Abstract
BackgroundRotator cuff tendinopathy (RCT) is a leading cause of shoulder pain and disability. Management is mainly conservative, but the limited ability of tendons to regenerate is the main cause of unsatisfactory results. So, we conducted our study to compare the efficacy of deep prolotherapy (glucose 25%), platelet-rich plasma (PRP), and betamethasone corticosteroid for treatment of RCT to find the most effective one based on clinical, functional, and radiological assessment.ResultsRegarding visual analog scale (VAS), it was significantly (p < 0.001) improved after injection among group 1 (prolotherapy group) and group 3 (steroid group) patients, while no significant improvement was noted among group 2 (PRP group) (p = 0.212) patients. The Western Ontario Rotator Cuff (WORC) Index significantly improved among the studied groups (p < 0.001, p = 0.049, and p < 0.001, respectively) after injection. Regarding the range of motion (ROM), a significant improvement (p = 0.029) was achieved in group 1 after injection but no significant improvements were noted among group 2 and 3 patients (p = 0.529 and 0.121, respectively). There was a significant improvement among group 1 and 2 patients (p < 0.001 and p = 0.020, respectively) regarding the grade of tendon lesions but no improvement occurred among group 3 patients (p = 0.470).ConclusionProlotherapy injections improve shoulder ROM, VAS, WORC index, and rotator cuff tendon healing while PRP injections improve WORC index and tendon healing but steroid injection has no effect on healing.Trial registrationPACTR202005610509496. Retrospective registration on May 25, 2020, Pan African Clinical Trial Registry.
Highlights
Rotator cuff tendinopathy (RCT) is a leading cause of shoulder pain and disability
Three months post-injection, there was a significant improvement (p = 0.029) in range of motion (ROM) of group 1 but no improvement was detected in group 2 or 3 (p = 0.529 and 0.121, respectively), with one of the patients in group 2 became worse and had ROM limitations in all directions (Table 2)
Among group 2 patients, significant (p = 0.049 and p = 0.020) improvement of Western Ontario Rotator Cuff (WORC) index and tendon lesions, respectively, with no improvements noticed regarding other parameters used. This may be related to the beneficial effects of platelet-rich plasma (PRP) on the healing process attributed to bone morphogenetic proteins, transforming growth factor β (TGF) and FGFs [14], which proved to promote tendon cell proliferation, collagen synthesis, and vascularization in vitro and in vivo [15]. This agreed with Kesikburun and his colleague [1] and Carr et al [16] who state that no difference in clinical outcomes in patients who received PRP injection for RCT compared to controls
Summary
Rotator cuff tendinopathy (RCT) is a leading cause of shoulder pain and disability. Management is mainly conservative, but the limited ability of tendons to regenerate is the main cause of unsatisfactory results. Rotator cuff tendinopathy (RCT) or rotator cuff disease (RCD) is a leading cause of shoulder pain and a significant source of disability and loss of work. It is a common disorder, and its prevalence increases with age and with occupations involving overhead activities [1]. Tendon healing is unsatisfactory with the resultant tendinosis which progresses to partial tear full-thickness tear. RCT can be diagnosed by musculoskeletal ultrasound (MSUS) as it is rapid, inexpensive, non-invasive, has virtually no side effects and allows the rotator cuff to be visualized dynamically [3].
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