Sports Medicine | PRP for Rotator Cuff Tendon Injury
The rotator cuff is made up of a network of four muscles and a few tendons that form a covering on the top of the upper arm bone. It functions to hold the bone in place in the shoulder joint and enables the arm to rotate. In addition, it compresses the upper arm head (ball) into its socket. Among the few tendons it has, there is one tendon that is most commonly involved in tears as well as degeneration and that is known as the supraspinatus tendon. This tendon is more prone to development of tendinosis.
Rotator cuff tendinosis is a very common condition that causes shoulder pain and loss of function. It is common in people above the age of 40.
Cause
Most of the cases are due to overuse of the upper arm or trauma to the tendon, thus putting a stress on the tendon. As we age, our tendons lose strength and if injured, they are not able to repair or heal. If you have a poor posture, it may cause shoulder blades to tilt forwards and down, which may lead to tendinosis.
Symptoms
The first sign of rotator cuff tendinosis is pain that will progressively get worse without treatment. The pain may increase when you perform an activity, and may also be worse at night. When asked about the onset of pain, most people are unable to remember. You may feel pain while trying to reach for an object or lifting something heavy. Since the tendon is structurally intact and not torn, strength is not affected, but the movement of the arm is limited due to pain. In some patients, pain may sometimes radiate to the neck, back, or upper arm due to shoulder fatigue.
Diagnosis
Patient’s history of the condition and physical examination of the affected area may be all that is necessary to make a diagnosis of rotator cuff tendinosis. Your doctor may ask for an X-ray to screen for other possible causes of shoulder pain such as arthritis or calcific tendonitis. If there is any doubt on the injury of the rotator cuff, an MRI with dye injected into the shoulder joint is conducted which seems to be the most accurate diagnostic tool to assess the integrity of the tendon.
Treatment
As a first step of treatment, one should avoid all activities that give rise to pain. Rest is essential. Your doctor may ask you to perform only those activities that do not cause you pain. These are encouraged to prevent muscle atrophy and stiffness which can occur from disuse.
Applying ice can help in reducing swelling and pain. It is especially important after exercise sessions. Applying ice for fifteen to twenty minutes every four hours for several days helps in reducing pain. Ice should be wrapped in a towel or napkin and not applied directly on the skin.
Non-steroid anti-inflammatory drugs, more commonly called as NSAIDs, reduce both pain and swelling. They may be more effective in early rotator cuff tendinosis when inflammation is more prevalent, however, they have several side effects. It is better to educate yourself on the short and long-term side effects of each medication prior to use.
Physical therapy may be employed such as stretching exercises to restore proper flexibility to the shoulder capsule; strengthening exercise once adequate healing has occurred, and certain exercises to improve posture and position of the shoulder blade.
Some doctors advocate the use of steroid injections which is injected adjacent to the rotator cuff. Although tendinosis is not an inflammatory condition, steroids can relieve pain that may last anywhere from a week to several months. A Steroid injections main side effect is that they can cause weakening of the tendon tissue and may cause more harm than good.
Generally surgery is not recommended unless the injury will not heal.
Surgery should be planned and based on how the condition affects a person’s quality of life. Typically, surgery known as diagnostic shoulder arthroscopy is performed that entails putting a small camera inside the shoulder for the surgeon to look directly at the tissues around the rotator cuff. The tendon is carefully inspected for fraying or tissue damage. Any inflamed capsule is removed.
Exercises to strengthen the rotator cuff and shoulder muscles are started after the tendon has healed and after full range of motion is recovered. Risks associated with surgery include infection, damage to nerves and blood vessels, shoulder stiffness, recurrent shoulder pain, and complications related to anesthesia. Though these risks and rare, they can happen.
PRP For Rotator Cuff Tendonitis / Tendinosis
An increasing numbers, physicians are utilizing PRP therapy to treat rotator cuff tendonitis and tendinosis. Both conditions are quite painful and cause those who suffer from them, to experience a great deal of discomfort.
Though the terms are very similar, the conditions vary pretty significantly. Tendonitis is characterized by an acute inflammation of the tendon. It develops when the tendon is stressed or when a person suddenly begins an activity that proves to be exceedingly taxing for tendon. Tendinosis is a degenerative condition characterized by continuous micro-trauma and an inability of the tendon to heal. The latter may be caused by repetitive trauma, age or for some other unknown or undetectable reason.
Traditional therapy for tendonitis involves icing the tendon, the use of anti-inflammatory medications and rest. Persons that suffer from tendonitis will more often then not, experience relief and a complete healing of the tendon. A person with tendinosis is not likely to. More comprehensive and extensive measures are often necessary. One that is growing in popularity is PRP (platelet rich plasma) therapy.
Tendinosis is often treated with rest, anti-inflammatory medication and cortisone shots. The latter two help mask the pain but do nothing for strengthening or repairing the tendon. In fact, the long term use of the pain medication and cortisone shots can do more harm then good, for instance, cortisone shots are known to weaken the tendon and worsen its degeneration.
Platelet rich plasma therapy involves the use of ones own blood to promote healing. Platelets found in our blood help to accelerate the healing process because of the growth factors they contain. A doctor will extract and then inject them into the injured body part.
A doctor might suggest PRP therapy for patients who have had tendinosis for a significant amount of time or whose tendinosis hadn’t responded to rest and/or anti-inflammatory medication. Doctors or patients adverse to cortisone shots may also opt for PRP therapy.
Some people will be interested in trying PRP after learning that their favorite athlete has undergone it. In recent years, professional athletes have used PRP therapy with much success. Well known athletes such as Tiger Woods and Alex Rodriguez have utilized PRP therapy to speed up the healing processes and afterwards, extolled its benefits.
PRP therapy is great in both the short and long term. In the short term it can help relieve pain. In the long term, it can promote healing. Of all the traditional therapies for tendinosis, none besides rest do so and even that does not guarantee the repair of the tendon. A doctor may agree to treat a person suffering from tendonitis with Platelet rich plasma therapy if their pain is severe and/or they need their shoulder to be at full capacity in a short amount of time.
Because PRP therapy is considered experimental, insurance companies will not cover it, though this might soon change. Many doctors believe that it will soon become a standard form of treatment for soft tissue and bone injuries or conditions. PRP injections are priced between $500 and $1500 per injection.
FAQs-Questions to Ask Your Doctor
1. How long before I can expect to see results?
2. How much experience do you have with PRP therapy?
3. How many injections will I need?
4. Do you accept payments or will I be expected to pay-in-full prior to beginning treatment?
5. What happens if it doesn’t work?
Prognosis
Tendinosis is generally a self-limiting condition that subsides with proper treatment. The healing is slow and may take many weeks to months. During this time, the patient must avoid all activities that caused the condition, especially overuse of the arm.
Complications
In left untreated, in some cases, the condition may progress to a rotator cuff tear. After progressive weakening of the tendon fibers in the shoulder, there may be potential for complete tendon failure. This generally does not happen before the age of 40, but becomes common with increasing age.
Prevention
Having a strong rotator cuff is the best defense against tendonitis. Frequent stretching exercises can help to prevent many conditions.
Questions your doctor may ask you about your condition
- How long have you had your pain?
- What is your occupation?
- Do you play sports? If yes, what kind of sports?
- How many hours do you play daily?
- Do you exercise too?
- Do you have any other problems?
- Have you tried treatment at home for this condition?
- Have you tried taking any medicines for this condition?
- Did you get any relief from home measures or medicines?
