At the Christ Hospital Health Network, we offer a complete range of orthopaedic services for the treatment of sports medicine and active lifestyle injuries for adolescents and adults. One such service is PRP,(Platelet-Rich Plasma) injections.
PRP plays a key role in the process of wound and soft tissue healing – helping with injured tendons, ligaments, muscles, and joints.
Jennifer Chung, MD, joins the show to discuss the many benefits of PRP and when to refer to specialist.
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Should You Consider Platelet-Rich Plasma (PRP) Injections for Your Patients?
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Learn more about Jennifer Chung, MD
Jennifer Chung, MD
Dr. Jennifer Chung earned her medical degree from Drexel University College of Medicine and completed residency training at New York University Langone Medical Center, where she served as chief resident.Learn more about Jennifer Chung, MD
Transcription:
Should You Consider Platelet-Rich Plasma (PRP) Injections for Your Patients?
Melanie Cole(Host): During the past several years, much has been written about a preparation called platelet rich plasma, PRP and its potential effectiveness in the treatment of injuries. My guest today is Dr. Jennifer Chung. She’s a physical medicine and rehabilitation physician with the Christ Hospital Health Network. Welcome to the show Dr. Chung. So, what is PRP and what’s the evolution of it?
Dr. Jennifer Chung, MD (Guest): Well good morning and thank you very much for having me. It’s my pleasure to talk about PRP, which is definitely a treatment that’s been gaining a lot of recognition. We see a lot of professional athletes pursuing these treatments with excellent responses. So, we have been seeing a lot of patients come into the offices to inquire about the treatments. PRP as you mentioned, is also called platelet rich plasma. It is a form of regenerative medicine that basically treats chronic sports or musculoskeletal injuries. It is a non-steroid, non-surgical approach to tissue healing to ultimately help reduce pain and improve mobility and function. So, for people who prefer to avoid surgery or are considered not surgical – not good surgical candidates, PRP would be an excellent treatment option for them.
Melanie: Dr. Chung, as a relatively new orthobiologic; what conditions can you treat with PRP and how effective is it?
Dr. Chung: So, the most common conditions currently being treated with PRP are chronic tendon injuries such as epicondylitis, also known as tendon elbow, acute ligament or muscle injuries such as the common hamstring strain, also knee, hip and shoulder arthritis. The injections can also be used into the disks and joints in the spine as well. These are generally the more common indications for PRP. We see excellent results. Generally, I would say anywhere from 70-90% improvement but of course results do vary by the individual and the condition being treated.
Melanie: Speak about the patient selection criteria. Are there certain people for whom this is contraindicated?
Dr. Chung: At this time, I don’t think necessarily there are patients who are not considered candidates. Obviously, if there is an active infection, we would want to wait until that is healed. If the patient is on an anticoagulation treatment, such as Coumadin; they would need to hold that therapy for the injection and if they are not able to and not cleared by their family physician or their cardiologist then they also would not be able to get the treatment. But PRP works by – in the human body, platelets contain what we call growth factors and in injured tendons, ligaments and cartilage; which on its own have a poor blood supply; by injecting your own platelets into these injured areas, you are actually providing healing growth factors as well as restarting the healing inflammatory process to allow that tissue to finally heal. So, sometimes even if the tendon is affected and it’s been a chronic issue for several years; this may finally allow that area to start healing once again.
Melanie: And now what about the procedure itself? Is this an image guided procedure? Tell us exactly how it works.
Dr. Chung: Sure, so the injections are done in an outpatient setting. The entire process should take anywhere from 30-45 minutes. Essentially, the blood is collected from the individuals and the platelets which are the main source of the growth factors; the platelets are separated from the blood and then injected into the area where there is injury. A local anesthetic is used to the skin to help provide some relief from any pain associated with the injection. We do not use lidocaine with the PRP due to its ability to interfere with platelet function, so there can be pain with and after the injection. Sometimes depending on the location, ultrasound can be used, fluoroscopy would also be used if the spine was being injected.
Melanie: Dr. Chung: What is life like for the patient after the procedure and how soon can they get back to their normal activities?
