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Peptide Receptor Radionuclide Therapy (PRRT)

Management Team

Peptide Receptor Radionuclide Therapy (PRRT)

Overview

PRRT is a targeted form of radionuclide therapy predominantly used in the treatment of neuroendocrine tumours (NETs). In this therapy, a radioactive moiety (commonly Lu-177, occasionally Ac-225) is combined with a biological molecule to specifically target the tumour receptors.  PRRT delivers targeted radiation directly to cancer cells, minimising side effects and improving the quality of life compared to conventional chemotherapy. 

The U.S. Food and Drug Administration (FDA) approved the PRRT in 2018, and it has since been used routinely in the clinical management of neuroendocrine tumours. Additionally, PRRT can also be used in somatostatin receptors (SSTR) expressing malignancies such as phaeochromocytoma, paraganglioma, neuroblastoma, lung carcinoid, medullary thyroid carcinoma, and meningioma.

Initially, PRRT was used only in the metastatic setting after progression on conventional therapy (usually octreotide). However, in the light of recent trials (NETTER-2), PRRT can be offered in the upfront setting as well. PRRT has known to prolong the progression free survival compared to conventional therapy (NEETTER 1 Trial). PRRT has been shown to significantly improve progression-free survival and alleviate symptoms (such as diarrhoea, gastritis, and hypoglycemic episodes) associated with neuroendocrine tumours.

PRRT is administered in the form of cycles, usually 4-6 with a gap of 10-12 weeks. Following two cycles, response evaluation is done with DOTA PET scan (FDG PET CT if required). Depending on the nature of the tumour, PRRT may be combined with somatostatin analogues or chemotherapy. 

  • DOTA PET CT scan as a part of prelude to PRRT, confirms the receptor expression status on the targeted lesions. FDG PET-CT can also be combined in a specific setting.
  • Lab tests: CBC, serum creatinine, LFT, and RFT to confirm the parameters are within the expected range.
  • ECOG / performance status
  • Comorbidities evaluation

  • Precautionary medications are administered, including antiemetics, steroids if necessary, and amino acid infusion to reduce renal toxicity.
  • Radionuclide therapy is administered slowly under the supervision of the Nuclear Medicine Physician with continuous monitoring of vitals. Therapies are administered only in designated wards approved by the regional radiation regularity body.
  • The total time taken for the therapy administration ranges from 4 to 6 hours. Depending on the patient's clinical status, the patient is discharged on the same or following day.

  • The most common immediate side effects of PRRT are nausea and vomiting, which are managed by pre-therapeutic antiemetic medications.
  • Rare side effects include carcinoid/catecholamine crisis, managed by proper pre-therapeutic evaluation, continuous monitoring of vitals during the therapy administration, and tackled accordingly with the antagonistic medications.  
  • Long-term side effects can occur, such as derangement of liver and kidney functions. However, monitoring the LFT and RFT before the therapy and in between the PRRT cycles can help the Nuclear Medicine Physician tailor the PRRT dose accordingly.
  • Transient suppression of RBC, WBC, and platelet counts can occur; however, the counts recover by the end of the month and are restricted to lower grades.

PRRT uses very small amounts of radiation. Over the next several days, the radionuclide will leave the body through urine and faeces. Patients are instructed to stay away from children and pregnant women for a few days. No other specific precautions post PRRT administrations are required.

  • Significant reduction of symptoms such as pain and hormone-related symptoms.
  • Reduction of disease burden on the PET CT scan or stability of the disease (stable disease is also considered a significant response as per international guidelines)
  • Improved quality of life
  • Improved progression-free survival
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Pancreatic cancer

Management Team

Pancreatic cancer

Overview

Pancreatic cancer refers to malignancy that originates in the pancreas, a gland located behind the stomach that plays a key role in digestion and blood sugar regulation. The pancreas contains two main types of cells:

  • Exocrine cells (which make digestive enzymes).
  • Endocrine cells (which make hormones like insulin).

