Dr Lorenzo Masci is one of an increasing number of Specialist Sports doctors who take a holistic approach to diagnosing and managing sports and exercise-related problems including sports injuries, work-related injuries and medical problems associated with exercise. He will assess your injury and provide an accurate diagnosis and management plan. He performs ultrasound on-site and can seamlessly refer you for other imaging such as X-Ray, MRI (magnetic resonance imaging), and CT scans.
As a Specialist Sports Doctor, Dr Lorenzo Masci has undergone extensive training in ultrasound-guided injections. Ultrasound guidance enables more accurate placement of the substance injected and may improve outcome.
Dr Lorenzo Masci performs a range of ultrasound-guided injections including cortisone, autologous blood, PRP, high-volume injections and hyaluronic acid injections (Ostenil, Synvisc) to treat tendon disease, tendinitis, tendinopathy and joint osteoarthritis. He regularly performs ultrasound-guided injections for the following conditions:
If you have private health insurance, ultrasound-guided injections will require prior approval. This injection may be possible at the time of the initial consultation. However, you will need to tell us if you wish to have an injection at the initial consultation as we will need to allow for more time.
Platelet Rich Plasma injections or PRP are relatively controversial injections that involve taking the patient’s blood and spinning it in a centrifuge to separate the serum from the red cells. The serum, which contains a high concentration of platelets and growth factors, is then injected into the diseased tissue or joint.
There is still debate regarding the way PRP works. Some studies performed in laboratories have found that PRP improves the healing response of the body. Other studies have not found this beneficial effect.
As the procedure involves taking the patient’s own blood, it is not considered to have harmful effects like other injections such as cortisone.
As a Specialist Sports Doctor, Dr Lorenzo Masci uses PRP injections for more cases that do not respond to conventional rehabilitation. Generally, a series of injections is required over a few months but the exact number depends on the severity of the injury.
Conditions that may respond to PRP injections:
PRP injections usually work best when coupled with a comprehensive rehabilitation program. Patients are referred back to their physiotherapists for a graded functional program to accelerate the natural healing response.
What are Ultrasound-guided injections into joints and soft tissue?
There are times when injections are useful as part of the overall management of your condition. Injections assist in reducing pain and allowing progression of a rehabilitation programme. They are rarely used as a sole treatment. Studies and experience shows that ultrasound-guidance improves accuracy and effectiveness of injections and reduces adverse outcomes.
What types of injections does Dr Masci perform?
There are three main types of injections: cortisone, hyaluronic acid and Platelet-rich plasma (or PRP).
The aim of this injection is to reduce inflammation in a joint or soft tissue (tendon or ligament). By reducing inflammation, it is thought that pain is reduced as well.
Cortisone injections are best done under ultrasound-guidance to target the correct tissue and to reduce the amount of cortisone that is injected into other areas, thereby reducing side effects.
Cortisone injection usually work after a few days and the effect can last from a few weeks to a few months. Rarely does the effect of cortisone last for more than 3 months.
Hyaluronic acid injections:
These types of injections are commonly used for degenerative disease in joints such as osteoarthritis. Although the exact mechanism of action is controversial, it is thought to provide lubrication and stimulate joint fluid that provides pain relief.
Hyaluronic acid injections are best done under ultrasound-guidance to make sure the injectate is placed directly into the joint.
Hyaluronic acid injections usually take up to a month to work but the effect can last up to 6 months and beyond.
Platelet-rich plasma (or PRP):
These types of injections are part of the novel field of regenerative medicine. They are used for osteoarthritis and tendon disease.
It involves taking blood from your vein and spinning the blood so that the red cells are separated from the clear serum. The clear serum consists of a high concentration of platelets, which contains a magnitude of growth factors.
The use of PRP injections in musculoskeletal injections is controversial. Recent higher level evidence suggests that there is evolving evidence for use to in knee osteoarthritis. However, the evidence for use in soft tissue injury (tendons and ligaments) is less with higher level studies demonstrating no difference to placebo injections.
What are the side effects of these injections?
Injections are relatively safe. Dr Masci will go through risks associated with your type of injection at the time of the consultation.
Risks of injections include:
Medical concerns and injections
There are some medical conditions and medication that will interact with injections. Some examples include a fever, joint or skin infection, psoriasis, diabetes, immune deficiency and HIV infection. Medication that are of concern with injections include warfarin and other blood thinners, HIV medication and some fungal tablet medication. If you might be pregnant, you need to tell Dr Masci prior to the injection.
What are the post-injection instructions?
You will need to wait in the clinic 15 minutes after the injection to make sure you don’t develop an allergic reaction.
You should not drive for several hours after the injection.
Resumption of rehabilitation and exercise is dependent on the type of injection and the structure injected. In general, hyaluronic acid and PRP injections of a joint can return to normal activities after 3-4 days. Injections into other structure (tendons and ligaments) and cortisone injections will need at least 7-10 days of protected loading. Dr Masci will explain these instructions to you at the time of the injection.
Extracorporal Shockwave Therapy (ESWT) is an innovative treatment that can provide pain relief for various sports injuries and musculoskeletal conditions including:
ESWT works by sending a mechanical sound wave to the affected tissue. The theory of how ishockwave works is controversial but it’s thought to have a direct effect on remodeling of the affected tissue or a direct effect on pain nerve fibres.
Usually 3-5 sessions at one weekly intervals are required. You will need to check with your private insurance regarding reimbursement of costs.
The tendon clinic is the only one-stop combined tendon clinic in London (see http://www.iseh.co.uk/patients/clinical-services/combined-tendon-clinic) dedicated to the assessment and treatment of tendon complaints, both upper and lower limb. The clinic is a unique service run by Dr Lorenzo Masci (Consultant Sports Physician) and Christopher Myers (Clinical Specialist Physiotherapist). Both clinicians have extensive experience with tendon complaints, more specifically chronic tendons that are not improving. This ‘combined approach’ is normal for elite athletes and is now available to amateur athletes who are struggling to reach their goals. We are a results-based clinic and all clients fill out a questionnaire at their first appointment and following their treatment to follow their progress.
Every new patient has an hour initial consultation, which include:
Following the consultation, an individualised evidence based treatment programme tailored to your needs and goals will be implemented. This may include injection therapy, shockwave therapy and /or a specific rehabilitation programme. On some occasions, this may involve minimally invasive procedure or surgery. We work with the world’s leading surgeons and will ensure you see the right person for your problem.
If you have any questions before booking in then please don’t hesitate to email us at email@example.com
Chris is a highly experienced and specialised physiotherapist in musculoskeletal medicine and sports injuries. He has over 10 years of working with difficult tendon complaints and believes a combined approach is essential to getting clients out of pain and back to full function, whether this is an Olympic athlete, Premiership footballer or a recreational sports person.
Chris has a Masters in Sports Medicine and specialises in the assessment and treatment of tendon disorders. He is a visiting lecturer at University College London and Canterbury University and is currently involved in a large tendon research study.
He has worked with many individual elite athletes with a variety of tendon complaints and has worked with England squash, British Athletics, Tottenham Hotspur FC and Great Britain Badminton. He worked as a physiotherapist at the London 2012 Olympics and Paralympics. He currently treats an elite sprinting group (100m and 200m) and fully understands the demands running places on tendons and what has to implemented to return clients back to running - fitter, stronger and faster than before the injury.
Chris is one of the few physiotherapists in the country to also be a musculoskeletal sonographer and uses diagnostic ultrasound to diagnose muscle, ligament, tendon, joint and nerve problems.