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Pain Management

PRP

PRP (Platelet Rich Plasma) in NYC

Dr. Kulick specializes in treating both the symptom and the cause of pain using a technique known as PRP in his clinic in NYC. PRP stands for platelet rich plasma. Like prolotherapy, the treatment causes the formation of new ligament tissue in areas where it has become weak. The difference between prolotherapy and PRP lies in the ability of platelets to attach unguided to an injury that cannot otherwise be visualized. In the case of a torn labrum or meniscus there is no way to accurately guide the injection to the exact site of the tear. Using PRP it is unnecessary to hit a specific target. When injected into a joint the platelets are “wired” to attach to the tear and begin the repair process. Although research continues on PRP’s application, it is gaining broad acceptance as a non invasive way to treat sports injuries and degenerative conditions. While some conservative physicians dismiss PRP as experimental, the American Orthopedic Society recognizes it as legitimate. In fact, some orthopedic surgeons will routinely combine surgery with PRP. With few exceptions, Dr. Kulick uses the power of PRP in place of surgery.

Why PRP is important

PRP is essentially a vehicle for nonsurgical ligament reconstruction, labral tears in the shoulder and hip, in the meniscus of the knee, and treatment for chronic pain without physical therapy or surgery. When prolotherapy fails to bring relief, Dr. Kulick will treat the patient with PRP. Injuries and pain that require extra precision or are difficult to visualize with ultrasound benefit from PRP.

Symptoms it treats

Aside from common sports injuries resulting in strains and sprains or partially torn tendons, ligament and cartilage damage, a wide variety of musculoskeletal conditions can be improved using PRP. These include certain fractures, rotator cuff injuries, muscle and cartilage tears, tennis elbow/golf elbow, tendonitis, and back and neck pain. Quite often muscle spasms can be traced back to ligament laxity.

How it works

The principle applies to any joint. The integrity of all our joints—knee, wrist, hip, shoulder, ankle—are maintained by ligaments and tendons. Essentially ligaments and tendons are the rope that binds bones and joints together. Either through sports injuries or simple wear and tear as we age, ligaments become loose and in some instances begin to fray, or tear. Once the ligament is damaged, the integrity is compromised which can disrupt, dislocate or shift the joint. The idea behind PRP is to strengthen the ligament or tendon at the site of insertion. This frequently allows a muscle that has spasmed to relax, as it no longer needs to provide the support normally provided by the tendon or ligament.

In PRP a patient’s blood is placed in a centrifuge rendering a serum high in platelets. When an injured area is injected with PRP, the platelets act like a laser guided missile to the site of injury setting off the same inflammatory response as prolotherapy. PRP elicits a more powerful response than prolotherapy, is repeated less often, results in greater initial soreness and is usually reserved for more severe injuries because of the associated (higher) expense. In addition, PRP can be injected blindly, in the interior ligaments of the knee, an area that cannot be visualized by ultrasound. The platelets provide a built in guidance system. Platelets were always thought to act as “plugs” to stop bleeding but now research indicates that they also trigger an inflammatory cascade which influences stem cells and growth factors. When the stem cells are “turned on” by the harkening of platelets—repair of the wound or injury begins.

Methodology

PRP is non surgical. It is introduced to the injured site through an injection comprised of a highly concentrated serum of your own blood (roughly 4 to 9 times the amount of platelets.) Dr. Kulick guides the needle into the area of the injury. The concentrated solution injected flows across the membrane where it triggers a repair response. Depending upon the severity of the injury 2-6 sessions spaced 3 weeks apart may be advised.

Side effects

When considering PRP vs. surgery, it is important to recognize that the invasive nature of surgery has its own inherent consequences and complications. PRP gets the patient functional almost immediately, generally replacing physical therapy. The injection is painless. Patients are sore 2-3 days during the inflammatory response and then back in action. As a physician, Dr. Kulick is well versed in situations that he determines dictate surgery, such as a locked knee and will not hesitate to refer.