Prp injection in shoulder pain

1. THE ROLE OF PLATELET RICH PLASMA IN ROTATOR CUFF
TENDINOPATHY AND TEARS
NAME:- DR.T.VAISHNAVI
FIRSTYEARRESIDENT
DEPARTMENT OFORTHOPAEDICS
GUIDE:- DR.HARANADH
PROFESSOR
DEPARTMENT OFORTHOPAEDICS
COGUIDE:- DR.VENKATKISHAN
PROFESSOR
DEPARTMENTOFRADIOLOGY

2. AIM
• To study the role of platelet rich plasma in the management of rotator cuff
tendinopathy and tears
OBJECTIVES
• To evaluate the response of the patients to dual injection PRP[platlet rich plasma] as a treatment
modality in rotator cuff tendinopathy and tears.
• To estimate the efficacy of dual injection PRP[platlet rich plasma] for the treatment of patients with
rotator cuff tendinopathy and tears.

3. INTRODUCTION
• Shoulder pain affects up to 67% of the population at some point in
one’s lifespan 1.
• Common diagnoses implicated in the etiology of shoulder pain include impingement
syndromes (e.g-subacromial and subcoracoid),osteoarthrosis, labral tears, and soft
tissue pathologies of the rotator cuff such as tendinopathy of the various diagnosis
attributed to shoulder pain1.
• It has been estimated that approximately 65% of individuals present with some form
of rotator cuff pathology (e.g-tendinopathy and tear), with the supraspinatus and
infraspinatus most often affected 2.

4. • Tendinopathy is a collective term used to describe pathology within, and pain arising from,
the tendon itself. In the shoulder, PRP has been used for treatment of rotator cuff tendinitis
or partial thickness rotator cuff (PTRC) tears in a number of studies and has shown
improvement in symptoms compared to steroids, physical therapy, hyaluronic acid and
placebo controls3,4,5,6,7,8,9,10 .

5. METHODOLOGY
• PLACE OF STUDY: DEPARTMENT OF ORTHOPAEDICS KAMINENI INSTITUTE OF MEDICAL
SCIENCES,NARKETPALLY
• TYPE OF STUDY: Prospective study
• SAMPLE SIZE: 100 patients.
• STUDY DURATION :April 2023 to MARCH 2025
• The study will be conducted after approval by the Ethics Committee of Kamineni Institute Of Medical
Sciences , Narketpally.
• All patients satisfying the inclusion criteria will be enrolled in the study.
• A written informed consent will be taken from the patients prior to start of the study.

6. • Dual PRP injection is offered to all patients who have rotator cuff tendinopathy and tears.
• Rotator cuff tendinopathy and tears are evaluated by clinical and radiological examination in each
case.
• The clinical examinations and rotator cuff tendinopathy and tears are diagnosed based on shoulder
pain, a positive NEER and Hawkins sign, and increased pain with elevation of the arm.
INVESTIGATIONS
• Xray Shoulder- Anteroposterior view , axillary view Grashey(True AP) and Y view
• Ultrasonography(USG) of Shoulder

7. Based on the USG results, patients are divided into 4 groups:
• NORMAL TENDON: The tendon has a normal homogenous appearance throughout, and where it
inserts onto the greater tuberosity there is no abnormal reaction-taking place on the bone side.
• ABNORMAL TENDON: The tendon may appear abnormal with loss of the homogenous appearance
or appear abnormally thin. There is an abnormal tendon enthesis, which is clearly visualized as a
ragged greater tuberosity. Fluid may be present in the bursa.
• PARTIAL-THICKNESS TEAR:A lucent patch is visualized in the tendon either on the articular or
bursal surface, but there are continuous tendon fibers inserting into the greater tuberosity. In all cases
an abnormal tendon enthesis was observed (even in those with bursal sided tears). Fluid is often seen
in the bursa.

8. • FULL-THICKNESS TEAR: A lucent patch is visualized running through the full-thickness of
the tendon. The width of this in the sagittal plane is the tear size. This is associated with a
concavity in the bursal surface, which is either directly visualized or becomes apparent
with pressure from the probe. The tendon enthesis is abnormal and there is fluid in the
bursa. In larger tears no tendon is often visible. The surface of the greater tuberosity is
abnormal and a heterogenous substance fills the space left by the tendon. In smaller
tears a tendon edge may be visible in the longitudinal plane and this measurement is the
degree of retraction.

9. Table 1 Patient Demographics
DERMOGRAPHICS All patients Normal Abnormal
tendon
Partial
thickness
tear
Full
Thickness
tear
Total
Male
Female
Mean age

10. Prior to injection Quick Disabilities of the Arm, Shoulder, and Hand (QDASH)
assessment and Pain Visual Analog Scale (VAS) scores were obtained on all
patients.

