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PRP treatment for tendons


gator1
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Don't know if you guys have heard, there is a newish procedure for chronic sore elbow and sore patellar tendon.

 

If your elbow hurts at rest, odds are the tendon is slightly torn. They used to operate, screw the tendon back on, 6 weeks in cast.

 

Now they suck your own blood out, and then inject it back into the tendon where it attaches to the bone. Not a pleasant experience, since they have to poke the tendon and bone a bunch of times, but a lot better then operations. Three injections, separated by a week.

 

Fixed my elbow 4 years ago, and I just finished getting the third round in my knee.

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Called PRP I had it done on two of my knee tendons for tendonitis. Worked great on one and cured it quickly. The second did help but didn't wipe it out, but did help alot. I could have gone in for a second round but never did. Watch out though most insurance doesn't cover it all but will cover some components.
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I have got the most acute, painful tendinitis right now on the inside of my left elbow. Elbow orthopedic told me it may be cubital tunnel syndrome (pressure on the ulnar nerve) and could require surgery. I think I'll go with rest first as my season will end in a week or so. If any of you have treatment recommendations that are outside the normal ice, larger handle diameter, radius handle, stretching, etc., I'd love to hear them. I've been doing all the above with no improvement at all. Maybe the blood injections will be worth a try.
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The Ortho's we work with in the Motherload (Ca.) will be very upfront in admitting there is ***Nothing conclusive in the literature regarding the efficacy of PRP as a form of treating joints, muscle, tendon or bone tissue. Level 1 research published in ortho journals is the only form of evidence based medicine to go off of. Level 5 research is expert opinion (not good), make sure you know the difference. PRP is not covered by many providers thus it is typically an out of pocket crap shoot. This is also why there is not much research on it currently. If you believe it will help the placebo effect (which is very real) is on your side!

@Jimbrake, nerve glides and slides along with non aggravating stretching and ice is your method of treatment. This link was a video I did for guitar players in another forum but includes ulnar nerve glides. Let me know if you want more info on them.

-Don

 

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@jimbrake I'd had sore right elbow before (I'm LFF), but nothing like the pain I had before I went and did the PRP. It was bad enough that it kept me up at night with stinging/burning. I had the PRP, it was getting much better, got run into by a kid body surfing about a month after the last injection. Back to big pain. Got the PRP again, pain all gone.

 

My ortho surgeon/ski buddy used to do 10/12 operations per year for "golfers elbow" which is what this is called. He hasn't done any since he started doing the PRP about 8 years ago.

 

Originally, they were pulling the blood, and spinning it in a centrifuge, then squirting the concentrate back in. He found that was no better then just pulling the blood and three injections. If you don't have other weird stuff going on, and it is just tendonitis, I'd really be in favor of trying it. Not much to lose if it doesn't work.

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Thanks, Don! Free ski ride waiting for you at BA. Come on up!

 

@gator1 - I will certainly keep PRP in mind. I've got the night time stinging and burning, too. I will do more self PT and ice (and also quit leaning on it on my desk at work) and see how that goes, then consider the PRP.

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@jimbrake not wishing you ill, just so you know: the stinging/burning at night symptom vs just pain under load and to touch on that little point of the bone symptom is supposedly the tip point in diagnosing between torn-that-won't-heal-on-its-own, and irritated/inflamed-will-heal-on-its-own.

 

I screwed around with mine for a whole season and then the following winter, wished I'd fixed it much earlier.

 

Best of luck to you, and hope it heals up on its own.

-Craig

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@gator1 - Thanks. I'll check into it sooner than later. Ortho I went to see didn't mention it. He wants me to get a test done on the ulnar nerve first. Doing that next week. I don't have any numbness or tingling in my fingers, so thinking the nerve could be irritated but not terribly.
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I just had PRP injections under both knee caps and in my back a week ago. I'll let you know how it works out. One thing's for sure, the knee injections hurt like hell for at least a week. I've been off the water for a week then just had to try skiing today. My knees are pissed at me now for rushing them. I've had excellent results with this in the past on my elbow and ankles so I remain a fan.
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I have read where some Docs use PRP on other operations to speed healing as well.

My friend's wife had PRP in her rotator cuffs and said it was one of the most painful things she has gone through. She is happy with the outcome, but said it was not a cake walk. And she is a pretty tough customer.

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Never count out the placebo effect. The current pain science says if you believe it will work, it will!

They did a study where ultra sound machines were not plugged in and they had the same effect as those that were. Yet PT clinics still use them -because they can bill for it. Evidence based medicine is the direction all healthcare is moving, don't settle for experience or anecdotal based treatments. Core issue here fellas, your will cannot force a change in the physiology. We do not want to take the time off it takes to heal and short line skiing takes a toll on an aging body.

Don't hate me for telling you the truth!

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@cragginshred: I don't hate you. Odds are, since you are a skier, I'd like you.

 

But, in my case, I know you are wrong.

 

Few other points:

1)I'm not aware that the placebo effect has been proven on @tjm horses.

2)My ski buddy/surgeon is losing gobs of money by using PRP instead of operating on people

3)I believe in ice, rest, rehabilitation too, less so then I did in PRP. Why did the placebo affect not convince me ice rest and rehab was working?

