FAQ PRP

If you are suffering from arthritis in your hip, knee, or shoulder or chronic tendonitis in your elbow, ankle, or shoulder, you should consider PRP treatments. PRP is an alternative treatment option for patients who want to explore options other than surgery. The initial evaluation will determine whether PRP is a viable treatment option for you.

Unlike cortisone injections, platelet-rich plasma (PRP) has growth factors that provide healing properties. While cortisone injections may offer temporary relief and reduce inflammation, they can potentially weaken the local tissue. Hence, they typically do not offer long-term healing benefits. Moreover, the effectiveness of cortisone injections diminishes with multiple injections.

PRP treatment is generally safe, and complications are rare. Although uncommon, the risks include:

• Pain and mild swelling for a few days
• Infection
• No relief of symptoms
• Allergic reaction

Patients with bleeding disorders, active infections, cancer, and pregnancy, as well as those taking some blood thinners (such as Coumadin), are not eligible for PRP treatment.

The PRP treatment is not a quick fix and requires time and rehabilitation to promote long-term healing of the tendon.

In my clinical experience, the literature shows that the PRP treatment for arthritis can provide relief for 1-2 years. However, it's important to note that this treatment doesn't reverse the joint changes or cure arthritis. On the other hand, for partial tendon, ligament injuries, and tendinitis, PRP may provide permanent relief as it is believed to have the potential to heal the tear.

When treating Tendinitis, one treatment is typically sufficient . When treating Arthritis, however, evidence suggests that receiving two injections 7 to 10 days apart will produce better results.. 

As PRP treatment is a relatively new treatment, OHIP does not cover its cost. 

The protocol for PRP treatment may differ from person to person, depending on the condition being treated, and the pricing of procedures can also vary. An evaluation is necessary to better understand the condition, treatment, and costs specific to your situation.

PRP  treatment works by enhancing the body’s natural ability to heal. It generally takes a few weeks to begin feeling the difference.

We recommend filling out the patients' forms on our website or contacting our office to determine if you are a good candidate.alternatively you  can ask your family doctor or nurse practitioner to fax a referral with the relevant investigation to 905-721-6648

The procedure typically takes about 30-40  minutes. It involves drawing a vial of blood from your vein, separating the blood components by spinning them in a centrifuge, and then injecting the plasma and platelets into the affected joint or tendon with the help of ultrasound guidance.

Ultrasound technology enables doctors to produce images of the inside of their patients' bodies using sound waves. To do this, a small probe and gel are placed directly onto the skin. High-frequency sound waves are then transmitted into the body, and the probe collects the sounds that bounce back. This information is sent to a computer that creates an image using those waves. The best part is that ultrasound technology doesn't use any ionizing radiation, so patients aren't exposed to any radiation. The images are captured in real time, displaying the structure and movement of one's soft tissue.

Using ultrasound-guided technology for musculoskeletal injections ensures precise accuracy during treatment. Since the areas receiving treatment are only a few millimeters in size, utilizing imaging can help doctors accurately locate and target these structures with precision.

Traditionally, musculoskeletal injections have been performed using anatomical landmarks, or a "blind" technique. In this method, the doctor feels for specific bones, muscles, or tendons and injects into the desired area. However, there is no definitive way of knowing where the tip of the needle is entering. Musculoskeletal ultrasound has become increasingly popular for guiding needles during musculoskeletal injections, especially for injecting joints and tendons.

Ultrasound-guided injections offer several advantages over traditional blind injections.

With ultrasound imaging, doctors can optimize the exact location of the injection and visualize the needle tip on the screen, increasing precision. This precision reduces pain for the patient during the procedure and lowers the risk of complications, such as nerve damage or excessive bleeding, by helping doctors avoid hitting nerves and blood vessels. 

Additionally, the accuracy of the injection allows for more effective treatment and can increase diagnostic feedback for the provider. If the injection is correctly placed in the target area but does not work, the doctor can look for other causes of the patient's symptoms. 

Multiple studies have shown that ultrasound-guided injections are more accurate than landmark-guided injections, supporting their use in medical practice. The American Medical Society for Sports Medicine (AMSSM) has published a position statement based on a systematic literature review, including 124 studies demonstrating high-quality evidence of the accuracy of ultrasound-guided injections.

 nSTRIDE is an autologous protein solution that concentrates white blood cells, platelets, and plasma proteins in a small volume of plasma. All these components are derived from the patient’s blood, creating two to three cc of an anti-inflammatory solution.

 In osteoarthritis of the knee, there is a higher ratio of inflammatory proteins compared to anti-inflammatory proteins. This imbalance leads to inflammation and the gradual deterioration of knee cartilage. nSTRIDE APS works by reducing the activity of inflammatory proteins while increasing the concentration of anti-inflammatory proteins in the solution. This helps to decrease inflammation and slow down or stop the breakdown of the cartilage in the knee.

• nSTRIDE Significantly improved relief of pain and function in the treated knee.
• The treatment only requires one blood sample and is administered as a single injection.".
• It helps to protect the cartilage from catabolic degeneration.
• The treatment utilizes your own blood (autologous), minimizing the risk of adverse reactions.
• Studies have shown that it can provide pain relief for up to two years.

 If you have arthritis in the knee, you should consider nSTRIDE as it acts as an alternative for patients who want to explore more options than surgery. An initial evaluation will be done to determine if it is a viable treatment for the patient.

nSTRIDE treatment is not permanent, although patients can expect the benefits to last up to 24 months.

