% of improvement, the group of patients over 60 showed only 30% of improvement of clinical outcome.

Conclusions
Our study have demonstrated a positive effect of treatment of degenerative cartilage pathology with Platelet-derived growth factors in middle-age patients (<60y) at short term. Medium-long term studies are needed to confirm the durability of this treatment.

ICRS - International Cartilage Repair Society.

Knee Cartilage Cell Stimulation with Platelet Rich Plasma, Warsaw Poland, Oct 07'

Effects of autologous platelet-rich plasma on the metabolism of human articular chondrocytes
K. Nakagawa1, T. Sasho1, M. Arai1, S. Kitahara1, S. Ogino1, Y. Wada2, H. Moriya1; 1Chiba/JP, 2Ichihara/JP

Purpose

Platelet-rich plasma (PRP) is a fraction of plasma in which platelets are concentrated and is reported to be utilized as a source of multiple growth factors. Recent basic studies have shown that allogenic PRP has a promotive effect on chondrocyte metabolism. For the clinical application of PRP to cartilage defects, it is essential to use autologuous prepared PRP in each case. The purpose of this study was to examnie the effect of autologous PRP on adult human chondrocytes.
Methods and Materials
Fresh blood (54ml) and cartilage tissue were obtained from three patients (mean age: 70y.o.) underwent total knee arthroplasty with their consent. Platelet poor plasma (PPP) and PRP were prepared using a platelet concentration system. Chondrocytes were isolated with enzymatic digestion and cultured in monolayer. WST-8 was used for cell proliferation assay. Gene expression of types I, II collagen and aggrecan were examined with a relative quantitative real time RT-PCR assay.
Results
The concentrations of PDGF and TGF-beta1 in the PRP were much higher than those in the PPP. The WST-8 assay showed a higher absorbency in the PRP group, which reflects an enhancement of cell proliferation. PRP significantly enhanced type II collagen synthesis by human chondrocytes, while their aggrecan synthesis was inhibited.
Conclusions
We demonstrated for the first time that autologous PRP stimulated proliferation and collagen synthesis of adult human chondrocytes. PRP is easy to prepare and utilize as both soluble platelet releasate and fibrin gel. The results of this study suggested the usefulness of autologous PRP for the treatment of cartilage defects.

ICRS - International Cartilage Repair Society. http://www.cartilage.org/

New Studies on Platelet Rich Plasma and Knee Osteoarthritis

My Colleague Bert Mandelbaum MD, just returned from the (ICRS) International Cartilage Repair Society Meeting in Warsaw Poland last wk with exciting news. Two studies document efficacy & safety of PRP use in cartilage disorders of the knee. Previously the only link I was aware of connecting PRP benefits with cartilage was a study by Hunziker et al. This study links one of the growth factors in PRP, TGF-b to cartilage regeneration.

www.corronline.com/pt/re/corr/abstract.00003086-200110001-00017.htm;jsessionid=GWpFpfW1dldQXqQm2sCVGwDXkl

Also, many patients have heard of another biologic treatment being performed in Dusseldorf Germany called Orthokine. Some of our patients have unsuccessfully tried this therapy or were considering travelling to Germany before learning about what we do here in Santa Monica. www.orthokine.com www.neue-orthopaedie.de

The following studies are available on this site. (Sorry there is no direct link available yet). We are hoping to do a large knee Osteoarthritis study on PRP soon. These new studies presented in Europe suggest that the cocktail of growth factors work on stimulating cartilage cells called "chondrocytes." The study below injected 30 patients with knee OA in a series of 3 PRP injections at 3 week intervals. Patients were re-evaluated at 6 months. Patients younger than 60 years (presumably with less severe arthritis) improved 85% versus 30% for those over 60 years. This encourages further discussion regarding the use of PRP in OA as well as consideration of a series of injections.

The following were presented at the ICRS from Warsaw. www.cartilage.orgUtilization of Platelet-derived growth factors for the treatment of cartilage degenerative pathology from Bologna Italy by E. Kon, G. Filardo, M. Lo Presti, M. Delcogliano, F. Iacono, C. Montaperto, M. Marcacci;

Effects of autologous platelet-rich plasma on the metabolism of human articular chondrocytes
Basic Science / Growth factors
K. Nakagawa1, T. Sasho1, M. Arai1, S. Kitahara1, S. Ogino1, Y. Wada2, H. Moriya1; 1Chiba/JP, 2Ichihara/JP

PRP knee injection 8 wks post injection update

Well it's been 8 wks now since my infamous surfing experience & subsaquent injection. I have been doing terrific. By now, I have received a series of MRI's and an ultrasound that document decreased edema & show tendon thickening (indicating healing of my MCL ligament. Initially I had a grade II MCL sprain. Because I have my own MRI machine, I have the luxury of performing seriel studies.

Anyways, I have been attending PT weekly with Cheyanne Kane PT in West LA (good therapist). She has been using modalities including Laser which have been helpful. Also, I have Cheyanne place the laser on acupuncture points for healing and relaxation.

