From the Guidelines
Hyaluronic acid injections are a viable alternative to corticosteroids and PRP for partial rotator cuff rupture, providing lubrication and anti-inflammatory effects in the shoulder joint. According to a study published in The Journal of the American Academy of Orthopaedic Surgeons in 2020 1, limited evidence supports the use of hyaluronic acid injections in the nonsurgical management of patients with rotator cuff pathology. Other alternatives include prolotherapy using dextrose solutions, stem cell injections, autologous conditioned serum (ACS), and botulinum toxin injections. These alternatives work through different mechanisms, with some providing symptomatic relief and others aiming to stimulate healing processes.
Key Considerations
- The choice of injection depends on factors including tear severity, patient age, activity level, and previous treatments.
- Most injections are performed under ultrasound guidance to ensure accurate placement.
- Patients typically require physical therapy alongside any injection therapy to optimize outcomes.
- A study from 2020 1 highlights the importance of physical therapy in improving patient-reported outcomes (PROs) in symptomatic patients with full-thickness rotator cuff tears, which may also apply to partial tears.
Injection Options
- Hyaluronic acid injections: typically administered as a series of 1-3 injections spaced one week apart.
- Prolotherapy: using dextrose solutions (typically 12.5-25%) to stimulate local healing by creating controlled inflammation.
- Stem cell injections: particularly mesenchymal stem cells derived from bone marrow or adipose tissue, may promote tissue regeneration.
- Autologous conditioned serum (ACS): contains concentrated anti-inflammatory cytokines from the patient's own blood, typically given as a series of 3-6 injections.
- Botulinum toxin injections: help by reducing muscle tension around the injured tendon, allowing for better healing conditions.
From the Research
Alternatives to Corticosteroids and PRP for Partial Rotator Cuff Rupture
- Other injectable options for partial rotator cuff rupture include:
- Hyaluronic acid injections: Studies have shown that hyaluronic acid injections can be effective in treating partial rotator cuff tears, with some research suggesting that combining hyaluronic acid with corticosteroid injections may be more effective than using either treatment alone 2.
- Prolotherapy: Although there is limited research on the use of prolotherapy for partial rotator cuff tears, some studies suggest that it may be a viable alternative to other injectable treatments 3, 2.
- Stem cells: Some research has explored the use of stem cell injections for treating rotator cuff injuries, although more studies are needed to fully understand their effectiveness 4.
- Comparison of different injectable treatments:
- A network meta-analysis found that combining corticosteroid injections with hyaluronic acid injections may be the most effective treatment for rotator cuff injuries, followed by platelet-rich plasma injections combined with corticosteroid injections 2.
- Another study found that single platelet-rich plasma injections had comparable benefits to three doses of hyaluronic acid injections in patients with partial-thickness rotator cuff tears, with an extended effect on passive shoulder abduction range of motion and Constant-Murley Shoulder Score 5.
Key Findings
- The efficacy and safety of different injectable treatments for partial rotator cuff rupture can vary, and more research is needed to fully understand their effects 4, 2.
- Some studies suggest that combining different injectable treatments, such as corticosteroids and hyaluronic acid, may be more effective than using either treatment alone 2.
- The optimal biologic injectable and formulation for treating partial rotator cuff rupture is still unknown, and further research is needed to determine the most effective treatment options 4.