 

Finally, I'm skiing pain free. I wasn't before. Don't give a shit if its all in my head or in PRP. Don't want you to discourage people from trying it if nothing else will get them back on the water.

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@gator1 I'm seeing if it can help me with my patellar thermal arthritis. The mad doctor seems highly confident that it will help a lot. Right now I'm thinking that when the pain from the cure subsides, the pain from the condition will seem like nothing =)
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The use of PRP has some medical literature support for epicondylitis of the elbow (lateral specifically - "tennis elbow"). It is being used for many other conditions, but it remains largely experimental. In fact, some studies have shown detrimental effects on the rotator cuff, particularly when used during rotator cuff repair surgery. Since there is little scientific support, the insurance companies don't typically pay for it. It generally costs hundreds of dollars out of pocket.
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@gator1 Yes, from my understanding, that's exactly what I've got. The injections are not "blood." They draw your blood then centrifuge it, separating it into layers. Between the separated red cell and plasma layers is a thin layer of platelet rich plasma. This is where most of the blood's healing properties reside. The goal is to inject these platelets into areas that are typically poorly serviced by normal blood flow, areas like ligaments, tendons and in joints. In this case, I've had the prp injected around my L5 spinal disk (no pain at all from these injections) plus four injections under each knee cap (pretty uncomfortable). I'm no doctor or scientist, but I can't see how harmful it can be, rounding up your body's natural healers and injecting them back into the body they came from.
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@cragginshred I had the rope pulled out of my hands a few weeks ago and my forearm all the way down to my hands has been hurting since. I did those exercises in the video the last couple days and its feeling a lot better. Need to put those on my daily routine.
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@skijay can't wait to hear if this works under your kneecap. I've had synthetic synovial fluid injected into the joint under the knee cap. 3 injections one week apart. Not a good time. But seems to lube the joint up for about 6 months, then I'm back to whining again. I've done this twice.

 

Kobe and other ballers (of the highly paid type) have been going over to Germany and getting a version of this where they heat the plasma to 101 degrees before they shoot it back in. Not approved in US.

 

I hadn't heard of using PRP to heal cartilage. You are up in BC?

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@skijay Glad the PRP helped your knee. I should also note that there is some medical literature support of PRP for patellar tendinopathy. The studies are from Europe and are not technically controlled randomized studies (best for scientific studies), but at least they look promising. There is also some early favorable data using PRP injections for knee arthritis. Again though, insurance typically doesn't cover it.

 

The "synthetic synovial fluid" noted by @gator1 is better known as viscosupplementation. Patients commonly refer to the injections as "chicken shots" or "rooster comb injections." Basically, it's a thick viscous medication made from the comb of roosters that seems to help a lot of patients with knee arthritis. It's usually given as either a single injection or a series of 3-5 injections, one a week. It tends to work longer than cortisone injections when it works. Insurance typically pays for this, especially for patients who only have limited relief with cortisone.

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If you REALLY want to get your money out, for $5, 000, you can now have some fat liposuctioned then processed into stem cell injections that are injected like platelet rich plasma (prp) into the injury. Prolo therapy - good, PRP- better, stem cells - best.
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I had my patellar tendon scoped in '89 and the Doc said it would give me a good 15 years. I got a few extra out of it and now I think it just buckles under me sometimes on my offside turn, as I have no other explanation for trying to kiss the tip of my ski when smoking a pass. MRI shows lots of arthritis under knee cap now. Had to give up basketball last year after it swelled up like a watermelon. Took weeks to loosen up. Doc says arthritis, not much can be done, so please let us know how the injections work.
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I'm amazed at how many skiers over 50 years old are talking about patellar thermal (knee cap) arthritis lately. I guess that's why one of the doctors I've seen about it called it "normal age-appropriate wear." That same doctor recommended viscosupplementation but said it needs to be refreshed every three to six months in perpetuity.

 

The doctor giving me PRP is saying I can expect to hold off further degeneration for a number of years and possibly do a little regenerating in the process too. Maybe, and maybe not, but I'm giving it a solid chance by doing two rounds of the PRP therapy. The next one is in early October, so I'll report back around then and again later on. Fingers crossed ...

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Hoping it works for you @Skijay. I think our generation is part of a changing wave of acting like a kid forever. My co-lake owner and I were just talking about that at lunch yesterday. We both agree that we need to lose weight, but still are pretty active, after playing competitive sports for a long time, much longer than our parents generation. We are the high mileage crowd!

 

I have two sets of parents still here with us, both around the 80 mark, one set is active, like my Dad plays golf 3 or 4 times a week, and the other stopped being active years ago. My Dad looks 15 years younger, but is the oldest in the bunch. My observation is that when you stop being active, the aging process takes over at a faster rate.

 

When I was in NY in the 80's, I skied with a guy in his mid-60's who could run 28 off on a good day. He was very thin and active. One year, he picked up a nasty respiratory infection after a vacation and took an entire season off, and also spent a lot of time in a chair. When he started the next year, he was never able to physically get back and soon after, gave up skiing altogether. His rate of decline physically was huge in one year of inactivity. I guess the moral of all this is to stay active and push your physical exercise as long as you can.

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