Grand Rounds Dr. Haruki Ishii: Corticosteroid vs. Platelet-Rich Plasma Injections, Part 2

Both corticosteroid injection and PRP demonstrate initial efficacy where steroid appears to provide superior pain relief, as you can see here going down within the first four weeks, whereas PRP demonstrated longer lasting effect, as you can see that the VAS score is actually going down all the way up to 24 weeks, where the corticosteroid injections kind of peak at four weeks, and then slowly the pain comes back to its original level by 24 weeks, maybe around, even like a 12 weeks' time mark. So, both steroid and PRP are considered safe and an effective treatment for the GTPS. But in more recently years, it seems like PRP has a better efficacious indication over CSI for the treatment of GTPS. In a recent system review, it was concluded that PRP seems to be safe and effective when treating degenerative meniscus tears. However, additional studies are warranted. It seems like I'm going to sound like a broken record here, but truly understanding clinical implications of PRP on meniscus treatment due to heterogeneity of the studies reviewed. Similarly, in a recent review, although PRP appears to yield improvements in clinical outcomes. its clinical significance remains uncertain given, again, heterogeneity of the studies. Regarding knee ligament injuries, injection treatment is typically not common for knee ligament related injuries, but injection therapies have a role in reflective cases or when there are significant functional limitations due to pain. Introduction by Dr. Francis Lopez.  Q&A followed Part 2. 

Dr. Haruki Ishii discussed a review paper on the risks and benefits of corticosteroid injections versus plasma injections in patients. The aim of this review was to compare the evidence for clinical applications of these injectates as a treatment for a variety of musculoskeletal conditions in patients. Platelet-Rich Plasma (PRP) injections for clinical use as discussed here, is defined as autologous  plasma, extracted from minimally processed blood, and then containing activated platelets. So PRP delivers concentrated growth factors and cytokines acting as extra cell signaling molecules at the side of the injection. Key clinical applications of PRP include tendinopathies, osteoarthritis, muscle injuries, and then post -surgical healing treatment. The first study looked at is one published in 2021, a systemic review article. What it showed was that the corticosteroid injection yielded significant superior functional recovery and in pain compared with the PRP injections for rotator cuff lesions during the short -term follow-up period. He referred to an article that looked at the difference between a corticosteroid injection and a PRP injection for frozen shoulder patients, involving the functional outcome between those two injectates. Introduction by Dr. Francis Lopez. 

Dr. Kathleen Martin Ginis is a Distinguished University Scholar and a Professor in the Department of Medicine (Division of Physical Medicine and Rehabilitation) and in the School of Health and Exercise Sciences at The University of British Columbia. She holds the Reichwald Family Chair in Preventive Medicine and is a Fellow of the Royal Society of Canada, the Canadian Academy of Health Sciences, the Canadian Society for Psychomotor Learning and Sport Psychology, and as is an International Fellow of the National Academy of Kinesiology. The focus of Dr. Martin Ginis's research is placed on understanding and changing physical activity behaviour, particularly among people living with spinal cord injury. She is deeply committed to knowledge translation; specifically, the development and implementation of evidence-based best-practices to improve health and well-being among people with disabilities. By example, Dr. Martin Ginis spearheaded the formulation and knowledge translation of scientific exercise guidelines for adults with spinal cord injury. These guidelines have been translated into nearly 20 languages and are used worldwide in clinical and community settings. Part 2 Eighty percent admittedly is an arbitrary number, but it's one that most exercise scientists use as a sort of the minimum threshold for deeming someone adherent to the protocol. There were no differences in pain reduction between those with neuropathic versus musculoskeletal pain, but the small ends, small sample sizes for those two groups, make it difficult to really confirm that there is no difference in exercise outcomes for those two groups. She thinks we need to look at that further with bigger samples for each type of pain. Given the pragmatic nature of the trial that we let people exercise on their own in the community, she thinks this speaks to the feasibility of using exercise as a pain self-management strategy, but with the caveat that it's likely not going to be effective for everyone. Fifty percent of people with spinal cord injury report no leisure time physical activity whatsoever. In other words, no activity that could potentially improve cardiorespiratory fitness or muscle strength. And that's not the fault of people with spinal cord injury. Factors that influence physical activity don't just rest within the person, but they rest within society.

