Initial Conservative Treatment Options

Cortisone

Injection of a strong anti-inflammatory agent often used to treat acute exacerbation of musculoskeletal pain and inflammation. May take 5-6 days to kick in. Often used in conjunction with physical therapy.

Physical Therapy

Referral to musculoskeletal professionals that supervise, train, and facilitate strengthening and stretching of specific muscle groups to optimize biomechanics of the body to promote healing and reduce pain, injury, and risk of reinjury.

Dry Needling

Insertion of a sterile needle into muscles and tendons to increase localized blood flow and try to stimulate growth factors to the area. This is called 'prolotherapy' when an irritant such as dextrose is also injected.

Platelet Rich Plasma

PRP is concentrated from your own blood, prepared to standardized concentrations.

PRP injections contain healing factors such as Platelet Derived Growth Factor (PDGF) and Vascular Endothelial Growth Factor (VEGF) which can bypass failed delivery when injected directly into the area of chronic injury or tendinopathy.

Platelets release cytokines that recruit other cells to promote healing.

Restrictions

  • Do not take NSAIDs or ice the area for 1 week prior and 4 weeks after injection
  • No use of the area for first 24 hours
  • Modify activities for 1-2 weeks

Expectations

  • Resume normal activity after 1 month
  • Final healing result up to 3 months
  • Expect decreased range of motion, likely feeling worse before it feels better
  • Very low risk of reaction to injection
  • Not covered by insurance - $$

Percutaneous Tenotomy

  • This is a fairly new minimally-invasive procedure that is developed from the harmonic resonance technology used in cataract surgery.
  • The procedure is done while awake with local anesthesia only.
  • Ultrasound is used to guide the needle to damaged or injured tendon.
  • Inserted needle can micro-debride damaged tissue or calcifications 1mm at a time, while healthy elastic tissue is left undamaged.
  • No incision, a tiny scar, less risk for infection, and faster recovery time compared to more invasive procedures.
  • There are no limitations for NSAID use.
  • Restrict activity for 2 weeks, then perform physical therapy and modify activities for the following 4 weeks.
  • Full effect of procedure and tendon remodeling usually seen around 3 months after treatment.

Covered by most insurance.

BMAC

  • Bone marrow cells enhance the body’s natural healing process, with stages of initial inflammation, proliferation, and cell remodeling.
  • Alters local cell function, creating an immune driven cascade of healing.
  • Using a Marrow Cellution™ needle minimizes trauma to cancellous bone and marrow.
  • Expect some discomfort immediately following treatment as local anesthesia wears off.
  • The remodeling phase of hematopoetic stem cells to the area of injury or illness will continue for 12 weeks.

Not covered by insurance - $$$

Amnio

  • Growth factors cultured from amniotic tissue
  • Injected into tendons & joints with lower blood flow
  • No blood draw necessary
  • Please do not take NSAIDs or use ice for 1 week before and 4 weeks after injection
  • Limit activity for 1-2 weeks, normal activity within a month
  • Available in 1mL and 2mL

Not covered by insurance - $$$