Rotator Cuff Tendon Healing

Platelet Rich Fibrin Matrix used for Rotator Cuff Tendon Healing

Another interesting article regarding the use of PRFM (platelet Rich Fibrin Matrix) on rotator cuff tendon healing.  This study shows that there is no effect, and possibly a negative effect, on the rate of recovery post surgery.  Something to consider for those considering surgery of the rotator cuff.  At our chiropractic office in Fairfax, we employ multiple techniques of Pre-reb, or rehab before the surgery, designed to reduce recovery time after the surgery is performed.

The Effect of Platelet-Rich Fibrin Matrix on Rotator Cuff Tendon Healing: A Prospective, Randomized Clinical Study

by Rodeo, S. A., Delos, D., Williams, R. J., Adler, R. S., Pearle, A., Warren, R. F.

Background: There is a strong need for methods to improve the biological potential of rotator cuff tendon healing. Platelet-rich fibrin matrix (PRFM) allows delivery of autologous cytokines to healing tissue, and limited evidence suggests a positive effect of platelet-rich plasma on tendon biology.

Purpose: To evaluate the effect of platelet-rich fibrin matrix on rotator cuff tendon healing.

Study Design: Randomized controlled trial; Level of evidence, 2.

Methods: Seventy-nine patients undergoing arthroscopic rotator cuff tendon repair were randomized intraoperatively to either receive PRFM at the tendon-bone interface (n = 40) or standard repair with no PRFM (n = 39). Standardized repair techniques were used for all patients. The postoperative rehabilitation protocol was the same in both groups. The primary outcome was tendon healing evaluated by ultrasound (intact vs defect at repair site) at 6 and 12 weeks. Power Doppler ultrasound was also used to evaluate vascularity in the peribursal, peritendinous, and musculotendinous and insertion site areas of the tendon and bone anchor site. Secondary outcomes included standardized shoulder outcome scales (American Shoulder and Elbow Surgeons [ASES] and L’Insalata) and strength measurements using a handheld dynamometer. Patients and the evaluator were blinded to treatment group. All patients were evaluated at minimum 1-year follow-up. A logistic regression model was used to predict outcome (healed vs defect) based on tear severity, repair type, treatment type (PRFM or control), and platelet count.

Results: Overall, there were no differences in tendon-to-bone healing between the PRFM and control groups. Complete tendon-to-bone healing (intact repair) was found in 24 of 36 (67%) in the PRFM group and 25 of 31 (81%) in the control group (P = .20). There were no significant differences in healing by ultrasound between 6 and 12 weeks. There were gradual increases in ASES and L’Insalata scores over time in both groups, but there were no differences in scores between the groups. We also found no difference in vascularity in the peribursal, peritendinous, and musculotendinous areas of the tendon between groups. There were no differences in strength between groups. Platelet count had no effect on healing. Logistic regression analysis demonstrated that PRFM was a significant predictor (P = .037) for a tendon defect at 12 weeks, with an odds ratio of 5.8.

Conclusion: Platelet-rich fibrin matrix applied to the tendon-bone interface at the time of rotator cuff repair had no demonstrable effect on tendon healing, tendon vascularity, manual muscle strength, or clinical rating scales. In fact, the regression analysis suggests that PRFM may have a negative effect on healing. Further study is required to evaluate the role of PRFM in rotator cuff repair.

Joshua M. Brooks, D.C.

............................................................

ABC Clinics

Rosa Family Chiropractic

2750 Prosperity Ave, Suite 550

Fairfax, VA  22031

 703.876.5600

............................................................

www.RosaChiropracticFairfax.com

www.RecoveryDoc.net

Suffering from Plantar Fasciitis? Chiropractic Care Can Help!

Chiropractic for Plantar Fasciitis

Do you have pain in the bottom of your foot when you take your first step out of bed in the morning?  If so, you could be suffering from a very common condition called plantar fasciitis. 

This is caused by repetitive stress causing strain, weakness, swelling, and irritation to the plantar fascia at bottom of the foot.  It is very important to seek treatment for this condition as soon as one starts to feel any pain or discomfort.  Plantar fasciitis has a tendency to become a chronic injury when it goes untreated.

