PRP – What Is It and Can It Fix Me?

PRP treating knee and elbow injuriesBy now a majority of people have heard of PRP, which stands for platelet-rich plasma. This is a procedure performed by a physician in the office that involves taking a small sample of blood from a patient. That blood is then placed into a centrifuge machine, which helps to separate the blood into different layers based upon their densities. A specific density layer is targeted which contains the platelets and growth factors responsible for the healing process invoked when we have injured tissues. This layer is then typically injected into patients at the target site of injury, often under ultrasound to enhance the precision of the injection.

The popularity for this treatment really took off when several professional athletes turned to injections of PRP for different reasons in order to help them. Famously, Hines Ward of the Pittsburgh Steelers had his MCL injury to his knee injected when he sustained a grade 2 sprain just two weeks before the super bowl. Kobe Bryant and Dirk Nowitzki in the NBA have had their knees injected as well during their careers.

There is an important and growing role for the use of PRP in baseball players, most commonly in the elbow for partial tears of the ulnar collateral ligament, or UCL (Tommy John ligament). Certainly, we do not think that a complete or full thickness tear can be treated with this injection; that will require surgical intervention if the pitcher wishes to return to play. However, in the properly selected patient and with proper technique, there is a role for PRP injections for some partial tears. This is usually based on a thorough patient history, physical examination, and review of recent X-rays and an MRI with contrast injected into the joint (aka ‘arthrogram’). After PRP injection, there is a period of time away from throwing, followed buy a return to throwing program.

We are still actively conducting high quality research studies to elucidate the volume and frequency of injections, as well as comparing these injections to other injection types or even placebos to ensure that we can understand the science and statistics behind when and if this treatment is superior.

Ask your sports medicine physician with expertise in treating baseball injuries if PRP is an option for you or your child.

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Growth Plate Fractures in Children

My child has a growth plate fracture in their arm – should I be really worried? I see patients of all ages, from toddlers to the elderly. A large part of my practice involves treatment of routine injuries in children, adolescents, and teenagers. Fractures of the hand, wrist, forearm and elbow are very common. Here’s a little bit about how we grow: The growth plates are the centers of growth and the location of lots of injuries. We get longer in our bones because of the growth plates. The growth plate is also the weak spot on the bone. It is largely made up of cartilage which eventually ossifies or turns into bone – like the remainder of the more mature bone. The cartilage isn’t as strong as regular bone.

On an x-ray, you can tell if somebody is still growing based on the presence or absence of growth plates at specific, known locations within the bone. If the growth plate is still very wide-meaning lots of distance from the rest of the bone on either side of the growth plate-then the child is younger. As a child ages, the growth plate narrows, until eventually it is just a thin line between two parts of that bone, and eventually it becomes invisible all together. At this point, the bone is done growing.

We classify fractures involving the growth plates using something called The Salter-Harris classification. There are five subtypes of classifications, increasing in severity of injury and problems to the bone with increasing number. Fortunately, most growth plate fractures are a type 1 or type 2 Salter-Harris fracture – which is the most mild kind. While it is possible to have disruption or problems related to future growth with any type of growth plate fracture, fortunately they are pretty uncommon for type one and two fractures. Also, most kids sustain a type one or type two fracture as well – not the more serious types (3-5).

So – in short, if you or your child sustained a fracture to the growth plate, do not necessarily worry! Get it checked by somebody who is comfortable treating orthopedic injuries in kids of all ages. Most of the time, this is the more mild type involving a type one or two fracture. Most of these do not have any long-term sequela to the injury. Also, bones can tolerate being a little bit angulated, or crooked, particularly in very young kids. Their bodies know to grow the bones straighter overtime. The younger the patient, the more crooked the bone could be; there are certain specific parameters that we measure based on age and the x-ray. The growth plate is weaker than the ligaments, tendons, or remainder of the shaft of the bone, so this is where most injuries occur. Chances are, your child will heal up just fine and be back at it in no time!

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Prevent Baseball Arm Injuries With Proper Rest and Cross Training

baseball arm injuriesTaking care of your arm involves adhering to some well-established practices such as keeping track of pitch counts, proper mechanics, not throwing when fatigued or tired, and ensuring proper rest between outings. Nevertheless, injury to the elbow ulnar collateral ligament (UCL) necessitating UCL or Tommy John surgery is always a risk, especially with involvement in baseball around the clock, year-round, and at earlier ages. It’s important that we remember to cross train, as no one sport can provide all types of work and exercise – for example, incorporating other activities such as running, swimming, yoga and basketball.

Read more at baseballarm.com
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Dr. Kuremsky and Sports Medicine

sports medicine UCL injuriesThe same treatment will not work universally for every patient, so the physician draws upon experience and knowledge base to customize the care provided to each individual patient – especially true in sports medicine. Through a full year of subspecialty advanced fellowship training in orthopedic sports medicine at the American Sports Medicine Institute in Birmingham, Alabama with Dr. James Andrews and his partners, I gained invaluable skills and experience that I use every day in my my orthopedic practice. Each athlete under my care gets a treatment plan tailored to their needs. That may involve ulnar collateral ligament (UCL) Tommy John surgery, platelet rich plasma (PRP) injections, or other treatment options.

Read more at baseballarm.com
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Elbow Injuries and Tommy John UCL Surgery

baseball player throwing athlete elbow injuryInjuries to the ulnar collateral ligament (UCL) are very common in the sport of baseball. Tommy John surgery is unequivocally recommended for baseball players with a complete detachment of the ligament from their elbow. Decisions exist and uncertainty arises when there are partial or incomplete tears of the ligaments. Some people may be candidates for nonsurgical options such as platelet rich plasma, or PRP treatments. Some variables in the decision whether to proceed with surgery include time of the year during which the athlete is being seen, prior history of elbow injuries, and MRI results, among other things.

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Ulnar Collateral Ligament Injuries and Treatment

The phrase “Tommy John” refers to injury sustained to the athlete’s elbow, specifically the ulnar collateral ligament or UCL. Surgical treatment of this injury is known as Tommy John reconstructive surgery, whereby a new ligament is recreated to replace the function of the injured one.

Tommy John himself was a successful baseball player in the 1970s and 80s for the Los Angeles Dodgers and the New York Yankees. His fame truly derives from the fact that his career appeared to be in jeopardy when he sustained an injury to his inner elbow at the UCL. At that time, no professional major-league baseball pitcher had ever returned to play after having sustained this significant injury.

Behind the treatment and pioneering work of Dr Frank Jobe, John had surgery and ultimately returned to continue playing baseball – and had several more exceptional years. From here, other players also began to have this surgery and henceforth the procedure known as “Tommy John” refers to elbow ligament reconstruction in athletes.

The incidence of Tommy John injuries is rising. Of even greater concern is the fact that injuries are happening not only more frequently but to younger athletes. It is estimated that more than 55% of all pictures in the major and minor leagues have had Tommy John surgery.

Research has provided insight into the mechanism of injury. These include some of the following: year-round throwing, failure to adhere to established pitch counts and pitch limits, initiating curveballs at an early age or before mastery of fastballs and breaking balls, poor throwing mechanics, and others.

Throwing athletes of all ages should see a sports medicine elbow specialist if they are having elbow pain or a decrease in velocity when throwing. An experienced physician can help sort out the diagnosis as well as provide next steps for treatments or rehabilitation.
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