In a previous post about bilateral elbow OA management, it was suggested PRP and ESWT. For those with experience, what are typical treatment protocols? I am wondering if the arthritis is still mild, do we have a better chance with a one time treatment or at least yearly? Since my client will need to travel, should I locate somewhere that offers both and hit the elbows with both therapies?
Thank You,
Missi
PRP and ESWT for Elbows
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David Lane
- Posts: 164
- Joined: Mon Oct 24, 2016 10:51 pm
Re: PRP and ESWT for Elbows
IMHO…
I tell clients that with either PRP or ESWT, about 80% (for the PRP, this is based on one paper, and fits with my personal experience) of OA cases respond. I personally have no preference to which modality I use as there are pros and cons to each:
PRP Pros:
• Lasts longer (typically 9 months). I know some people repeat the injection if the 1st one doesn’t take, but I haven’t done that much (I usually switch to ESWT at that point instead of repeating PRP). I do think it works better with mild to moderate OA vs bone-on-bone-end-stage-it-hurts-my-eyes-just-to-look-at-your-elbows-severe OA).
• For severe OA, I think there is logic in combined MSC and PRP for max effect, which some do…. but that’s to say its not worth a try of just PRP (which is what I usually do). It really looks like MSCs treat neuropathic pain, so that may worth considering. MSC/PRP combo generally lasts 11 month.
PRP Cons:
• More expensive than ESWT initially (ie: if it doesn’t work, then the client spent more to find that out)
• Dogs may need to be sedated. For moderately relaxed dogs, the medial approach to the elbow is well tolerated and doesn’t require sedation (which is great for the geriatrics), but tense dogs may need a hit of torb. Occassionally I have to go as far as propofol or something equivalent for the truly manic (I’m looking at you, GSDs).
ESWT Pros:
• Cheaper up front costs than PRP (tends to even out on a per month basis long term)
• Generally no sedation required (This applies to a radial ESWT unit – focus units do require sedation)
ESWT Cons:
• Multiple trips required. I generally use a protocol of q7d x3 rounds, followed by q3m prn. If the 1st one doesn’t work, then I don’t bother repeating it and move to PRP instead.
For most clients, I find it boils down to how far have they travelled to see me. If repeat visits aren’t a problem, then we go ESWT. If they travelled a huge distance, then we PRP.
Any time I use either modality, I’m also doing EFA’s, wt control, therapeutic exercise etc. etc. Because of that, I find many cases don’t automatically relapse to the same degree once the PRP or ESWT wears off… so hopefully it doesn’t automatically need to be repeated.
David Lane
DVM, ACVSMR
I tell clients that with either PRP or ESWT, about 80% (for the PRP, this is based on one paper, and fits with my personal experience) of OA cases respond. I personally have no preference to which modality I use as there are pros and cons to each:
PRP Pros:
• Lasts longer (typically 9 months). I know some people repeat the injection if the 1st one doesn’t take, but I haven’t done that much (I usually switch to ESWT at that point instead of repeating PRP). I do think it works better with mild to moderate OA vs bone-on-bone-end-stage-it-hurts-my-eyes-just-to-look-at-your-elbows-severe OA).
• For severe OA, I think there is logic in combined MSC and PRP for max effect, which some do…. but that’s to say its not worth a try of just PRP (which is what I usually do). It really looks like MSCs treat neuropathic pain, so that may worth considering. MSC/PRP combo generally lasts 11 month.
PRP Cons:
• More expensive than ESWT initially (ie: if it doesn’t work, then the client spent more to find that out)
• Dogs may need to be sedated. For moderately relaxed dogs, the medial approach to the elbow is well tolerated and doesn’t require sedation (which is great for the geriatrics), but tense dogs may need a hit of torb. Occassionally I have to go as far as propofol or something equivalent for the truly manic (I’m looking at you, GSDs).
ESWT Pros:
• Cheaper up front costs than PRP (tends to even out on a per month basis long term)
• Generally no sedation required (This applies to a radial ESWT unit – focus units do require sedation)
ESWT Cons:
• Multiple trips required. I generally use a protocol of q7d x3 rounds, followed by q3m prn. If the 1st one doesn’t work, then I don’t bother repeating it and move to PRP instead.
For most clients, I find it boils down to how far have they travelled to see me. If repeat visits aren’t a problem, then we go ESWT. If they travelled a huge distance, then we PRP.
Any time I use either modality, I’m also doing EFA’s, wt control, therapeutic exercise etc. etc. Because of that, I find many cases don’t automatically relapse to the same degree once the PRP or ESWT wears off… so hopefully it doesn’t automatically need to be repeated.
David Lane
DVM, ACVSMR
David Lane DVM
ACVSMR, CVA, CVSMT, CCRP
ACVSMR, CVA, CVSMT, CCRP
Re: PRP and ESWT for Elbows
Thank you for your time and experience! This is exactly what I was looking for.
Missi
Missi