The most common type of pancreatic cancer arises from the exocrine cells, while cancers that arise from endocrine cells are much less common. Pancreatic cancer is often diagnosed at an advanced stage due to the lack of early symptoms, which makes it one of the most aggressive and deadly cancers. It is the fourth leading cause of cancer-related death globally, with a poor prognosis due to late diagnosis and limited treatment options.

  • Exocrine pancreatic cancer: This is the most common type of pancreatic cancer, accounting for approximately 95% of all cases. The primary form of exocrine pancreatic cancer is pancreatic ductal adenocarcinoma (PDAC).
    • Pancreatic ductal adenocarcinoma (PDAC): This cancer starts in the cells lining the ducts of the pancreas, which are responsible for secreting digestive enzymes into the small intestine. PDAC is often diagnosed when the tumour has spread to nearby organs and structures, which makes it difficult to treat effectively.
  • Endocrine pancreatic cancer (pancreatic neuroendocrine tumours or PanNETs): Pancreatic endocrine tumours (or pancreatic neuroendocrine tumours [PanNETs]) are much rarer and arise from the hormone-producing cells in the pancreas. These tumours may or may not produce hormones, and they can be benign or malignant.
    • Functional PanNETs: These tumours secrete hormones, such as insulin (insulinoma), gastrin (gastrinoma), glucagon, and others, leading to specific symptoms depending on the hormone secreted.
    • Non-functional PanNETs: These tumours do not secrete hormones and may only cause symptoms due to their size or location.

While PanNETs are less common and typically have a better prognosis than PDAC, they can still be aggressive and difficult to treat, especially if they are malignant and metastasise.

Several factors can increase the risk of developing pancreatic cancer. These include:

  • Age: Pancreatic cancer is most common in individuals aged 60 to 80.
  • Smoking: Cigarette smoking is one of the leading causes of pancreatic cancer.
  • Chronic pancreatitis: Long-term inflammation of the pancreas, often due to alcohol abuse or genetic conditions, increases the risk.
  • Family history: A family history of pancreatic cancer or certain inherited genetic syndromes (e.g., hereditary pancreatitis, BRCA1/BRCA2 mutations, Lynch syndrome, and Peutz-Jeghers syndrome) can increase the risk.
  • Diabetes: People with diabetes, particularly type 2 diabetes, are at an increased risk of developing pancreatic cancer.
  • Obesity: Excess body weight is associated with an increased risk of pancreatic cancer.
  • Diet: Diets high in red meat, processed foods, and low in fruits and vegetables may increase the risk.
  • Chronic infection with certain viruses: Hepatitis B and certain genetic conditions like cystic fibrosis can increase the risk of developing pancreatic cancer.

Pancreatic cancer often does not cause symptoms in its early stages, which is why it is often diagnosed late. When symptoms do appear, they can include:

  • Abdominal pain: Often in the upper abdomen or back, and may be worse after eating.
  • Jaundice: Yellowing of the skin and eyes, often associated with dark urine, pale stools, and itchy skin. This occurs if the tumour blocks the bile duct, which is responsible for draining bile from the liver to the small intestine.
  • Unexplained weight loss: This is common in many cancers, but particularly in pancreatic cancer due to loss of appetite and metabolic changes.
  • Digestive problems: Nausea, vomiting, and bloating due to blockage of the digestive tract or insufficient digestive enzyme production.
  • New-onset diabetes: This can occur, especially in older adults, as pancreatic cancer affects the insulin-producing cells in the pancreas.
  • Fatigue: Due to the cancer and metabolic changes, individuals may experience chronic fatigue.
  • Blood clots: In some cases, pancreatic cancer can lead to blood clot formation in the veins (deep vein thrombosis or DVT), which may be a sign of advanced disease.

