Archiwa Regenerative medicine for the musculoskeletal system - Goczewski

Dry Needling (Tendon Fenestration)

Marcin Goczewski — Mon, 08 Feb 2021 12:04:53 +0000

Dry Needling (Tendon Fenestration)

Ultrasound guided tendon fenestration involves passing a needle through the areas of tendinosis multiple times.

It changes a chronic degenerative process into an acute inflammation and disrupts area of tendinosis. Bleeding that occurs within the tendon during the procedure causes release of growth factors which stimulate tendon healing through scar remodelling. This method is applied in a chronic degenerative enthesopathies where the structure of tendon attachment is changed with developing of scars, ruptures, calcifications and spurs.

The most common conditions we treat with tendon fenestration:

Tennis elbow,
Golfer’s elbow,
plantar fasciitis,
Jumper’s knee,
gluteal tendinopathies.

Indication for the treatment:

Lack of good results in conservative treatment of chronic pain due to tendinosis.

Contraindications:

bleeding disorders,
infection,
prior steroid injection
allergy to local anesthetic,
pregnancy.

What does the procedure entail?

After local anaesthesia of the subcutaneus tissue the doctor punctures the affected area of the tendon multiple times with the needle. The whole procedure is performed only under ultrasound visualisation.

Post-procedure recommendation:

avoid ice,
avoid anti-inflammatory drugs, In the case of pain it is recommended to use paracetamol,
rest for two weeks,
after two weeks gradual returning to activities,
after two weeks start of rehabilitation.

Dr. Marcin Goczewski performs dry needling procedure only under ultrasound guidance.

Artykuł Dry Needling (Tendon Fenestration) pochodzi z serwisu Goczewski.

Viscosupplementation

Marcin Goczewski — Mon, 08 Feb 2021 12:00:43 +0000

Viscosupplementation

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Hyaluronic acid is a key component of the joint fluid and gives the joint fluid viscoelastic properties.

This unique feature helps reduce joint friction during movement and adds cushioning to protect the cartilage during weight-bearing activity. With disease progression of osteoarthritis the concentration of hialuronic acid in joint fluid decreases. Viscosupplementation is a procedure in which hyaluronic acid is injectetd into the joint cavity in order to increase hyaluronic acid concentration in synovial fluid and as a result to slow down degeneration process.

Indications for injection:

osteoarthritis,
knee pain,
limited range of motion in the joint,
joint stiffness.

Benefits of injection:

improvement of the lubricating properties of the joint fluid,
pain relief,
mobility improvement,
stiffness relief.

Depending on the brand used, the treatment involves between 1 to 3 injections. If more than one injection is recommended, they are given one week apart. After treatment with hyaluronic acid patient shouldn’t do hard weight-bearing activity for two days. Hyaluronic acid injection is very safe and well tolerated procedure. Sometimes after injection the patient may experience temporary mild pain and swelling.

Dr. Marcin Goczewski performs hyaluronic acid injections only under ultrasound guidance, to ensure precise medicine injection and reduce the risk of complications.

Artykuł Viscosupplementation pochodzi z serwisu Goczewski.

Prolotherapy

Marcin Goczewski — Mon, 08 Feb 2021 11:57:49 +0000

Prolotherapy

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Prolotherapy is a very old method of treatment which dates back to Roman times when hot needles were poked into shoulders of injured gladiators to create irritation and stimulate healing wounds.

Modern prolotherapy began in the1950s when American doctor George Hackett started injecting irritant solution dextrose in order to treat a musculosceletal conditions. A major goal of prolotherapy is to change a chronic degenerative process into an acute inflammation. The inflammation that occurs after the procedure causes release of growth factors which help to heal an affected area.

Growth factors released during prolotherapy:

platelet-derived growth  factor,
transforming growth factor beta,
epidarmal growth factor,
basic fibroblast growth factor,
connective tissue growth factor,

Indications for prolotherapy:

Tennis elbow,
Golfer’s elbow,
osteoarthritis,
lumbar pain,
trochanteric pain syndrome,
myofascial pain,
plantar fascitis,

Contraindications:

bleeding disorders,
infection,
prior steroid injection
allergy to local anesthetic,
pregnancy,
acute injury,
pain due to cancer,

Preparing for prolotherapy:

avoid anti-inflammatory medications before the procedure,
in the case of pain it is allowed to take paracetamol.

What does the procedure entail?

The procedure is very safe, under ultrasound guidance a doctor is injecting a concentrated dextrose into affected area. It is recommended to repeat this procedure 3-6 times.

Side effects:

There may be temporary side effects like pain and signs of inflammation. These symptoms should disappear after a fiew days.

Indications after the procedure:

Avoid anti-inflammatory medications,
In the case of pain take paracetamol,
Start rehabilitation after 2 weeks,

Dr. Marcin Goczewski performs prolotherapy injections only under ultrasound guidance, to ensure precise medicine injection and reduce the risk of complications.

Artykuł Prolotherapy pochodzi z serwisu Goczewski.

Platelet-rich Plasma (PRP)

Marcin Goczewski — Mon, 08 Feb 2021 11:54:00 +0000

Platelet-rich Plasma (PRP)

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Platelet-rich plasma (PRP) is a plasma containing concentrated platelets acquired from autologous blood.

Concentration of platelets in such plasma is 4-5 larger than in normal blood.

There are four main categories of preparation of platelet-rich plasma based on its leukocyte and fibrin architecture contents:

Leukocyte-Pure Platelet Rich Plasma (P-PRP),
Leukocyte-Rich Platelet-Rich Plasma (L-PRP),
Leukocyte-Poor Platelet-Rich Firbin (P-PRF),
Leukocyte-Rich Platelet-Rich Fibrin (R-PRF),

Depending on the kind of pathology different types of PRP are applied. PRP is currently used as a concentrated source of growth factors released from the activated platelets to stimulate regeneration of different structures of musculosceletal system.

Preparing for the procedure:

Before PRP injection it is required to show the doctor a complete blood count and to determine coagulation factors.

Indications for PRP teratment:

acute sports injury,
chronic degenerative soft tissue diseases like tennis elbow, golfer’s elbow, plantar fascitis,
osteoarthritis.

Contraindications:

coagulation disorder,
impossibility of taking a rest and rehabilitation after PRP injection,
platelet count disorder,
some systemic diseases,
anti-coagulation therapy,
chronic liver disease,
sepsis,
acute and chronic infections.

What does the procedure entail?

PRP is made by centrifuging a whole blood in order to concentrate the platelets in the plasma. The plasma is injected into the affected area afterwards.

Post-procedure recommendation:

avoid ice,
avoid steroids three weeks before and four weeks after PRP injection,
in the case of wearing brace it is recommended to apply antithrombotic prophylaxis,
If wearing a brace is recommended , it may also be advisable to use crutches,
avoid anti-inflammatory drugs, In the case of pain it is recommended to take paracetamol,
rest for two weeks,
after two weeks start of rehabilitation,
after four weeks gradual returning to activities.

PRP side effects:

temporary inflammation,
temporary pain,
infection.

Dr. Marcin Goczewski performs platelet rich plasma injections only under ultrasound guidance to ensure precise medicine injection and reduce the risk of complications.

Artykuł Platelet-rich Plasma (PRP) pochodzi z serwisu Goczewski.