Jeffrey Peng, MD
@JeffreyPengMD
Followers
1,287
Following
33
Media
136
Statuses
2,272
Sports Medicine & Family Medicine. Helping people live active & healthy. Educating next gen doctors.
San Francisco Bay Area
Joined January 2012
Don't wanna be here?
Send us removal request.
Explore trending content on Musk Viewer
LINGORM OPPO A3 MISSION
• 731522 Tweets
Peringatan Darurat
• 286074 Tweets
バニーの日
• 244588 Tweets
#SnowMan
• 196740 Tweets
ALRIGHT TEASER
• 168945 Tweets
ゲリラ豪雨
• 145107 Tweets
アルバム
• 127972 Tweets
Vote Harris
• 124550 Tweets
#EMPIRE
• 95272 Tweets
SASUKE
• 86602 Tweets
Sterling
• 63005 Tweets
マンホール
• 49842 Tweets
ドームツアー
• 45183 Tweets
#剣持刀也のお誕生日会
• 41690 Tweets
ALWAYS 8Y JAEMIN SIDE
• 37229 Tweets
#JO1ANNX
• 33872 Tweets
PRINCE FELIX
• 22599 Tweets
Manuel Neuer
• 21857 Tweets
オリエント工業
• 17971 Tweets
ドゥレッツァ
• 16256 Tweets
剣持誕生日
• 14559 Tweets
D-6 TO CHANYEOL SOLO
• 14241 Tweets
インターナショナルS
• 13961 Tweets
シティオブトロイ
• 11097 Tweets
Pinned Tweet
I just updated my knee osteoarthritis treatment table.
It has ALL the common treatments including short term benefits, mid-long term benefits, impact on arthritis progression, side effects, and cost
Weight, diet/nutrition, and exercise are by far the best overall treatments.
48
110
662
Updating my chart for knee osteoarthritis treatments.
Agree? Disagree?
What would you change/modify?
What treatments would you add?
#orthotwitter
11
10
62
PRP injections result in the same outcomes as adipose stem cells for knee osteoarthritis at 12 months.
There really is no reason to recommend stem cells at this time. PRP is so much cheaper and easier and the outcomes are the same.
4
9
64
Extracorporeal shockwave therapy can be a very effective treatment for tendinopathies including elbow tendinopathy, plantar fasciopathy, and achilles tendinopathy.
1
14
59
High dose PRP results in better outcomes than low dose PRP.
Finally we have a study that shows the amount of platelets administered into a knee affects outcomes.
From the study: Patients with knee OA had significantly better improvement in pain and function when treated with
7
4
53
@mcuban
@matthewloop
I’m saddened by the results. My goal of working in academic medicine is to train physicians who can use evidence based medicine and then individualize them to each patient. Each person comes from a different socioeconomical background and does not fall perfectly in an algorithm.
33
2
52
@mcuban
@costplusdrugs
Any way viscosupplements (hyaluronic acid) injections can get on
@costplusdrugs
? Ex: monovisc costs $1556 on GoodRx, but physician offices can buy it for less than $100 and then upsell to patients. Patients should get the cheaper prices too! Thanks
@mcuban
for all the hard work
3
1
49
I diagnosed a patient with early rotator cuff calcific tendonitis via ultrasound. We were able to lavage it and aspirate out a LOT.
At just 6 weeks follow up, I couldn't even find it on ultrasound anymore -- it was gone! The patient's pain and symptoms were also gone. Amazing!
6
2
46
This is interesting!
Shockwave therapy might help meniscus tears heal.
"Radial ESWT promoted meniscal tear healing in the avascular zone, modulated inflammatory factors in the menisci and knee joints in rats, and alleviated cartilage degeneration."
1
7
44
This is exciting!
New meta-analysis suggests PRP injection is superior to corticosteroid for rotator cuff disease in the long term.
This would be consistent with data from tennis/golfer's elbow, plantar fasciitis, gluteal tendinopathy, etc.
