Orthobiologics

Orthobiologics are a type of therapy that use natural substances, such as sugars, proteins, blood, or tissue.

Because orthobiologics are a new form of therapy, much remains unknown about their effects. However, they have shown promise in reducing pain from a variety of sports injuries and orthopedic conditions.

The Boston Children’s Sports Ultrasound Clinic uses orthobiologic therapies to reduce pain related to a number of overuse injuries, including:

• Tendonitis (tennis elbow or Little League shoulder)
• Ligament or cartilage injuries
• Stress fractures and avulsion fractures
• Bone, joint, or muscle pain

Sometimes used in combination with orthobiologics therapies, shockwave therapy is a non-invasive treatment that uses high-energy sound waves in an attempt to relieve pain. Shockwave therapy is used to reduce pain in various musculoskeletal conditions.

Ultrasound-guided injections help clinicians deliver therapies into an injured area with precision and accuracy. At Boston Children’s Sports Ultrasound Clinic, we use ultrasound guidance for the following therapies.

Platelet-rich plasma (PRP) injection

Platelets are found in blood and play an important role in wound healing through coagulation (clotting) and the release of growth factors. PRP is derived from the patient’s own blood through simple processing techniques to separate plasma containing concentrated platelets. PRP injections are commonly used to reduce pain in joints and in tendons and ligaments for conditions like tennis elbow and Little League shoulder.

Autologous blood injection

Autologous blood injections are used to reduce pain associated with chronic tendonitis or tendinopathy. The procedure involves injecting a patient’s own blood back into the damaged area of the tendon.

Hydrodissection

Hydrodissection is an injection of fluid into an area where nerves have become entrapped by scar tissue or fascia (a thin lining of tissue that holds muscles in place). The injection is used to physically break up or separate the nerve from surrounding tissue to reduce pain at the site.

Tenotomy

Tenotomy is a procedure used to divide or “release” a tendon and break up scar tissue for relief of pain. Tenotomy is most commonly performed on tendons of the feet, ankles, and elbows. There are two types of tenotomy, non-surgical and surgical. The non-surgical procedure, or percutaneous needle tenotomy, uses a small needle and ultrasound guidance to separate the tendon tissue.

Cortisone injection

Cortisone (steroid) injections can temporarily reduce pain and inflammation around an injured muscle or joint. Cortisone injections are a type of ultrasound guided injection, however, cortisone, (also known as corticosteroid), is manufactured rather than natural.

Side effects are uncommon but may include facial flushing, nausea, swelling, redness, pain at the injection site, temporary numbness and weakness of the extremity, and skin discoloration. These side effects can last from one to three days.

Ultrasound-guided injection is a safe procedure with very few risks. You may experience pain that worsens over days following the injection. This usually lasts between three to five days. This may indicate either an aggravation of the membrane that protects the joint from damage or, very rarely, an infection of the joint. If you experience increased pain, contact your referring doctor or seek emergency care as soon as possible.

Two weeks before your appointment

In most cases, you do not need to do anything special to prepare for an ultrasound-guided injection. Be sure to drink plenty of fluids to stay hydrated before your appointment.

If you are scheduled for a platelet rich plasma (PRP) injection or an autologous blood injection, DO NOT take any anti-inflammatory medications 14 days before your injection appointment. This includes Naprosyn, Aleve, Advil, Motrin, ibuprofen, Celebrex, Feldene, and diclofenac.

On the day of your appointment

If you have broken skin, redness or swelling near the area to be treated, let your doctor know in advance. The injection may need to be delayed until the area is healed and free of infection.

• Bring a person who can give you a safe ride home. We recommend not driving for at least 24 hours after an ultrasound-guided injection.
• Bring any previous X-rays, ultrasound, CT, or MRI scans taken as part of your joint pain history.
• Tell the doctor or nurse if you are allergic to any medications.
• Wear comfortable clothing with easy access to the area that will be injected.