Dr. Chung: So, immediately after the injection, you might experience some swelling at the injection site for just a couple of days. I would recommend using cold compresses a few times a day for 10-20 minutes at a time to help with any pain and swelling. I would recommend that they rest probably for just even a day or so, but they should be able to go back to work the next day after the treatment. Now another important part of the whole treatment plan is physical therapy. Initially, after the injections, we do restrict more vigorous activities, I would say maybe just one to three days after the injection. In terms of physical therapy, it will be divided into three phases. The first phase would just be gentle range of motion of the injected extremity and that would essentially just be the first to third treatment then we would progress to strengthening and neuromuscular control exercises and then the final phase would be dynamic extremity control and stabilization. So, the physical therapy component will definitely be an important part of the treatment and aid in continued recovery.
Melanie: So, how long is it beneficial for? And how many injections would someone have to go through to see these benefits?
Dr. Chung: It really just depends. There can be situations where the individual will get one injection and then they have excellent results for even up to two years. There are times that we may need to repeat the injection depending again on what is being treated. So, there may be several injections spaced apart by two or three weeks. But generally, it is one injection at a time, then follow-up in four weeks and then just monitoring over the next several months. So, again, it may be repeated every few years or it may be repeated annually. Just depends again on how the patient responds.
Melanie: Please tell other physicians when you think it is important that they refer to a specialist.
Dr. Chung: I would like the physicians in the community if they have a patient that comes in with again, joints – painful joints or a chronic tendon injury to consider this.
Melanie: And in summary, Dr. Chung, just let other physicians what you would like them to know about PRP.
Dr. Chung: That there are other options other than steroid injections and surgery; that regenerative medicine is just growing by leaps and bounds and really providing excellent quality of life back to the patient, helping to improve their function and mobility and their ability to either push off or avoid surgery. So, I’m happy to accept any patients that again, are presenting with any type of musculoskeletal injury and I’m happy to try these treatments for them. Now as I mentioned, the insurance at this time does not cover these treatments, so sometimes cost is a limiting factor. They can range anywhere from $500 to even $1000, but again, for some people who would rather avoid surgery and with how successful the injections are; they are willing to try the treatment.
Melanie: Thank you so much Dr. Chung for being with us today. You’re listening to Expert Insights Physician Views and News with the Christ Hospital Health Network. More information on Dr. Chung and all of the Christ Hospital physicians is available at www.tchpconnect.org , that’s www.tchpconnect.org. This is Melanie Cole. Thanks so much for listening.
Should You Consider Platelet-Rich Plasma (PRP) Injections for Your Patients?
Melanie Cole(Host): During the past several years, much has been written about a preparation called platelet rich plasma, PRP and its potential effectiveness in the treatment of injuries. My guest today is Dr. Jennifer Chung. She’s a physical medicine and rehabilitation physician with the Christ Hospital Health Network. Welcome to the show Dr. Chung. So, what is PRP and what’s the evolution of it?
Dr. Jennifer Chung, MD (Guest): Well good morning and thank you very much for having me. It’s my pleasure to talk about PRP, which is definitely a treatment that’s been gaining a lot of recognition. We see a lot of professional athletes pursuing these treatments with excellent responses. So, we have been seeing a lot of patients come into the offices to inquire about the treatments. PRP as you mentioned, is also called platelet rich plasma. It is a form of regenerative medicine that basically treats chronic sports or musculoskeletal injuries. It is a non-steroid, non-surgical approach to tissue healing to ultimately help reduce pain and improve mobility and function. So, for people who prefer to avoid surgery or are considered not surgical – not good surgical candidates, PRP would be an excellent treatment option for them.
Melanie: Dr. Chung, as a relatively new orthobiologic; what conditions can you treat with PRP and how effective is it?
Dr. Chung: So, the most common conditions currently being treated with PRP are chronic tendon injuries such as epicondylitis, also known as tendon elbow, acute ligament or muscle injuries such as the common hamstring strain, also knee, hip and shoulder arthritis. The injections can also be used into the disks and joints in the spine as well. These are generally the more common indications for PRP. We see excellent results. Generally, I would say anywhere from 70-90% improvement but of course results do vary by the individual and the condition being treated.