#orthotwitter
5
2
43
Great study on frozen shoulder:
-Intra-articular steroids help with pain and function
-Capsular distension even better for both (my favorite)
-Shockwave helps but is $$
-Lasers also help but $$
-Combine treatments with PT for best outcomes
Thoughts?
7
10
42
PRP demonstrated significantly improved pain and function for patients with knee osteoarthritis compared with placebo. Additionally, PRP exhibited the highest SUCRA values for these outcomes when compared with BMAC, HA, and CS.
1
8
40
HA + PRP for rotator cuff partial tears was better than PRP alone.
Interesting findings, but I don't know of anyone who actually recommends this. As far as I'm aware, HA isn't even covered by insurances for soft tissues.
5
6
40
Cortisone shots are widely recommended for arthritis and tendonitis. But did you know they actually have quite SEVERE side effects?
A 🧵:
3
6
38
PRP injections: 1 vs 3 vs 5 for knee OA?
- 3 and 5 injection protocols resulted in significantly better outcomes than 1 injection
- No difference between 3 and 5 injections
The problem? They used 20 cc blood draw (low dose!)
5
5
35
If you are looking into getting PRP injections for orthopedic issues (arthritis, tendonitis/tendinopathies, tendon tears, etc), here is a list of questions you MUST ask:
1. What dose of PRP are you getting? Higher dose is superior to lower dose.
High dose for 1 joint injection
4
4
34
@AdamMeakins
Hyperglycemia, hypercholesterolemia, and metabolic syndrome are all associated with tendon disorders. Patients on statins have at least one, if not all of these.
Tendinopathies are as much a metabolic disease as they are a "wear and tear" disease.
1
10
31
You don't need 10,000 steps per day.
Here's how many you need:
🧵1/
I combed through scientific data to get you the optimal number of steps to take per day to stay healthy (all cause mortality, cardiovascular disease, mental health/function, immune function, weight loss, etc).
3
7
32
There are three critical mistakes that can undermine the effectiveness of PRP injections and these mistakes directly translate into disappointing outcomes. But here’s the good news, each mistake is completely preventable.
5
10
30
Another study confirming PRP is better than any other injection we have for knee osteoarthritis.
"PRP provides symptomatic relief, has the potential to reduce disease progression, and has sustained effects up to 12 months."
2
3
29
This is an EXCELLENT summary of how to approach athletes who observe Ramadan.
@BJSM_BMJ
#sportsmedicine
0
9
28
Ultrasound guided vs landmark guided injections for de Quervain disease:
- both groups improved at 6 months
- landmark injection group had more recurrence and skin side effects
2
5
25
New study: PRP no better than exercise for knee OA.
*Sigh*... another study finding no benefits of PRP injections.
They probably used low dose PRP.
*checks methods*
Yup, low dose PRP.
*yawn*
Please stop using low dose PRP. It doesn't work. You're just wasting patients' money
6
4
24
A lot of people still post the RESTORE trial as proof that PRP doesn't work.
But they don't realize that not all PRP is the same.
The RESTORE trial used RegenLab BCT kits with a total of 10 cc blood draw. This results in about 1 billion platelets. They found that this dose of
2
3
23
I did an ultrasound guided injection today into a tendon. MRI showed no tear. Diagnostic u/s showed no tear.
But when the injectate went into the tendon, there was a noticeable "gap" in the tendon as the fluid flowed distally and proximally. That's an intra-substance tear that
4
3
23
This study suggests a direct association between electrodiagnostic severity and ultrasound measurements of the median nerve in patients with suspected CTS.
Got to say, doing an ultrasound in clinic is so much faster than referring to EMG/NCS.
0
4
23
#Statin
myopathy not a thing? Randomized placebo controlled trial in
@bmj_latest
found no overall effect of
#atorvastatin
on muscle symptoms compared with placebo in participants who had previously reported severe muscle symptoms when taking statins.
2
7
22
For those who don't believe in PRP, I hear you. I was skeptical at first. I thought people just wanted to make a quick buck.