Chiropractic Muscle Simulation can be used to Treat Plantar Fasciitis

As a chiropractor, there are many modalities that I can utilize to heal plantar fasciitis.  Muscle stimulation, therapeutic ultrasound, Graston, soft tissue massage, and ice massage are very helpful when treating this condition.  Custom orthotics can also be made to support the arch and proper biomechanical motion. Implementing regular stretching and icing at home is also crucial to the patient’s recovery.   

Your Daily Metro Trip Can Cause Plantar Fasciitis 

In Alexandria and the Washington, D.C. / Northern Virginia region many people use public transportation.  Walking to and from the metro or up and the down stairs multiple times per day can potentially do some serious damage on one’s feet.  Whether it’s plantar fasciitis, or any other musculoskeletal foot condition, your chiropractor at Rosa Family Chiropractic of Alexandria is here to help.

Dr. Nick Andolina

Chiropractor, Physiotherapist

Alexandria, VA

Suffering Pain? Study Reveals Physical Therapy is Your Best Pain Relief Option

A Recent Study Suggests Physical Therapy Better than Injections
A recent study highlights the ineffectiveness of injections when used for adhesive capsulitis (frozen shoulder).  In our clinic in Fairfax, we certainly do not discourage the use of injections as we work with many different orthopedists in the area.  There certainly is a benefit for the procedure as it has helped with many of our patients suffering from frozen shoulder.  However, we typically recommend a course of rehab in our office first, prior to any invasive procedure.   Many times we can achieve your goals without injections, and should the procedure be necessary, we would co-treat and combine both rehab and medicine together.  See the study below...

Abstract 

Hsieh L-F, Hsu W-C, Lin Y-J, Chang H-L, Chen C-C, Huang V. Addition of intra-articular hyaluronate injection to physical therapy program produces no extra benefits in patients with adhesive capsulitis of the shoulder: a randomized controlled trial.

Objective

To compare the efficacy of intra-articular hyaluronic acid (HA) injections plus physical therapy (PT) with that of PT alone for the treatment of adhesive capsulitis (AC) of the shoulder.

Design

Prospective, randomized controlled trial.

Setting

Rehabilitation and orthopedics department of a private teaching hospital.

Participants

Patients (N=70) with AC of the shoulder were randomly placed into either of the following treatment groups: group 1, HA injections with PT (HAPT group); or group 2, PT alone (PT group).

Interventions

The patients in group 1 received intra-articular glenohumeral joint injections of HA, 20mg, once per week for 3 consecutive weeks and also participated in a PT program for 3 months. The patients in group 2 received PT alone.

Main Outcome Measures

Active and passive range of motion (ROM) of the affected shoulder, pain, disability, and quality of life.

Results

Both groups experienced improvements in terms of pain, disability, and quality of life after the treatments; furthermore, the active and passive ROM improved linearly with increasing treatment duration. When the groups were compared, no significant group effect was found for any of the outcome measurements.

Conclusions

Intra-articular HA injections did not produce added benefits for patients with AC of the shoulder who were already receiving PT. Thus, the use of intra-articular HA injections for patients with AC of the shoulder should be carefully assessed to reduce unnecessary medical expenditures.

New Food Pyramid Makes it Easy to Create a Well Balanced Meal

The New Food Pyramid in the Shape of a Plate Makes it Easy to Plan a Well Balanced Dish

The new food pyramid, called MyPlate, was introduced to show people how a typical meal should look.  Fruits and vegetables contain important nutrients such as fiber and potassium that help reduce the risk of developing heart disease, type 2 diabetes, and high blood pressure.

Whole grains should be consumed, allowing the food to be broken down slowly while preventing sharp spikes in blood glucose while also helping to lower cholesterol.  Protein sources should consist of lean meats including at least 8 oz of fish per week. Calcium, phosphorus, and vitamin D are some of the reasons that having dairy at each meal is very beneficial.

The new MyPlate also shows the proper portion size when compared to your standard dinner plate.  This differs from the food pyramids of the past that gave recommendations as to how many servings one should consume from each individual food group with no attention paid to portion size. 

For more information and articles on health tips and wellness please visit our website at www.rosachiropracticfairfax.com.