Case Report Knee

Joy Wellness Partners
Platelet-Rich Plasma (PRP)
RegenLab®
Case Report
22 June 2018
Carol Hanselman Bender, RNP
Shawn Tierney, DC, RSMK Musculoskeletal Sonologist

Problem: Back & bilateral knee pain

Intro
Patient is a 44-year-old female who presented with persistent pain in her right lower back and both knees.

Diagnosis
The patient was examined by Dr. Tierney using a high-resolution ultrasound. The exam revealed tenderness to palpation of the right T11 subcostal nerve and left medial patellar retinaculum. It showed mild laxity in the left knee medial collateral ligament, and effusion in the left lateral joint line through the left lateral meniscus and iliotibial band. There was also mild loss of echotexture of the left anterior medial coronary ligament with a lateral meniscal cyst coming through the iliotibial band.

Treatment
Under ultrasound guidance, a solution of 1 mL 1% Lidocaine and 9 mL Normal Sterile Saline followed by 6 mL 0.5% Ropivacaine was used to hydrodissect the T11 subcostal nerve. Next a solution of 14 mL Normal Sterile Saline and 6 mL Ropivacaine was injected in the lumbar plexus to perform a lumbar sympathetic block and reset the pain pathways. Finally a solution of 14 mL Normal Sterile Saline and 25 mL PRP was injected into the lateral meniscus, medial coronary ligaments and left knee joint.

Follow-up
Two months after the treatment, the patient reported she was pain free, back to her yoga routine and had just begun running again. She stated she was grateful the treatment allowed her to return so quickly to her physical activities, especially since she thought it would be impossible without surgery.

Results
Figure 1. Self-Reported Pain on a 1-10 Scale, Before & After PRP

Conclusion
In conclusion, it was found that ultrasound-guided regenerative injection of PRP was an effective solution to the patient’s lower back and knee pain, as demonstrated by the 100% reduction in the patient’s self-reported pain level.

1. https://www.regenlabusa.com/leukocyte-poor-prp/
2. The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.

Placental Tissue Matrix Allograft (PTMA)
Skye® Biologics PX50™
Case Report
1 May 2017
Carol Hanselman Bender, RNP
Shawn Tierney, DC, RSMK Musculoskeletal Sonologist

Problem: Left Ankle Pain

Intro
Patient is a 16-year-old male who presented with a sprained left ankle. His pain is located on the lateral ankle, and it has remained swollen and tender for the last month.

Diagnosis
The patient was examined by Dr. Tierney using a high-resolution ultrasound. The exam revealed a 60% to 70% anterior talofibular ligament tendinosis with full thickness tear. Additionally, joint fluid was extruding subcutaneously, irritating the left superficial peroneal nerve and left sural nerve. The patient was also diagnosed with a partial tear of the distal anterior talotibial ligament.

Treatment
Under ultrasound guidance, 0.5 mL 0.5% Ropivacaine with 0.5 mL Skye® Biologics PTMA PX50™ was injected into the anterior talofibular ligament (ATFL) and anterior talotibial ligament (ATTL). The ankle was then taped with Cover Roll Stretch and Leukotape.

Follow-up
Two weeks after the injection, the patient began physical therapy, including the Rocker Board® and Foundation Training®. He stated that his Achilles Tendon was notably less sore, and he felt ready to start golfing again.

Eight weeks after the injection, during his follow-up ultrasound exam, his ATFL and ATTL tendon fibers were much more robust, there was no joint fluid extruding superficially, and there was no irritation of his peripheral nerves. The patient reported returning to basketball and playing without swelling or pain.

Results
Figure 1. Self-Reported Pain on a 1-10 Scale, Before & After PX50™

Conclusion
In conclusion, it was found that ultrasound-guided regenerative injection of Skye® Biologics PTMA PX50™ was an effective solution to the patient’s ligament tendinosis, as demonstrated by a 83% reduction in the patient’s self-reported ankle pain.

1 – https://www.skyebiologics.com/biorenew-ptm-therapy

2 – The ultrasound was a GE R6 B-mode using 8 to 13MHz high frequency GE 12L linear transducer.

