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Platelet-Rich Plasma vs. Cortisone Injectionsfor the Non-Surgical Treatment of Shoulder                   Pain            ...
Objective of Study• To evaluate the outcomes of platelet-rich plasma  (PRP) injections vs cortisone injections in  patient...
Introduction• In the literature, outcomes vary significantly in treating  shoulder pain non-surgically• Platelet-Rich Plas...
Study Design• Case-control study• Collection period: 1/09 – 12/11• Pain scores, ASES scores taken every week for 1  month,...
Study Design• All patients with shoulder pain• Inclusions:  – failed NSAID’s and physical therapy regimen• Exclusions:  – ...
PRP Technique• 10 cc autologous blood drawn• Using ACP system, blood spun for 5 minutes at 1500  RPM• Platelet Rich-Plasma...
Injection Technique• All injections done by the primary author under  ultrasound guidance
Patient DataStudy Group                  Control Group• 186 patients               • 299 patients• 85 male / 101 female   ...
Distribution of PathologyAdhesive Capsulitis                                                                       70     ...
All Patients               Pain Scores                       ASES Scores7.0                                       80.06.0 ...
All Patients                                        ROM 160.0 140.0 120.0 100.0                                           ...
Tendonopathy         Pain Scores                             ASES Scores8.0                                       90.07.0 ...
PASTA Lesions                  Pain Scores                           ASES Scores8.0                                       ...
Full RC Tears               Pain Scores                            ASES Scores  8.0                                       ...
Adhesive Capsulitis               Pain Scores                            ASES Scores  6.0                                 ...
Shoulder DJD               Pain Scores                            ASES Scores  7.0                                        ...
Discussion• Both PRP & Cortisone injections can help  relieve shoulder pain• BUT PRP improves pain & function  significant...
PRP – Superior to Cortisone       • Tendonopathy       • PASTA lesions
PRP & Cortisone – Similar Effects        • Adhesive capsulitis        • Full-thickness RCT’s        • DJD
Conclusion• PRP can help diminish pain and improve function and ROM in patients with specific shoulder pathologies more th...
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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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