Platelet Rich Plasma (PRP)

PRP has increasingly shown promise for a number of painful conditions affecting the tendons of the shoulder(1) and elbow(2), as well as for osteoarthritis(3).  PRP is used as an adjunct to other nonsurgical treatments, or as an alternative to surgery when other treatments have not worked.  Because of PRP’s modulation of the inflammatory process and emerging evidence of efficacy, it is gaining popularity and is increasingly used in athletes of all ages including professionals(4).

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When platelets are activated outside the body, they release growth factors (including IGF-1, TGF-, EGF, PDGF, VEGF, and FGF) that cause an anabolic (healing) response. Platelet activation also causes release of signaling cytokines that modulate the destructive inflammatory process seen in arthritis and tendinopathy. While PRP cannot regenerate cartilage or tendon, it is hypothesized to improve the biologic environment where pain originates.

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PRP injection involves having your blood drawn in a sterile fashion by a staff member, followed by a few minutes of waiting for processing.  During this time your blood is placed into a centrifuge to separate the components and the platelet-dense plasma is activated by a chemical activator.  When ready, the yellow-tinged plasma solution is injected into the treatment area.  The total time for the procedure is less than a half-hour.

The injection can be uncomfortable, and it may take several days to a couple weeks to notice the effects.  Soreness is treated with icing, elevation, and rest for the days following the injection, as routine with other injections.

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Emerging evidence suggests that a series of three injections of platelet rich plasma (“PRP”) may be more effective than a single dose of PRP up to one year following the injection series, especially for conditions including knee osteoarthritis or tendinosis. The goal of PRP therapy is improvement of pain and function, which is typically experienced within several weeks of the completion of the series. Our injection series recommendation harnesses the body’s inflammatory (healing) response after the injections. We recommend modifying your use of medications during the PRP series as outlined below.

Steps

1. A series of three (3) injections spaced one week apart are performed. Not more than one injection per week is recommended on the same body part. Ensure the Barrington Orthopedics waiver is signed and on file with practice management.
2. Tylenol® (acetaminophen), pain medications, and ice are recommended for post-injection pain ONLY. It is recommended you DO NOT take NSAIDs (ibuprofen, naproxen, meloxicam, etc.) during the series and for one week after the third and final injection.
3. One week following the third and final injection, you may resume NSAID including meloxicam or naproxen. You should take the medications as directed with meals. Naproxen (Aleve®) can be taken two tablets at morning and two at night.
4. Schedule a follow up appointment with our team six (6) weeks after the third and final injection. We would like to discuss your response and finalize your treatment plan.

Other tips

We recommend you adequately hydrate the day or two preceding the injection. Eat a small snack prior to your appointment. Each PRP procedure takes approximately one-half hour which includes time for drawing your blood and preparing the PRP specimen for administration.

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• Research Insights – PRP Injection Outcomes – 3 Injections vs 1 Injection
• Research Insights – PRP Proves Superior to Corticosteroid for Tendon Pain