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Platelet-rich plasma, aka PRP, is a growth factor treatment for arthritis, tendon tears, and ligament tears. For many individuals looking to avoid surgery, it's a powerful pain-reliever that does the trick. Platelets are natural powerhouses for several different growth factors that stimulate tissue repair. For the purposes of this article, we will focus on PRP therapy's use for the treatment of rotator cuff tears. Many adults over 40 years of age with shoulder pain are ultimately diagnosed with a partial rotator cuff tear by MRI. In those cases for which non-operative treatments such as rest, anti-inflammatory medications, cortisone injections, and physical therapy do not cure the pain, the next option is most commonly arthroscopic shoulder surgery. While arthroscopic shoulder surgery is an excellent option in these cases, not all individuals want to proceed with surgery for a variety of reasons. High-deductible insurance plans are becoming more and more common and, therefore, the patient is often forced to pay most of the costs associated with surgery (medical clearance and testing, equipment and operating room expenses, anesthesiologist fees, surgeon fees, and postoperative physical therapy) instead of the insurance company. Others are anxious to proceed with an operation. Still others cannot afford the sometimes lengthy time away from work to recover from a surgical procedure. Regenerative medicine therapy is another group of non-operative treatments to consider before proceeding with surgery in these types of cases. This group of treatments includes such things as PRP therapy, Bone marrow-derived stem cell therapy, and Amniotic-derived stem cell therapy. Only those orthopedic surgeons who are specially-trained in the appropriate indications, preparation, and injection of these therapeutics offer them to their patients. PRP therapy is a procedure that is done in the office. The procedure starts with a blood draw from the arm, just as with blood drawn for laboratory studies. The blood is specially processed and spun at a high velocity to separate it into layers. The concentrated platelet layer, PRP, is extracted and transferred to a syringe. The PRP is then injected under ultrasound guidance at the shoulder directly into the partially torn rotator cuff tendon. The patient leaves with a band-aid and post-procedure instructions. Sometimes there is an initial achy pain felt at the injection site for a few days, which is thought to be a positive indicator that the tissue repair process has been ignited and is under way. After the procedure, the patient will work on gentle stretching and range of motion exercises initially. Weight lifting should be restricted for about 4 weeks. The patient will be re-evaluated in the weeks following the injection to make a decision on whether another PRP injection should be given to further aid in the recovery process. Michael A. Cohn, M.D. Orthopedic Surgeon Shoulder to Hand Surgery Orthopedic Center of Palm Beach County (561) 967-6500 Stem Cell and PRP therapy Florida
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PRP, rotator cuff, rotator cuff tear, shoulder pain, orthopedics,
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