Given that pancreatic cancer typically presents with vague symptoms, it is often diagnosed in advanced stages. However, several diagnostic methods are available:

  • Imaging studies:
    • CT: A CT scan of the abdomen is commonly used to assess the pancreas and surrounding structures, detect masses, and evaluate the extent of the cancer.
    • MRI (magnetic resonance imaging): MRI can provide detailed images of the pancreas and is sometimes used to evaluate tumours or suspicious lesions.
    • Endoscopic ultrasound (EUS): This is a highly sensitive technique used to detect small tumours and obtain tissue samples (biopsy) for diagnosis. EUS is also helpful in assessing nearby blood vessels and lymph nodes.
    • PET (positron emission tomography): A PET scan can detect areas of increased metabolic activity that are often seen in cancer cells and can help determine the extent of cancer spread (staging).
  • Endoscopic procedures:
    • Endoscopic retrograde cholangiopancreatography (ERCP): This procedure uses an endoscope to examine the bile and pancreatic ducts and can help detect blockages or tumours. A biopsy can be obtained during ERCP.
    • Biopsy: A tissue sample from the pancreas is often needed to confirm the diagnosis of pancreatic cancer. This may be done during an endoscopic ultrasound or ERCP.
  • Blood tests:
    • CA 19-9 test: This test is used to evaluate CA 19-9, a tumour marker whose levels can be elevated in pancreatic cancer. Importantly, it is not specific to the disease and can be elevated in other conditions, such as cholestasis or pancreatitis. It is used primarily to monitor treatment response or detect recurrence after treatment.

The treatment of pancreatic cancer depends on the stage of the disease, the location of the tumour, and the patient’s overall health. The main treatment options include:

  • Surgery:
    • Whipple procedure (pancreaticoduodenectomy): This is the most common surgery for locally resectable pancreatic cancer. It involves removing the head of the pancreas, the duodenum, a portion of the stomach, and sometimes the bile duct and lymph nodes.
    • Distal pancreatectomy: If the cancer is in the tail or body of the pancreas, the affected portion of the pancreas may be removed.
    • Total pancreatectomy: In some cases, the entire pancreas may need to be removed if the cancer involves a large portion of the organ.
  • Chemotherapy: Common chemotherapy regimens include FOLFIRINOX (a combination of fluorouracil (5-FU), oxaliplatin, irinotecan, and leucovorin) and gemcitabine. Chemotherapy may also be used to treat advanced pancreatic cancer when surgery is not an option.
    • Adjuvant chemotherapy (chemotherapy given after surgery) is often used to kill any remaining cancer cells and reduce the risk of recurrence.
    • Neoadjuvant chemotherapy (chemotherapy given before surgery) may be used to shrink the tumour to make it more amenable to surgical resection.
  • Radiation therapy: Radiation therapy can be used to shrink tumours, control pain, or help with symptoms such as obstruction of the bile duct. It may be combined with chemotherapy (chemoradiation) in some cases. It is more commonly used in locally advanced cases rather than metastatic disease.
  • Targeted therapy: Targeted therapy is a newer treatment approach that uses drugs to target specific molecules involved in the growth and spread of cancer. For example, erlotinib is sometimes used for pancreatic cancer that expresses certain mutations in the EGFR (epidermal growth factor receptor).
  • Immunotherapy: Immunotherapy, while still under investigation for pancreatic cancer, may hold promise for certain types of tumours with specific genetic mutations, such as those with high microsatellite instability (MSI-H) or PD-L1 expression.
  • Palliative care: For advanced pancreatic cancer where curative treatment is not possible, palliative care aims to improve quality of life and relieve symptoms. This can include pain management, nutritional support, and interventions to manage obstruction of the bile duct or stomach.
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Perfusion Scans (MAA) for Lung Shunts and Lung Quantification

Management Team

Perfusion Scans (MAA) for Lung Shunts and Lung Quantification

Overview

A Lung Perfusion scan is a diagnostic test used to evaluate blood flow (perfusion) to the lungs in specific situations and may be used to:

  • Assess lung function before lung surgery
  • Monitor lung function after treatment or surgery
  • Evaluate lung diseases such as chronic obstructive pulmonary disease (COPD) or emphysema
  • Quantify liver-lung shunts

  • Medications: Inform your doctor about all medications you are taking, including blood thinners or inhalers. You may be asked to stop certain medications before the scan.
  • Allergies: Notify your doctor if you have any allergies, especially to iodine, contrast agents, or medications.
  • Pregnancy and breastfeeding: If you are pregnant or breastfeeding, inform your doctor. 

