Shoulder Pain: Nonsurgical and Surgical Solutions

The shoulder is compromised of several joints that work together to provide us with a wide range of motion. Because we use our shoulders to perform a variety of different tasks throughout the day, it can be prone to injury and pain.

Treatment options for shoulder pain will vary depending on the severity of the injury or condition. Below, we have listed some of the most common causes of shoulder pain along with common treatment options. As with any condition or injury, it’s best to consult a doctor in order to receive a proper evaluation and treatment plan.

Common Causes of Shoulder Pain:

  • Shoulder Impingement Syndrome: 
    shoulder pain - dr. jason pirozzolo - shoulder bursitis

    Dr. Jason Pirozzolo explains shoulder bursitis.

    Shoulder impingement syndrome is a collection of shoulder symptoms related to impingement, bursitis, and tendinitis in and around the shoulder joint. The most common symptom of shoulder impingement is pain, especially when one tries to use the affected arm above the level of the head (e.g., overhead activity, throwing).

  • Arthritis:
    Arthritis in the shoulder usually results in swelling, pain and stiffness. Osteoarthritis is the most common type of arthritis in the shoulder. Pain due to osteoarthritis may worsen over time.
  • Instability:
    Instability occurs when the head of the upper arm bone is forced out of the shoulder socket. Instability is usually the result of an injury or overuse. Sometimes instability, or a dislocation, can occur repeatedly which can increase the risk of arthritis developing in the shoulder.
  • Fracture:
    A fracture, also known as a broken bone, often occurs as the result of a traumatic injury. Shoulder fractures in older patients can occur after a fall. Shoulder fractures are also common in high-energy contact sports.
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prp for wrist osteoarthritis

Regenerative Platelet Rich Plasma Injections for Wrist Osteoarthritis

Orlando, Florida – Wrist osteoarthritis is a “wear and tear” degeneration of the joint surfaces in your wrist. The wrist contains 8 carpal bones that serve as a junction between the other bones of your thumb, hand and forearm. Inflammation can occur at any of these joint surfaces, causing pain and decreased range of motion. Your doctor can make the diagnosis of wrist osteoarthritis by your history, physical examination, and x-rays.

Wrist osteoarthritis can range from mildly irritating to severely debilitating. Gordie Howe, a.k.a. “Mister Hockey,” had to retire from the game because of severe arthritis in his left wrist. Howe is widely regarded as one of the greatest hockey players of all time, but wrist osteoarthritis prematurely ended his career in the National Hockey League.

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finger arthritis platelet rich plasma orlando hand surgery

Finger Arthritis and Platelet Rich Plasma Treatments

Orlando, Florida – Finger arthritis is one of the most common forms of osteoarthritis, and the prevalence is expected to increase as the population ages.1 Finger arthritis causes pain, loss of function, decreased ability to grip objects with the hand, and it reduces overall quality of life.1 Healthcare professionals can diagnose finger osteoarthritis through a detailed history and physical examination along with radiological studies, such as hand x-rays.

Finger osteoarthritis may be caused by a single major injury or repetitive use, i.e., small injuries that accumulate over time.2 For example, NBA player Kobe Bryant has severe osteoarthritis in his right index finger. He likely developed the condition from a combination of major injury and continued, repetitive use while playing basketball.

Finger Arthritis and Platelet Rich Plasma Treatments

The current goal of finger osteoarthritis treatment is to alleviate symptoms such as pain. Thus, nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed treatment. NSAIDs may be taken orally or applied topically. Likewise, topical capsaicin has also been used to treat finger osteoarthritis. While splints, the application of heat or ice, and even assistive devices have been tried, they result in little to no improvement.1Physical therapy exercises may decrease pain and increase strength and range of motion. Unlike rheumatoid arthritis, there are no disease modifying drugs available for finger osteoarthritis.1 Occasionally, steroid injections may be used to treat finger osteoarthritis, but their benefits are limited.1 If nonsurgical treatments fail to provide adequate relief, surgery may be attempted.

