TREATMENTS

Facilitate Healing

Education

We try to identify which environmental and lifestyle factors may be contributing to a problem.  Gaining an understanding can facilitate healing.

Exercise

Exercise has many benefits. Some types of exercise can strengthen muscles, tendons, ligaments and bones and facilitate resolution of pain and disability. Other types can prevent falls and injuries.

Corticosteroid and Local Anesthetic Injections

Corticosteroid injections have traditionally been used to treat pain, but we are concerned about their side effects. We use them judiciously and find them to be most effective for certain conditions such as frozen shoulder, carpal tunnel syndrome, trigger finger, shoulder impingement and spinal stenosis in which an anti-inflammatory or atrophic stimulus is helpful. We often use local anesthetic injections to confirm the source of pain, but these can sometimes provide permanent relief.

Biologic Injections

Autologous platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) can be injected to facilitate a healing response. In our experience, the best outcomes are for avascular structures when a distinct lesion can be seen and for intervertebral discs. We strive to make our injections as painless as possible and have published research on how much local anesthetic can be mixed with PRP to minimize discomfort without reducing efficacy.

Ultrasound-Guided Surgery

In the 1990s, mini-open and arthroscopic techniques were developed for carpal tunnel release (CTR). With the advancement of ultrasound imaging, we can now perform CTR with the “camera on the outside” through an incision as small as 1 mm. We also perform ultrasound-guided procedures for vaccination-related shoulder dysfunction, calcium deposits, tendon contractures and nerve entrapments.

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.