Although side effects are typically uncommon, they can vary from 

• pain or mild swelling for a few days
• Infection
• No relief from symptoms
• Allergic reactions

 Although nSTRIDE and PRP use blood proteins from the patient's body to promote tissue healing, nSTRIDE contains white blood cells and anti-inflammatory proteins, which are absent in PRP. Furthermore, PRP requires two injections to attain results, while nSTRIDE only uses one.

 nSTRIDE prevents further deterioration of tissue with its anti-inflammatory properties, while cortisone acts as temporary relief by only reducing inflammation. Cortisone can also weaken the local tissue, staggering any long-term healing benefits. Lastly, the effectiveness of cortisone injections diminishes with multiple injections.

 We recommend you limit your physical activity to 14 days; however, one should not exceed their usual level before the injection.

nSTRIDE can be repeated in the future if necessary.

nSTRIDE is not covered by OHIP, as it is a fairly new treatment.

The pricing of this treatment will vary from patient to patient. An evaluation is necessary to assess  if you are candidate for  the treatment, condition, and cost. 

 The nSTRIDE treatment may take some time to provide relief, usually expected within  two weeks, some time it may take little longer.

We recommend filling out a patient’s form on our website or contacting our office to determine if you are a good candidate.

DUROLNE uses hyaluronic acid, a crucial molecule found in joint fluid. It aids in joint movement and absorbs shock during physical activity.

If you suffer from knee, shoulder, hip, or ankle osteoarthritis, you can be considered for DUROLANE.

 Cortisone acts more quickly than hyaluronic acid injections and is more effective in reducing inflammation and pain compared to DUROLANE. However, DUROLANE has longer-lasting effects. Additionally, DUROLANE does not deteriorate the articular lining of the joints. Both don’t stop/delay the progress of arthritis.

 Joint pain, swelling, and stiffness at the site of injection were side effects seen in clinical trials. These reactions were typically mild to moderate and did not last long.

 DUROLANE should not be used if there are skin infections at the injection site. It is contraindicated for patients with known hypersensitivity or allergies to sodium hyaluronate. Additionally, it should not be used on pregnant, lactating women or children.

One should avoid physical activities and heavy lifting for two days.

DUROLANE treatment is not permanent, but it typically lasts for 6-8 months, providing a temporary solution that can postpone the need for surgery.

 OHIP does not cover DUROLANE; however, it is covered by many private insurance companies. Contacting them directly is a good way to check if your plan covers DUROLANE.

 The effects of the treatment usually occur within 3 to 10 days after the injection.

Medical Cortisone has been artificially synthesized to mimic human Cortisone hormone but with long-lasting and potent effects. Cortisone is a hormone in the body secreted by adrenal glands and acts as a natural anti-inflammatory steroid.

One should consider Cortisone if their medical conditions involve inflammation as the underlying issue, such as arthritis, bursitis, carpal tunnel syndrome, trigger finger, and tendinitis.

The potential side effects and risks typically increase with higher doses and more frequent usage. These side effects may include:

• Cartilage damage
• Acceleration of arthritis progression
• Reduced effectiveness of cortisone with multiple injections
• Joint infection
• Short-term increase in pain, swelling, and irritation in the joint
• Short-term increase in blood sugar for diabetic patients
• Weakening or rupture of tendons if cortisone injected into the tendon
• Thinning of nearby bone (osteoporosis)
• Thinning of the skin and soft tissue around the injection site (fat atrophy)
• Whitening or lightening of the skin around the injection site.

Patients with active infections or active cancer are not candidates for cortisone injections. Patients with diabetes may experience a temporary increase in glucose levels following the injection and should monitor their blood sugar.

After the cortisone injection, we recommend resting the injected part for two days, except for basic daily living activities. Then, based on the pain relief, you can gradually resume regular activity.   

The average duration of pain relief for arthritis is approximately four months. Cortisone will not cure arthritis. Cortisone injections may provide long term solution for bursitis and tendinitis, although the recurrence of symptoms is common following the injection.

The injection can be performed using ultrasound guidance or anatomical landmarks. Ultrasound guidance enables precise delivery of the medication to the target.

Most patients will begin to experience pain relief within a few days after the injection. If the condition is chronic or the inflammation is severe, it may take longer for the effects to occur.

The average duration of arthritis pain relief is around four months. Cortisone injections may provide a cure for bursitis and tendinitis, although the recurrence of symptoms is common following the injection.

Typically, Cortisone injections take 15 minutes to complete, while an ultrasound-guided injection It depends on how you will respond to the injection in terms of pain relief. If the pain relief only lasts for 1-2 months, you may need to consider alternative injections or treatments.takes 20-30 minutes.

For arthritis, alternative injections include Platelet-Rich Plasma (PRP) and nSTRIDE, both of which may slow the progression of arthritis, and Durolane. 

For tendinitis and bursitis, PRP is an alternative that may provide a cure for tendinitis 

It depends how you will response to the injection in terms of pain relief. If the pain relief lasts for only 1-2 months maybe you should look at alternative injections or treatments.

 After receiving a cortisone shot, some people may experience redness and warmth in their chests and faces. For individuals with diabetes, a cortisone shot may temporarily increase their blood sugar levels.

• Protect the area for a day or two. For example, if you received a cortisone shot in your shoulder, avoid heavy lifting. If it was in your knee, avoid strenous exercises and prolonged walking.
• Use ice on the injection site as needed to relieve pain. Do not use heating pads.
• You can take simple pain medication such as Tylenol (if you don’t have an allergy). You can take two tablets of extra-strength Tylenol every 8 hours if needed.
• Do not use a bathtub, hot tub, or whirlpool for two days. Showering is fine.
• Watch for signs of infection, including increasing pain, redness, and swelling lasting more than 48 hours.