But dive into the literature. It tells a different story.
Let's take knee osteoarthritis as an example. It's a much better option than everything else we
4
2
21
@hjluks
“For the before-and-after comparison within the GLP-1RA group, we observed a significant decrease of symptom-relieving medication consumption and cartilage loss velocity of medial femorotibial joint”
Needs more data but looks promising.
1
4
21
Here's the video where I discuss each treatment in MUCH more detail. Enjoy!
1
2
20
Physician empathy is associated with BETTER outcomes at 12 months in those with chronic pain.
Other studies have shown this is also true of MRI reports.
Our words and attitude directly impact patient outcomes.
2
7
19
Pt: "WHY DIDN'T THEY DO THIS 9 MONTHS AGO?!"
I saw a ~40 yo patient the other day with 9+ months of knee pain. Hurts every time she squatted. Couldn't cross her legs. No trauma. X-rays were normal. Physical therapy made symptoms WORSE. She couldn't exercise. MRI was totally
8
2
19
Which is the most SENSITIVE test for a meniscus tear?
It's not a McMurray's (61% sensitivity; 84% specificity)
It's joint line tenderness (83% sensitivity; 83% specificity)
1
2
18
Prolotherapy with 5% dextrose can help with knee osteoarthritis symptoms.
It seems injecting the peri-articular nerves in addition to intra-articular injection works better than intra-articular injection alone.
0
2
19
What started as a pandemic side project just passed another milestone.
After 2 years, 1 month, 5 days, I crossed 100,000 subscribers on YouTube!
Thanks to all who offered support and encouragement. Here's to the next 100k and for more evidence based sports medicine content!
3
1
18
Hip and core exercises can help reduce lower extremity injuries in novice runners.
Strength training is key and significantly underrated in runners!
0
1
18
There's still a lot to learn about PRP (dosing, LR vs LP, etc) but what's clear is PRP works.
"The use PRP for various orthopaedic conditions, in particular for the treatment of knee osteoarthritis, is supported by a large number of clinical studies."
2
3
17
Osteoarthritis is as much a metabolic disease as it is wear and tear.
"BMI, body fat percentage, waist circumference, and hip circumference has a causal effect on knee osteoarthritis."
Fix your metabolic health and your knee pain will improve.
1
7
17
Weather likely affects arthritis pain!
"Barometric pressure and relative humidity were positively correlated to OA pain intensity, while temperature was negatively correlated to OA pain."
0
4
15
Those with fatty liver disease (and metabolic syndrome) have exceedingly high risk of developing osteoarthritis.
OA is as much a metabolic disease as it is a "wear and tear" disease.
We need to focus treatment on diet, exercise, and weight management.
2
7
15
Ultrasound guided needling / barbotage had equivalent results in terms of pain and functional improvement to arthroscopic surgery for calcific tendonitis. It's also way cheaper and easier to do with a faster recovery.
#orthotwitter
#msktwitter
#sportsmed
3
5
16
My 2 cents on post-PRP injection for knee osteoarthritis:
- Restricting NSAID use is critical, especially after the injection. I tell patients hold 1 week prior and continue to hold at least 2 weeks after, longer the better.
- Acetaminophen likely does NOT affect platelet
🚨hot off the press🚨
Great collaboration
@UCSFSportsMed
@Columbia_Rehab
@KPsportsmedNCal
Still so much to learn about rehab after PRP, especially after joint injections!
@CartilageRepair
4
5
34
4
3
16
Exercise and physical therapy are first line treatments for knee arthritis pain.
Recent
@BJSM_BMJ
study found that delayed initiation of PT (>1 month after dx) is associated with increased future risk of ANY opioid use.
#orthotwitter
1
5
15
Platelet rich plasma injections are more effective than corticosteroid injection, shockwave therapy, and placebo in reducing pain and improving function in those with plantar fasciitis.
Systematic review and meta-analysis of 21 RCTs, 1356 patients
0
1
15
With all the stem cell discussions within the ortho/sports community in the last few days, it's important to point out the results of this recent study.
