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Specialist Orthopaedic Doctors

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Back Pain Injections

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Fluoroscopically Guided Digital X-Ray Injections

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Spinal Manipulation

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Exercise & Rehabilitation Programmes for the Young...

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...and the Not So Young

PRP - Platelet Rich Plasma

PRP or Platelet-Rich Plasma is derived from a blood sample taken from a vein in your arm. It is spun down in a centrifuge and the portion with the most platelets (small cells responsible for clotting) is drawn off. This has been shown to contain a high concentration of growth factors – proteins that boost healing. PRP has been used in many parts of the body and for many different injuries with varying success. It has been used in tendinosis (degeneration of tendons such as Achilles tendons) and in tennis elbow. The area in which the evidence of success is most convincing is in the treatment of osteo-arthritis – wear and tear of joints, especially in the knee. An injection of PRP has been shown to be at least as effective as cortico-steroids (cortisone) and visco-supplementation - joint lubricants such as Ostenil. It can also last longer.
The effects often allows greater movement and less pain and so allows an exercise programme supervised by one of our physiotherapists to be more effective. The improvement can be longer term – 6-12 months or longer. It is probable that it works by supplying increased levels of the growth factors that promote healing of the joint surface.

The Procedure

You will be asked if you agree to the treatment after it has been explained to you by the doctor. A small amount of blood is taken from a vein in the non-painful arm. The identified area on the painful arm will then be injected with your own blood. For platelet rich plasma (PRP) injections the plasma will be separated in a centrifuge first before the injection.

The procedure will take place in the theatre or consulting room. Everything will be explained to you as it is happening. A fluoroscope or ultrasound scanner may be used to aid in the placement of the injection. A fluoroscope is a special x-ray machine which allows the doctor to be very accurate in the placement of the needle. The x-rays used are to guide the injection and are a much smaller dose than normal x-rays.

Local anaesthetic is used so it is not an excessively painful procedure but you may experience some pain. If you do it is important to tell the doctor and/or nurses so they can administer extra pain relief if appropriate.

What to expect after your injection

You might not feel any benefit for the first day or two and some people feel worse temporarily for a few days. This may be due to bruising or soreness near to the injection site. Your pain may worsen significantly for 1-3 days, but should begin to settle within one week.

The pain relief should allow you to gradually increase your activities. It is important that you do not immediately take up unaccustomed exercise until your muscles have had time to adapt. You should book in to see your physiotherapist at Blackberry Clinic one week after your injection so they can monitor your progress and give you a graduated exercise program to follow.

Maintaining regular contact with your physiotherapist will help to maintain the improvement gained.

Follow up

We routinely perform one injection initially and there may occasionally be a requirement of a second injection four weeks later. Most pain relief occurs within the first 4-6 weeks. Please contact the clinic if you need advice as to whether you need a second injection for the best outcome.

Aftercare advice

Pain relief – discomfort can be treated by application of a cold pack to the painful area. Suitable cold packs include bought gel packs but can be as simple as a bag of frozen peas or some crushed ice in a plastic bag. Wrap the cold pack in a damp tea towel and apply for 10 minutes at a time, repeat hourly if necessary. Do not apply ice directly to the skin. In addition, you can take medication such as Paracetamol. Please avoid anti-inflammatories such as Ibuprofen (Nurofen).

Wound dressing - remove the dressing after 24hrs. Keep the area dry in that time.

Complete Rest - if possible, it is best to refrain from pain provoking activities for 2 days.

Relative Rest - avoid very strenuous activity on the joint/area, such as heavy lifting, for up to 2 weeks. Scientific studies have shown this period of rest may improve the effect of the injection.

Possible complications

Reaction - shortness of breath, dizziness or severe headache are rare reactions following the injection and could occur within 24 hours. An allergic reaction is rare but could present as a rash, shortness of breath, facial swelling or a wheeze. If you experience any of these symptoms, you should call the Blackberry Clinic, your doctor (or Out of Hours service), go immediately to A&E or call the emergency services, as appropriate.

Infection – an abscess or infection in other tissues is a very rare complication. Please monitor yourself for signs of fever, redness, swelling and increasing pain. Infections can be treated with antibiotics or surgery if necessary.

If you have any concerns following your procedure, please contact the clinic.
If the clinic is closed, please contact your GP or local out of hours service

Dr Simon Petrides, Registered Manager, Care Quality Commission