The most common affliction of the musculoskeletal system is injury.
This may be sudden injury from a large external force, such as an accident or fall. It may also be from repeated micro-injury, depriving the muscles of enough time to recover completely.
Maintaining the good health of the musculoskeletal system is essentially a balance of wear and repair. If repair cannot keep up with wear, there is a tear or injury.
In circumstances where healing or repair cannot keep up with injury, the injury becomes chronic, and usually painful.
There may be associated secondary changes or adaptations, which are detrimental as well. These include irritation of joint or tendon linings (synovitis/tenosynovitis), wasting, muscle weakness, or loss of joint stability.
Healing is a sophisticated biological mechanism that is being slowly understood with more research into the basic cellular and biochemical factors involved.
What is now known is that the body chemicals (growth factors) involved are carried in the blood stream and released or activated where they are needed.
These occur in several tissues, and are also available in concentrated form in platelets.
Platelets are a component of blood that is important in controlling bleeding (as commonly occurs in injury), as well as coordination of healing.
Amongst the growth factors known to be abundant in platelets and important for healing are Platelet-Derived Growth Factor (stimulates multiplication of cells), Transforming Growth Factor (regulates bone cell metabolism), and Vascular Endothelial Growth Factor (promotes the growth of new blood vessels).
This has led to attempts to harvest the body's natural healing capacity by collecting platelets from a patient, concentrating them in a small amount of plasma, and administering the platelets at the site of injury.
This is called Platelet Rich Plasma (PRP) therapy.
The procedure of extracting platelets is just like having a regular blood test, and takes between 20 and 30 minutes.
It is then injected into the site of pain/disease, as any other medication would be (ie steroids, local anaesthetic or other medications).
For the past 20 years in Europe, PRP has been used in an attempt to speed up the healing process or to restart the process that is not doing well.
Successful reports of use have been for tennis elbow, plantar fasciitis, pain relief after total knee replacement surgery, and non-union of fracture and torn tendons or muscles, amongst others.
The method of application of extracted platelets is either during open surgery, where it is part of the entire surgical process, or by injection into the specific area.
From what is known about how this treatment may work, it is critical to get the platelets to the exact area of disease.
The evidence for how well PRP works is not universally good.
This has been attributed to the variety of areas of the body that it has been used, the conditions it has been used for, and the different PRP systems used.
Given that it is prepared easily from the patient's own blood and its use is not regulated, there have been many attempts to use it for conditions where it is not likely to make a difference.
This has led to confusion about the actual role of PRP in the management of musculoskeletal conditions.
This is further compounded by the fact that pain may not correlate with the extent of degeneration present. So, the question of whether PRP removes the pain or completely repairs the degenerative process is not clear.
In summary, PRP provides a promising alternative to surgery by promoting safe and natural healing.
It is not a universal panacea for perfect musculoskeletal heath. It must be used with caution because of the variability of preparation methods in concentrating the platelets.
Real-time ultrasound guidance is a safe and effective way of guiding injections in the body, and has a central role in the use of PRP.
1. Platelet Rich Plasma injection grafts for musculoskeletal injuries: a review. Sampson S, Gerhardt M, Mandelbaum B. Current review of musculoskeletal medicine 2008. 1:165-174
2. Platelet Rich Plasma in Orthopedics. Chapter 26. By Jennifer E. Woodell-May and William S Pietrzak. From: Orthopedic Biology and Medicine: Musculoskeletal Tissue Regeneration, Biological Materials and Methods. Human Press, Totowa, NJ
■ Dr Rajesh Singh is a consultant orthopaedic, hand & micro-surgeon. For further information, e-mail email@example.com. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.