  1. You will receive a small amount of radiopharmaceutical injection into a vein in your arm to evaluate blood flow through your lungs.
  2. The gamma camera will take more images of your lungs, and in some cases, images of your brain and abdomen will also be taken.
  3. This part takes about 15-30 minutes.

  • You will lie down on a table while the gamma camera takes pictures. The camera will move around your chest but will not touch you.
  • The procedure is generally painless, though you may feel a slight pinch from the injection.
  • The entire process usually takes 30-60 minutes.

  • You can resume normal activities immediately after the scan.
  • Drink plenty of fluids to help flush the radioactive tracer from your body.
  • The radioactive material will naturally leave your body within 24 hours.
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PSMA-targeted Therapy (Prostate-specific Membrane Antigen-targeted Therapy)

Management Team

PSMA-targeted Therapy (Prostate-specific Membrane Antigen-targeted Therapy)

Overview

PSMA-targeted therapy is a specialised radionuclide therapy primarily used for metastatic or advanced prostate cancer. This therapy uses radionuclides (commonly Lu-177, occasionally Ac-225) combined with a biomolecule that specifically targets the receptors on prostate cancer cells. Since PSMA radionuclide therapy is receptor-specific, it has fewer side effects than in conventional chemotherapy. PSMA therapy has been approved by the US-FDA (Food and Drug Administration) following the VISION Trial.

  • Patients are usually referred to a nuclear medicine physician for PSMA therapy when they have progressed on androgen deprivation drugs and taxane-based chemotherapy.
  • They can also be referred following progression to androgen drugs and are not candidates for taxane-based chemotherapy.

  • PSMA PET scan: to ascertain the target expression, sometimes in conjunction with FDG PET CT
  • Serum PSA
  • Performance status (ECOG)
  • Comprehensive blood work: including CBC, liver (LFT), and renal function tests (RFT)

  • Patient hydration is ensured, and IV hydration is provided if necessary.
  • Standard PSMA dosage is then slowly injected into the veins. The injection process usually takes just a few minutes.
  • PSMA-targeted therapy is usually an outpatient procedure. However, depending upon the local radiation guidelines, patient may be discharged the very next day.

PSMA radiolucent therapy is administered cyclically, usually 4-6 cycles depending upon the response following every cycle. Each cycle is administered with a gap of 6-8 weeks with multiple blood investigations, including the serum PSA and blood counts, to evaluate the treatment efficacy and side effects, if any.

The predominant benefit is symptomatic relief, translating to improved quality of life. Prostate cancer most commonly spreads to the skeleton and can cause bony pains; this can be optimally targeted by PSMA radioligand therapy. Most patients usually experience symptomatic relief in 2-4 weeks.

Some patients may experience dry mouth (xerostomia), dry eyes, fatigue, nausea, vomiting, loss of appetite, and transient reduction of blood counts, which usually recovers within a month.

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Parathyroid Scans

Management Team

Parathyroid Scans

Overview

A parathyroid sestamibi scan is a nuclear imaging test used to detect overactive parathyroid glands, which regulate the body’s calcium levels and are located behind the thyroid gland. This scan is especially useful for detecting hyperparathyroidism, a condition where one or more of these glands becomes overactive and produces too much hormone, causing elevated calcium levels.

Your doctor may recommend this scan for:

  • Locating parathyroid adenomas (benign tumours)
  • Diagnosing hyperparathyroidism
  • Evaluating parathyroid gland function before or after surgery

A small amount of a radioactive tracer called sestamibi is injected into a vein. The tracer is absorbed by overactive parathyroid glands. A gamma camera then captures images revealing which parathyroid gland(s) are overactive.

  • Fasting: not required
  • Medications: Inform your doctor about all medications you are taking, especially those that affect calcium levels. Some medications may need to be stopped temporarily before the scan.
  • Pregnancy and breastfeeding: Notify your doctor if you are pregnant, suspect you may be pregnant or are breastfeeding. This test is usually not recommended during pregnancy or while breastfeeding.

