Sean Mulvaney, M.D.
Platelet-rich plasma is used in musculoskeletal medicine to focus your own body’s ability to heal. It has many well-done published randomized control trials (RCT) which demonstrate both its effectiveness and safety in many musculoskeletal conditions, including osteoarthritis, tendinopathies, and damaged vertebral discs. PRP has been in clinical use since the 1990’s. Many people know that platelets form a clot if there is a cut in the skin. It turns out that platelets do not only form a clot, they also start the body’s own repair process. When platelets activate to form a clot, they also release alpha granules which have hundreds of chemical messengers in them that initiate and organize repair to the damaged tissue. Precisely placing PRP into the site of injury will initiate the healing process by activating on the damaged cartilage or tendon. This is an inflammatory process, and inflammation is the vital first phase of healing.
What to expect and how to prepare for PRP
2 weeks prior to the procedure: depending on the procedure, you may need to arrange
for a driver to bring you home. IF you are having a lower extremity procedure, and IF you will not be able to manage using crutches, arrange for a wheelchair rental for 3 days (the day of and 2 days after your procedure). (Wheel chair rental available at Annapolis Healthcare Supplies, (40 dollars for 2-3 days), 410 295-7300). We can provide crutches as needed.
7 days prior to the procedure: Stop taking anti-inflammatory drugs like ibuprofen, Naprosyn, Celebrex. Let your doctor know if you have been taking prednisone or other corticosteroids in the last month.
The day before the procedure: thoroughly shower and clean your skin. You will not be able to shower for 24 hours after the procedure.
The day of the procedure: Wear loose-fitting clothing like sweatpants or shorts. If you are having an upper body procedure wear a top that can button or zip up.
PRP will initiate healing and a productive inflammation, and PRP therapy will make the body part treated sore for 4 days to two weeks. Anti-inflammatory drugs (i.e. ibuprofen, Naprosyn, Celebrex) and corticosteroids such as prednisone can blunt or stop this process, so it is important to not take any anti-inflammatory drugs for 7 days before getting PRP therapy, or for at least three weeks after PRP therapy. Corticosteroid injections can blunt inflammation for 30 days, so let us know if you have had one recently. Depending on the body part injected, you may be in a sling or on crutches for several days. Just like wringing out a wet dishcloth, if you load or tense a tendon or ligament that has just been injected with PRP, some of the PRP injected will squish out. By keeping the body part treated relaxed by using a sling (for the shoulder or arm) or crutches (for hips and legs) for a few days, the PRP can bind in place and do its job. You may need a driver to bring you home. Tobacco is a potent toxin and its use constricts small blood vessels which are needed for tissue repair. Tobacco use will limit the effectiveness of any treatment and stopping tobacco use is one of the single greatest actions you can take to improve your health. Avoid toxins like alcohol, which inhibits and depresses the cells needed for tissue repair.
What happens during the PRP procedure?
Platelet rich plasma is made by taking some of your blood and performing a two-stage centrifuge process on it to concentrate the PRP. First, your blood is drawn into a syringe with a small amount of anti-coagulant in it (this is to keep the blood from clotting during this process). The amount of blood drawn is usually about 50 milliliters, but 100 milliliters may also be drawn depending on how much PRP is needed for the treatment. (There are 355 milliliters in a 12- ounce soda can for comparison). Then the blood is transferred in a sterile fashion into a centrifuge tube. It is then centrifuged for the first cycle where the red blood cells are isolated and discarded. In the second centrifuge cycle, the platelet-rich fraction of the remaining plasma is concentrated and placed in a syringe. The skin at the injection site is numbed with a small needle and local anesthetic (buffered lidocaine). Dr Mulvaney will then precisely inject the PRP into the injury site using ultrasound or fluoroscopic guidance.
What to do after your procedure
I will give you specific medicine to control any discomfort you may have after the procedure. Usually very little or no medication is needed by most patients. Avoid NSAIDs like ibuprofen. Acetaminophen can be used for mild pain. Let me know if you have a history of opioid addiction so we can use appropriate pain medication. Avoid showering for 1 day and avoid immersion in water for 3 days. Any bandages can be removed after 1 day. Depending on the part of the body treated, usually you will be placed in a sling or on crutches for 1 to 3 days. Do your best not to tense or load the treated area during this time. After 3 days, unless otherwise instructed, the treated body part should be used and slowly moved through its full range of motion. It will be sore, but you will not be doing damage by moving it, in fact it needs to move to heal. If you were on crutches for a period of time, walking is ok once you are off the crutches. For now, avoid activities that specifically hurt you before being treated. Exercise is vital to good health and finding a way to cross train around your injury is important not only for your physical health, but for your mental health as well. Ask me about cross training options for your injury. Some brief (10 minutes or less) period of heat or ice therapy will not hurt the therapy, but it is not required. Usually, depending on the initial injury, physical therapy is started from two weeks to four weeks after injection. Improvements in pain and function should be expected from 8 weeks to 12 weeks after injection and some injuries may require more than one treatment.
SEAN MULVANEY, MD