Comparative Study of Methylprednisolone, Platelet-Rich Plasma and Prolotherapy Injections In Management of Shoulder Rotator Cuff Tendinopathies

Introduction: RC tendinopathies account for 85% of cases of shoulder pain. Conservative management includes, NSAIDs, Physiotherapy and Local corticosteroid injections. Emerging treatments include local PRP and Prolotherapy injections with the latter one showing promising results. Prolotherapy injections most commonly used are Hyperosmolar dextrose injections (25%) which help in healing of tendinosis and partial tears by stimulating a local inflammatory cascade and release of growth factors and cytokines causing regeneration of connective tissues and tendons. Methodology: It was a Prospective Observational Randomized Comparative Double blinded Study with 3 groups having 20 patients each (COR, PRP, PRO). Each patient was assessed clinically and if needed radiologically investigated. All injections were given through a landmark based posterior approach under aseptic precautions and the patient followed up at 3,12 and 24 weeks and pain and functional outcome measured on the basis of VAS and ASES score. Results: Median(25th-75th percentile) of visual analogue scale (VAS) on 24th week in COR was 4(3.75-5) which was significantly higher as compared to PRP (3(3-3.25)) (p value=0.007) and PRO(1.5(1-2)) (p value<.0001). Median(25th-75th percentile) of visual analogue scale (VAS) on 24th week in PRP was significantly higher as compared to PRO. (p value=0.0004) Mean ± SD of American shoulder and elbow surgeons shoulder score(ASES) on 24th week in COR was 63.9 ± 12.01 which was significantly lower as compared to PRO (85.75 ± 4.33) (p value<.0001) and PRP (84.55 ± 4.75) (p value<.0001). No significant difference was seen in American shoulder and elbow surgeons shoulder score(ASES) on 24th week between PRP and PRO. (p value=0.631). Conclusion: Intra articular shoulder injection is a safe and effective management of shoulder pain. Corticosteroids provide great short term pain relief and improved ROM, but the effect is not well sustained. PRP when injected takes about 6 weeks to show any improvement but with long term follow up of up to 24 weeks there is good amount of pain relief and improved function, the only shortcoming being cumbersome procedure of PRP preparation with many variations in each preparation and reluctance of many patients for venepuncture. Dextrose prolotherapy being a readily available compound in Hospital setting, is a good candidate to provide long term relief in pain with gradual ROM improvement, with no adverse effects even in well controlled diabetics