Abstract
BackgroundStudies evaluating the role of both corticosteroids and platelet-rich plasma (PRP) in the treatment of rotator cuff (RC) tendinopathies have been contradicting.We compared structural and clinical changes in RC muscles after corticosteroids and PRP injections.MethodsThis is a randomized double-blind clinical trial. All individuals with diagnosis of RC tendinitis during 2014–2017 were considered. Individuals were randomly allocated to either receive PRP or corticosteroids.Overall, 3cc of PRP was injected within the subacromial joint and another 3cc was injected at the site of the tendon tear, under the guide of sonography. For the corticosteroid group, 1cc of Depo-medrol 40mg and 1cc of lidocaine (2%) was injected within the subacromial joint.ResultsOverall, 58 patients entered the study. Comparison of pain, range of motion (ROM), Western Ontario RC (WORC), Disability of Arm-Hand-Shoulder (DASH) scores, and supraspinatus thickness showed significant improvement during follow-ups in both groups (p<0.05).During 3 months of follow-up, pain improvement was significantly better within the PRP group during (from 6.66±2.26 to 3.08±2.14 and 5.53±1.80 to 3.88±1.99, respectively; p=0.023). Regarding ROM, the PRP group had significant improvement in adduction (20.50°±8.23° to 28°±3.61° and 23.21°±7.09° to 28.46°±4.18° for the PRP and corticosteroid groups, respectively; p=0.011) and external rotation (59.66°±23.81° to 76.66°±18.30° and 57.14°±24.69° to 65.57°±26.39°, for the PRP and corticosteroid groups, respectively; p=0.036) compared to the corticosteroid group.ConclusionWe found that PRP renders similar results to that of corticosteroids in most clinical aspects among patients with RC tendinopathies; however, pain and ROM may show more significant improvement with the use of PRP. Considering that the use of corticosteroids may be contraindicated in some patients and may be associated with the risk of tendon rupture, we suggest the use of PRP in place of corticosteroid-based injections among patients with RC tendinopathy.Trial registrationClinical trial registration code: IRCT201302174251N9
Highlights
Shoulder pain is among the most common complaints in medicine and disorders attributed to the rotator cuff (RC) are the most common cause of shoulder pains [1]
Comparison of the two groups showed that changes in pain was significantly higher within the platelet-rich plasma (PRP) group compared to the corticosteroid group during the 3-month follow-up period
The two groups did not show any difference in improvement of other measures of range of motion (ROM), Western Ontario RC (WORC) score, Disability of Arm-Hand-Shoulder (DASH) score, and supraspinatus thickness during the follow-up period (p > 0.05) (Table 2)
Summary
Shoulder pain is among the most common complaints in medicine and disorders attributed to the RC are the most common cause of shoulder pains [1]. More than 50% of all shoulder pains are considered to be that related to tendinopathies of the RC, as supraspinatus incomplete thickness tears and tendinosis [2]. In clinical assessment of RC tendinopathies, rehabilitation time can be lengthy as the healing ability of tendons is limited; treatment modalities have been introduced that focus on the potential to induce more rapid healing. Physical rehabilitation, rest, and nonsteroidal anti-inflammatory drugs (NSAIDs) are considered for a patient with RC tendinopathy as the first line of treatment [3, 4]. Corticosteroids have been more effective during the acute phase of tendinitis, they have been associated with risks of tendon tear and may inhibit collagen synthesis [5, 6]. We compared structural and clinical changes in RC muscles after corticosteroids and PRP injections
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