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Dr. Steven Stahle spent 15 minutes one recent afternoon preparing Clay Vollet's arm for a procedure to treat tennis elbow.
Then, Stahle, co-founder of the U.S. Center for Sports Medicine in Kirkwood, spent less than two minutes performing the procedure, called Focused Aspiration of Soft Tissue -- or, aptly enough, FAST. It was approved by the Food and Drug Administration last fall and is one of the latest techniques used in sports medicine to get athletes of all ages back to their sport as quickly as possible. Platelet rich plasma therapy is another, though it's still undergoing studies.
With the help of two assistants, Stahle draped Vollet's arm with several sterile blue towels at 1:14 p.m. He performed an ultrasound to find the precise location of soft tissue damage in Vollet's elbow, then sterilized and numbed the area with lydocaine. He also tested the needle-like probe that would be inserted into an incision the size of a grain of rice.
"That sound you hear is the machine that will do the procedure, but you won't feel a thing," Stahle said, revving the probe several times to test it. "It sounds like a mean dental drill."
At 1:21 p.m., he inserted the probe into Vollet's elbow through the incision. He poked it around at the site of damaged tissue, which he could see on an ultrasound screen. He revved the energy button on it several times to break up the bad tissue and suck it out. The frequency of the probe's vibrations are such that it removes only bad tissue.
As he did this, Vollet explained that he hurt his elbow opening and closing a rickety door on a duck blind.
"It got worse and worse and worse and after a few months, I said, I know a guy who can fix this," he said, referring to Stahle, who'd also treated a shoulder injury he suffered while lifting weights. "It affects everything you do when you have this. Most importantly, my golf game."
At 1:23 p.m., two minutes after inserting the probe in Vollet's elbow, Stahle removed it, then sutured and bandaged the incision.
"All right, I'm kicking you out," he told Vollet.
Stahle is one of about 10 local physicians using the procedure, which was developed at the Mayo Clinic.
"Usually my patients are middle-aged athletes who develop tendon problems," Stahle said. "By the time they've seen me, they've already tried ibuprofen, rest and stretching. Tennis players and runners are die-hards. They don't like to be sidelined."
Health insurance covers the FAST procedure, but not platelet rich plasma therapy, also called PRP.
Cardinals pitcher Kyle McClellan recently received PRP treatment for his ailing right elbow.
The human body naturally sends platelet cells to the site of injured soft tissue to help repair it. With PRP therapy, a small sample of blood is drawn from the patient and put into a centrifuge to separate the platelets from other components. That plasma, which has an unusually high concentration of platelets, is then injected into and around the injury, theoretically boosting the body's healing process.
"Insurance doesn't cover that, because there's no definitive code, and it's considered experimental. But that's a good procedure too," Stahle said.
Dr. Michael Horwitz, a foot surgeon and director of the Feet For Life Centers, has been using shockwave therapy to treat plantar fasciitis with success for several years. But he, too, recently began performing the FAST Procedure in combination with it.
"If you throw everything including the kitchen sink at something, you get a better result as long as you throw it with accuracy ," he said.
BABY BOOMERS TARGETED
Before the FAST Procedure and PRP therapy, patients who had tennis elbow and other forms of tendinitis often had to stop their sport for several weeks to let the injury heal.
For about 10 percent of people, rest did no good, and a much more invasive and costly surgery to remove damaged tissue and stimulate healing was required.
"I've seen lots of technological advancements come and go, but this is the best," Stahle said. "This I think is going to stick around. I really like it."
He and other sports medicine experts point to physically active baby boomers as their best customers for the new technology.
According to a survey by National Ambulatory Medical Care, sports injuries have become the No. 2 reason for visits to doctors' offices. Baby boomers, those born between 1946 and 1964, are the No. 1 demographic seeking treatment.
"Our population overall is graying and becoming more mature, and there's also a push toward a more active lifestyle as people mature and age," said Dr. Laurence Laudicina, an orthopedic surgeon in Albuquerque, N.M., and spokesman for the American Academy of Orthopedic Surgeons.
He divides the people suffering those injuries into two categories:
-- Veteran athletes whose bodies have worn down over time and don't recover as quickly as they once did.
-- Sedentary people who want to get back in shape and end up injured because they don't have what he calls the fundamentals in place.
"It's never too late to get started even at 30, 40 and 50," Laudicina says. "And our treatments are constantly evolving to become less invasive, more effective and with less risk."
Michael Bernal, 47, general manager of WingHaven Country Club in O'Fallon, Mo., had been struggling for about a month with tennis elbow from playing golf.
"I went through cortisone shots and physical therapy, which worked a little bit, but there was still noticeable discomfort after playing," he said. "When it's at its worst, you can't open a jar of peanut butter. It'll knock you off your feet."
He underwent the FAST procedure in mid-December. He recalls being virtually pain-free within five days and playing golf in less than a week.
Sports medicine specialists rarely advise patients to quit their beloved sport altogether anymore.
"That's old school," Laudicina says. "I wouldn't be able to set that answer for myself."
But he advises doctors, first, to work at preventing injuries among aging patients who are active by encouraging them to slow down, decrease the amount of time they devote to their chosen activity and mix in cross-training. "It's an easier pill to swallow when you tell them to change the way they do things rather than stop them altogether," he said. "It's difficult to tell a runner he can't run anymore. It's much better to say, well you can't run as much as you used to and you need to start cross-training."
(c)2012 the St. Louis Post-Dispatch
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