hi I'm Dr Alex delduca a naturopathic physician on Vancouver Island I'm here with my patient Jaden Jaden here is getting some platelet-rich Plasma in his glenohumeral joint today under ultrasound guidance using the clarius L7 Wireless scanner Jayden's had a history of shoulder instability and multiple dislocations over the last 10 years we're going to be giving him some PRP to help strengthen and support the glenohumeral joint so hopefully he gets some relief from the instability and we'll just have that arm up for a little second there okay you need a phobic at all Jaden oh no no okay great so we're going to be just cutting off the um using a tourniquet to help make the veins a little more pronounced for drawing the PRP we're going to be wiping with alcohol making sure that we're as clean as can be so today we're going to be using the arthrex PRP system the angel system by arthrex and that system will be collecting 120 ml of whole blood that will be centrifuge down to approximately three to four cc's of concentrated PRP processing time can take upwards of 20 to 30 minutes however this is one of the more concentrated products which can help yield a beneficial effect from The PRP Jaden here has not had PRP in the past he has had Prolotherapy from a dextro's solution K Jaden is going to be a teeny tiny poke you ready and one two three poke sorry about that okay great okay so we're collecting the blood and we don't want to be collecting this too fast from Jaden we want to be very gentle with these platelets as if we're too aggressive too shaking they can rupture so here we are adding the second syringe of two to the arthrex angel PRP system we've collected a total of 120 mils of fluid for the PRP system here so this is going to be collected in bag one it'll be spun in the centrifuge device this machine is very easy to use and the setup yields one of the most concentrated products on the market and it does take about 20 minutes with 120 mils of blood and you'll see the three chambers chamber one fill up here and then separate all those fluids here and we'll check back in 20 minutes to see our finished product so we'll go ahead and get Jaden prepped for the injection we've already prepped two percent chlorhexidine swab which is also going to be acting as our transducer medium okay Jayden just a little bit of wetness there let's take a look at the tissue okay so here we have an image of the posterior glenohumeral joint we can see the curvature of the posterior humeral head and we can even see the labral tissue we'll be inserting the needle in between the posterior humeral head on the medial aspect and the labrum we're going to start I don't see any issues in terms of vascularization on the way to the injection and this looks like an optimized image to have a successful injection okay Jaden we're going to feel a little pinch you doing okay yes sir great and a little poke one two three poke this injection is performed and often more steep than most Physicians realize when they begin injecting shoulders and very often we have to take a few tries at injecting this area to make sure that we're being so so so delicate with the labrum and soft tissue in and around the joint we doing okay yes sir great okay so we're just going through a little bit of tissue here excellent okay great perfect so we missed the labral tissue there and we're going to see if we see any distension and if we don't we can determine that that is in the capsule so a little bit of distension great that is a perfect injection no problems we even see that fluid going in and we haven't Disturbed the labrum how you doing there Jayden fantastic gonna feel a little teeny tiny bit full and there we go so because this is PRP I've explained to Jaden that there is going to be some minor discomfort over the next few days this is an inflammatory injection which is in contrast to cortisone where it generally doesn't flare as commonly as regenerative injections and this is going to help strengthen soft tissue and hopefully move Jaden along in his experience with chronic shoulder instability and we are done thank you so much for watching
