Category Archives: platelet-rich plasma

What are my options for shoulder pain?

The shoulder has the honor of being is the largest, most complex, and most mobile joint in the body.  And it is this reason that makes it the most vulnerable to overuse.

The shoulder consists of three bones: the humerus (upper arm bone), clavicle (collarbone), and scapula (shoulder blade).

The rotator cuff muscles and tendons are responsible for movement and stabilization of the shoulder.

In addition, there are other muscles and a complex array of ligaments that also serve to ensure stability.

Another tendon, the biceps tendon, originates from the glenoid (the cup of the shoulder blade where the humerus sits) and extends down the humerus.  It is responsible for certain arm and shoulder movements.

The ironic fact is that a patient who complains of shoulder pain may have nothing wrong with the shoulder!shoulder-pain

For example, many medical conditions such as gall bladder disease, pneumonia, and ectopic pregnancies can present with shoulder pain.  Also, neck conditions often cause referred pain to the shoulder.  Patients with heart disease who are experiencing a heart attack may complain of pain in the left shoulder and arm.

Shoulder ailments fall into three major groups.  The first is trauma.  An example may be a skier who falls on an extended arm.  The impact can drive the head of the arm bone into the socket and cause damage to the cartilage, the bone, as well as the rotator cuff tendons. If the ligaments are stretched or torn, the shoulder can dislocate.  While the shoulder can be “relocated”, once dislocation occurs, the patient is at increased risk for another dislocation. Significant impact can cause damage to the cartilage that cushions the head of the femur as well as the “cup” of the scapula.  This cup is referred to as the glenoid.  The glenoid also has a lip of tougher cartilage that can be torn with impact injuries.

Trauma, if significant enough, can cause dislocation of the joint joining the collar bone to the shoulder blade. The common term for this is a “separated shoulder.”

A related but different type of ailment is wear and tear.  Because so many of the structures that permit shoulder movement and provide stability are made of connective tissue, it stands to reason that over time, they can begin to wear out.  And that is exactly what happens.  Tendons- the ropes that connect muscles to bone-, ligaments, and bursae (fluid filled sacks that cushion joint movement) all are prone to injury as a result of overuse.

When this occurs, conditions such as tendinopathy (previously known as tendonitis), bursitis, and ligament strain ensue.

While inflammation may be present, the overwhelming problem is tissue breakdown.

The last ailment that affects the shoulder is arthritis.  The three bones that make up the shoulder interact with each other at two specific points.  At these two points, there is a joint where two bones whose ends are covered with cartilage articulate.  The two joints are the glenohumeral joint- the joint that joins the shoulder blade and the humerus and the acromioclavicular joint that joins the collarbone to the shoulder blade.

Arthritis at these two areas can develop as a result of systemic disease such as rheumatoid arthritis or as a result of wear and tear- osteoarthritis.

The treatment of shoulder disorders depends upon both the underlying problem as well as the amount of patient discomfort and the impact on quality of life.

For traumatic disorder where there is obvious tissue disruption, surgery is usually required.  The type of surgery will be up to both the surgeon as well as to the individual who has the problem. The shoulder is a complex joint so it’s important to ensure whoever works on the shoulder is an expert.

For most wear and tear problems, non-steroidal anti-inflammatory medicines (NSAIDS) are sometimes, but not always, helpful. Ice and rest also can be useful.

Patients may require a steroid injection. For people who don’t respond to medicines, injections, and physical therapy, surgery may be an option. Ultrasound guidance is important.

Regenerative medicine techniques can be used for shoulder issues.  An example would be a procedure called percutaneous needle tenotomy which can be used to treat rotator cuff tendinopathy and tears.

In this procedure, a small needle is introduced using local anesthetic and ultrasound guidance. The needle is used to irritate the tendons of the rotator cuff and induce inflammation. Then, platelet-rich plasma, obtained from the patient’s whole blood is injected into the area where the tendons have been irritated. Ultrasound guidance here is mandatory. Platelets are cells in the blood that contain many growth and healing factors. This stimulates the production of new strong tendon tissue.

Another example of a regenerative medicine technique is the use of autologous stem cells (a patient’s own stem cells) for glenohumeral arthritis.

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Another excellent study showing PRP works for tennis elbow!

Tara Haelle writing in Rheumatology News reported on a 24 week randomized controlled and double blind study looked at the effectiveness of platelet-rich plasma –PRP in treating tennis elbow. prp

The study  involved 230 patients who had failed physical therapy, non-steroidal anti-inflammatory drugs, and/or cortisone shots and was conducted at the Rothman Institute of Thomas Jefferson University.  The PRP group showed a 71.5% improvement in pain scores while the control group showed a 56.1% improvement.

tennis-elbow-on-fire

Comment: The differences weren’t huge but this still indicates PRP is the treatment of choice for this extremely painful disorder.

Cortisone shots should be avoided since they actually damage soft tissue and lead to more recurrence of tennis elbow and other forms of tendinopathy.

PRP should be administered using ultrasound guided needle tenotomy technique.

For more information on arthritis treatments and other arthritis problems,  go to:

Arthritis Treatment

And don’t forget to sign up for  free weekly arthritis tips and a free copy of our special report “The Consumer’s Guide to Arthritis”

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Steroid injections for tennis elbow make it worse

Genevra Pittman writing in Reuters reported that in an Australian study published in the Journal of the American Medical Association, researchers evaluated 165 adults with tennis elbow.

tennis-elbowThe participants were divided into four treatment groups: cortisone shots without physical therapy, cortisone shots with physical therapy, placebo shots without physical therapy, and placebo shots with physical therapy. After one year, 83% of the participants who received a cortisone shot reported that they had completely recovered, compared to 96% of those who received a placebo shot.

Steroid shots weaken tendons over the long haul.  A much more physiologic approach is to use ultrasound guided needle tenotomy and platelet-rich plasma (PRP).

For more information on arthritis treatments and other arthritis problems,  go to:

Arthritis Treatment

And don’t forget to sign up for  free weekly arthritis tips and a free copy of our special report “The Consumer’s Guide to Arthritis”

Just go here Contact