3 – https://www.bsnmedical.com/products/orthopaedics/category-product-search-o/physiotherapy-bandages/physiotherapy/leukotaper-k.html

Placental Tissue Matrix Allograft (PTMA)
Skye® Biologics PX50™
Case Report
26 August 2016
Carol Hanselman Bender, RNP
Shawn Tierney, DC, RSMK Musculoskeletal Sonologist

Problem: Left ankle pain

Intro
Patient is a 47-year-old female who presented with constant pain in her left ankle for the past two months, which worsened after long bouts of sitting or standing, and only mildly improved with taping. She had difficulty sleeping due to the aching pain. She reported radiographs had revealed a bone spur in her left ankle.

Diagnosis
The patient was examined by Dr. Tierney using a high-resolution ultrasound. The exam revealed left plantar fascia partial tearing and reflexive muscle spasm causing plantar nerve impingement. The plantar fascia was 0.82 cm thick and has a 50% loss of compact fibular echotexture cross-sectionally.

The patient was recommended to keep the heel taped for eight weeks, and then return for a Skye® Biologics PTMA PX50™ treatment to the left plantar fascia.

Treatment
Under ultrasound guidance, a solution of 0.5 mL 0.5% Ropivacaine and 0.5 mL Skye® Biologics PTMA PX50™ was used to perform a needle tenotomy and injected into the left plantar fascia. Cover-Roll® Stretch and Leukotape was subsequently used to externally stabilize the musculature and plantar fascia of the left foot. The patient was instructed to perform rocker board exercises and to avoid passive stretching for nine weeks.

Follow-up
One week after the treatment, the patient reported the absence of a previous burning pain in her left ankle and foot, as well as a newfound ability to get out of bed without having to hold herself up.

Two weeks after the treatment, the patient returned and stated that she had sprained her ankle, which caused the pain to flare up. An ultrasound exam showed mild improvements of the plantar fascia on the left, despite the interruption in healing due to the recent ankle sprain.

Results
Figure 1. Self-Reported Pain on a 1-10 Scale, Before & After PX50™

Conclusion
In conclusion, it was found that ultrasound-guided regenerative injection of Skye® Biologics PTMA PX50™ was an effective solution to the patient’s left ankle pain, as demonstrated by the 50% reduction in the patient’s self-reported pain level.

1 – https://www.skyebiologics.com/biorenew-ptm-therapy

2 – The ultrasound was a GE R6 B-mode using 8 to 13MHz high frequency GE 12L linear transducer.

3 – https://www.bsnmedical.com/products/orthopaedics/category-product-search-o/physiotherapy-bandages/physiotherapy/leukotaper-k.html

4 – https://www.bsnmedical.us/products/wound-care-vascular/category-product-search/acute-wound-care/fixation/cover-rollr-stretch.html

Placental Tissue Matrix Allograft (PTMA)
Skye® Biologics PX50™
Case Report
26 August 2016
Carol Hanselman Bender, RNP
Shawn Tierney, DC, RSMK Musculoskeletal Sonologist

Problem: Left ankle pain

Intro
Patient is a 47-year-old female who presented with constant pain in her left ankle for the past two months, which worsened after long bouts of sitting or standing, and only mildly improved with taping. She had difficulty sleeping due to the aching pain. She reported radiographs had revealed a bone spur in her left ankle.

Diagnosis
The patient was examined by Dr. Tierney using a high-resolution ultrasound. The exam revealed left plantar fascia partial tearing and reflexive muscle spasm causing plantar nerve impingement. The plantar fascia was 0.82 cm thick and has a 50% loss of compact fibular echotexture cross-sectionally.

The patient was recommended to keep the heel taped for eight weeks, and then return for a Skye® Biologics PTMA PX50™ treatment to the left plantar fascia.

Treatment
Under ultrasound guidance, a solution of 0.5 mL 0.5% Ropivacaine and 0.5 mL Skye® Biologics PTMA PX50™ was used to perform a needle tenotomy and injected into the left plantar fascia. Cover-Roll® Stretch and Leukotape was subsequently used to externally stabilize the musculature and plantar fascia of the left foot. The patient was instructed to perform rocker board exercises and to avoid passive stretching for nine weeks.

