A comparative analysis of pain reduction following a single intra-articular injection of platelet-rich plasma, steroid or normal saline in chronic external shoulder impingement syndrome

Authors

  • Mohit R. Shete Department of Orthopaedics, Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane, Maharashtra, India
  • Sanjay V. Popere Department of Orthopaedics, Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane, Maharashtra, India
  • Rushan Khan Department of Orthopaedics, Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane, Maharashtra, India
  • Abhay P. Kulkarni Department of Orthopaedics, Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane, Maharashtra, India
  • James John Department of Medical Services, SIRO Clinpharm Ltd., Thane, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20230024

Keywords:

Shoulder impingement, Shoulder pain, Platelet rich plasma, Periarthritis, Frozen shoulder, Adhesive capsulitis

Abstract

Background: Shoulder impingement is a common diagnosis for patients with pain and dysfunction of shoulder joint. Due to its chronicity of clinical manifestation of the impingement syndrome, there is a need to find new therapies that collaborate to improve pain management.

Methods: A hospital based descriptive, epidemiological study was conducted with 150 patients. The patients were divided in the following three groups of 50 patients each: Platelet-rich plasma (PRP) group: 50 patients received PRP, steroid group: 50 patients received steroid injection normal saline group: 50 patients received normal saline injection. Baseline visual analogue scale (VAS) score on overhead activities were recorded. After the 4th week, 12th week, and 24th week, patients were examined in the outpatient clinic. The main outcome measure was pain with overhead activities using a VAS.

Results: The VAS score improved significantly in PRP group and Steroid group compared to normal saline group at the 4th week, 12th-week and 24th-week follow-up periods post injection, as per ANOVA test (p<0.05).

Conclusions: PRP and steroids, both can be considered effective methods to treat pain in chronic shoulder impingement syndrome (SIS) and less invasive compared to surgical treatment. They improve the pain and hence shoulder function in chronic impingement syndrome.

References

Michener L, McClure P, Karduna A. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech (Bristol, Avon). 2003;18(5):369-79.

Neer C. 2nd Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972;54(1):41-50.

Davis D, Nickerson M, Varacallo M. StatPearls. StatPearls Publishing; Treasure Island (FL). 2020.

Consigliere P, Haddo O, Levy O, Sforza G. Subacromial impingement syndrome: management challenges. Orthop Res Rev. 2018;10:83-91.

Garving C, Jakob S, Bauer I, Nadjar R, Brunner U. Impingement Syndrome of the Shoulder. Dtsch Arztebl Int. 2017;114(45):765-76.

Kon E, Filardo G, Delcogliano M, Presti M, Russo A, Bondi A et al. Platelet-rich plasma: new clinical application: a pilot study for treatment of jumper's knee. Injury. 2009;40:598-603.

De Vos R, Weir A, van Schie H, Bierma-Zeinstra S, Verhaar J, Weinans H et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010;303:144-9.

Dhurat R, Sukesh M. Principles and Methods of Preparation of Platelet-Rich Plasma: A Review and Author's Perspective. J Cutan Aesthet Surg. 2014;7:189-97.

Arnoczky S, Sheibani-Rad S. The basic science of platelet-rich plasma (PRP): what clinicians need to know. Sports Med Arthrosc Rev. 2013;21:180-5.

Lewis J. Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment? Br J Sports Med. 2009;43:259-64.

Rees J, Maffulli N, Cook J. Management of tendinopathy. Am J Sports Med. 2009;37:1855-67.

Bhattacharyya R, Edwards K, Wallace A. Does arthroscopic sub-acromial decompression really work for sub-acromial impingement syndrome: a cohort study. BMC Musculoskelet Disord. 2014;15:1-7.

Eppley B, Woodell J, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg. 2004;114:1502-8.

Pasin T, Ataoglu S, Pasin O, Ankarali H. Comparison of the Effectiveness of Platelet- Rich Plasma, Corticosteroid, and Physical Therapy in Subacromial Impingement Syndrome. Arch Rheumatol. 2019;34(3):308-16.

Mahajan A. Clinical and Functional Outcome Comparison for Platelet‑Rich Plasma with Steroid Injection in Patients with Isolated SubAcromial Impingement Syndrome. J OrthopTraumatol Rehabil. 2019;11:79-83.

El Gharbawy N, Labib H. Role of Platelet Rich Plasma (PRP) injection in treatment of rotator cuff tear. Egypt Rheumatol Rehabil. 2020;47:30.

De Mos M, Van der Windt A, Jahr H, Van Schie H, Weinans H, Verhaar J et al. Can platelet‑rich plasma enhance tendon repair? A cell culture study. Am J Sports Med. 2008;36:1171-8.

Šmíd P, Hart R, Komzák M, Paša L, Puskeiler M. Léčba impingement syndrome ramena pomocí injekce PRP [Treatment of the Shoulder Impingement Syndrome with PRP Injection]. Acta Chir Orthop Traumatol Cech. 2018;85(4):261-5.

Wang C, Zhang Z, Ma Y, Liu X, Zhu Q. Platelet-rich plasma injection vs corticosteroid injection for conservative treatment of rotator cuff lesions: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2021;100(7):e24680.

Hamid AM, Sazlina S. Platelet-rich plasma for rotator cuff tendinopathy: A systematic review and meta-analysis. PloS one. 2021;16(5):e0251111.

Shams A, El-Sayed M, Gamal O, Ewes W. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Eur J Orthopaed Surg Traumatol. 2016;26(8):837-42.

Say F, Gürler D, Bülbül M. Platelet-rich plasma versus steroid injection for subacromial impingement syndrome. J Orthop Surg. 2016;24(1):62-6.

Downloads

Published

2023-01-16

Issue

Section

Original Research Articles