Shoulder Disorders
Shoulder disorders are commonly seen in general practice. There are several different shoulder disorders but approximately half of these are accounted for by shoulder impingement syndrome.
This syndrome is a common cause of shoulder pain, which is caused by a tendon rubbing or catching on nearby structures or bone when the arm is lifted. It can affect the rotator cuff. The condition may improve in a few weeks, or it can become a chronic problem. Other symptoms include sleep disruption due to pain and arm weakness (https://www.nhs.uk/conditions/shoulder-impingement-syndrome/).
Shoulder impingement syndrome involves inflammation and degeneration of shoulder structures. Causes include stress-induced spurs on the underside of the acromion (outer tip of the shoulder blade), shoulder joint spurs, joint dysfunction, and dysfunction due to diabetes, aging, or steroid injections.
This syndrome is traditionally treated non-surgically with non-steroidal anti-inflammatory medications, physical therapy, and corticosteroid injections. Surgical treatment is an option if conservative methods fail. Other, modern treatment approaches include platelet-rich plasma (PRP) and prolotherapy injections.
PRP Described
PRP uses the patient’s own blood which is spun in a centrifuge to separate the blood components into layers. The bioactive platelet layer has high concentrations of growth factors that stimulate healing in the injured tissue by increasing collagen synthesis, stimulating a new blood supply, and promoting proliferation of stem cells into tissue-specific cells.
The Study
Twenty-one shoulders in twenty patients with confirmed shoulder impingement syndrome that failed traditional treatment were included in this study. A double-spin centrifuge method, which results in a higher concentration of platelets, was used to prepare PRP.
A single injection of 2 mL was given to each shoulder. The injectate was directed just below the mid-lateral acromion and into the subacromial-subdeltoid bursa under ultrasound guidance. Local anesthesia was not used. Care was taken to avoid the tendon and rotator cuff.
Post-procedure, patients were instructed to avoid high-impact activity for a week and perform gentle shoulder pendulum and range of motion exercises. This was followed by rotator cuff strengthening exercises. Patients were followed up at six and twelve weeks.
Results
At baseline, the patients’ average pain rating was 5.1 (presumably on a ten-point scale). Three months post-injection, pain was significantly lessened as reflected by a pain rating of 3.3 on the visual analog scale.
• Seven patients experienced improved forward flexion of the shoulder by greater than 30 degrees.
• Thirteen showed a range of 10-to-30-degree improvement.
• One patient improved less than 10 degrees flexion.
A similar pattern was observed in improved abduction. There was no improvement in internal rotation in five patients. Seven patients were able to reach their 3rd vertebra, and another seven were able to reach their 4th vertebra.
Overall, there was significant improvement in range of motion three months after injection.
Summary
This study demonstrates the effectiveness of a single injection of PRP combined with a post-procedure exercise protocol on shoulder impingement syndrome. There were significant improvements in pain, range of motion, and functional outcomes. No side effects were documented.
Reference
Saurav S, Aggarwal AN, Shahi P, et al. (2022). Efficacy of single injection of Platelet-Rich Plasma in shoulder impingement syndrome. Cureus. 7;14(6):e25727. doi: 10.7759/cureus.25727. PMID: 35812631; PMCID: PMC9270084.
