From the Guidelines
Platelet-rich plasma (PRP) therapy for rotator cuff injuries and chronic shoulder dislocations typically targets the supraspinatus, infraspinatus, subscapularis, and teres minor tendons, which collectively form the rotator cuff, as well as the glenoid labrum, glenohumeral ligaments, and the joint capsule for chronic dislocations. The primary goal of PRP therapy in this context is to promote tissue healing, reduce inflammation, and stimulate collagen production, thereby improving morbidity, mortality, and quality of life outcomes for patients with these conditions.
Key Tendons and Ligaments Addressed by PRP Therapy
- Supraspinatus tendon
- Infraspinatus tendon
- Subscapularis tendon
- Teres minor tendon
- Glenoid labrum
- Glenohumeral ligaments (particularly the inferior glenohumeral ligament complex)
- Joint capsule
The procedure for PRP therapy involves drawing the patient's blood, processing it to concentrate platelets, and injecting this platelet-rich solution directly into the damaged tissues under ultrasound or fluoroscopic guidance, as suggested by studies such as 1. Typically, 3-5ml of PRP is injected per site, with patients often receiving 1-3 treatments spaced 4-6 weeks apart. Following injection, patients should limit activity for 24-48 hours and gradually return to normal activities over 1-2 weeks, avoiding anti-inflammatory medications which may interfere with the healing process, as noted in 1 and 1.
Considerations for PRP Therapy
- Patient selection: PRP therapy is particularly beneficial for partial tears and tendinopathy where the body's natural healing response is inadequate.
- Treatment protocol: The number of treatments and the volume of PRP injected can vary depending on the severity of the condition and the patient's response to treatment.
- Post-injection care: Patients should avoid anti-inflammatory medications and gradually return to normal activities to optimize the healing process.
By prioritizing the most recent and highest quality evidence, such as 1, and considering the potential benefits and limitations of PRP therapy, healthcare providers can make informed decisions about the use of PRP therapy for rotator cuff injuries and chronic shoulder dislocations, ultimately improving patient outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Tendons and Ligaments Addressed with PRP for Rotator Cuff Injuries
- The supraspinatus tendon is a common target for PRP injection in the treatment of rotator cuff injuries, as seen in studies 2, 3.
- Other tendons involved in rotator cuff injuries, such as the infraspinatus and teres minor, may also be addressed with PRP, although specific studies on these tendons are limited 4, 5.
- The use of PRP for chronic shoulder dislocations is not well-studied, and most research focuses on its application in rotator cuff tears and tendinopathies 6.
Specific Tendons and Ligaments
- Supraspinatus tendon: PRP injection has been shown to improve pain and function in patients with supraspinatus tendinopathy 3.
- Rotator cuff tendons: PRP has been used to augment rotator cuff repair and improve tendon healing, although results are mixed and more research is needed 2, 4, 5.
- No specific studies were found on the use of PRP for ligament injuries in the context of rotator cuff injuries or chronic shoulder dislocations.
PRP Application and Efficacy
- PRP can be applied through injection or as a fibrin matrix, with varying degrees of efficacy depending on the specific formulation and application method 4, 5.
- The use of leukocyte-rich PRP may be beneficial for tendon healing, although more research is needed to confirm this 5.
- PRP has been shown to improve functional outcomes and reduce pain in patients with rotator cuff tears, although results are not always consistent and more studies are needed to fully understand its effects 3, 5.