The parathyroid sestamibi scan typically involves three stages:

  1. You will receive an injection of the radioactive tracer (Tc99m) into a vein in your arm.
  2. After about 20 minutes, you will be asked to lie down on a table, and a gamma camera will capture images of your neck to visualise your thyroid. This takes about 15 minutes.
  3. Thereafter, you will receive a second injection of another radioactive tracer (sestamibi) into a vein in your arm.
  4. First Scan (Early Images): About 15 to 20 minutes after the injection, you will lie down on a table, and a gamma camera will take images of your neck and chest. This takes about 15 minutes.
  5. Second Scan (Delayed Images): After 1-3 hours, a second set of images will be taken to show how the parathyroid glands have absorbed the tracer. This scan also takes around 15 minutes.
  6. SPECT: At some point during the 1st and 2nd scans, a 3D rotational scan may also be performed to capture images of your neck and chest. This scan also takes around 30 minutes.

  • The injection may feel like a quick pinch, but the procedure itself is painless.
  • You will need to lie still during the scans to ensure clear images.
  • The entire process, including waiting periods between scans, may take between 4 to 5 hours. You may bring something to read or do during the waiting period.

  • You can resume normal activities right away unless directed otherwise.
  • The radioactive material used in the scan is minimal and will naturally leave your body within 24 hours. Drinking plenty of fluids will help flush it out.
  • If you are breastfeeding, ask your doctor if you need to take any precautions afterwards.

  • The amount of radioactive material used is minimal and generally leaves your system within 1 day, presenting low risk. However, as with any medical procedure, discuss any concerns or allergies with your healthcare provider.
  • Test should not be done in pregnant women.
  • Special precautions needed for lactating females
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Prostatic Urethral Lift

Management Team

Prostatic Urethral Lift

Overview

The prostate surrounds the urethra (the tube that carries urine out of the body), so when it is enlarged, it restricts the flow of urine out of the body. A prostatic urethral lift can relieve these symptoms. In this procedure, small implants are used to pull the prostate away from the urethra. It is also called a UroLift.

A prostatic urethral lift is used to relieve the symptoms of benign prostate enlargement or hyperplasia (BPE or BPH). It offers the following advantages:

  • It offers quick relief
  • You may no longer need a catheter
  • It reduces the risk of retrograde ejaculation, a condition in which semen travels into the bladder instead of through the penis during ejaculation
  • Recovery is faster and more comfortable than other surgical procedures

It is a minimally invasive procedure. The technique is relatively new, but it has shown good short- and medium-term results.

  • The procedure is an outpatient procedure that usually takes less than an hour
  • After the procedure, most patients will be able to go home on the same day and without a catheter
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Prostate Cancer

Management Team

Prostate Cancer

Overview

The Prostate Cancer Clinic at Sir H. N. Reliance Foundation Hospital is Mumbai’s first specialised centre for diagnosing and managing prostate-related diseases and cancer.

Our team of expert urologists and state-of-the-art technology offers advanced diagnosis, treatment, and rehabilitation under one roof, ensuring comprehensive care from prevention to post-surgery recovery. 

We also provide educational sessions to help men understand and manage prostate conditions confidently and without stigma. Our goal is to empower men to lead healthier, more comfortable lives while receiving world-class care for prostate-related concerns.

Location: Level 3, Tower Building

  • Our Services
  • Conditions We Treat

Our clinic provides a wide range of specialised services aimed at the management, diagnosis, and treatment of various prostate diseases.

