TREATMENTS

Helping to Enhance Healing

Prevention

For each patient we try to identify out which factors might have led to their problem. By identifying and correcting these factors, symptoms often resolve without any further treatment.

Exercise

Exercise has many benefits. Certain types of exercise lead to specific adaptations in muscles, tendons, ligaments and discs, with resolution of pain and disability.

Corticosteroid Injections

Corticosteroid injections can provide long-standing relief for certain conditions, particularly those which have an immune-mediated inflammatory component such as frozen shoulder, or those in which there is enlargement of tissues within a limited space, such as carpal tunnel syndrome, trigger finger, shoulder impingement and spinal stenosis.

Biologic Procedures

Because corticosteroid injections reduce protein synthesis and can weaken tendons and cartilage, biologic injections such as platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) obtained from the patient’s own blood and bone marrow are being used to treat chronic injuries and degenerative conditions. In our practice, we have noted certain chronic injuries respond well to PRP, such as a torn hip labrum or medial meniscus, while others respond well to BMAC, such as osteoarthritis of the knee, shoulder and wrist. In the spine, approximately two-thirds of patients with chronic disc pain experience substantial long-term improvement or resolution of their pain after an intradiscal PRP injection procedure.

Ultrasound-Guided Surgery

Carpal tunnel syndrome was originally treated using an open approach with general anesthesia. In the 1990s, arthroscopic and mini-open techniques were developed using local or regional anesthesia. In the 2000s, ultra-minimally invasive ultrasound-guided carpal tunnel release techniques were developed. Patients are typically able to return to work within a few days. Other conditions such as vaccination-related shoulder dysfunction, osteophytes in the knee, calcific deposits in tendons, tendon contractures and nerve entrapment in the leg (compartment syndrome) have been treated successfully using ultrasound-guided techniques.

Frequently Asked Questions

We like to use platelet rich plasma (PRP) that is leukocyte poor at concentrations from 5 to 10 fold baseline concentration with a minimum of red blood cells. We sometimes activate the platelets in order to induce adhesion, contraction and formation of a fibrin matrix, and at other times we will let the platelets self-activate when they come in contact with exposed collagen, resulting in a slower and more sustained release of platelet growth factors. Our decision as to what concentration and volume of platelets to use and whether to activate them or not depends on our analysis of the injury, its architecture and precise calculations performed on the basis of MRI and ultrasound imaging.

The speed of recovery and resolution of symptoms depends on the size and nature of the injury and how amenable it is to biologic treatments. Small muscle and tendon tears can respond as quickly as 1 -2 weeks, whereas long-standing disc tears may take longer than 8 weeks. PRP and stem cells for joints can take up to 1 – 2 months to start to get better and generally continue to improve over a number of months.

In general we allow activities as tolerated as long as one is not taking anything to relieve pain. Platelets and stem cells amplify the normal communication between injured tissue and the brain providing an added level of safety from overload. Most commonly we advise to let pain be the guide. We encourage exercise and activities of daily living as soon as possible while protecting the injured area from any movements or loading that provoke the pain. A mild sensation of pain with activities is generally acceptable assuming that nothing is taken to mask the pain response.