12. PLATELET RICH PLASMA PREPARATION
• 20ML of blood was drawn from each Patient and processed
through a double Spin technique to create 2 doses 5 ML of PRP.
• PRP is injected in 2 separate locations at the time of treatment.
• The first injection is injected into the bursal surface of supraspinatus tendon.
• The second injection is injected with the patient in prone position into the glenohumeral
intra-articular space under the supraspinatus tendon just proximal to the superior equator
of the humeral head

14. The first injection is into the supraspinatus tendon
insertion critical zone and bursal area with the
patient seated.
The second injection is into glenohumeral intra
articular space under the supraspinatous
tendon at or just proximal to the superior
equator o the head with patient in prone
position

15. After treatment, patients are advised to limit activity for one week, and to use topical ice
and acetaminophen as needed. After one week, patients were counselled to resume
normal activities and has to follow these:
1. Avoidance of non-steroidal anti-inflammatory medication (NSAIDs) since there is
evidence that NSAIDs, both Cox 1 and 2, interfere with rotator cuff healing [14, 15].
2. Avoidance of corticosteroid injection into the shoulder, because corticosteroids can
cause tendon damage [16–18].
3. Avoidance of all activities that cause pain for one week, followed by gradual increase in
activity.
4. Avoidance of other analgesics including topical liniments, ice, kinesiotape, and oral
analgesics, which can accelerate damage by masking pain and allowing greater use.

16. Clinical outcome and pain are to be evaluated using patient completed Q-DASH
assessment and VAS at 6 months, 12 months and 18 months after treatment.
A global assessment of combined pain and functional improvement will be performed by
asking patients the percent improvement from before treatment to the follow up point.
Patients who described at least a 30 % improvement will be considered to have a
significantly improved outcome.
Statistical analysis will be performed using comparison of means between the pre-
treatment VAS and QDASH scores and scores at 6 months,12 months and 18 months.
Similar analysis will be performed for scores in each of the subgroups and for the change in
global scores between subgroups.

17. INCLUSION CRITERIA:
1. USG report showing Tendinopathy and Tears.
2. USG report showing Partial thickness tear.
3. Patients who have given consent for PRP injection.
4. Patient age > 40 years

18. EXCLUSION CRITERIA
• Patients who had surgery or other treatment in the six months prior to the
PRP injection
• Patients with significant shoulder tendinopathy and tears, such as severe
arthritis.

19. PROFORMA
AGE:
SEX:
CHIEF COMPLAINT:
HISTORY O PRESENT ILLNESS:
PAST HISTORY:
PERSONAL HISTORY:
FAMILY HISTORY:
GENERAL EXAMINATION:
LOCAL EXAMINATION: Inspection-abnormal swelling and deformity,attitude,overlying skin
Palpation-local rise of temperature,tenderness,crepitus,
Range of movements-
Neck examination-
Distal neurovascular deficiency
SYSTEMIC EXAMINATION:

20. I/We, the relative of the patient have read and understood the information
provided in the “patient information sheet” and have been informed and
explained the purpose and nature of the evaluation in the language I
understand.
I am aware of the fact that I may not derive any benefit from the evaluation
and that I reserve the right to opt out of the study at any point of time.
I am willingly agree to participate in this study
Patient’s sign/thumb impression witness’s sign/thumb
impression
Name: Name:
Date: Date:
CONSENT

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of imaged pathology and response to guided diagnostic blocks. BMC Musculoskelet Disord 2011;12: 119,.
3. Cai YU, Sun Z, Liao B, Song Z, Xiao T, Zhu P. Sodium Hyaluronate and Platelet-Rich Plasma for Partial-Thickness Rotator
Cuff Tears. Med Sci Sports Exerc. 2019;51(2):227–33.
4. Ilhanli I, Guder N, Gul M. Platelet-Rich Plasma Treatment With Physical Therapy in Chronic Partial Supraspinatus Tears.
Iran Red Crescent Med J. 2015;17(9):e23732.
5. Jo CH, Lee SY, Yoon KS, Oh S, Shin S. Allogenic Pure Platelet-Rich Plasma Therapy for Rotator Cuff Disease: A Bench and
Bed Study. Am J Sports Med. 2018;46(13):3142–54.
6. Kesikburun S, Tan AK, Yilmaz B, Yaşar E, Yazicioğlu K. Platelet-rich plasma injections in the treatment of chronic rotator
cuff tendinopathy: a randomized controlled trial with 1-year follow-up. Am J Sports Med. 2013; 41(11):2609–16.
7. Mautner K, Colberg RE, Malanga G, Borg-Stein JP, Harmon KG, Dharamsi AS, et al. Outcomes after ultrasound-guided
platelet-rich plasma injections for chronic tendinopathy: a multicenter, retrospective review. Pm r. 2013;5(3): 169–75.
REFERENCE

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24. THANK YOU