PRP-San Diego
San Diego Center for Integrative Medicine
Dr. Joseph  Aiello

Ultrasound

Musculoskeletal Ultrasound

We have started using ultrasound for diagnosis and injection guidance.  Ultrasound is very helpful for identifying injuries to joints.  It is also helpful to guide injections.  For example, if a tear is noted in a ligament or tendon with ultrasound, the PRP can be targeted at that tear using ultrasound.  Ultrasound can be used in many different joints.

It is particularly helpful in identifying shoulder rotator cuff tears.  Sometimes it may find tears that MRI may miss.  This is because when visualizing a ligament or tendon, the joint can be passed through its range of motion while doing the ultrasound which may reveal a tear that a static MRI might not see.  Ultrasound can visualize the biceps tendon, the rotator cuff interval, the subscapularis tendon, the infraspinatus tendon, and the supraspinatus tendon very well.

Ultrasound is also helpful in guiding joint injections.  In the shoulder, if a tear is identified, the tear can be targeted for treatment.   In the knee, it is possible to find joint spaces with fluid or recesses to inject.  For example, the posterior horns of the medial and lateral menisci can be seen and then targeted for injection. 

It is very easy to do in the office at the time of examination.  This gives immediate diagnostic information to help the patient and doctor determine the best therapy.  It can also give relief when no tears are found.

Below are before(first) and after(second) images of a tear in the supraspinatus tendon of the right shoulder of a 52 year old male that was repaired with PRP in 2011.  Prior to the PRP, the patient had chronic pain for about 4 months.  He had torn the tendon doing weight lifting.  The pain was constant and he couldn't sleep at night.  The after image is taken 2 months after PRP treatment.  He currently has no pain and is back to weight lifting.

The third image shows the use of ultrasound to guide injections into various tendons; this one being the supraspinatus of a different patient.

This demonstrates the power of PRP to repair tissues.
The elipses show the tear before and after PRP.  Notice how the tear has dramatically decreased in thickness.  The tendon is almost back to normal in less than 2 months. 





The next image shows a needle injecting into the supraspinatus tendon.



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