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Dr. Jesse Sally Performs a Live Platelet Rich Plasma Procedure with Patient Permission

Originally shared on Facebook Live: Watch a live platelet rich plasma procedure to treat bicep tendon and rotator cuff tears

About nine months ago, one of our patients suffered a throwing injury to his shoulder. Thinking the pain would go away and it would heal by itself, he put off treatment. Over the last few months he has experienced significant pain doing everyday activities: reaching behind him into the back seat of his car, holding objects in front of him, rotating his shoulder in any way, gripping items – the list goes on. In less than 15 minutes on January 8th, this patient started on his way to a pain-free and functioning shoulder, all thanks to a platelet rich plasma procedure with Dr. Sally at Regenexx – a quicker, safer, and more effective alternative to shoulder surgery. See our patient’s introduction and an overview of the condition and the platelet procedure with Dr. Sally:

 

Originally shared on Facebook Live, our patient gave us permission to share his entire platelet rich plasma (PRP) procedure to treat bicep tendon and rotator cuff tears. The patient is awake and answers the doctor’s questions throughout. The entire live procedure is completed in about 15 minutes.

Of course there’s more to the process than the actual procedure, but we wanted you stop see how this very successful procedure can be accomplished in a minimally invasive way. Before the procedure is a thorough exam and review of the patient’s MRI and past treatment history. On the same day of the procedure we draw the patient’s blood to extract the platelet rich plasma needed for the procedure.

The automated centrifuges used in most clinics typically concentrate the platelet count by a factor of 2-5 times. Regenexx uses a more advanced process that can yield 10 to 40 times the normal number of platelets, allowing us to customize the solution for each patient! In our lab tests, this higher concentration has been shown to have a positive effect on the stem cells responsible for repairing damaged tissue.

A Step by Step Look Into A Platelet Rich Plasma Procedure

A week before the procedure, our patient came into Regenexx finally seeking treatment for his shoulder pain. An ultrasound evaluation revealed small tears and inflammation in both his bicep tendon (the front part of his shoulder) and in the rotator cuff (the top part of his shoulder), as shown in the diagram on the left [1].

To treat his injury, Regenexx used a Platelet Rich Plasma (PRP) procedure, which is a non-surgical blood platelet treatment typically used to treat muscle strains & tears, ligament & tendon tears, minor arthritis, and for joint maintenance. The concentrated blood platelet injection contains healing growth components that increase the body’s natural ability to repair itself. PRP treatments can be effective because platelets have a stimulating effect on the stem cells within the targeted area. Stem cells are found throughout the entire body and play a key role in repairing damaged tissue, so a primary goal in platelet treatments is to get these powerful cells to work harder and faster.

 

Step 1: Right before the procedure, the patient was given a nerve block for pain relief. His shoulder was then prepped and sterilized to avoid infection.

Step 2: An ultrasound machine was used to locate the tears in his shoulder and determine where the PRP injections would be placed. The image on the right shows the bicep tendon (the round structure sitting between the humps on the bottom of the screen). You can see black fluid around the tendon, which indicates inflammation. Dr. Sally also made note of blood vessels inside the tendon to avoid injecting into them during the procedure, as this could cause damage to the vessels. Dr. Sally determined that the injections would be placed in the bicep tendon sheath (the area around the tendon) and also in the tendon itself to account for any irregularities.

Step 3: Dr. Sally numbed the surface skin with an anesthesia spray (lidocaine) and marked his “approach” so he would know where to inject the needle. As the needle made its way through the skin and around the bicep tendon, Dr. Sally continued to inject anesthesia. Afterwards, he injected an even stronger, longer lasting anesthetic into the tendon itself to avoid inhibiting any of the platelet activity inside the muscle.

Step 4: Now the actual platelet product (PRP) was ready to be injected. Using the ultrasound machine to guide the needle, about 1 mL of PRP was injected into the bicep tendon sheath to help with the inflammation around the tendon.

Step 5: Removing the needle, Dr. Sally switched over to using an even higher concentration of platelet material. This was then injected into the tendon itself.

Step 6: Dr. Sally asked the patient to modify his position so that he could easier locate the rotator cuff tendon muscle with the ultrasound machine. He then identified a jagged area where there had been a tear in the muscle (the tendon was separated from bone a bit). This kind of tear is common and can sometimes be simply caused by wear and tear over time. He also noted black fluid above the tear, again indicating inflammation.

Step 7: Before injecting, Dr. Sally used the anesthetic spray to numb the surface skin and injected anesthetic around the rotator cuff tendon. Just like with the bicep tendon, he switched to an even stronger, longer lasting anesthetic to be injected inside the rotator cuff itself.

Step 8: Dr. Sally then injected the PRP into and around the rotator cuff.

Step 9: Thrombin (an activating agent) was injected into the tear itself to jumpstart the platelets into doing their job. This created a jelly-like matrix in the tendon that allows the platelets to adhere and provide better overall healing. The thrombin was also injected into the tendon tissue where the tendon attaches to the bone. This addressed any substance changes within tendon itself or tendinopathy, which refers to the breakdown of collagen in the tendon (tendinopathy causes burning pain in addition to reduced flexibility and range of motion).

The entire PRP placement procedure took less than 15 minutes total.

Recovery Timeline and Pain after PRP Procedure vs. Shoulder Surgery

Immediately following the procedure, our patient felt a little bit of pressure and stiffness in his shoulder. Dr. Sally explained that this is very normal for all patients after a procedure and that the patient should expect to be sore later on in the day. Over the next few days, inflammation in the shoulder should decrease and the healing effect of the platelets will take effect. Dr. Sally said he will follow up with the patient in about 6 weeks to see how he is feeling.

This procedure is quicker, safer, and more effective compared to shoulder surgery. Most post-surgery instructions require a patient to keep their arm from moving (most likely wrapped in a sling) and to avoid using the arm for the first 4 to 6 weeks. With a surgical procedure a full recovery is expected to take several months [2]. Risks associated with shoulder surgery include damage to adjacent nerves and blood vessels, infection, and stiffness lasting 6 to 12 months after surgery with positive outcomes. Re-tear rates also tend to be much higher with surgical patients compared to those who underwent non-surgical treatment [3].

Get Back for the Activities You Love by Spring – Safely

The world may not be fully reopened yet, but Regenexx is open to serve our community – safely. Here’s how:

  • Pre-Appointment patient COVID-19 symptom checks by phone
  • Patients go from car to one-at-a-time check-in to a private exam room.
  • On-premises patient temperature check and COVID-19 symptom re-check.
  • All staff are COVID-19 vaccinated
  • All providers and staff wear masks to reduce potential spread of virus to patients.
  • All providers and patients use frequent hand washing.
  • All common surfaces cleaned frequently with medical grade anti-viral disinfectants.
  • Patients have safe choices, and if needed, Telehealth appointments are possible for initial consultations

We know it can be overwhelming to choose a solution for your pain, so if you’re a little earlier in your research process, perhaps you may benefit from attending  a live webinar with one of Regenexx Pittsburgh’s three doctors.

As our world works towards its recovery from COVID-19, you can work towards yours and be ready to take on the world as soon as it’s ready for you! TO learn more ask for a Regenexx patient info packet by email by tapping the “Research Nonsurgical Options” image below.

References

[1] https://orthoinfo.aaos.org/en/diseases–conditions/biceps-tendinitis/

[2] https://orthoinfo.aaos.org/en/treatment/rotator-cuff-tears-surgical-treatment-options/

[3]https://www.sports-health.com/treatment/shoulder-injury-treatment/rotator-cuff-surgery-risks-and-complications