Background & Aims
Rotator cuff (RC) tears are regarded as a common shoulder condition among the general population. Several factors are predisposing to the development of such tears. Old age, obesity, acute injury, genetic factors are among these causes. The diagnosis is confirmed by clinical examination and the available imaging modalities. Besides magnetic resonance imaging (MRI), ultrasonography (US) is frequently utilized to diagnose rotator cuff tears. Non-steroidal anti-inflammatory drugs (NSAIDS) and physical exercise are the first line of management. Despite the growing use of platelets rich plasma (PRP) in the treatment of various tendon injuries, only a small number of studies have examined its effectiveness in partial rotator cuff tears . In this prospective randomized controlled study, it is hypothesized that sub-acromial PRP injection may not be inferior than corticosteroid injection to improve the clinical and functional outcomes in patients with painful partial rotator cuff injury.
Methods
This trial was conducted in the period between August 2021 and November 2022 .Sixty patients were studied. Inclusion criteria were patients with symptomatic partial RC tears of both sexes, between the ages of 20 and 70 years scheduled for an ultrasound guided sub-acromial injections. Patients were randomly divided into two groups ; Steroid group where thirty patients received sub-acromial injection of 1 ml methylprednisolone +1 ml 0.5% bupivacaine +2.5 ml normal saline and PRP group where thirty patients received sub-acromial injection of 3 ml PRP + 0.5 ml of PRP activator (10% calcium gluconate) +1 ml 0.5% bupivacaine. Post injection pain relief was assessed by the visual analogue Score (VAS) and the shoulder function was assessed by the simple shoulder assessment Test is a questionnaire that consists of 12 items for assessing the function of the joint . The rate and timing of rotator cuff tears after injection as well as any complications related to the injections were recorded
Results
There were no significant differences between the two groups in terms of patient demographics, comorbidities, or the laterality. (p > 0.05) . The VAS score improved in the steroid group for 12 weeks after injection, while it continued to be lower than the basic score for four months after PRP injection. The VAS score was significantly lower in the steroid group than the PRP group at 2 weeks of follow-up (p < 0.001). It was significantly lower in PRP group at 12 weeks and 4 months follow-up (p < 0.001). A simple shoulder test showed that there was significant improvement in should function for short period up to 6 weeks after injection in steroid group but the functionality declined significantly at 4 month in comparison to baseline values. The shoulder function test was significantly better in the PRP group than the steroid group at 6, 8, and 12 weeks and 4 months of follow-up (P = 0.049, <0.001, <0.001, <0.001 respectively). No major complications were recorded in both groups .
Conclusions
Ultrasound guided Sub-acromial platelets rich plasma injection provided a prolonged
analgesic effect and superior shoulder functional improvement than ultrasound guided sub-acromial steroids injection in patients with symptomatic partial rotator cuff tears
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Presenting Author
Tarek Mohamed Ahmed Sarhan
Poster Authors
Topics
- Treatment/Management: Interventional Therapies – Injections/Blocks