Platelet-rich Plasma vs. Cortisone Injections for the Non-surgical Treatment of Shoulder Pain

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Presentation at Canadian Orthopaedic Association 2012 - Platelet-rich Plasma vs. Cortisone Injections for the Non-surgical Treatment of Shoulder Pain

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Platelet-rich Plasma vs. Cortisone Injections for the Non-surgical Treatment of Shoulder Pain

  1. 1. Platelet-Rich Plasma vs. Cortisone Injectionsfor the Non-Surgical Treatment of Shoulder Pain Alan M. Hirahara, M.D., FRCS(C) Private Practice Sacramento, CA USA Medical Director Team Physician ConsultantSacramento State Athletics Sacramento River Cats Oakland A’s MiLB - AAA
  2. 2. Objective of Study• To evaluate the outcomes of platelet-rich plasma (PRP) injections vs cortisone injections in patients with shoulder pain• To reduce the risks of treating patients with shoulder pain by using a safe, effective, non- surgical treatment of shoulder pain
  3. 3. Introduction• In the literature, outcomes vary significantly in treating shoulder pain non-surgically• Platelet-Rich Plasma (PRP) - Improved healing of soft tissues & bone• Cortisone carries risk of degeneration of tissue, AVN, inhibition of cell proliferation – PRP has not been shown to carry any risk
  4. 4. Study Design• Case-control study• Collection period: 1/09 – 12/11• Pain scores, ASES scores taken every week for 1 month, then every month for 6 months – ROM measured pre-injection / 4 wks post
  5. 5. Study Design• All patients with shoulder pain• Inclusions: – failed NSAID’s and physical therapy regimen• Exclusions: – any trauma post-injection – non-compliance with therapy protocol – blood dyscrasias
  6. 6. PRP Technique• 10 cc autologous blood drawn• Using ACP system, blood spun for 5 minutes at 1500 RPM• Platelet Rich-Plasma (PRP) collected
  7. 7. Injection Technique• All injections done by the primary author under ultrasound guidance
  8. 8. Patient DataStudy Group Control Group• 186 patients • 299 patients• 85 male / 101 female • 128 male / 171 female• Age range: 17 – 86 years • Age range: 22 – 90 years• Age average: 52.48 years • Age average: 54.09 years
  9. 9. Distribution of PathologyAdhesive Capsulitis 70 84 Biceps tendonitis 4 6 Ca tendonitis 13 7 DJD 19 39 Instability 4 5 pRCT 23 24 RCT 26 48 SLAP lesion 8 18 Tendonopathy 19 68 0 10 20 30 40 50 60 70 80 90 PRP Cortisone
  10. 10. All Patients Pain Scores ASES Scores7.0 80.06.0 70.05.0 60.04.0 50.03.0 40.02.0 30.0 20.01.0 10.00.0 0.0 Study Group Control Group Study n = 186 * p < 0.05 for Months 4 – 6 & 3 – 6 Control n = 299
  11. 11. All Patients ROM 160.0 140.0 120.0 100.0 Flexion - Study Flexion - Control 80.0 Abduction - Study Abduction - Control 60.0 External Rotation - Study External Rotation - Control 40.0 20.0 0.0 Pre-Injection 4 Weeks* No statistical significance between groups
  12. 12. Tendonopathy Pain Scores ASES Scores8.0 90.07.0 80.0 70.06.0 60.05.0 50.04.0 40.03.0 30.02.0 20.01.0 10.0 - - Study n = 19 * p < 0.05 for Mo 6 & Mo 1 – 3, 6 Control n = 68
  13. 13. PASTA Lesions Pain Scores ASES Scores8.0 80.07.0 70.06.0 60.05.0 50.04.0 40.03.0 30.0 20.02.0 10.01.0 - - Study n = 23 * p < 0.05 for Wk 3 - Mo 6 & Mo 1, 4 - 6 Control n = 24
  14. 14. Full RC Tears Pain Scores ASES Scores 8.0 80.0 7.0 70.0 6.0 60.0 5.0 50.0 4.0 40.0 3.0 30.0 20.0 2.0 10.0 1.0 - - Study n = 26* No statistical significance between groups Control n = 48
  15. 15. Adhesive Capsulitis Pain Scores ASES Scores 6.0 80.0 70.0 5.0 60.0 4.0 50.0 3.0 40.0 30.0 2.0 20.0 1.0 10.0 - - Study n = 70* No statistical significance between groups Control n = 84
  16. 16. Shoulder DJD Pain Scores ASES Scores 7.0 80.0 6.0 70.0 5.0 60.0 50.0 4.0 40.0 3.0 30.0 2.0 20.0 10.0 1.0 - - Study n = 19* No statistical significance between groups Control n = 39
  17. 17. Discussion• Both PRP & Cortisone injections can help relieve shoulder pain• BUT PRP improves pain & function significantly more
  18. 18. PRP – Superior to Cortisone • Tendonopathy • PASTA lesions
  19. 19. PRP & Cortisone – Similar Effects • Adhesive capsulitis • Full-thickness RCT’s • DJD
  20. 20. Conclusion• PRP can help diminish pain and improve function and ROM in patients with specific shoulder pathologies more than cortisone but with significantly less side-effects or risks• Randomized study needed to confirm results
  21. 21. Thank You!

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