Procedure: PRP (Platelets Rich Plasma) Trigger Point Injection

Muscle Spasticity (Myofascial pain) is a very common condition, myofascial spasticity can lead to the formation of painful knots or ‘trigger’ points this is often treated with physical therapy and local injections that are performed either by feeling or under visual ultrasound guidance. 

Injected medications include steroid or non-steroidal substances in addition to a local anesthetic. 

More recently however PRP, Platelet Rich Plasma, has been gaining in popularity as an alternative to steroid-based injections which may have medication-related side effects. A recent study from Frontiers in Neurology studied a particular group of patients with temporomandibular disorders.  This condition is a classic example of muscle spasticity as it occurs in a muscle called the masseter which is involved in active chewing.   

Patients identified with a temporomandibular disorder were treated with PRP injections, their pain scores were assessed and it has been determined that 60 to 70% of patients had improvement that lasted over 18 months. 

Typically trigger point injections using steroids can last up to a month and should not be repeated more than three times per year. 

PRP injections for trigger points, however, have been known to last a record of two years, more importantly, trigger point injections using PRP and repeated yearly can provide a stabilizing maintenance effect. 

The mechanical risk factors using PRP are no different than trigger point injections with or without steroids. The advantage, of course, is that PRP can be repeated frequently without side effects. 

Procedure: PRP (Platelets Rich Plasma) injection for Shoulder Pain.

The shoulder joint is the most mobile of the large joints in the body connecting to the torso through a shallow cup-shaped articular surface from the scapula to a significantly oversized ball-shaped end of the bone on the humerus, the shoulder joint allows a wide range of motion not seen in other large joints. 

The shoulder joint suffers from a unique set of disorders partially because of its extreme range of motion these include easier dislocations, osteoarthritis, rupture of the rotator cuff muscles or tendons, articular surface damage, and ligamentous and tendon injuries.

When untreated this can result in an involuntary decreased range of motion which can later lead to reduced mobility or a “frozen“ shoulder , the patient may try various treatments including intra-articular steroid injections, which are usually limited to no more than two injections per year. Surgical options for a frozen shoulder can compound the problem.  

Steroid injections can be effective but are limited in frequency due to side effects, Platelet Rich Plasma injections can be an excellent alternative option. 

In October 2021, a systematic review and meta-analysis article for non-operative PRP injections for rotator cuff pathology was performed, the purpose of the review was to look at the efficiency of PRP in rotator cuff tears and to measure pain reduction and improvement in function. 

The authors looked at various peer review studies and concluded that at least six of them met the criteria for evaluation. These studies concluded that PRP pain scores were significantly better in the short term when compared to physical therapy alone or with nonsteroidal anti-inflammatory medication and steroid injections. 

Procedure: PRP (Platelets Rich Plasma) injection for Hip Pain.  

The HIP joint is the largest joint in the body this serves to transmit the weight from the entire upper torso into the HIP and lower extremities.

The hip joint is a deep ball and socket joint which has limited mobility but is highly stable this is required for bipedal ambulation. 

Diseases of the hip joint like other large joints include osteoarthrosis degeneration of the joint or bone due to trauma or vascular insufficiency as well as ligamentous damage.  

Pain due to hip pathology especially osteoarthrosis can be quite debilitating. 

This often leads the patient to try various treatments including intra-articular steroid injections, which are usually limited to no more than two injections per year.

Steroid injections do help, however, when repeatedly done it can cause damage to the delicate blood supply of the hip causing a condition called avascular necrosis.  

Platelet Rich Plasma intra-articular injections can be an excellent alternative option. 

The earliest randomized controlled trial of the use of PRP was in 2012, since then, studies have been done to compare PRP to other intra-articular joint injection therapies, such as conservative management and hyaluronic acid treatment.  

In general, most of the articles conclude that PRP is a safe treatment and has demonstrated potential for symptom relief, especially in osteoarthritis for up to a year with a single treatment. Younger patients with hip pathology tend to be more responsive. 

Severe osteoarthritic hip joints are treated with hip replacements, though in many cases, however, such an extensive surgery is not an option. For this group of patients, a series of PRP treatments can be highly effective and improve function and decrease pain scores allowing for a better quality of life.  

Procedure: PRP (Platelets Rich Plasma) injection for Knee Pain.  

The knee joint is the most complex joint in the body, not only does it transmit weight from the upper part of the body to the legs and feet, but it also allows its unique architecture, flexion, extension, and subtle interlocking to allow us to stand for sustained periods of time. It is truly a mechanical feat of a weight-bearing engineering marvel! 

The knee joint is affected by almost all of the conditions that affect any other large joint. 

Particularly disabling and quite common especially in the elderly is arthritis of the knee. Meniscal tears and tears of the lateral supporting ligaments, such as the medial and lateral collateral ligaments, and anterior and posterior cruciate stabilizing ligaments can also be injured either by trauma or natural degeneration.  

This often leads the patient to try various treatments including intra-articular steroid injections, which are usually limited to no more than two injections per year. Although steroid injections do help, they cannot be used often and Platelet Rich Plasma can be an excellent alternative option. 

Steroid injections are often given as a single injection for their efficacy, PRP injections are most effective when given more than once. 

In a recent April 2021 article, a meta-analysis compared the efficacy of PRP with placebo and other conservative treatments,  researchers reviewed 23 controlled trials in which PRP was compared to other treatments it was concluded when compared to placebo, PRP recipients had a lower pain scale and a higher knee function score by the sixth month of treatment. Improvement in function, pain, and stiffness was also seen. 

When PRP was compared with oral NSAIDs, PRP had better functional scores, improved pain and decreased stiffness by the sixth month. 

Pain scores were statistically decreased when using PRP.  

The side effects of PRP versus placebo or hyaluronic acid gel injections were about the same. 

The final conclusion is that PRP is more effective in relieving symptoms and the side effect profile is no different than other injections and its safety profile allows a greater more frequent use to maintain pain.

Platelet Rich Plasma Therapy Overview

This minimally-invasive procedure is performed through a small tubular device. It is designed to relieve pain caused by herniated discs pressing on nerve roots. The surgery is performed under local or epidural anesthesia, allowing the patient to leave the hospital the same day.

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Before and After the Procedure and the Risks

A PRP injection is very similar to any other injection based on the body part.

After drawing approximately 30 to 50 ML of blood, this is been centrifuged and the respective components are extracted and injected into the area.

Anti-inflammatory medications must be avoided for about six weeks to allow the area to develop a mild inflammation, and recruitment of healing factors and cells.

After the procedure: ice can be used or Tylenol for any mild pain.