Melanie: Speak about the patient selection criteria. Are there certain people for whom this is contraindicated?
Dr. Chung: At this time, I don’t think necessarily there are patients who are not considered candidates. Obviously, if there is an active infection, we would want to wait until that is healed. If the patient is on an anticoagulation treatment, such as Coumadin; they would need to hold that therapy for the injection and if they are not able to and not cleared by their family physician or their cardiologist then they also would not be able to get the treatment. But PRP works by – in the human body, platelets contain what we call growth factors and in injured tendons, ligaments and cartilage; which on its own have a poor blood supply; by injecting your own platelets into these injured areas, you are actually providing healing growth factors as well as restarting the healing inflammatory process to allow that tissue to finally heal. So, sometimes even if the tendon is affected and it’s been a chronic issue for several years; this may finally allow that area to start healing once again.
Melanie: And now what about the procedure itself? Is this an image guided procedure? Tell us exactly how it works.
Dr. Chung: Sure, so the injections are done in an outpatient setting. The entire process should take anywhere from 30-45 minutes. Essentially, the blood is collected from the individuals and the platelets which are the main source of the growth factors; the platelets are separated from the blood and then injected into the area where there is injury. A local anesthetic is used to the skin to help provide some relief from any pain associated with the injection. We do not use lidocaine with the PRP due to its ability to interfere with platelet function, so there can be pain with and after the injection. Sometimes depending on the location, ultrasound can be used, fluoroscopy would also be used if the spine was being injected.
Melanie: Dr. Chung: What is life like for the patient after the procedure and how soon can they get back to their normal activities?
Dr. Chung: So, immediately after the injection, you might experience some swelling at the injection site for just a couple of days. I would recommend using cold compresses a few times a day for 10-20 minutes at a time to help with any pain and swelling. I would recommend that they rest probably for just even a day or so, but they should be able to go back to work the next day after the treatment. Now another important part of the whole treatment plan is physical therapy. Initially, after the injections, we do restrict more vigorous activities, I would say maybe just one to three days after the injection. In terms of physical therapy, it will be divided into three phases. The first phase would just be gentle range of motion of the injected extremity and that would essentially just be the first to third treatment then we would progress to strengthening and neuromuscular control exercises and then the final phase would be dynamic extremity control and stabilization. So, the physical therapy component will definitely be an important part of the treatment and aid in continued recovery.
Melanie: So, how long is it beneficial for? And how many injections would someone have to go through to see these benefits?
Dr. Chung: It really just depends. There can be situations where the individual will get one injection and then they have excellent results for even up to two years. There are times that we may need to repeat the injection depending again on what is being treated. So, there may be several injections spaced apart by two or three weeks. But generally, it is one injection at a time, then follow-up in four weeks and then just monitoring over the next several months. So, again, it may be repeated every few years or it may be repeated annually. Just depends again on how the patient responds.
Melanie: Please tell other physicians when you think it is important that they refer to a specialist.
Dr. Chung: I would like the physicians in the community if they have a patient that comes in with again, joints – painful joints or a chronic tendon injury to consider this.
Melanie: And in summary, Dr. Chung, just let other physicians what you would like them to know about PRP.
Dr. Chung: That there are other options other than steroid injections and surgery; that regenerative medicine is just growing by leaps and bounds and really providing excellent quality of life back to the patient, helping to improve their function and mobility and their ability to either push off or avoid surgery. So, I’m happy to accept any patients that again, are presenting with any type of musculoskeletal injury and I’m happy to try these treatments for them. Now as I mentioned, the insurance at this time does not cover these treatments, so sometimes cost is a limiting factor. They can range anywhere from $500 to even $1000, but again, for some people who would rather avoid surgery and with how successful the injections are; they are willing to try the treatment.
Melanie: Thank you so much Dr. Chung for being with us today. You’re listening to Expert Insights Physician Views and News with the Christ Hospital Health Network. More information on Dr. Chung and all of the Christ Hospital physicians is available at www.tchpconnect.org , that’s www.tchpconnect.org. This is Melanie Cole. Thanks so much for listening.