As an update on a previous blog post where I mentioned Ms H, a 73 year old woman with wrist tendinitis treated with 2 treatments of PRP after failing prior steroid injections, nsaids, and OT. Her pain level originally decreased from pain at rest with max pain level 8/10, to no pain at rest and max pain 3/10 after 2 PRP treatments. She attended OT again, but her pain and functional level have essentially stabilized at max pain of 3/10. Our current plan is to give a repeat PRP treatment in order to kick start her healing process and continue her improvement.
I can not help but wonder whether if Ms H had received PRP treatments initially rather than steroid injections, would her injury be better healed at this stage. There is evidence for patellar tendinitis that utilizing PRP first can result in a better response as compared to using PRP after having failed steroid injections. In the setting of a acute or subacute injury steroid injections have been the typical treatment recommendation. In my experience this is a short sighted approach. The steroid injection will give pain relief, which may enable better participation with PT/OT. But the steroid injection itself doesn’t improve the actual tissue injury. If your goals are long term and you would like to treat an injury at the cellular level, a cell based approach makes much more sense. Prolotherapy or PRP for mild injuries, PRP for moderate injuries, and stem cells for more severe ones.