The objective of this study was to evaluate the effectiveness of platelet-rich plasma (PRP) injections on shoulder pain, performed under ultrasound guidance

1. Platelet-Rich Plasma Injection for Non-Surgical Treatment of Shoulder Pain
Alan M Hirahara MD FRCSC
Private Practice, Sacramento, CA
INTRODUCTION STUDY RESULTS
• Variable success reported for conservative management of shoulder pain [1]. Pain Scores - All Patients ASES Scores - All Patients ROM - All Patients
160.0
• Meta-analysis of corticosteroid injections appears helpful for shoulder pain [2].
7.0 80.0
140.0
6.0 70.0
60.0 120.0
• Platelet-Rich Plasma (PRP) – Improved healing of soft tissues & bone [3].
5.0
50.0 100.0
4.0
40.0 80.0
3.0
30.0
STUDY DESIGN
60.0
2.0
20.0
40.0
1.0 10.0 p = .005 p = .004 p = .001
• Case Series analysis of 95 patients, collected 1/09 – 1/10 0.0 0.0
20.0
.018 .008 .0003
p = <0.0001
0.0 .001 .004 .004
• Same surgeon, same therapy group
Pre-Injection 1 Week 2 Weeks 3 Weeks 4 Weeks
Green bars indicate statistical significance Green bars indicate statistical significance Flexion Abduction External Rotation
• Inclusions: Patients with shoulder pain, failing NSAID’s & physical therapy Statistically significant:
• Exclusions: Any post-op trauma or non-compliance with therapy protocol - Improved pain scores by day 2 / Improved ASES scores by day 4 / Improved ROM by week 1
• Did not exclude patients for previously having corticosteroids or surgery
Pain Scores - Adhesive Capsulitis Pain Scores – Partial RC Tears Pain Scores - Tendonopathy
PREPARATION / INJECTION OF PRP* 7.0 7.0 8.0
7.0
6.0 6.0
6.0
5.0 5.0
5.0
4.0 4.0
4.0
10 ml blood from patient 3.0 3.0
3.0
2.0 2.0
2.0
1.0 1.0 1.0
- - -
Green bars indicate statistical significance n = 35 n = 19 Green bars indicate statistical significance n = 18
Green bars indicate statistical significance
Blood centrifuged for 5 minutes using a Pain Scores - DJD Went on to surgery: Pain Scores - RC Tears
platelet concentration system* 8.0 7.0
7.0 - AC: 12 / 35 (34%) 6.0
6.0 5.0
5.0
4.0
- Tendonopathy: 6 / 18 (33%) 4.0
3.0
- RCT: 3 / 12 (25%)
3.0
2.0
2.0
Injection of PRP under Ultrasound# 1.0
- pRCT, DJD: 0 / 27 (0%)
1.0
guidance - -
Green bars indicate statistical significance n=8 - Overall: 23 / 95 (24%) Green bars indicate statistical significance n = 12
CONCLUSIONS
PATIENT DEMOGRAPHICS
• PRP injections for shoulder pain:
• 95 patients
• Reduces pain & improves function (esp. adhesive
• 40 male (42%), 55 female capsulitis & tendonopathy) REFERENCES
• Age range: 19 – 86 years 1. Dorrestijn O. et al. JBJS-A. 2010 92(2): 474.
• Helps pRCT’s & DJD initially then pain returns
• Age average: 54.03 years 2. Arroll, B. et al. Br J Gen Pract. 2005 55(513): 314.
• Less effective for full-thickness rotator cuff tears 3. Marx, R. J Oral Maxfac Surgery 2004;62:489-96.
* Autologous Conditioned PlasmaTM , Arthrex Inc.
• Only resulted in 24% of patients needing surgery # M-Turbo, SonoSite Inc.