Largest RCT to date of stem cells vs corticosteroids for knee osteoarthritis. Over 400 patients (compared to the 20-30 in
2
2
15
I think as a whole, the MSK community can do a much better job in counseling our patients that their tendonitis / tendinopathy / osteoarthritis is as much a metabolic disease as it is a 'wear and tear' problem.
0
0
15
Rotator cuff calcific tendonitis:
This study found no difference between operative and non-operative treatments. However, if there was a cuff tear, the operative group did better.
1
1
14
👏
@AAOS1
AAOS Technology Overview Summary: PRP injections for Knee Arthritis
TLDR; Platelet rich plasma injections essentially beats every other injection treatment we have for knee OA.
0
1
13
Yes, you can squat even with knee arthritis.
You might not go all the way down or use weights, but with training, it’s possible.
You are not making the arthritis worse.
In fact, the more you train, the more you PROTECT your knee and PREVENT the arthritis from getting worse.
1
0
14
The myth that “exercise worsens knee arthritis” needs to be debunked once and for all.
Both aerobic and resistance training exercises strengthen the muscles around the knee, improve flexibility, and reduce stiffness. This ultimately enhances joint function and reduces pain.
2
1
14
Yet another study concluding PRP injections are superior to corticosteroid injections in the long term treatment of elbow tendinopathy (ie tennis elbow).
3
1
14
Osteoarthritis is NOT just a "wear and tear" disease.
Metabolic syndrome is one of the most important risk factors. Addressing your metabolic health goes a long way in treating symptoms related to arthritis.
0
0
13
@hjluks
Corticosteroids have short term benefits but have been shown to cause LONG TERM HARM. Patients actually do worse over time after cortisone.
Platelet rich plasma is a much better option for chronic pain from elbow tendinopathy that is refractory to other conservative management.
3
0
13
Here's a friendly reminder when reviewing PRP studies:
You must first look at the platelet count and concentration administered. This affects outcomes. And the reality is, most studies don't report this critical information.
1
1
13
Strength and aerobic exercises are among the most effective treatments for knee arthritis.
They cost nothing but time and determination.
In contrast, doctors, physical therapists, and injections can be expensive and may not yield better outcomes compared to regular exercise.
3
1
14
Corticosteroid injection within 3 months of knee arthroplasty significantly increased the risk of periprosthetic joint infection.
"Intra-articular steroid injection is not a safe procedure for patients who are expected to undergo TKA."
#orthotwitter
1
5
12
Exercise is medicine.
It often outperforms many prescription medications for chronic diseases.
Build strength, boost health, and elevate your energy.
Consistency is key—start small and stay committed.
Your future self will thank you!
1
2
14
Happy to see more studies confirming what I've been saying all along:
PRP injection platelet dosing matters!
High dose PRP with rotator cuff repair improves healing and functional outcomes when compared to low dose PRP.
2
2
13
@anniewe3
@mcuban
@matthewloop
The answer is SO complicated. Docs are increasingly burdened by administrative tasks that pull us away from what we were trained to do -- patient care. The hours of paperwork we do (not seen by the public) is crushing and leads to significant burnout.
12
1
13
Everyone thinks their tendons hurt because of inflammation. But they’re all wrong. Here’s the truth. A lot of painful conditions like achilles tendonitis, patellar tendonitis, lateral epicondylitis, and rotator cuff tendonitis actually have very little to no inflammation.
A 🧵 :
3
3
12
For partial tear of the rotator cuff, PRP injection is superior to corticosteroid and hyaluronic acid for pain relief and functional improvement.
#orthotwitter
1
1
13
If you have vague anterior knee pain with a NORMAL MRI, chances are you have a trigger point in your vastus medialis oblique muscle.
Take a massage gun, lacrosse ball, or foam roller and hit the area marked by this X. It will likely take a lot of your pain away.
0
1
13
Is it safe to walk with knee arthritis?
Are you going to make arthritis worse the more you walk?
