Muscle or tendon pain can affect everyone: from a weekend warrior who joined a city softball league, to a collegiate volleyball player, to an avid recreational gardener. There may be no bony injury so x-rays would be normal. However, a focused physical exam can reveal that while there are no fractures, there can still be significant soft tissue pathology. This may be a result of a particular injury, overuse with improper body mechanics, or lack of stretching and strength conditioning. Orthobiologics are a good treatment option for muscle or tendon injuries that fail typical conservative measures.
Muscles attach to bone via rope like structures known as tendons. As the brain signals muscles to contract in order to initiate movement, the tendons are subject to a large number of forces. Injuries to these structures can fall under the categories: tendinitis, tendinosis, or tears.
Tendinitis or tendinosis
The terms tendinosis and tendinitis are often used interchangeably. Technically the difference between the two is related to histologic changes seen under a microscope. However, a clinical way to distinguish between tendonitis and tendinosis is time.
Tendonitis is acute inflammation of a tendon due to an injury
Tendinosis is chronic injury caused by repetitive trauma or an injury that hasn’t healed
Tendon or muscle tears
If the injury progresses past the point of tendon inflammation or thickening, it might actually cause the tendon or muscle to tear. Alternatively, a muscle or tendon can tear acutely in a specific injury. A complete tear can usually be diagnosed clinically with significant bruising, swelling, and weakness when testing the muscle. Smaller partial tears however might be more difficult to distinguish and could require an ultrasound or MRI to make the diagnosis. While complete tears might require surgery to reattach the tendon to the bone, partial tears are often treated conservatively and could be candidates for Orthobiologics.
First line treatments for simple muscle or tendon injuries include RICE (Rest, Ice, Compression, Elevation) and anti-inflammatory medications. If pain persists, a physician directed home exercise program or physical therapy may be helpful to improve pain and functionality. However, for cases of muscle or tendon injuries that are refractory to these initial conservative measures, there are other options.
While cortisone can be very helpful to control pain and inflammation in joints, cortisone cannot be used to inject muscles or tendons. Injecting cortisone into a muscle or tendon puts the structure at risk for rupture and potentially the need for surgical intervention. For that reason, muscle or tendon injuries are better treated with Orthobiologics.
Orthobiologics are natural substances such as cells, tissue, blood components, and growth factors that can be used to treat tendon or muscle injuries. Orthobiologics can stimulate regeneration and promote healing, reduce pain and inflammation, and improve joint function. Two types of Orthobiologic medications we use at Midwest Orthopaedic Consultants(MOC) are platelet rich plasma (PRP) and Amniox.
PRP is a blood derived Orthobiologic that is derived directly from a patient’s whole blood. MOC uses PEAK centrifuge technology to spin down 27mL of whole blood which is drawn in the office at the time of the office visit into 3mL of concentrated plasma. This plasma is rich in platelets which are the regenerative cells of blood. The platelet rich plasma is then injected into the diseased muscle or tendon. The goal of PRP injections is to directly apply these regenerative cells to the area the body needs it the most.
As an alternative to the blood derived PRP, Amniox is an Orthobiologic which is derived from stem cells. Placental cells are collected from voluntary postpartum donors. The cells are collected from the usually discarded placental tissue after birth. This is then purified and sterilized before being delivered to the clinic. Just like PRP, Amniox is then injected directly into the muscle or tendon that is injured and works similarly to promote healing.
Post procedure considerations
Important post procedure instructions for Orthobiologic injections include avoidance of anti-inflammatory medications or ice for at least a week. This is because injecting the tendon or muscle creates an inflammatory response and aids healing by signaling growth factors to the injury site. Medications that decrease inflammation therefore reduce this effect. Additionally, it is normal to have increased pain or warmth at the injection site for several weeks after the injection before the pain starts to improve. If pain relief is required, it is okay for Tylenol or heat as needed. Typically by 6 weeks after the injection patients are feeling significantly better.
Talk to your doctor if you have any acute or chronic muscle or tendon injuries including but not limited to:
Patellar tendinitis/tendinosis (jumper’s knee)
Lateral epicondylitis (tennis elbow)
Medial epicondylitis (golfers elbow)
Partial tears of the hamstring or quadricep