Musculoskeletal Ultrasound seeing increased use in Orthopaedics

Yale New Haven Hospital is among the growing community of progressive physicians integrating ultrasound into their orthopaedic practice.

I believe musculoskleletal ultrasound will become a standard tool to help physicians in orthopaedics & sports medicine, much like it is in Europe. With advancements in technology, ultrasound provides unbelievable images of tendons, ligaments, and fluid inside the body. These images are very useful for diagnostic purposesand also guide the physician with injection procedures to ensure accuracy within millimeters of the target. Anecdotally I have found that patients getting cortisone injections have less discomfort with ultrasound guidance because painful structures like bone & tendon are avoided. Also patients enjoy the interaction that ultrasound provides with the physician. Patients can for example move their shoulder around to a particular position to reproduce pain that may not be seen with a static exam like x-ray or MRI. Also ultrasound is cost effective.

A series of studies examined the use, training, outcomes and accuracy of surgeon-held musculoskeletal ultrasound at Yale School of Medicine and Duke Medical School. Researchers found that orthopaedic surgeons can reduce overall time to patient diagnosis, enhance subjective and objective clinical outcomes, and significantly lower some out-of-pocket expense for patients. Results of the studies were presented at the 2008 American Academy of Orthopaedic Surgeons (AAOS) and American Institute of Ultrasound Medicine (AIUM) annual meetings.

http://www.ynhh.org/press/2009/orthoultrasound.html

Kentucky Derby rasising awareness of platelet rich plasma and stem cell treatments in horses

With the timing of the Kentucky Derby today, there has been recent press about PRP therapy & stem cell usage in athletic horses.

A company called VetCell's from the UK just announced a Stem Cell Technique to Undergo Human Trials. They have treated over 1500 horses successfully & are now applying this stem cell technology to humans. I expect many studies in the next few years which will enlighten us exactly how we can maximize natural healing utilizing stem cells.

http://www.thehorse.com/ViewArticle.aspx?ID=13991&src=RA

Another study from Cornell University was just published on PRP use with horses showing effectiveness of healing tendon injuries. Tendon injuries are an important cause of catastrophic injury in athletic horses, and even minor injuries are often slow to heal and prone to future injury. Researchers performed ultrasound examinations of the tendons at 0, 2, 4, 6, and 8 weeks and mechanical, biochemical, and microscopic evaluation of the tendons 8 weeks after treatment.
Ultrasound while commonly used to look at babies, is seeing increased use in orthopedics and sports medicine to diagnose tendon injuries and to guide needle injections to ensure precise accuracy.

http://www.ncbi.nlm.nih.gov/pubmed/19350658?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Platelet Rich Plasma Injection Therapy Use in Korea

Recently I had the pleasure of meeting Jae Wook Ryu MD PhD from Seoul Korea. Dr Ryu is the team doctor of professional baseball team (Woori Heros). Dr Ryu visited our clinic in Los Angeles all the way from S. Korea to exchange experiences & protocols. We encourage these international meetings and have had physicians visit from other countries as well.

Dr Ryu incorporates additional protocols prior to PRP therapy including acupuncture and nutritional supplementation & IV therapy to stimulate collagen (tissue) growth. Dr Ryu has treated professional athletes including a Korean professional baseball pitcher with great results. PRP holds great promise & hopefully by exchanging ideas with other pioneering docs across the globe we can make great advancements in medicine.

www.salm.co.kr

Breakthrough treatment boosts stem cells to heal bone fractures

Recent research on a drug FDA approved in 2002 for Osteoporosis, Forteo: suggests that it may enhance release of adult stem cells to heal bone fractures.Of the six million fractures in the United States each year, approximately five percent will have slow or incomplete healing. Options are few for some patients who suffer with prolonged healing. Perhaps until now...

This is another example of how we are learning more & more that the key element to healing revolves around circulation of stem cells. We are entering the dawn of a "cellular phase" of medicine. Research is being done to treat challenging diseases like arthritis & diabetes. This drug helps turn stem cells into bone cells to cut fracture healing time down & reducing pain. This prompted a large government funded study.

http://www.eurekalert.org/pub_releases/2009-04/uorm-sdw040809.php

The story was covered on ABC nightly news:
World News - ABC News

Botox use getting more attention for healing rather than cosmetic use

Recently Botox has been getting more press about it's applications for conditions other than vanity. Botox temporarily weakens muscle and blocks "substance p" which in turn blocks pain. Unlike many other meds, botox has very little side effect & lasts for months. As a result there is increased use across the board in medicine including migraines, neck and low back pain, and buttock pain (piriformis syndrome). Research is being conducted on prostate enlargement (BPH) and overactive bladder. Also patients with tight limbs from strokes or brain injuries receive this treatment to improve function.

