PRP Q & A

What does PRP stand for?

PRP stands for Platelet Rich Plasma. Plasma is the liquid aspect of our blood which houses all the cellular components such as red and white blood cells, as well as platelets. In simple terms, platelets naturally make up only 10% of our blood’s cellular components. In PRP, the platelet ratio is flipped to 90% platelets. Therefore, PRP is plasma rich in platelets.

What is PRP therapy?

PRP is a progressive non-surgical healing treatment used in many fields, including sports medicine and orthopedics. In the field of non-surgical orthopedics, PRP is injected into the affected region to stimulate and enhance healing. PRP is your own blood modified in a way to produce mega doses of your body’s own healing “ingredients” that are stored in our platelets. The medical term for these ingredients is called Growth Factors.

What types of conditions are treated with PRP?

Based on current research, soft tissue injuries are the most responsive to PRP. This includes tendonitis, tendinosis, tendon tears, ligament sprains or tears, loose ligaments, and muscle tears. PRP has also been effective at treating cartilage degeneration such as arthritis as well as labrum tears in joints.

What are some common diagnoses treated with PRP?

SHOULDER: Rotator cuff tendinitis or tear, rotator cuff impingement syndrome or bursitis, bicipital tendinitis, labrum tear, arthritis, instability
ELBOW/WRIST/HAND: Tennis elbow*, golfer’s elbow, DeQuervaine’s Tenosynovitis, trigger finger, arthritis, other wrist or finger tendonitis
HIP: Iliotibial band tendinitis (ITB Syndrome), psoas tendinitis and bursitis, greater trochanteric bursitis, labrum tears, arthritis, sacroiliac joint dysfunction
KNEE: Patellar tendinitis, partially torn or strained major ligaments of knee (ACL/LCL/MCL), meniscus tears, chondromalacia, arthritis, instability
ANKLE: Achilles tendinitis, peroneal tendinitis, ankle sprain, instability ,other foot or ankle tendinitis
SPINE: Whiplash injury, ligament sprain, instability, rib problems, arthritis

* Currently our clinic is participating in an FDA-approved clinical trial on tennis elbow to determine if PRP is safe and effective.

How is PRP treatment administered?

First, approximately one hour prior to patient’s scheduled PRP therapy, the patient’s blood is collected and then spun in a centrifuge specifically designed to concentrate platelets for PRP purposes. Second, topical and injected local anesthetic is provided to the affected region. Third, the needle is advanced in real time under musculoskeletal ultrasound (MSKUS) guidance, until the problem target site is reached. There is excellent visualization on MSKUS as the PRP flows into the affected region within 2mm proximity of the anatomical abnormality.

Is PRP curative or just a band-aide?

Unlike Cortisone shots, PRP actually heals the injured region.

How does PRP work to heal?

Growth Factors are released from large quantities of activated platelets at the site of injury. This leads to an induced inflammatory reaction that initiates a powerful effective healing cascade. Growth factors stimulate blood flow, promote matrix formation which is the “groundwork” of all soft tissue, restore tendon and ligamentous proteins that may have been previously compromised, and “toughen up” cartilage to become more firm and resilient.

Is PRP painful?

Patients typically tolerate the procedure well although post-injection soreness is expected given the PRP-induced inflammatory response.

How many treatments do you need?

One to three treatments depending on the degree of injury and how long the injury has been there. In some instances, a fourth treatment is provided.

How far apart are treatments spaced?

Typically 4-6 weeks if indicated.

What can you expect after getting PRP?

For the first 48 hours, swelling and discomfort are typical in the injected area. Therefore, all patients are provided with pain medicine after PRP and can ice as needed after the injection. By day 5, these symptoms will begin to substantially resolve. At this point, physical therapy is started to optimize PRP affects. Follow-up with the physician will be one month later to evaluate improvement using ultrasound as well as symptom evolution.

Are there any side effects or complications of PRP?

When PRP is performed without image guidance, there is risk of nerve or vessel injury. Also, prolonged increased pain and stiffness have been reported after PRP although these should resolve with time.

Are there any exclusion criteria that inhibit someone from getting PRP

Severe anemia, low platelet count, abnormal platelet function, active systemic infection or active cancer are all contra-indications.

Is PRP covered?

No, PRP is considered experimental by insurance companies at this time.

How long has PRP been around for?

In the field of sports medicine, approximately 10 years.

How long does it take the PRP to “work”?

Most patients notice some element of improvement by 2-6 weeks after PRP. Symptom improvement is slow and subtle as days and weeks pass, with usual report of original pain being replaced with more of a soreness. “Good days” become more and “bad days” become less as time passes, with pain intensity dropping along the way. Increased endurance and strength are typically reported. Clinical trials are reporting ongoing improvement up to 6-9 months after PRP in some cases.