AMSSM Sports Medcast - The Evidence Behind Injection Therapy in Sports Medicine

AMSSM has a series of podcasts (https://www.amssm.org/E-Learning.php) and here experts highlight the management of shoulder, elbow and knee pain with a focus on the declining role of corticosteroid injections. The sports physicians discuss other injection treatment options – PRP, prolotherapy and viscosupplementation where relevant. Keep the AMSSM’s 2016 Annual Meeting in mind – Registration opens on January 8th. It will be in Dallas, Texas, April 15-20, 2016. And the special AMSSM issue of BJSM appears online first on January 18th, 2016.(Mental health theme). The experienced and popular hosts are Dr Blair Becker and Dr Scott Young, with special guest AMSSM Vice-President, Dr Matt Gammons. Timeline: 2:00 m Shoulder pain and subacromial corticosteroid injection – what is the level 1 evidence? 4:05 m What about corticosteroid for frozen shoulder? Does distention add benefits? 5:30 m Dr Gammons in his experience with adhesive capsulitis and shared decision making. 6:30 m The severity of symptoms may influence the decision. What would make it worth it for the patient to have an injection? 7:30 m PRP – platelet rich plasma. Again, as usually the case with PRP, no therapeutic benefit. What about prolotherapy? 8:30 m The AMSSM position statement on ultrasound guidance for shoulder injection. 12:30 m The elbow – an area where corticosteroids are becoming less popular. 15:30 m Is there support for long-term benefit of PRP? Nothing in the short term but a benefit at 2 years? 16:00 m Dr Gammons provides an overview. “Tools to add to the toolbox”, “Reasonable discussions to have with the patient”. Remember that the natural history is toward resolution. 17:00 m Shared decision making is key 17:30 m Moving on to the knee. Osteoarthritis and corticosteroid – short term benefit. Dealing with the acute flare-up. 18:40 m Viscosupplementation. See also the AMSSM scientific statement – (http://ow.ly/VKUxC ) and its recommendation for use in patients aged >60 years with grade 2 or 3 Kellgren-Lawrence. 20:00 m Dextrose prolotherapy for knee osteoarthritis (University of Wisconsin). 21:00 m Intra-articular PRP for knee osteoarthritis 23:30 m Other targets around the knee. Iliotibial band, pes anserinus as well as the patellar tendon. 25:30 m Summary of clinical practice – putting it all into perspective. Other links Clinical Journal of Sport Medicine blog and link to AMSSM Viscosupplementation position statement http://ow.ly/VKUxC

Evidence against elbow PRP via Dr Robert-Jan de Vos: http://bjsm.bmj.com/content/48/12/952.long