TREATMENTS

Helping to Enhance Healing

Insight

We try to identify what factors led to their problem. By gaining an understanding of anatomy and mechanisms of injury, one can often achieve healing without any further interventions.

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 such as frozen shoulder, which has an immune-mediated inflammatory component, or for carpal tunnel syndrome, trigger finger, shoulder impingement and spinal stenosis, conditions in which swelling and enlargement of tissues causes problems.

Biologic Injections

Biologics such as platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) obtained from a patient’s own blood and bone marrow are potential options for chronic injuries and degenerative conditions. Certain structures respond well to PRP, such as a torn hip labrum or knee meniscus, while osteoarthritis responds better to BMAC. 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 and general anesthesia. In the 1990s, arthroscopic and mini-open techniques were developed. In the 2000s, ultra-minimally invasive ultrasound-guided techniques were developed wherein the “camera” stays on the outside. Most patients are able to return to work in several days. Ultrasound-guided surgery can be done for conditions such as vaccination-related shoulder dysfunction, calcium deposits, tendon contractures and nerve entrapment.

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.