Corticosteroids or platelet-rich plasma injections for rotator cuff tendinopathy: a randomized clinical trial study

Abstract

Background Studies evaluating the role of both corticosteroids and platelet-rich plasma (PRP) in the treatment of rotator cuff (RC) tendinopathies have been contradicting. We compared structural and clinical changes in RC muscles after corticosteroids and PRP injections. Methods This is a randomized double-blind clinical trial. All individuals with diagnosis of RC tendinitis during 2014–2017 were considered. Individuals were randomly allocated to either receive PRP or corticosteroids. Overall, 3cc of PRP was injected within the subacromial joint and another 3cc was injected at the site of the tendon tear, under the guide of sonography. For the corticosteroid group, 1cc of Depo-medrol 40mg and 1cc of lidocaine (2%) was injected within the subacromial joint. Results Overall, 58 patients entered the study. Comparison of pain, range of motion (ROM), Western Ontario RC (WORC), Disability of Arm-Hand-Shoulder (DASH) scores, and supraspinatus thickness showed significant improvement during follow-ups in both groups (p<0.05). During 3 months of follow-up, pain improvement was significantly better within the PRP group during (from 6.66±2.26 to 3.08±2.14 and 5.53±1.80 to 3.88±1.99, respectively; p=0.023). Regarding ROM, the PRP group had significant improvement in adduction (20.50°±8.23° to 28°±3.61° and 23.21°±7.09° to 28.46°±4.18° for the PRP and corticosteroid groups, respectively; p=0.011) and external rotation (59.66°±23.81° to 76.66°±18.30° and 57.14°±24.69° to 65.57°±26.39°, for the PRP and corticosteroid groups, respectively; p=0.036) compared to the corticosteroid group. Conclusion We found that PRP renders similar results to that of corticosteroids in most clinical aspects among patients with RC tendinopathies; however, pain and ROM may show more significant improvement with the use of PRP. Considering that the use of corticosteroids may be contraindicated in some patients and may be associated with the risk of tendon rupture, we suggest the use of PRP in place of corticosteroid-based injections among patients with RC tendinopathy. Trial registration Clinical trial registration code: IRCT201302174251N9

Platelet‐rich plasma versus corticosteroid injections in the management of patients with rotator cuff disease: A systematic review and meta‐analysis

“…The baseline VAS scores along with their change from base‐line can be found in Table 4 . At short‐ and intermediate‐term follow‐up, the change from baseline was comparable between the CS and PRP groups and no difference was observed (short‐term: MD = −0.30, 95% CI: −1.40, 0.08; p = 0.59; I 2 = 89% 12 , 26 , 28 , 32 , 34 ) (Intermediate‐term: MD = 0.28, 95% CI: −0.71, 1.28; p = 0.58; I 2 = 84% 26 , 27 , 28 , 31 , 32 ). At medium‐term follow‐up, no difference in the change of VAS score from base‐line was observed between the PRP and CS groups (MD = 0.39, 95% CI: −1.84, 2.62; p = 0.73; I 2 = 97% 12 , 28 , 32 , 34 ).…”

“…DASH score was reported in four studies 25,26,28,30 (Figure 5). At the short-term follow-up, there exists a difference between the two cohorts such that the change from baseline was higher in the 0.67, 6.15; p = 0.01; I 2 = 0% 25,26,28,30 ).…”

“…DASH score was reported in four studies 25,26,28,30 (Figure 5). At the short-term follow-up, there exists a difference between the two cohorts such that the change from baseline was higher in the 0.67, 6.15; p = 0.01; I 2 = 0% 25,26,28,30 ). During medium-term follow-up, the mean change from baseline was comparable between the two groups with no difference (MD = 0.95, 95% CI: −4.88, 6.79; p = 0.75; I 2 = 80% 28,28 ).…”

The use of platelet-rich plasma in management of musculoskeletal pain: a narrative review

“…More than 50% of all shoulder pain cases are considered to be related to tendinopathies of the rotator cuff (RC), such as tendinosis and incomplete thickness tears of the supraspinatus [ 81 ]. In the management of RC tendinopathy, physical rehabilitation, rest, and nonsteroidal anti-inflammatory drugs are considered conventional treatments; however, the best treatment is still inconclusive [ 83 , 84 ].…”

Platelet-Rich Plasma Injection in Non-Operative Treatment of Partial-Thickness Rotator Cuff Tears: A Systematic Review and Meta-Analysis

“…A total of 641 patients were included (318 patients in the PRP group and 323 in the control group). The control groups in the included studies were as follows: 3 studies used placebo (saline or dry needle) (20)(21)(22); and 8 used conservative treatments (corticosteroids injection or physical therapy) (23)(24)(25)(26)(27)(28)(29)(30). Ten studies prepared PRP via centrifugation.…”