Let's answer these questions (and more)!
A thread:
1
2
12
@FitFounder
In many situations, this is already recommended. Patients struggle to heed the advice, opting instead for a quick fix and a pill. The reality is both sides can do better to meet in the middle.
3
2
12
@hjluks
Great thread!
Hydrodilations have been practice changing for me.
This is one of the few procedures where patients often cry (out of happiness!) immediately after the injection because of the sudden improvement in ROM and pain.
Pro tip: go through the rotator interval
3
1
12
Let's discuss platelet rich plasma (PRP) injections for knee osteoarthritis in the context of a recent and compelling clinical study.
PRP could revolutionize your experience with pain and enhance your daily function.
A 🧵 :
3
2
11
Great quote:
"Exercise is not a magic bullet solution to every brain and health condition, but it is one of the most promising and scalable approaches to improve and maintain brain health throughout the lifespan."
1
0
12
The data for arthroscopic partial meniscectomy just isn't great.
"Worsening of BMLs and cartilage defects with arthroscopic partial meniscectomy compared to physical therapy with optional delayed surgery at 2 years."
1
0
11
Platelet rich plasma (PRP) injections are one of the best treatments for tennis elbow and golfer's elbow.
Here's why!
2
1
12
For those interested in diving deeper into the evidence, I've compiled a medical literature database featuring studies on PRP and other therapies, which can be found here:
0
1
12
Turmeric & curcumin supplements work just as good as NSAIDs for reducing symptoms related to arthritis and without any of the side effects!
Don't believe me?
A 🧵 :
1
0
12
The evidence supporting the use of PRP injections for disc disease is getting better.
"PRP injection was beneficial for delaying disc degeneration and promoting disc remodeling."
0
1
13
I saw a patient who told me he got a PRP injection from his naturopath.
This "doctor" drew his blood into one small tube, divided the whole blood into small syringes, and then reinjected it all around the patient's knee. No centrifuge involved... 🤯
Not all PRP is the same!
1
1
10
Which exercise program is best for hip osteoarthritis?
Different exercise programs are both effective for improving function, pain, and quality of life.
The message is simple: just start exercising.
0
1
11
Many people suffering from osteoarthritis are truly shocked to hear that they can continue to exercise. They thought they could no longer walk, jog, run, play pickleball, etc.
Exercise IS medicine.
It helps treat symptoms and REDUCE the progression of arthritis.
0
1
10
"Given the large body of existing literature and expert opinions, PRP was regarded as a valid treatment option for knee OA and as a possible first-line injectable treatment option for nonoperative management of knee OA, mainly for KL grades 1-3."
1
1
11
Friendly reminder that a diagnosis of arthritis does NOT mean you need to stop exercising.
In fact, quite the opposite.
Both aerobic and strength training exercises are arguably the MOST IMPORTANT treatments for arthritis.
0
1
11
I used ultrasound to help drain a knee. Got 35 cc. The patient watched the screen as I did it.
Patient: how do make sure you drain everything if you don't have ultrasound?
Me: You can't.
Ultrasound guided MSK procedures will soon be standard of care (if not already).
1
0
9
This study found that for the treatment of degenerative meniscus tear, exercise therapy had a lower risk of knee OA progression than arthroscopic partial meniscectomy. Outcomes for pain and function were comparable.
"It is not recommended to use APM."
1
0
11
"The incidence and prevalence of OA are increasing among younger populations... Modifiable risk factors such as unhealthy lifestyle and obesity representing key targets for future interventions"
OA is as much a METABOLIC disease as it is wear and tear.
0
0
11
This randomized controlled trial found that a series of 3 platelet rich plasma (PRP) injections reduced pain by up to 90% and improved function by almost 50% when used to treat symptomatic knee osteoarthritis.
1
3
10
Friendly reminder that corticosteroid injections have been shown to weaken tendons and result in worse outcomes over time. Cortisone is also chondrotoxic and results in worse arthritis and worse outcomes.
