For cer­tain shoul­der in­juries

The Middletown Press (Middletown, CT) - - YOUR DAILY BREAK -

DEAR DOC­TOR » My doc­tor at the lo­cal bone and joint clinic said I was a good can­di­date for an ex­per­i­men­tal in­jec­tion of PRP for arthri­tis in my right shoul­der. What is your opin­ion? I’m 71. DEAR READER » Un­like your doc­tor, I’m not fa­mil­iar with your med­i­cal his­tory or your shoul­der con­di­tion, so I can’t of­fer a spe­cific med­i­cal opin­ion. What I can do is ex­plain a bit more about this pro­ce­dure and its po­ten­tial.

First, some back­ground: Be­cause ten­dons, lig­a­ments and car­ti­lage have limited blood flow, the body’s abil­ity to re­pair them is limited. Au­tol­o­gous platelet-rich plasma (PRP) aims to com­pen­sate for this. It’s pre­pared by re­mov­ing about 30 to 60 cu­bic cen­time­ters of blood from your arm. The blood is then fil­tered through a process called plasma­phere­sis, which con­cen­trates the platelets. The won­der­ful thing about platelets is that they’re usu­ally the first blood com­po­nent to ar­rive at the site of an in­jury, bring­ing mol­e­cules that en­cour­age heal­ing. Thus, platelet in­jec­tions have the po­ten­tial to im­prove heal­ing of an area with nor­mally poor blood flow.

Most stud­ies of PRP for the shoul­der have in­volved peo­ple hav­ing sur­gi­cal re­pair of the joint, with sur­geons us­ing PRP to bol­ster a ro­ta­tor cuff re­pair or to boost heal­ing af­ter shoul­der re­place­ment. A 2015 study com­bined data from eight stud­ies com­par­ing arthro­scopic surgery for ro­ta­tor cuff ten­don tears with PRP and with­out PRP. Of 464 pa­tients, 234 had PRP in­jec­tions. The au­thors found no dif­fer­ence in the rates of ten­dons retear­ing af­ter surgery, nor did they find any sig­nif­i­cant MRI changes in the PRP group. Fur­ther, the stud­ies did not find any dif­fer­ence in range of mo­tion or pain with the use of PRP.

An­other 2015 anal­y­sis — this one of 11 stud­ies with a to­tal of 597 pa­tients — also failed to show MRI or symp­tom ben­e­fit with the use of PRP. How­ever, PRP did show ben­e­fit among peo­ple who had ro­ta­tor cuff ten­don tears greater than 3 cen­time­ters. A 2016 study showed ben­e­fit in the use of PRP in the first month af­ter surgery, but no sig­nif­i­cant ben­e­fit af­ter six months.

Also, there are small stud­ies that show PRP can help peo­ple who are not hav­ing shoul­der surgery. Some stud­ies have com­pared PRP to steroid in­jec­tions in the shoul­der for par­tial ro­ta­tor cuff tears or for impinge­ment syn­drome and found that PRP was equiv­a­lent or even more help­ful than steroid in­jec­tions. How­ever, a study from Iran found that while PRP did ease pain and im­prove mo­bil­ity of the shoul­der, it was not su­pe­rior to phys­i­cal ther­apy.

As for arthri­tis of the shoul­der, I haven’t found good stud­ies to sup­port the use of PRP. Some stud­ies show ben­e­fit for arthri­tis of the knees, but their poor de­sign and lack of com­par­i­son sub­jects make con­clu­sions dif­fi­cult.

That said, while I don’t know the de­gree of your shoul­der arthri­tis, if you have impinge­ment of the shoul­der or a par­tial tear of your ro­ta­tor cuff ten­don, PRP in ad­di­tion to phys­i­cal ther­apy may have ben­e­fit.

I’m with your doc­tor on this: It’s worth a try.

Robert Ash­ley

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