Lateral Epicondylitis (tennis elbow)
This elbow injury has been found most commonly in people who play tennis, although it can be found in many patients who have never played tennis. This can be caused by acute trauma or by repetitive motion activities such as frequent keyboard use. Lateral Epicondylitis is associated with pain along the outside of the elbow with a specific area of tenderness. The cause of this pain is tearing of the extensor carpi radialis tendon at it attaches at the elbow (a forearm muscle which extends the wrist, attaches at the elbow, and tears at its point of attachment). This area can be treated with a number of different conservative approaches, although the most effective long term approach Dr. Kloth believes to be PRP injection. This treatment has been shown to have a greater than 90% long term response in recent studies. Surgery should be reserved for only the most recalcitrant cases.
Medial Epicondylitis (golfer’s elbow)
This condition is classically seen in golfers , but can occur from a variety of different injuries and many patients with this condition have never played golf. This can be caused by trauma, repetitive motion activity, or strain. Similar to lateral Epicondylitis, this injury can be treated with PRP, which provides good long term results without the need for repetitive treatment. Surgery should be reserved for the most recalcitrant cases.
Triceps or Biceps Tendon Injury
Injuries to these tendons occur typically related to trauma or strain. These are effectively treated with PRP therapy when there only incomplete or partial tears of the tendon. Complete tears with retraction require surgical correction. Partial tears or full thickness tears without retraction can often be repaired conservatively.
Achilles Tendonosis or Achilles Tendon Tear
The Achilles tendon lies in the back of the heel. Injury to this is associated with marked difficulty with walking. When there is a complete tear of the Achilles tendon open surgical intervention is required. Partial tears of the Achilles tendon can often be treated before they progress to full tears with regenerative therapy techniques. In fact, recent studies show an approximate 80% reduction in symptoms and improvement in function following the application of regenerative medicine techniques to Achilles tendon injuries.
Heel pain is frequently related to plantar fasciitis. While it was previously believed that heel spurs were the primary cause of heel pain, it is now felt that it is the strain placed on the calcaneus or heel that causes the spur to grow. Treatment of the primary plantar fasciitis is now the most common therapy today (please see foot and ankle for the treatment of other possible injuries). Plantar fasciitis can be treated effectively with regenerative medicine techniques. Open surgical intervention is associated with a long period of recovery and a significant incidence of treatment failure. PRP injection into the plantar fascia can be highly effective at repairing and regenerating this damaged tissue. A fat graft is often included with PRP therapy to the plantar fascia to improve efficacy and provide additional cushion for the heel during ambulation.
Patellar/Quadriceps Tendon Tears
Tears of the tendon above (quadricep) and below (patella) the knee can be associated with significant difficultly with walking and pain in the knee region. Injury of these tendons causes the area to be tender to touch. Partial tears can be treated effectively with regenerative medicine techniques. Full tear with avulsion or retraction requires open surgical treatment.
One of the most common knee injuries today is medial and lateral meniscus tears. These tears are often associated with injury or trauma to the medial or lateral collateral ligaments respectively. The classic treatment approach for this is open surgical intervention, however today there are a number of studies which show healing of these meniscus tears utilizing regenerative medicine techniques, specifically PRP injections.
Both the shoulder and hip are ball and socket type joints. As part of the stabilizing component of these joints there is an internal sleeve, or attachment, called the labrum. The ball of the humerus (arm) or femur (leg) inserts into the socket and is partially held in place by the labrum. Tearing of the labrum can occur with traumatic injuries. This is often associated with pain. In some patients open surgical intervention is required for treatment of these labral tears. In patients with lessor degrees of tearing, PRP injection intra-articularly (into the joint itself), may result in symptomatic improvement on a long term sustained basis.
Hamstring tears typically recover and heal on their own. Some patients develop chronic pain related to chronic tearing of their hamstring muscle or tendon. This tendon attaches at the ischael tuberosity (the bone you sit on). Injection of this tendon and/or the attachment of the ischael tuberosity with PRP can be effective at controlling these symptoms and at promoting healing of the tear.