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Platelet Rich Plasma Therapy for Shoulder Impingement, Bursitis, Tendonitis

Platelet Rich Plasma for Shoulder Impingement, Bursitis, Tendinitis

Orlando, Florida – Shoulder impingement syndrome is a collection of shoulder symptoms related to impingement, bursitis, and tendinitis in and around the shoulder joint. The most common symptom of shoulder impingement is pain, especially when one tries to use the affected arm above the level of the head (e.g., overhead activity, throwing). There may be pain over the deltoid muscle or the outside of the upper arm as well.1 Since shoulder impingement syndrome includes inflammation of the bursa, rotator cuff, biceps tendon, and labrum, the physical examination findings are extensive. Physicians often find evidence of shoulder bursitis and tendinitis along with generalized pain and inflammation. X-rays, ultrasound, or MRI may be used to confirm the diagnosis or rule out other possible causes of shoulder pain.

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What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a common and painful disorder of the wrist and hand. In most cases, carpal tunnel syndrome symptoms worsen over time. If you think you may be dealing with carpal tunnel syndrome, it is important to receive a proper diagnosis and treatment before symptoms become more severe.

What Is carpal tunnel syndrome?

The carpal tunnel is a narrow passageway that allows the median nerve to pass from the forearm to the hand. Carpal tunnel syndrome occurs when the median nerve is pinched or pressed. Pressure from the pinched nerve may cause swelling in the tunnel resulting in pain, numbness, and tingling in the hand and wrist.

Causes

There are various factors that may contribute to the development of carpal tunnel syndrome. Risk factors for this condition include:

– Repetitive Stress
– Arthritis
– Joint dislocations
– Fractures
– Fluid retention during pregnancy
– Swelling of the flexor tendons

Symptoms

Symptoms usually occur along the nerve path and may cause the hand to “fall asleep.” Symptoms are often times felt during the night, but may be noticed during the day as well, while performing normal activities. In most cases, symptoms begin gradually and may come and go. In severe cases, permanent damage may occur, causing loss of sensation and strength in the hand and wrist.

Some symptoms include:

– Numbness and pain in the thumb, index, middle, and ring fingers
– Weak grip
– Tingling
– Sensitivity to cold
– Muscle deterioration

Diagnosis 

Providing a detailed summary of medical conditions, injuries, and how the hands are currently being used, are necessary when diagnosing carpal tunnel syndrome. Nerve tests and x-rays may be taken in order to check for fractures, arthritis, and other possible nerve issues.

Treatment

Treatment options will depend on the severity of the condition. Early treatment options include:

– A wrist splint to reduce pressure on the nerve
– Steroid injections to reduce swelling
– Activity modification

If symptoms persist, or become severe, surgery may be recommended.

To learn more about carpal tunnel syndrome, make an appointment with one of our doctors at Orlando Hand Surgery Associates at any of our three locations.

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Platelet Rich Plasma Therapy for Arthritis | Dr. Jason Pirozzolo

At the Orlando Center for Regenerative Medicine, we commonly use platelet rich plasma therapy for arthritis in the hand, wrist, elbow, shoulder, hip, knee, ankle and foot. Dr. Jason Pirozzolo explains arthritis, and how platelet rich plasma therapy can be used for this common condition as a surgery and steroid alternative, in the video listed. Watch the video and read below to learn more.

What is Arthritis?

Arthritis is a progressively debilitating condition that eventually affects nearly everyone in one way or another. Essentially, arthritis is the wearing away of joint cartilage over time that leads to pain, swelling, and loss of function.

Early Treatments for Arthritis

Arthritis can affect any joint, but it is most commonly associated with the shoulder, hand, wrist, and knee. When arthritis pain does become a problem, early treatments include corticosteroid injections and oral medication, along with activity modification and physical therapy.

Eventually, these conservative therapies become less effective over time, and many patients are presented with a surgical option of a joint replacement. Until recently, that was the treatment of course typically followed by millions of patients, but now we have an alternative. What has been thrust into the spotlight by world-class athletes and is now available to everyone is platelet rich plasma, or PRP therapy.

What is Platelet Rich Plasma Therapy?

