Intro to Injection Therapy

Oct 15, 2019

PRP

What is it?

Injection of autologous plasma meaning reinfusion of blood/blood components, thereby making inherently safe/free from transmissible diseases such as HIV and hepatitis

Injection contains proteins to help blood clot as well as acting on healing capable cells to increase their numbers (mitogenesis) and increase vascular growth (angiogenesis) – and it is much more concentrated than regular plasma thereby helping body’s tissues to heal faster

Cost? USD $500 - $2000, may or may not be covered by insurance companies

Potential uses? Hair loss, tendinopathies, acute injuries, post surgical repair, OA

More studies needed to validate efficacy

 

Stem Cell/concentrated bone marrow

What is it?

Injection of stem cells located in the bone marrow  that are pleuripotent (able to differentiate into various cell types). When exposed to the appropriate conditions, create new cells to help repair injured tissues.

Cost US $1750 – $2700 per treatment

Not currently covered by most major medical insurance plans

Potential uses? Mod-severe cases of OA, tennis/golfers elbow, labral tears, Achilles tendonitis, plantar fasciitis

Promising results but volume, timing, and number of treatments not well characterized in research 

 

Hyaluronic Acid

What is it?

substance that is found naturally in the human body – highest conc in fluids in the eyes and joints

- helps to prevent mechanical degradation of the cartilage

Has been shown to have anti infl properties

“created a scaffold around the tenorrhaphy site because of its high viscoelastic property. This macromolecular network would prevent fibrous ingrowth from the surrounding tissues”

Cost

$310 per injection, 3.6 avg number of injections, therefore $1128 (likely covered by insurance plan)

Potential uses? OA, tendinopathies, skin wounds/burns

Recent (2015) study showed when used for knee OA, more effective and safe short term option for pain, and was more effective than NSAIDs, a cortisone injection, or a placebo

When using for tendinopathies, recent studies show good efficacy in short term outcomes (<6mo), but less promising with long term outcomes 

 

Cortisone

Corticosteroids act directly on nuclear steroid receptors and interrupt the inflammatory and immune cascade at several levels

By this means, they reduce vascular permeability and inhibit accumulation of many types of inflammatory cells and prevent the synthesis and secretion of several inflammatory mediators

Cost: $100, likely covered by health insurance plan

Potential uses? Bursitis, tendinopathies, OA, plantar faciitis, frozen shoulder, impingement syndrome, sciatica

Risks? Joint infection, nerve damage, thinning of skin/soft tissue around injection site, temporary flare of pain and inflammation in the joint, tendon weakening or rupture, Osteoporosis, temporary increase in blood sugar

OA: Most of the current research shows cortisone injection provides short term reduction in osteoarthritis pain

Long term effects:

- theme of lack of long-term efficacy cortisone, but may be useful to help reduce short term pain therefore helping to pull individual out of cycle below

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