Hit ’em Straight and Long

January 20, 2021 | Uncategorized


Is your shoulder injury preventing you from having your best golf game? Perhaps your swing isn’t what it used to be. Nowak Orthopedics has solutions that are non-operative treatments.  Below are just a few conservative approaches that we consider before surgery.

Conservative Treatment Options at Nowak Orthopedics

  • Cortisone Injection
  • Zilretta Injection
  • PRP Injection
  • ViscoSupplement injection (Euflexxa, Synvisc)
  • Mi-Eye (Needle Imaging)
  • Physical Therapy

Cortisone Injections

Many conditions where inflammation is an underlying problem will respond well to cortisone.   These include, but are certainly not limited to:

  • Shoulder Impingement
  • Shoulder bursitis or tendonitis
  • rotator cuff tear or partial tear
  • Calcific tendonitis
  • Osteoarthritis
  • Tennis or golfers elbow
  • Bursitis of the knee or hip
  • Knee inflammation

*Essentially, any time you believe inflammation may be the reason for pain cortisone may benefit the condition.

What is Cortisone? Your body naturally makes cortisone when it is under stress, this is called cortisol. It is a type of steroid that is produced naturally by your adrenal gland and is released when your body is under stress.

Injectable cortisone is synthetically produced but is a derivative of your body’s own product. One of the differences though is that synthetic cortisone is not injected into the blood stream, but into a particular area of inflammation.  In addition, the benefits of synthetic cortisone is that it is designed to act more potently and for a longer duration of time (days instead of minutes).

Cortisone is a strong anti-inflammatory medication. Cortisone only treats the inflammation. When pain is decreased from cortisone it is because the inflammation is decreased. By injecting the cortisone into a particular area of inflammation, very high concentrations of the medication can be given while keeping potential side effects to a minimum. Cortisone injections usually work in 3 days but can take up to 2 weeks to work, and the effects can last up to a month. Many times once the inflammation is gone, the pain will stay away.

How many injections can I have?

Many orthopedics will only recommend a maximum of 3 injections/year but there is not a specific limit to the number of shots you are allowed.  Generally, if a cortisone injection wears off quickly or does not help the problem, then repeating it may not be worthwhile.  In addition, animal studies have shown the effects of the weakening of tendons and softening of cartilage with cortisone injections. Repeated cortisone injections multiply these effects and increase the risk of potential problems. This is the reason many physicians limit the number of

Zilretta Injections

Conditions such as chronic Knee osteoarthritis may greatly benefit from Zilretta injections.

ZILRETTA is a new longer-acting steroid injection and should be considered for the first and only extended-release, intra-articular therapy for patients confronting osteoarthritis-related knee pain. ZILRETTA employs proprietary microsphere technology combining triamcinolone acetonide — a commonly administered, short-acting corticosteroid — with a poly lactic-co-glycolic acid (PLGA) matrix to provide extended pain relief. The pivotal Phase 3 trial, on which the approval of ZILRETTA was based, showed that ZILRETTA significantly reduced knee pain for 12 weeks, with some people experiencing pain relief through Week 16. ZILRETTA received approval from the U.S. Food and Drug Administration on October 6, 2017, and the company initiated the full commercial launch on November 20, 2017.

Platelet Rich Plasma Injections (PRP)

PRP is effective where steroid injections may have had minimal effectiveness or failure and should be considered as a first-line alternative to a cortisone injection.

Conditions such as chronic tendonitis/tendinosis, chronic muscle strains, muscle fibrosis, and ligament injuries may respond really well to PRP.

Some Conditions that may respond well to PRP:

  • Patellar tendonitis/tendinosis
  • Quadriceps muscle injuries
  • Ligament sprains or tears
  • Hamstring tendonitis or tears
  • Rotator Cuff tendonitis, tendinopathy or partial tears
  • Acromio-clavicular joint pain or arthritis
  • Biceps tendonitis
  • Medial and Lateral epicondylitis (golfers & tennis elbow)
  • Peroneal tendonitis
  • Achilles tendonitis or partial tears

What is PRP?

Platelet-rich plasma or PRP is an “autologous blood therapy” that uses a patient’s own blood components to stimulate a healing response in damaged tissues.

In response to an injury or tissue damage, your body naturally recruits platelets and white blood cells from the blood to initiate a healing response. By enhancing the body’s natural healing capacity, the treatment may lead to a more rapid, more efficient, and more thorough restoration of the tissue to a healthy state.

To get PRP, your orthopedic take any anywhere from one to a few tubes of your own blood and run it through a centrifuge to concentrate the platelets. These activated platelets are then injected directly into your injured tissue. This releases growth factors that stimulate and increase the number of reparative cells your body produces.

 How many PRP injections are needed?

Depending on the severity and duration of your injury you may be advised to have anywhere from 1-3 injections.  You may also be recommended to commence PT to enhance the success of the treatment.

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First Visit

  • Remember to register on the patient portal with Athena prior to your first visit
  • Kindly bring your license, healthcare cards at your first visit.
  • Wear shorts for lower extremity evaluation and a tank top or loose-fitting shirt for upper extremity evaluations
  • All patients are required to follow our posted Covoid-19 protocol including wearing a mask.