Dr. Kathleen Martin Ginis is a Distinguished University Scholar and a Professor in the Department of Medicine (Division of Physical Medicine and Rehabilitation) and in the School of Health and Exercise Sciences at The University of British Columbia. She holds the Reichwald Family Chair in Preventive Medicine and is a Fellow of the Royal Society of Canada, the Canadian Academy of Health Sciences, the Canadian Society for Psychomotor Learning and Sport Psychology, and as is an International Fellow of the National Academy of Kinesiology. The focus of Dr. Martin Ginis's research is placed on understanding and changing physical activity behaviour, particularly among people living with spinal cord injury. She is deeply committed to knowledge translation; specifically, the development and implementation of evidence-based best-practices to improve health and well-being among people with disabilities. By example, Dr. Martin Ginis spearheaded the formulation and knowledge translation of scientific exercise guidelines for adults with spinal cord injury. These guidelines have been translated into nearly 20 languages and are used worldwide in clinical and community settings. Part 1 One of her objectives is to present recent data showing the physical and mental health benefits of exercise for adults with spinal cord injury. She wants to introduce exercise guidelines for adults with SCI. Starting with the benefits of exercise from a mental and physical health perspective, probably the best two areas, best two outcomes for which there is evidence are improving insulin sensitivity and cardiovascular disease risk in this population. The fitness guideline stipulates that to improve cardiorespiratory fitness and muscle strength, adults with SCI should do at least 20 minutes of moderate to vigorous intensity, aerobic activity twice per week, and strength training exercises twice per week. The guideline for cardiometabolic health stipulates that a minimum of 30 minutes of moderate to vigorous intensity physical activity is required three times per week. She discussed how exercise improves well-being. She also talked about exercise in chronic pain. She described the Epic SCI trial, a pragmatic, randomized controlled trial, testing the effects of exercising according to the scientific SCI exercise guidelines on SCI chronic pain.

With over 20 years of extensive clinical experience, Dr. Kedzierska is a Board Certified Clinical Specialist in Neurologic Physical Therapy from the American Board of Physical Therapy Specialties. She serves as a faculty member of an Accredited Physical Therapy Neurology Residency Program. She mentors department staff on assessment/treatment for related diagnosis. She has presented in local and national conferences and is a published author in the ANPT newsletter and Brain Injury Journal. She received her Master's Degree in Physical Rehabilitation in Poland, Advanced Master's Degree from NYU and a doctorate degree from Northeastern University serving a variety of populations. Dr. Fay is a board certified Neurologic Clinical Specialist through the American Board of Physical Therapy Specialties and is a member of the faculty of the Neurological Residency program at Rusk Rehabilitation at NYU Langone Medical Center. She is an active member of the American Physical Therapy Association (APTA), and has served on the APTA's Vestibular EDGE Task Force; a select group of therapists chosen to review measures designed for assessment and treatment of patients with vestibular deficits. She has lectured at both local and national conferences on Vestibular Rehabilitation and is a published author in the Journal of Pediatric Physical Therapy. Her areas of special interest include vestibular rehabilitation in individuals with symptoms of dizziness. Part 1: The interview included the following topics: common vestibular disorders; challenges treating patients with vestibular disorders; other specialists involved in providing treatment; overlapping symptoms; advances in diagnosis; distinguishing between peripheral and central vestibular disorders; patient compliance; and involvement of family members in treatment.

Dr. Maria Janakos is a sports medicine physiatrist at NYU and a Clinical Assistant Professor at the NYU Grossman School of Medicine. She completed her residency at the University of Louisville and a Primary Care Sports Medicine Fellowship at Morristown Medical Center in New Jersey. Her clinical interests include concussion management, orthobiologics, musculoskeletal ultrasound, and event coverage. Dr. Janakos is actively involved in medical education at NYU, teaching medical students, residents, and fellows through lectures, hands-on training, and mentorship. At NYU, she is an active member of the NYU Concussion Center, where she regularly lectures on various concussion topics at both local and national levels. She specializes in the care of patients with acute concussions, treating individuals from adolescence through age 45. Part 2 The discussion included the following topics: challenges that patients face during the recovery period; factors determining treatment outcomes; preventing concussions; composition of the interdisciplinary treatment team; and the role of technology in treatment interventions.    