The NY Times recently published an article on botox seeing increased use for medical conditions.
http://www.nytimes.com/2009/04/12/business/12botox.html?hpw

Also I published a chapter on botox use for sciatica (buttock pain known as piriformis syndrome).
http://prpinjection.blogspot.com/search?q=piriformis

PRP Platelet Rich Plasma Therapy Blood Injection Featured on ABC's Good Morning America

PRP is getting a lot of attention in the media lately...here is a link from Good Morning America. This treatment speaks to the concept that the body has a remarkable ability to heal itself. Through innovative technology, we are revolutionizing how we address treatment of tendon and cartilage injuries.

http://abcnews.go.com/Health/PainNews/Story?id=6895441&page=1

President Barack Obama will soon lift the federal funding ban on embryonic stem cell research

After I attended the 4th annual stem cell summit in NYC today, analysts predicted that President Obama will reverse the ban on embryonic stem cell research in the coming days ahead.

It's important for the public to understand however that stem cells can be obtained and harvested from a variety of means. The term "stem cells" evokes controversy, mystique and caution. But what most aren't aware of is the availability of adult stem cells. Yes, we all have our own stem cells that have the capacity to replenish & regenerate tissue and disease.

Stem cells may be obtained from the following means:
-Umbilical cord
-Bone Marrow
-whole blood (after receiving injectibles that stimulate release from marrow to the periphery which is then drawn from the arm like neupogen & Mozobil)
Embryonic (the most controversial)
Menstrual blood (yes menstrual blood) it may be the most fresh compared to cord blood that is 9 months old.
Placenta?
Adipose (yes fat cells so one day a patient could receive liposuction & treatment for disease!)
Supplements?

Interestingly at the stem cell conference 38 of the leading companies from around the world presented their latest work. Of those only 6 represented embryonic stem cells compared to 32 with adult stem cells..

The presentations were overwhelmingly informative. I will summarize the info soon. Also I will be lecturing a grand rounds at Saint John's Health Center in Santa Monica, CA in March to educate physicians about future trends in medicine.

According to CNBC today, the stem cell market will see a dramatic rise from $1.7 billion last year to between $22 billion and $49 billion over the next 10 years. wow.

http://www.cnbc.com/id/29238629



Dr Steven Sampson

New York Times Article published on PRP blood injection Platelet Rich Plasma Therapy: Athletes’ Own Blood Could Nurse Them to Health

Following the mention of Hines Ward receiving a PRP injection to allow him to perform in the super bowl, there has been an increased interest in understanding this treatment. Recently I was interviewed by New York Times reporter Alan Schwarz and extensively contributed to the article which will be published in tomorrow morning's New York Times in section A1.


http://www.nytimes.com/2009/02/17/sports/17blood.html?_r=1

The article raises awareness that PRP is a cost effective and safe means of accelerating healing naturally without surgery. However I feel that PRP treatment represents only the beginning in a promising field known as "orthobiologics." I will be at the 4th annual Stem Cell Summit In New York City Feburary 17, 2008. The leading biologic and stem cell companies, physicians, and scientists will converge to share our latest work. I will post an update on the presentations and will soon give a grand rounds on stem cell & biologic progress.

I'm thrilled that (PRP) Platelet Rich Plasma Therapy is beginning to capture the public and medical community's attention. I hope to continue to train & educate physicians to expand the application of this innovative treatment in tendon and cartilage injuries. I hope to publish data from a PRP study on knee osteoarthritis this year.