Platelet rich plasma is obtained from your own blood. The blood is placed in a specialized tube and then treated by a centrification process, using a proprietary filtration process, which separates and concentrates your own platelet rich plasma.

platelet rich plasma patient success story

Watch one patient’s story with platelet rich plasma therapy for arthritis in her hands.

How Does PRP Therapy Work?

Scientists have identified different growth factors that promote the regeneration of bone, cartilage and tendons. Growth factors found in your platelets include: platelet derived growth factor, insulin like growth factor, vascular endothelial growth factor, platelet derived angiogenic growth factor, and transforming growth factor beta. These growth factors are activated upon injection of your platelet rich plasma.

Can PRP Therapy Work For Arthritis?

In March 2016 a systematic review of the literature was published and analyzed the outcome of patients with arthritis that were treated with platelet rich plasma (PRP) therapy. They concluded that there was a significant clinical improvement in those patients treated with PRP for up to 12 months post injection.

An ongoing study presented at the American Association of Orthopaedic Surgeons (AAOS) Annual Meeting compared the efficacy of platelet rich plasma injections vs. corticosteroid injection(s) for pain relief, functional return and improved range of motion in patients with carpometacarpal joint osteoarthritis. The study showed that after a 6-month follow-up, patients who received PRP showed a 90% decrease in pain from baseline. Patients who received corticosteroid injections showed an 8% increase in pain from baseline. Researchers found that compared to corticosteroid injections, PRP injections show merit for treatment of carpometacarpal joint osteoarthritis.

To schedule a regenerative medicine consultation with Dr. George White, Dr. Jason Pirozzolo, Dr. Brian White, or Dr. Anup Patel, call (407) 841-0001. Our center is conveniently located in the same building as our Orlando Hand Surgery Associates Downtown Orlando office at 801 N. Orange Ave., Suite 530, Orlando, FL 32801.

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PRP Therapy: What to Expect | Dr. Brian White

PRP (platelet rich plasma) therapy is an innovative nonsurgical treatment option used to activate healing in an area of injury and/or pain in the body. Unlike surgery or steroid injections, PRP therapy is a minimally invasive procedure that consists of only using a concentrated source of the patient’s own blood as the healing agent.

PRP therapy first gained headlines when high-level athletes (such as Kobe Bryant, Rafael Nadal, and Steph Curry) used the procedure for their joint pain. Thanks to recent advancements in regenerative medicine, we can now offer PRP therapy to all of our patients who are a good candidate for the procedure.

Our expert team of doctors at Orlando Hand Surgery Associates provide nonsurgical regenerative medicine procedures at our new facility, Orlando Center for Regenerative Medicine. The Orlando Center for Regenerative Medicine houses state-of-the-art technology for our procedures and it’s conveniently located in the same building as our Orlando Hand Surgery Associates Downtown Orlando office at 801 N. Orange Ave., Suite 530, Orlando, FL 32801.

Before making an appointment for a PRP injection, you will first have a consultation with one of our doctors. Our doctors take an individualized approach for each specific injury and condition in order to determine the best treatment plan for your situation. If PRP therapy is the best treatment option for you, our office will schedule an appointment for the procedure.

Anti-inflammatories should not be taken for 3 weeks prior to the procedure and 3 weeks after the procedure. A PRP therapy procedure begins with one of our registered nurses drawing your blood. Approximately 60 cc’s of blood is drawn; about the same amount you would expect to give for a blood donation.

Platelet Rich Plasma Concentration System (via Biomet) Orlando Center for Regenerative Medicine

Platelet Rich Plasma Concentration System (via Biomet Biologics)

The blood is then spun in a high-spinning machine called a centrifuge. The centrifuge separates the blood into 3 components: red bloods cells, platelet rich plasma, and platelet poor plasma. The platelet rich plasma component includes growth factors that can promote healing and relieve pain. Therefore, only the concentrated source of platelet rich plasma is injected into the area of pain and discomfort.

Many patients report that the injection is painless and most patients are able to return to normal daily activities immediately after the procedure. Patients typically start seeing an improvement in their mobility and symptoms within 2 to 4 weeks. Depending on the severity of the injury or condition, more than one injection may be required.

