Presentation at Canadian Orthopaedic Association 2012 - Platelet-rich Plasma vs. Cortisone Injections for the Non-surgical Treatment of Shoulder Pain

1. Platelet-Rich Plasma vs. Cortisone Injections
for the Non-Surgical Treatment of Shoulder
Pain
Alan M. Hirahara, M.D., FRCS(C)
Private Practice
Sacramento, CA USA
Medical Director Team Physician Consultant
Sacramento State Athletics Sacramento River Cats Oakland A’s
MiLB - AAA

2. Objective of Study
• To evaluate the outcomes of platelet-rich plasma
(PRP) injections vs cortisone injections in
patients with shoulder pain
• To reduce the risks of treating patients with
shoulder pain by using a safe, effective, non-
surgical treatment of shoulder pain

3. Introduction
• In the literature, outcomes vary significantly in treating
shoulder pain non-surgically
• Platelet-Rich Plasma (PRP) - Improved healing of soft
tissues & bone
• Cortisone carries risk of degeneration of tissue, AVN,
inhibition of cell proliferation
– PRP has not been shown to carry any risk

4. Study Design
• Case-control study
• Collection period: 1/09 – 12/11
• Pain scores, ASES scores taken every week for 1
month, then every month for 6 months
– ROM measured pre-injection / 4 wks post

5. Study Design
• All patients with shoulder pain
• Inclusions:
– failed NSAID’s and physical therapy regimen
• Exclusions:
– any trauma post-injection
– non-compliance with therapy protocol
– blood dyscrasias

6. PRP Technique
• 10 cc autologous blood drawn
• Using ACP system, blood spun for 5 minutes at 1500
RPM
• Platelet Rich-Plasma (PRP) collected

7. Injection Technique
• All injections done by the primary author under
ultrasound guidance

8. Patient Data
Study Group Control Group
• 186 patients • 299 patients
• 85 male / 101 female • 128 male / 171 female
• Age range: 17 – 86 years • Age range: 22 – 90 years
• Age average: 52.48 years • Age average: 54.09 years

9. Distribution of Pathology
Adhesive Capsulitis 70
84
Biceps tendonitis 4
6
Ca tendonitis 13
7
DJD 19
39
Instability 4
5
pRCT 23
24
RCT 26
48
SLAP lesion 8
18
Tendonopathy 19
68
0 10 20 30 40 50 60 70 80 90
PRP Cortisone

10. All Patients
Pain Scores ASES Scores
7.0 80.0
6.0 70.0
5.0 60.0
4.0 50.0
3.0 40.0
2.0 30.0
20.0
1.0
10.0
0.0
0.0
Study Group Control Group
Study n = 186
* p < 0.05 for Months 4 – 6 & 3 – 6
Control n = 299

11. All Patients
ROM
160.0
140.0
120.0
100.0 Flexion - Study
Flexion - Control
80.0 Abduction - Study
Abduction - Control
60.0 External Rotation - Study
External Rotation - Control
40.0
20.0
0.0
Pre-Injection 4 Weeks
* No statistical significance between groups

12. Tendonopathy
Pain Scores ASES Scores
8.0 90.0
7.0 80.0
70.0
6.0
60.0
5.0
50.0
4.0
40.0
3.0
30.0
2.0
20.0
1.0 10.0
- -
Study n = 19
* p < 0.05 for Mo 6 & Mo 1 – 3, 6 Control n = 68

13. PASTA Lesions
Pain Scores ASES Scores
8.0
80.0
7.0
70.0
6.0
60.0
5.0
50.0
4.0 40.0
3.0 30.0
20.0
2.0
10.0
1.0
-
-
Study n = 23
* p < 0.05 for Wk 3 - Mo 6 & Mo 1, 4 - 6 Control n = 24

14. Full RC Tears
Pain Scores ASES Scores
8.0
80.0
7.0
70.0
6.0
60.0
5.0
50.0
4.0 40.0
3.0 30.0
20.0
2.0
10.0
1.0
-
-
Study n = 26
* No statistical significance between groups Control n = 48

15. Adhesive Capsulitis
Pain Scores ASES Scores
6.0 80.0
70.0
5.0
60.0
4.0
50.0
3.0 40.0
30.0
2.0
20.0
1.0
10.0
- -
Study n = 70
* No statistical significance between groups Control n = 84

16. Shoulder DJD
Pain Scores ASES Scores
7.0
80.0
6.0
70.0
5.0 60.0
50.0
4.0
40.0
3.0
30.0
2.0 20.0
10.0
1.0
-
-
Study n = 19
* No statistical significance between groups Control n = 39

17. Discussion
• Both PRP & Cortisone injections can help
relieve shoulder pain
• BUT PRP improves pain & function
significantly more

18. PRP – Superior to Cortisone
• Tendonopathy
• PASTA lesions

19. PRP & Cortisone – Similar Effects
• Adhesive capsulitis
• Full-thickness RCT’s
• DJD

20. Conclusion
• PRP can help diminish pain and improve
function and ROM in patients with specific
shoulder pathologies more than cortisone but
with significantly less side-effects or risks
• Randomized study needed to confirm results

21. Thank You!