Rotator Cuff Tear
Rotator cuff injuries are one of the most common injuries and can occur from a variety of different traumatic events. These injuries are most commonly associated with throwing injuries, slips, and falls. It is also very common to see these injuries following a MVA and they typically occur on the side that the seatbelt crosses the shoulder. A thorough examination often will reveal the precise cause of the symptoms and interventional treatments can be considered including steroid injections, although on a long term basis this is likely not the best treatment option (long term use of steroids can damage tendons, ligaments, and cartilage). Regenerative therapy techniques provide good long term results and a chance for permanent cure of the underlying condition without surgery. We have found a high success rate at Connecticut Pain Care with the treatment of rotator cuff injuries using PRP therapy. Patient selection is paramount to success as not all lesions are amenable to this form of therapy.
The recovery period from PRP injection for a rotator cuff injury (versus traditional open surgery) is associated with significantly less pain, and a shorter period of acute soreness (a few days vs. weeks/months). No sling is required and most work can be resumed within one week. Both interventions require 4-6 months for full healing and an extended course of therapy/rehabilitation. PRP therapy is not associated with the potential for the development of progressive arthritis, whereas open surgical intervention in the shoulder (or any joint) has been claimed by some to be associated with the later development of progressive osteoarthritis. Partial thickness and full thickness rotator cuff tears without retraction can effectively be treated with PRP therapy or regenerative medicine. Typically these tendons are injected under direct ultrasound guidance to allow placement of PRP directly into the area of tearing, additional PRP is usually injected into the glenohumeral (shoulder) joint. PRP is not effective for rotator cuff tears which are associated with retraction of the tendon (i.e. – the two ends of the tendon are no longer connected but instead have pulled back or retracted from each other).
PRP has been used for a variety of different other musculoskeletal injuries typically involving tendon or ligamentous structures. If you have a tendinous or ligamentous injury, please inquire with Dr. Kloth as to whether your condition would be amenable to PRP therapy.
Osteoarthritis describes the progressive degeneration of a joint typically related to age, although this can occur prematurely related to trauma, surgery, or other causes. Treatment options include a variety of different injections or joint replacement. Steroid injections are the first line of therapy but when lasting relief is not achieved viscosupplementation (injection of a compound that lubricates the joint) may be beneficial short term. While traditionally the next step has been to replace the joint, regenerative medicine may be an option for some patients. Both PRP and Stem cell therapy in early studies have shown positive results in terms of pain. Regeneration of articular (joint surface) cartilage and reversal of the arthritic changes have been shown by others to be helpful in treating this condition. Total Joint replacement is still an option if regenerative medicine techniques fail. Joint replacement however has more acute post-op pain, more acute disability and lost work time (months vs. days), requires inpatient care, and has much higher risks, including infection, bleeding, and hardware related problems. Regenerative medicine is more likely to help joints which are less severely damaged.
Radiculopathy describes nerve pain which travels or radiates into the extremity from a nerve which is compressed or irritated in the spine. This nerve can be compressed by disc, bone, or other structures. Many patients refer to leg pain associated with a radiculopathy as sciatica. Although this is not an accurate term for this condition, it has become overused in popular culture and many people still confuse the two problems. Radiculopathy can occur at any spinal level (cervical, thoracic, and lumbar), which means that pain radiating into your arms or your legs can be considered radicular if the source of that pain occurs in the spine.
Spinal stenosis describes a condition where the spinal canal is narrowed. The spinal canal can be narrowed by disc herniations, bony overgrowth, ligamentous overgrowth (ligamentum flavum), and/or spondylolisthesis (a condition where one bone of the spine slips forward or backward in relation to the bone below). Spinal stenosis can occur centrally or in the foramen where the nerve exits. Placement of medication in close proximity to the area of narrowing provides the greatest degree of relief. Spinal stenosis may be effectively treated with intermittent injections, however if this does not provide lasting relief, surgical decompression may need to be considered; this can be performed with a minimally invasive technique in certain patients.
Spondylolisthesis describes the situation where one vertebral body or spinal bone moves forward or backward on top of the adjacent vertebral body (spinal bone). Spondylolisthesis is frequently associated with back pain, but may also be associated with nerve compression causing radiating pain into the lower extremity.