A wide range of conditions and injuries of the shoulder, elbow, wrist, hand, hip, knee, ankle and foot can be treated using PRP therapy at the Orlando Center for Regenerative Medicine.

To schedule a regenerative medicine consultation with Dr. George White, Dr. Jason Pirozzolo, Dr. Brian White, or Dr. Anup Patel call (407) 841-0001. To learn more about PRP therapy, or other regenerative medicine procedures, please visit OrlandoRegenerativeMed.com.

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Patient Success Story | Platelet Rich Plasma Therapy for Hand Pain

When Marilyn hit her retirement, she set out to stay more active than ever before. She planned on filling her days with activities such as swimming, rowing, biking, pottery, and playing with her grandkids. She finally had the freedom to do all the activities she loves, but there was only one thing standing in here way: osteoarthritis. “I’ve dealt with arthritis in my feet and knees before, but it wasn’t until I had osteoarthritis in my hands that everything changed,” says Marilyn. “I need my hands to do so many things that I enjoy doing.”

Patient Success Story | Platelet Rich Plasma Therapy for Hand PainWhat is Osteoarthritis?

Osteoarthritis is a common form of arthritis that causes the joints to degenerate. According to the Arthritis Foundation, osteoarthritis affects approximately 27 million Americans. Osteoarthritis can affect any joint, but it most commonly occurs in the knees, hands, wrists, and shoulders.

The most common forms of treatment for osteoarthritis include activity modification, rehabilitation, steroid injections, and in severe cases, surgery. “For a decade, I received steroid injections in my hands to relieve pain, and while they worked for a while, I wanted a more long-term option that didn’t include surgery, so I scheduled an appointment with Dr. Jason Pirozzolo at Orlando Hand Surgery Associates,” says Marilyn.

“When I first met Marilyn she came to see me after having repeated steroid injections into her finger for severe arthritis; she was having problems bending her fingers, and she was having significant pain,” says Dr. Jason Pirozzolo. “Over time, steroid injections can lose their effectiveness however, and that’s why we offered her a different treatment option: platelet rich plasma, which is PRP.”

What is Platelet Rich Plasma (PRP) Therapy?

A platelet rich plasma (PRP) therapy procedure begins with drawing the patient’s blood. The blood is placed in a specialized tube and then spun in a centrifuge. The centrifuge separates the blood into three components: platelet rich plasma, platelet poor plasma, and red blood cells. The doctor only uses the platelet rich plasma component to inject in the area of injury or pain. Watch a video on what to expect during a platelet rich plasma (PRP) therapy procedure here.Patient Success Story | Platelet Rich Plasma Therapy for Hand Pain

Platelet Rich Plasma (PRP) Therapy for Osteoarthritis

 “We believe platelet rich plasma works by stimulating cartilage matrix production. In addition, platelet rich plasma can help to modulate the inflammatory response. Doing both of those things in the setting of osteoarthritis may result in a reduction of pain and an improvement in function,” says Dr. Jason Pirozzolo.

What are the benefits of using platelet rich plasma (PRP) therapy?

  • The procedure is minimally invasive.
  • There’s minimal risk involved as the procedure consists of only using your own blood.
  • Many patients can resume normal daily activities almost immediately after the procedure.
  • Quicker recovery and rehabilitation time when compared to surgery.

After her first platelet rich plasma injection, Marilyn noticed a significant improvement in her pain and function. She’s now back to making pottery for her friends and family and doing the activities she loves. Watch Marilyn share her story with platelet rich plasma (PRP) therapy by watching the video above.

Dr. Jason Pirozzolo, Dr. George White, Dr. Brian White and Dr. Anup Patel perform platelet rich plasma (PRP) therapy and stem cell therapy procedures at the Orlando Center for Regenerative Medicine, located in the same building as our Orlando Hand Surgery Associates downtown Orlando location. Learn more about the regenerative medicine procedures we offer here: httpss://orlandoregenerativemed.com/.