Dr Steven Sampson
www.orthohealing.com

Dr Steven Sampson selected as a principal investigator for FDA Approved multi-center platelet rich plasma tennis elbow study

Dr Steven Sampson was selected as a principal investigator for an FDA approved study for Recover® Kit for Chronic Elbow Tendinosis using platelet rich plasma (PRP). This study includes up to 10 centers across the country and will hopefully pave the way for FDA approval and widespread use. Stay tuned for further info regarding this and other studies Dr Sampson is involved with in 2009.
www.orthohealing.com


http://www.biomet.com/patients/clinical_recruitment_recover.cfm

Platelet Rich Plasma (Blood Injection) reportedly used on Hines Ward's Knee in Superbowl

Just prior to the kickoff of superbowl XLIII, on field reporters from NBC credited Hines Ward's rapid recovery with a knee sprain to Platelet Rich Plasma therapy. According to NBC, Hines Ward had his blood drawn and later had the concentrated platelets injected back into his knee to accelerate healing.

Platelet Rich Plasma (PRP) has been used in numerous professional collegiate, & recreational athletes to accelerate recovery from injury. I have seen firsthand that PRP enables athletes to shorten their recovery time without ill effects. While athletes have the luxury of round the clock trainers, this therapy is useful in the weekend warrior as well.

Further studies are underway regarding PRP usage in osteoarthritis. For further information follow www.orthohealing.com

Platelet Rich Plasma Therapy seeing widespread use

The public, commerical, and medical community are becoming increasingly aware of the potential promise of platelet rich plasma, growth factors, and stem cell therapy. While I use PRP for tendon and cartilage disorders, physicians in South Africa have been using PRP for facial rejuvination and wrinkles by potentially stimulating collagen synthesis.

http://www.internationalshoulderjournal.org/article.asp?issn=0973-6042;year=2007;volume=1;issue=2;spage=64;epage=73;aulast=du
Also research is being conducted to treat alopecia (hair loss) by stimulating follicular growth. Adult Stem cells the precusor for these proteins may hold the most promise.

It is my opinion that there is much more to be learned regarding PRP. However ultimately we may find that isolating individual growth factors with specific responsibilities may be more effective. Researchers are already working on isolating individual growth factors for specific tasks like cartilage regeneration etc.

Dry Needling effective for Plantar Fasciitis

With musculoskeletal ultrasound to examine the heel (much like looking obstetrician's use to examine a fetus), physicians are able to accurately target heel pain.

With the advancement of technology we are able to further our understanding of disease as well as offer innovative treatments.

At the December 08 annual Radiological Society of North America, Luca M. Sconfienza, MD, from University of Genoa in Italy demonstrated 95% efficacy with dry needling followed by cortisone.

Plantar Fasciitis is one of the most common foot problems affecting 1 million people. Patients typically complain of inner heel pain with stiffness in the morning and later throughout the day with weight bearing.

44 patients were treated who had previously failed extra corporeal shockwave therapy. Shock wave therapy works by a similar means through creation of micro trauma that increases blood flow and promotes healing in a deficient ligament or tendon.

A similar procedure is done with platelet rich plasma therapy, which involves needling of the thickened and oxygen deficient plantar fascia under ultrasound guidance. But rather than using cortisone, the patients own growth factors (extracted from their arm from a blood draw) are injected into the area of injury to promote natural healing. Unlike cortisone, platelets & growth factors have no reported ill effects of tendon tearing or rupture, but rather regenerate the tissue.

http://www.healthimaging.com/index.php?option=com_articles&view=conference&id=publication:37:article:15307:section:1&division=hiit

Stem cell therapy for soldiers in battle?

Military medics often struggle to get donated blood to soldiers in battle, which can take weeks to deliver. Also hospitals in the US have seen a sharp drop in donated blood resulting from risks associated with hepatitis and other disease. This supply shortage has increased the cost of transfused blood to hospitals which are already suffering in a recession.

Researchers at the Defense Advanced Research Projects Agency (DARPA) were recently awarded a large grant to implement technology developed from John Hopkins University using nanofibers to mimic marrow to produce blood and stem cells. Theoretically this would decrease the need for transfusions and decrease the costs associated with them.

This work may contribute the the global understanding & usage of stem cells to help save lives and cure disease. Clearly in our lifetime we will see more and more stories on stem cells and growth factors unlocking some of the chains of disease.
http://www.popularmechanics.com/science/health_medicine/4296060.html

Dr Steven Sampson launches new web site: www.orthohealing.com

We are pleased to announce that our new web site has launched! Checkout www.orthohealing.com to read more about our practice. We want this website to be a resource for you, so please feel free to drop us an e-mail and let us know what you would like to read about!

This site replaces the former www.prpinjection.com