  • Comprehensive diagnostic examinations:
    • Physical examinations of the prostate
    • Urine and blood tests
    • Imaging studies
  • Fusion Prostate biopsy: combines MRI and ultrasound imaging to target suspicious areas within the prostate gland for cancer detection
  • Robotic-assisted radical prostatectomy (RARP): A minimally invasive robotic system-guided surgical procedure to remove the entire prostate gland and the surrounding tissues; this procedure is associated with reduced pain, shorter durations of hospital stay, and quicker recovery.
  • Pre- and post-surgery care: Our team offers comprehensive care to patients before and after surgery, including assistance with pre- and post-surgery to-dos, precautionary measures, rehabilitation, nutrition, and well-being.
  • Educational consultations with urologists: Our team offers exclusive one-on-one sessions for our patients; these include the dissemination of information regarding various conditions and counselling sessions to help patients deal with the psychological issues associated with their condition.
  • Consultations with the multidisciplinary tumour board (MDTB) for multidisciplinary care: Our team ensures that complex cases are reviewed by the MDTB to ensure that a more accurate treatment plan may be followed.

Our clinic is equipped to diagnose, treat, and manage a wide variety of prostate disorders.

  • Prostate cancers
  • Benign prostatic hyperplasia: The non-cancerous enlargement of the prostate that is common with ageing; this causes trouble with urination and ejaculation.
  • Prostatitis: Inflammation of the prostate gland, causing pain while urination, groin pain, and discomfort in the genitals and/or pelvic region.
  • Prostate stones: Occurrence of mineral deposits (primarily calcium phosphate) in the prostate.
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Pericoronitis

Management Team

Pericoronitis

Overview

Pericoronitis refers to the inflammation of the gum tissues around the wisdom teeth, the last set of adult teeth that erupt; this usually happens during the late teens or early 20s. Typically, pericoronitis may occur when one or more wisdom teeth are still partially impacted (trapped) under the gum tissues. This condition is more likely to develop around the wisdom teeth in the lower jaw than in those in the upper jaw. Pericoronitis may be mild (lasting a few days) or severe (lasting several weeks).

Partial tooth impaction, i.e., the partial trapping of a tooth within the gums, which often results in the growth of bacteria and ultimately, infection and inflammation, is the main cause of pericoronitis.

The symptoms of acute pericoronitis symptoms may include:

  • Severe pain around the back teeth
  • Redness and swelling of the gums
  • Difficulty swallowing
  • Trismus (lockjaw, i.e., restricted mouth opening)
  • Facial swelling
  • Pus or drainage
  • Fever
  • Swollen lymph nodes in the neck

The symptoms of chronic pericoronitis may include:

  • Mild pain (often, temporary) near the back teeth
  • Halitosis (bad breath)
  • Dysgeusia (bad taste in the mouth)

The diagnosis involves the following:

  • Oral examination: The dentist reviews the medical history, symptoms, and presentation, examines the wisdom teeth, and checks for excess gum tissues.
  • Dental X-ray: The dentist may perform dental X-ray to rule out other conditions, such as tooth decay, and examine the health of the roots.

If patients develop pericoronitis-associated symptoms, such as bleeding gums, tooth pain, and related fever, they are advised to schedule a dentist appointment right away. The dentists often prescribe antibiotics to treat infections, if any, and ascertain the requirement for further treatments. If pericoronitis is not treated promptly, it may exert a domino effect, i.e., lead to the deterioration of oral and overall health.

The severity of the pericoronitis-associated inflammation influences the course of treatment recommended for each patient; the dentist may recommend normal or deep cleaning, treatment with antibiotics and/or antibacterial mouthwash, and in some cases, wisdom teeth removal.

  • Dental cleaning: The affected area is irrigated to wash out bacteria, food particles, or other debris. The use of antibiotics or an antibacterial mouthwash may also be recommended.
  • Antibiotics: Oral antibiotics may be prescribed to clear the pericoronitis-associated infection.
  • Pericoronitis mouthwash: A prescription mouthwash that contains chlorhexidine, a topical antiseptic, is recommended to kill harmful bacteria in the oral cavity.
  • Pericoronitis removal surgery: In many cases, removal of the gum flap (operculum), which is a short oral surgery procedure, is recommended; sedation during this procedure is often unnecessary. Typically, with local anaesthesia, this procedure is completed within an hour.
  • Wisdom tooth removal: If the wisdom teeth continue to cause problems or recurrent pericoronitis, removing them may be necessary. This procedure is often performed by an oral surgeon or periodontist with or without sedation.
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Periapical Lesions or Draining Sinus