 

Request an appointment here 

 

 

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Cast Care: Signs & Symptoms | Dr. Jason Pirozzolo

When a cast is cared for properly, it can be an extremely effective tool in protecting injured bones and tissues. In order to receive a successful recovery when using a cast, it’s important to know what symptoms are normal and what symptoms require assistance from a health care provider.

Watch the video above for Dr. Jason Pirozzolo’s tips on cast care and read about a list of common signs and symptoms to look out for when wearing a cast, below.

Pain and swelling:

  • When dealing with pain and swelling, take pain medicine as prescribed and elevate your arm above the level of your heart to reduce swelling.
  • If your provider has given you a sling for your arm, wear it to keep the injured part elevated. Wiggling your fingers can also reduce swelling and stiffness.
  • Most cast problems and cast irritation arise from over using the extremity and not resting it properly.

Dryness:

  • A cast should never get wet.
  • A fiberglass cast won’t fall apart but the padding underneath may start to smell if it gets wet.
  • Wet padding may also hurt your skin.
  • You should bathe using a wet washcloth, rather than taking a shower or bath.
  • If you are going to be near water (even rain), put your cast in a heavy plastic bag. Hold the bag in place with a rubber band and try not to get the bag wet. If your cast does get wet, you can dry it with a hair dryer. If your cast gets wet and it doesn’t feel dry after 4 or 5 hours, call your health care provider.
  • The DryPro Waterproof Cast Cover is a great product to use in the event that your cast will be near water. You can purchase the cast cover here.

Itching:

  • Many people deal with itching inside a cast. Never reach inside a cast with your fingernails or another object to scratch. It may injure your skin and cause an infection.
  • Sometimes shaking a small amount of talcum powder inside a cast, or using a hair dryer on a cool setting, helps relieve the itching.
  • If itching persists, you may use over the counter Benadryl as directed.

Activity:

  • How active you can be depends on your injury.
  • You should avoid riding a bike or playing sports.
  • Ask your doctor about what activities you can safely do.

 After my cast is put on what problems should I watch for?

Contact your doctor immediately if you have any of these problems…

Swelling: 

Signs of problem swelling include:

  • You have severe or persistent pain.
  • Your fingers or toes feel numb, painful or can’t move.
  • The color of your fingernails or toenails change.

Infection: 

Sometimes the body part inside a cast can become infected. Signs of infection include:

  • Drainage from the skin under the cast.
  • Pain.
  • Fever.

Cast fit:

Call your doctor if the cast feels too loose or too tight.

Dealing with an upper extremity injury or issue? Call (407) 841-2100 or click here to request an appointment with one of our doctors.

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PRP Therapy Surgery Alternative OHSA

OHSA Now Offering PRP Therapy

Orlando Hand Surgery Associates now offers Platelet Rich Plasma (PRP) therapy as a new surgery alternative for those dealing with chronic pain and injuries. With PRP therapy you can use the power of your own body to activate healing.

WHAT IS PRP THERAPY?

Platelets and growth factors found in our body are known for their importance in the healing process during an injury. A PRP procedure consists of drawing the patient’s own blood and using a centrifuge to separate the platelets and growth factors from other blood plasma. After separation is complete, the concentrated source of platelet-rich plasma is then injected into the area of pain or injury to activate natural healing within the body.

HOW IS PRP OBTAINED?

prp therapy orlando hand surgery

HOW LONG DOES THE PROCEDURE TAKE?

A typical procedure may take anywhere from 45 to 90 minutes. In most cases, patients were able to return to their job, or usual activities, immediately after the procedure.

WILL MY BODY REJECT PRP?

There is little to no chance that your body will reject PRP as the procedure consists of using your own blood.

WILL MORE THAN ONE INJECTION BE REQUIRED?

While many patients receive relief after the first or second PRP injection, the amount of injections needed will depend on the severity of the injury or condition.

WHICH UPPER EXTREMITY INJURIES OR CONDITIONS CAN BE TREATED WITH PRP?

Chronic joint pain, tennis & golfers elbow, rotator cuff injuries, ligament tears, osteoarthritis, acute muscle injuries, and much more.

Watch one patient’s PRP therapy success story:

Want to learn more about PRP therapy? Request an appointment online or give us a call at (407) 841-2100.

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