By now, I have been swimming, biking, & running pain free. Occasionally my knee feels a little stiff after standing or sitting for prolonged periods, but maybe a 1/10 on the pain scale. I have not taken any medications other than tylenol for a few days after the initial injection.

I will soon publish a case report on my MCL injury with PRP injection. Hopefully this will inspire other professional & recreational athletes to consider this treatment to accelerate recovery with limited negative consequences. All of our professional soccer players with MCL sprains and PRP injections are doing great.

Thursday, August 23, 2007

Botulinum Neurotoxin (Botox) for pain management

I recently co-authored a chapter on Piriformis Syndrome in a new text by Grant Cooper, titled Therapeutic Uses of Botulinum Neurotoxin, http://www.amazon.com/Therapeutic-Botulinum-Toxin-Grant-Cooper/dp/1588299147/ref=sr_1_9/002-0107581-8821662?ie=UTF8&s=books&qid=1187909430&sr=1-9
Piriformis Syndrome refers to an irritation of the sciatic nerve in the buttock, which differs from a herniated disc in the spine.

After injecting many a forehead with botox, Plastic Surgeons learned that patient's headaches were alleviated. Through research, we have learned that botox works by temporarily weakening overworked muscles. Also, we now understand that Botox inhibits pain (nociceptive) fibers as well.

Botox is a purified form of Botulinum Neurotoxin type A that allows physicians to inject a small quantity into a specific area with a local response. In my residency training in New York City; we safely treated hundreds of adults with Stroke & children with Cerebal Palsy suffering from spasticity. "Spasticity" refers to muscle tightness (an increased reflex) after a brain injury. People with spasticity may have an elbow uncontrollably bent, thumb clenched inside a palm, or pointed feet with difficulty walking. We have seen dramatic functional benefits with return of independence; however the effects last approximately 3 months and need to be repeated periodically.

There is optimism that Botox may help alleviate knee osteoarthritic pain. A recent pilot study from Minnesota, showed decreased pain in patients with continued pain following knee replacements. http://clinicaltrials.gov/ct/show/NCT00403273?order=4
http://www.medpagetoday.com/Rheumatology/2005ACRMeeting/tb/4502
However, further research is certainly needed.

Sunday, August 19, 2007

Doctor Heal Thyself or How I Treated My Own Tendon Injury

After moving to California recently, I decided to take surfing lessons. However, I wasn't aware that I was about to receive a PRP injection myself after spraining my MCL on the first day! I felt a pop in my knee and subsequently had an MRI that showed bruising of my tibia & swelling/fluid at my MCL. Shortly afterwards, I received a PRP injection to my knee.

This experience let me understand the healing process & better communicate the recovery process with patients. Most importantly I have appreciated the necessary role of Physical therapy post injection. We are in the process of developing Physical therapy protcols to maximize positive outcomes & improve pain tolerance. Being a typical doctor, and not properly taking care of myself, I worked the day after my injection rather than resting as I recommend to others. This resulted in increased pain which was later relieved with a device I received called "game Ready" which provides cooling & compression with ice. Now, I describe the process as similar to experiencing a new injury. Although there isn't a second injury, we are releasing potent proteins/growth factors that normally accumulate when there is an acute injury.

I tell patients that they may feel a different pain which gradually subsides in 2-7 days. For some reason patient tolerance of the injection varies. Some describe significant brief discomfort, while others are completely fine.

Platelet Rich Plasma Introduction

This blog site was created to establish a non-competitive forum for physicians performing PRP treatments & for patients interested in learning more about this emerging treatment. I was introduced to this treatment by my colleagues, Dr Bert Mandelbaum & Dr Michael Gerhardt; who are premiere orthopaedists responsible for treating numerous soccer athletes from all over the world. PRP is being used by many European professional soccer clubs, and is now making it's way to the U.S.

Initially we injected a few professional soccer athletes for MCL tears/sprains and noted accelerated recovery & earlier than expected return to play. Click link to see article:
http://www.mlsnet.com/news/team_news.jsp?ymd=20070417&content_id=89302&vkey=news_cdc&fext=.jsp&team=t120

Shortly afterwards we began treating weekend warriors with chronic non-healing tendon injuries including tennis/golfers elbow, achilles tendonosis, patellar tendonosis (jumpers knee). After a favorable response from patients and following discussions with other leaders in the community on PRP, we are now injecting PRP for other non-healing injuries including knee arthritis & hip bursitis.

PRP provides a safe and natural alternative to surgery using the body's natural ability to heal itself.

Tuesday, December 18, 2007

Sunday, December 9, 2007

Sunday, December 2, 2007

Wednesday, November 28, 2007

Sunday, November 18, 2007

Thursday, November 8, 2007

Thursday, November 1, 2007

Monday, October 29, 2007

Tuesday, October 23, 2007

Thursday, October 18, 2007

Monday, October 15, 2007

Thursday, October 11, 2007

Thursday, August 23, 2007

Sunday, August 19, 2007

Tennis Elbow Injection

New Platelet Rich Plasma Web Site!

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