By Daniel Howard, MD
“Why does my shoulder hurt?” is one of the most common questions that I get asked in our office. People experience problems with all sorts of regular daily activities due to shoulder pain, from putting on a seatbelt, to taking a plate off the top shelf. Sometimes, patients experience even worse shoulder pain at night. This blog post will give an overview of some reasons why patients commonly have shoulder pain and describe some of the latest research showing that Platelet-Rich Plasma (PRP) injections can be extremely useful in healing shoulder pain.
The most common causes of shoulder pain include rotator cuff tendinopathy (also sometimes called tendinitis or tendinosis) and partial-thickness rotator cuff tear. The rotator cuff is a group of muscles that help to dynamically stabilize your shoulder and help support it during activities, so when the rotator cuff becomes injured, the whole shoulder can become problematic and lead to pain and functional issues.
There are many treatments for rotator cuff tendinopathy and partial-thickness rotator cuff tear (if you have a full-thickness rotator cuff tear, that’s a different ballgame, and we’ll get into that another time!) and most patients are able to get better without needing surgery. The non-surgical treatments include taking medications, doing exercises at home or physical therapy, and can sometimes include injections into the area just above the rotator cuff tendons, called the subacromial space.
The classic injection option has been a corticosteroid injection (i.e. a “cortisone shot”). Corticosteroids are anti-inflammatory medications that, when placed around the rotator cuff, can decrease pain and help patients on their path to restoring function. However, there are also concerns that corticosteroid injections may only act as a band-aid in covering up the pain and may not promote actual healing of the rotator cuff tendons. There are even concerns that corticosteroid injections may cause long-term damage to the rotator cuff tendons if repeated too much or too often.
We have therefore been looking for other non-surgical options to treat patients with rotator cuff disease that will potentially promote healing and not have a long-term detrimental effect. One of those options is Platelet-Rich Plasma (PRP). PRP is a concentration of platelets and growth factors that are harvested by drawing a patient’s blood and spinning it in a test tube at high speeds to separate out and collect those elements. PRP has shown some promising results in various tendon disorders and in arthritic joints.
For patients with shoulder pain, there were two recent quality studies published in orthopaedic surgery journals comparing PRP injections with corticosteroid injections in the treatment of rotator cuff disease. Both studies were randomized controlled trials where the patients and the doctors evaluating them did not know which injection was received, and they both showed that PRP can provide excellent relief of shoulder pain.
One of the studies, which was headed by Dr. Cory Kwong and published in Arthroscopy in February 2021, showed that the patients who received PRP had significantly greater relief of their pain and improvement in their patient survey scores at three months after the injection than patients who received corticosteroid injections, although the improvement in pain did not reach statistical significance at 12 months after the injection.
The other study, headed by Dr. Chris Jo and published in The Journal of Bone & Joint Surgery in December 2020, compared patients who received PRP that had been taken from another person with patients who received corticosteroid injections. Although we currently do not have donor PRP available in the United States, this study showed different patterns of pain relief from the two injections. The PRP group got steady relief from injection to six months, while the corticosteroid injection group experienced improvement mainly in the first month and pain then plateaued or increased. Patients in the PRP group also had significantly greater improvement in overall function at six months after the injection.
Although these studies have their own limitations, the results of both show that PRP is a vital non-surgical option for patients with persistent shoulder pain caused by rotator cuff tendinopathy or partial-thickness rotator cuff tears. And the best part about PRP is that there are virtually no detrimental effects since it is using your body’s own natural growth factors to help you heal, so if needed, you can repeat PRP injections without worrying about it causing long-term damage to your shoulder.
If you are experiencing shoulder pain or would like additional information on PRP, feel free to contact Dr. Howard’s office at (845) 230-5171 or request an appointment online.