Platelet rich plasma on the other hand results in significantly better
1
0
7
High volume capsular distension for adhesive capsulitis is one of my favorite procedures to do as a physician.
INSTANT pain relief and improvement in range of motion.
Works going through the rotator interval (preferred) as well as through the posterior glenohumeral joint.
3
0
10
Saw a patient today with the fellow.
2+ years of knee pain. Hurt to walk. Always felt pressure in the knee.
- Physical therapy didn't help
- Intra articular cortisone didn't help
- MRI shows possible infrapatellar fad pad impingement.
- Cortisone + infrapatellar fat pad
1
0
10
Occasional vigorous exercise in your routine is associated with a 20-30% decreased risk of dementia when compared to moderate physical activity only.
1
1
10
Stem cell injections (bone marrow, adipose, umbilical) were found to be NO BETTER than corticosteroid injections at 1 year for knee osteoarthritis.
3
0
9
Partial tears of the rotator cuff are very common in people WITHOUT shoulder pain.
So, if your MRI shows a partial tear, it does NOT mean you need surgery.
Non-surgical treatments focused on strengthening and supporting the shoulder are often enough to be pain-free.
0
1
10
Don't get stem cell injections. Get PRP instead.
Multiple trials show that "stem cell" injections are NOT superior to PRP injections. Stem cell injections also have NOT been shown to regenerate anything. So really, no reason to get them.
1
1
10
1/ "Pay attention to the evidence: in the longer term, intraarticular corticosteroid injections offer only harm for knee osteoarthritis"
@DrJohnOrchard
This, 100% this!!
#FOAMed
#sportsmedicine
#MedEd
#MedTwitter
#orthotwitter
1
1
10
Trigger points in the VMO are one of the most commonly missed sources of knee pain.
One QUICK session of trigger point needling and many people walk out of the clinic pain free.
0
2
9
@mcuban
Thanks for saving our patients SO much $$$! I tell all my patients who need help. Here's an example:
Celecoxib 200mg twice daily.
This usually requires PRE AUTH from insurance which means 1-2+ weeks of waiting!
@GoodRx
: $17-$100/mo
@costplusdrugs
: $6/mo
Easy choice.
1
0
10
@iain_harrington
@MRheumy
This is the first RCT that compared platelet dosing for PRP. They found that high dose PRP resulted in significantly better outcomes when compared to low dose PRP.
1
1
10
Friendly reminder that having a diagnosis of arthritis does NOT mean you need to stop exercising. Quite the opposite!
You need to move MORE. It doesn't matter how severe your arthritis is.
Starting walking. Start strength training. Start somewhere.
Your body will respond.
1
2
10
Interesting, extracorporeal shockwave therapy + PRP injection is superior to PRP injection alone for treating partial tears of the rotator cuff.
1
0
9
PRP is superior to corticosteroids at both 3 and 6 months for the treatment of tennis elbow.
#orthotwitter
#msktwitter
#sportsmed
0
2
9
Aren't we told that the single HA formulations like synvisc-ONE, durolane, and monovisc are the same as the 3 shot series?
This study found that the 3 shot series resulted in better outcomes when compared to 1 high dose HA injection.
1
2
9
Intra-articular VEGF and MMP-1 are primary drivers of worse knee symptoms and quality of life scores.
Want to know who has high VEGF and MMP levels?
Those with metabolic syndrome.
Arthritis is as much a metabolic disease as it is wear and tear.
1
1
9
Heel lifts are probably underused as a treatment for achilles tendinopathy.
"Using heel lifts not only improved symptom severity after 2 weeks but also immediately reduced pain during gait and had a positive impact on gait pattern and speed."
0
3
9
This is a REALLY good review article for the management of femoral acetabular impingement.
1
1
8
Collagen supplements are advertised to help reduce joint pain, improve stiffness, and slow down the progression of arthritis.
But do they ACTUALLY work? 🤔
Let’s look at what some recent clinical trials say. 👇
Collagen is a type of protein that is naturally found in the body
2
1
9