Dr. Maria Janakos is a sports medicine physiatrist at NYU and a Clinical Assistant Professor at the NYU Grossman School of Medicine. She completed her residency at the University of Louisville and a Primary Care Sports Medicine Fellowship at Morristown Medical Center in New Jersey. Her clinical interests include concussion management, orthobiologics, musculoskeletal ultrasound, and event coverage. Dr. Janakos is actively involved in medical education at NYU, teaching medical students, residents, and fellows through lectures, hands-on training, and mentorship. At NYU, she is an active member of the NYU Concussion Center, where she regularly lectures on various concussion topics at both local and national levels. She specializes in the care of patients with acute concussions, treating individuals from adolescence through age 45.   Part 1 The discussion included the following topics: age groups of patients receiving treatment; types of cases treated; distinguishing medical terms for brain injuries; common symptomology; patient journey from initial assessment through recovery; and collaboration with patients' families.  

Dr. Zhu is a clinical assistant professor in the Department of Rehabilitation Medicine at NYU Grossman School of Medicine. Her clinical interests include the management of a range of symptoms associated with cancer and its treatment, including weakness, pain, neuropathy, and limited range of motion. Throughout her career, she has been dedicated to proactive healthcare engagement, working closely with a team to provide comprehensive care. Her practice emphasizes patient education, along with helping individuals understand the causes of their symptoms and the changes their bodies are undergoing. She received her medical degree from Rutgers New Jersey Medical School. She then went on to complete a PM&R Residency at NYU Grossman School of Medicine and a Cancer Rehabilitation Fellowship at the University of Miami.    Part 1 The discussion included the following topics: primary purpose of this offering, educational objectives. Summit format, target audience, topics to be covered, and expected outcomes for participants.

Dr. Patricia Tan serves as Medical Director for Rusk Pediatrics Rehabilitation. Her Certification is from the American Board of Physical Medicine & Rehabilitation. She has been selected as a Fellow by the following organizations: American Academy of Physical Medicine and Rehabilitation; American Academy of Pediatrics; American Academy of Cerebral Palsy and Developmental Medicine; and the Association of Academic Physiatrists. Her medical degree is from the University of Santo Tomas in Manila, Philippines. Dr. Megan Conklin is Associate Director of Rusk Pediatric Therapy Services at NYU Langone. She works collaboratively with an interdisciplinary team across the spectrum of pediatric diagnoses from birth through the transition into adulthood. She has a Doctor of Physical Therapy degree, 20 years of clinical experience at NYU; and is certified as a clinical specialist in pediatric physical therapy by the American Board of Physical Therapy Specialties of the American Physical Therapy Association. Part 2 The discussion included the following topics: quality measures used to determine if desired outcomes are being achieved; challenges or potential downsides associated with a transition from pediatric to adult care; integration of artificial intelligence into pediatric rehabilitation; and current pediatric research conducted at NYU.

Dr. Patricia Tan serves as Medical Director for Rusk Pediatrics Rehabilitation. Her Certification is from the American Board of Physical Medicine & Rehabilitation. She has been selected as a Fellow by the following organizations: American Academy of Physical Medicine and Rehabilitation; American Academy of Pediatrics; American Academy of Cerebral Palsy and Developmental Medicine; and the Association of Academic Physiatrists. Her medical degree is from the University of Santo Tomas in Manila, Philippines. Dr. Megan Conklin is Associate Director of Rusk Pediatric Therapy Services at NYU Langone. She works collaboratively with an interdisciplinary team across the spectrum of pediatric diagnoses from birth through the transition into adulthood. She has a Doctor of Physical Therapy degree, 20 years of clinical experience at NYU; and is certified as a clinical specialist in pediatric physical therapy by the American Board of Physical Therapy Specialties of the American Physical Therapy Association. Part 1 The discussion included the following topics: kinds of health problems and conditions treated; age range of patients; clinical guidelines and evidence-based treatment protocols used; holistic approaches to treatment; collaboration with families of patients; and composition of the health care team