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Indications for platelet rich plasma, platelet poor plasma and steroid injections

Corticosteroid injections are commonly used in the management of a wide range of musculoskeletal conditions but often Platelet Rich Plasma (PRP) is preferable. Unfortunately, the indication for, and value of, Platelet Rich Plasma (PRP) are grey areas which in part reflects confusion as to what is actually being injected and why? This section attempts to explain a logical approach.

In summary:

When to perform platelet enriched plasma injection?

Under CT (arthrogram)-guidance

  • Shoulder, Hip, Knee or Ankle osteoarthritis either unsuitable for or awaiting joint replacement surgery.

Under US-guidance

  • Tennis (CEO) elbow with tearing.
  • Golfers (CFO) elbow with tearing.
  • Non-retracted gluteus medius or minimus tendon tear.
  • Non-retracted rotator cuff tear unsuitable for surgery.
  • Severe tendinopathy without body attempt at repair e.g.: plantar fascia, patella tendon.

When to perform corticosteroid injection?

Under US-guidance

  • Bursae – subacromial, trochanteric, olecranon etc (but consider PRP if adjacent tendinopathy to major tendons especially retrocalcaneal bursa (Achilles tendon) and deep pretibial bursa (Patella tendon).
  • Tenosynovitis – all sites (but consider PRP is associated tendinopathy).
  • Arthritis – all small / non-weight-bearing joints (unless arthropathy being considered).
  • Nerve entrapment – carpal tunnel, Guyon canal, cubital tunnel, tarsal tunnel etc (using dexamethasone).

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