Follow-up
One week after the treatment, the patient reported the absence of a previous burning pain in her left ankle and foot, as well as a newfound ability to get out of bed without having to hold herself up.

Two weeks after the treatment, the patient returned and stated that she had sprained her ankle, which caused the pain to flare up. An ultrasound exam showed mild improvements of the plantar fascia on the left, despite the interruption in healing due to the recent ankle sprain.

Results
Figure 1. Self-Reported Pain on a 1-10 Scale, Before & After PX50™

Conclusion
In conclusion, it was found that ultrasound-guided regenerative injection of Skye® Biologics PTMA PX50™ was an effective solution to the patient’s left ankle pain, as demonstrated by the 50% reduction in the patient’s self-reported pain level.

1 – https://www.skyebiologics.com/biorenew-ptm-therapy

2 – The ultrasound was a GE R6 B-mode using 8 to 13MHz high frequency GE 12L linear transducer.

3 – https://www.bsnmedical.com/products/orthopaedics/category-product-search-o/physiotherapy-bandages/physiotherapy/leukotaper-k.html

4 – https://www.bsnmedical.us/products/wound-care-vascular/category-product-search/acute-wound-care/fixation/cover-rollr-stretch.html

Placental Tissue Matrix Allograft (PTMA)
Skye® Biologics PX50™
Case Report
26 August 2016
Carol Hanselman Bender, RNP
Shawn Tierney, DC, RSMK Musculoskeletal Sonologist

Problem: Left ankle pain

Intro
Patient is a 47-year-old female who presented with constant pain in her left ankle for the past two months, which worsened after long bouts of sitting or standing, and only mildly improved with taping. She had difficulty sleeping due to the aching pain. She reported radiographs had revealed a bone spur in her left ankle.

Diagnosis
The patient was examined by Dr. Tierney using a high-resolution ultrasound. The exam revealed left plantar fascia partial tearing and reflexive muscle spasm causing plantar nerve impingement. The plantar fascia was 0.82 cm thick and has a 50% loss of compact fibular echotexture cross-sectionally.

The patient was recommended to keep the heel taped for eight weeks, and then return for a Skye® Biologics PTMA PX50™ treatment to the left plantar fascia.

Treatment
Under ultrasound guidance, a solution of 0.5 mL 0.5% Ropivacaine and 0.5 mL Skye® Biologics PTMA PX50™ was used to perform a needle tenotomy and injected into the left plantar fascia. Cover-Roll® Stretch and Leukotape was subsequently used to externally stabilize the musculature and plantar fascia of the left foot. The patient was instructed to perform rocker board exercises and to avoid passive stretching for nine weeks.

Follow-up
One week after the treatment, the patient reported the absence of a previous burning pain in her left ankle and foot, as well as a newfound ability to get out of bed without having to hold herself up.

Two weeks after the treatment, the patient returned and stated that she had sprained her ankle, which caused the pain to flare up. An ultrasound exam showed mild improvements of the plantar fascia on the left, despite the interruption in healing due to the recent ankle sprain.

Results
Figure 1. Self-Reported Pain on a 1-10 Scale, Before & After PX50™

Conclusion
In conclusion, it was found that ultrasound-guided regenerative injection of Skye® Biologics PTMA PX50™ was an effective solution to the patient’s left ankle pain, as demonstrated by the 50% reduction in the patient’s self-reported pain level.

1 – https://www.skyebiologics.com/biorenew-ptm-therapy

2 – The ultrasound was a GE R6 B-mode using 8 to 13MHz high frequency GE 12L linear transducer.

3 – https://www.bsnmedical.com/products/orthopaedics/category-product-search-o/physiotherapy-bandages/physiotherapy/leukotaper-k.html

4 – https://www.bsnmedical.us/products/wound-care-vascular/category-product-search/acute-wound-care/fixation/cover-rollr-stretch.html

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