Management Team

Periapical Lesions or Draining Sinus

Overview

A periapical tooth abscess refers to the formation of a pus-filled pocket of infection around the root of the tooth. The bacterial infection often spreads to the root of the tooth, resulting in inflammation4

The invasion of bacteria into the innermost part of the tooth, i.e., the dental pulp (which is rich in blood vessels, connective tissues, and nerves), can result in the formation of periapical abscesses; the bacterial cells often enter the pulp via a cavity or a chip/crack in the tooth and spread to the root, causing inflammation around the root tip (periapical tissue). At advanced stages, an abscess, which may sometimes drain into the oral cavity through a sinus, is formed. One is most likely to develop periapical abscess in the following scenarios:

  • The patient has poor oral hygiene
  • The patient suffers from dry mouth
  • The patient consumes a lot of sugary foods and drinks4

  • Severe throbbing toothache
  • Pain while chewing and biting
  • Pain radiating to the ears, neck, or jaw  
  • Halitosis, i.e., bad breath and/or bad taste in the mouth
  • Facial swelling
  • Fever

Periapical lesions are usually diagnosed using the following methods:

  • Physical examination: The dentist may examine the oral cavity to check for the following:
    • swellings in the gums
    • tenderness of tooth to percussion
    • presence of tooth cavity
    • swollen and tender lymph nodes
  • Dental X-ray: The infected tooth or swollen region is examined via X-ray imaging to confirm the presence of periapical abscess.

If patients experience any of the aforementioned symptoms (especially, when the symptoms are persistent), they are advised to contact their dentist as soon as possible.

In case of a periapical abscess, the tooth may require the following treatments: 

  • Root canal treatment: The infected tooth pulp is cleaned and filled with a filling material.
  • Tooth extraction or removal: In severe cases where the tooth cannot be salvaged, it might need to be extracted.
  • Medication: Supportive pain killer and antibiotics may also be prescribed.
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Patellar Tendonitis

Management Team

Patellar Tendonitis

Overview

The patellar tendon (patellar ligament) connects the knee cap (patella) to the top of the shin bone (tibia), along with the muscles at the front of the thigh. This tendon is responsible for knee extension. An injury or sprain to this tendon is known as patellar tendonitis. This condition is particularly prevalent among athletes engaged in sports that require frequent, intense physical activities; however, patellar tendonitis can also affect individuals who do not participate in sports. This disease has been reported to be more common among men than among women.

  • Intense physical activity: Such activities may stress the patellar tendon, causing this condition.
  • Tightness in leg muscles: Tightness of the quadriceps (thigh muscles) and hamstrings can increase the strain on the patellar tendon.
  • Muscle imbalances: Some muscles on the legs may be stronger than others, due to which the pull on the patellar tendon is uneven; this may result in patellar tendonitis.
  • Chronic health conditions: Kidney failure, certain metabolic conditions (diabetes), and/or autoimmune conditions (such as rheumatoid arthritis) may cause the blood flow to the knee to be impaired, weaking the patellar tendon.

  • Participation in professional sporting activities: These require the intense use of the knee joint (e.g., jumping, quick changes in direction, and sprinting)
  • Risky occupations: Physically demanding professions may increase the likelihood of developing this condition.
  • Ageing: Wear and tear of the knee joint with age may lead to this condition.

  • Discomfort, pain, tenderness, and swelling in the anterior (front) region of the knee, especially when climbing stairs or rising from a chair.
  • Occasional redness around the knee joint.

  • X-ray imaging: This is utilised to rule out other bone-related issues that could lead to knee pain.
  • Ultrasound: This can help orthopaedic doctors detect tears or bruises in the patellar tendon.
  • Magnetic resonance imaging (MRI): This can help accurately diagnose any continuity issues (such as tears in the tendon and injuries to adjacent structures).

Various treatment interventions for patellar tendonitis include:  

  • Stretching routines and sports physiotherapy
  • Muscle-strengthening exercises
  • Use of a patellar tendon support strap
  • Corticosteroid injections
  • Platelet-rich plasma (PRP therapy)
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