High Dose PRP – Platelet Rich Plasma – as a Treatment for Bursitis

Conditions that chronically affect the joints like osteoarthritis, and acute incidents that damage the joints like injuries are both common and expected by most people at some point in their lifetime. If there is one thing that patients with these experiences don’t need, it’s a painful byproduct of their joint pain. Unfortunately, for many, joint pain and stiffness may not only be a result of acute or chronic conditions, but a condition known as bursitis. In general, bursitis is a condition that manifests in the inflammation of the pads that protect our joints (bursae). While all of our joints contain bursae, it is more common for the bursae to become inflamed when the joint is repeatedly used– most commonly, the knee and elbow joints.

For decades, physicians have known the causes of bursitis and generally its direction for treatment. In 2001, doctors Arromdee and Matteson determined in The Journal of Musculoskeletal Medicine that, “[t]he most common causes of bursitis are repetitive microtrauma or macrotrauma . . .”. Microtrauma and Macrotrauma refers to inside and outside injury respectively. Doctors Arromdee and Matteson continue to list the micro/macro traumas to include, “. . . extension of inflammation from the surrounding structures, including adjacent tendons, muscle fascia, skin, and joint synovium; crystalline deposition diseases; and infection” (2001). To elaborate further, the extension of inflammation refers to other sections of the joints becoming inflamed and causing inflammation of the bursae. Crystalline deposition diseases that can contribute to bursitis include gout and other forms of arthritis. However, while some of these contributing factors to bursitis may appear serious, others are seemingly innocuous and even incidental.

Oddly enough, a study conducted in in 2020 by physicians Elizabeth Hesse and Ronald Navarro found that, “[s]ubdeltoid bursitis has been reported as an adverse event after intramuscular vaccination in the deltoid muscle . . . The cohort included 2 943 493 vaccinated persons. Sixteen cases of symptom onset in the risk interval and 51 cases of symptom onset in the control interval were identified. The median age of persons in the risk interval was 57.5 years (range, 24 to 98 years), and 69% were women. The incidence rate ratio was 3.24 (95% CI, 1.85 to 5.68). The attributable risk was 7.78 (CI, 2.19 to 13.38) additional cases of bursitis per 1 million persons vaccinated . . . Although an increased risk for bursitis after vaccination was present, the absolute risk was small” (2020). While the risk for bursitis after vaccination into the deltoid is small, patients can begin to see just how sensitive the bursae is to both micro and macro traumas and even though bursitis can be common, that does not make it less serious or negate the necessity for treatment.

“Bursitis is a common reason for seeking medical help, notably via emergency room visits. The olecranon and prepatellar [elbow and knee joints, respectively] bursae are the most often involved sites, as their superficial location exposes them to injury. About one-third of cases of olecranon and prepatellar bursitis are septic [or infected]. The annual incidence of olecranon and prepatellar bursitis has been estimated at 0.1/1000 population. Septic olecranon and prepatellar bursitis has been reported to account for 0.01% to 0.1% of all hospital admissions. These numbers may underestimate the true incidence of septic bursitis, as only the most severe forms require admission” (2018). As we discussed earlier, bursitis can be relatively common for a number of reasons. With up to 33% of bursitis cases requiring hospitalization, one can begin to see why treatment is not only desired to reduce pain and stiffness but stave off any further micro/macro traumas that could worsen to the incidence of septic bursitis.

Luckily, treatment for bursitis not only exists in the form of High Dose PRP, but this specialized treatment is offered by Orthagenex. A 2019 study in the Journal of Orthopaedics and Sports Medicine, doctors Madhan Jeyaraman and his associates evaluated the efficacy of high dose platelet rich plasma (PRP) as a treatment for bursitis. The physicians explain that their study was, “. . . conducted to review a series of patients prospectively with symptomatic retrocalcaneal [Achilles tendon] bursitis and its associations to determine if PRP injections (1) provide symptomatic relief, (2) improved VAS and AOFAS scores and (3) alleviation of need of surgery” (2019).

Once the three objectives were clear, the physicians continued and made their methods for study clear by explaining that, “[a]fter screening of cases, 128 cases entered into the study and have been treated with an autologous platelet rich plasma injection with due pre and post procedural care. The cases are followed up on day 0, at the end of 1st week, 1st and 6th month for pain and range of movements. The patients are followed up for complications and the data were analyzed statistically”. With a sample size of 128 cases entering the study, Dr. Jeyaraman and his associates were able to gain more accurate statistics and determine whether high dose platelet rich plasma injection had any bearing on Achilles pain levels and mobility.

At the end of this study, the physicians had their results and determined that, “[o]ut of 128 cases, 76 patients (59.37%) improved with 1st dose and a further 38 patients (29.68%) with a 2nd dose of autologous PRP injection with an interval of 3 weeks from the first dose. A total of 89.05% of patients, who got treated with autologous PRP injection, had a good clinical and functional outcome even at the end of 1 year of injections and presented with statistically significant results with a p value <0.001. No adverse reactions and serious complications are noted in the study participants . . . [t]he autologous PRP injection is considered superior in treatment of retrocalcaneal bursitis, which minimise the pain and improve the functional quality of life”. With nearly 90% of patients in this study finding both joint mobility and pain reduction with the use of high dose platelet rich plasma, one can begin to understand how it has become increasingly popular for treating painful conditions like bursitis. But, what exactly is high dose platelet rich plasma and how can Orthagenex help?

Dr. Jeyaraman referred to high dose platelet rich plasma as “autologous” which specifically means the plasma is from the patient’s own body. From a patient’s autologous blood, we are able to take platelets in a concentrated form. When blood is taken from these patients and put in a centrifuge, it is spun around quickly to separate red blood cells from white blood cells as well as concentrate the number of platelets together. These concentrated platelets, once extracted and applied, act as a treatment that can be used to target nerve-damaged areas. These damaged areas include nerves damaged through bursitis– regardless of their current pathogenesis.

High Dose PRP even has the potential to heal and regrow damaged tissue around the bursae and is often favored among those patients who have suffered acute injuries. We’ve all witnessed the human body’s incredible capability to heal injuries. A scraped back will bleed, scab, and scar in a number of days and a broken bone will reset itself in a matter of weeks. These healing processes work through the cells in our body activating and targeting the affected areas. With nerve damage, the process of treatment is more complicated. However, the healing capability of our body works in much the same way. The application of high dose platelet rich plasma to bursitis-affected areas is an assistance to the body’s natural healing process. According to a 2017 study evaluating the high dose platelet rich plasma treatment process, doctors Sanchez and his associates concluded that the six pieces of evidence that support nerve regeneration include: “1) neuroprotection and prevention of neuronal apoptosis, 2) stimulation of vascular regeneration, 3) promotion of axonal regeneration, 4) regulation of inflammatory response in the microenvironment, 5) alleviation of nerve collateral muscle atrophy, and 6) improvement of human nervous system parameters” (2017). With the benefits of this natural application of healing platelets in mind, patients struggling with bursitis are more and more likely to seek this type of treatment every day they have to live with the condition. Orthagenex not only offers patients high dose platelet rich plasma as a treatment for their bursitis, but consultation and educational tools to help them maintain and manage their bursitis with confidence. Sessions with Orthagenex see patients not only going through the treatment process to reduce pain and increase flexibility but ensure patients have the tools they need to manage their conditions on a daily basis.