Patient population: In this prospective study 10 active men and women between 40 and 55 years of age with primary,
or degenerative supraspinatus tendon tears proved by MRI (Figure 1) and ultrasound examination(Figure 2) within 18 months of initial diagnosis were included between September 2017 and march 2018.
Exclusion criteria were: Supraspinatus full thickness tendon tear,
prior surgical repair,
pre-existing conditions associated with upper extremity pain including carpal tunnel syndrome,
cervical neuropathy or any other nerve pathologies,
and systemic or bleeding disorders,
gross shoulder instability,
pregnant or plan to become pregnant in the next 12 months,
preoperative platelet count less than 125,000 or less likely,
problems with follow-up and patients in another on-going trial that would interfere with the assessment of the primary or secondary outcomes.
These patients underwent demographic and basic surveys initially and staged using shoulder pain and disability index (SPADI)(12) scoring system and indicated same score after managing them conservatively for 2 months.
All these patients were given PRP injection under ultrasound guidance,
and they were evaluated at 6 weeks and 3 months post-injection.
–Patients were subjected to: Full history,full clinical examination and shoulder ultrasound examination.Then shoulder MRI examination on the same day or within a few days.The ultrasound and the MRI were interpreted by two different radiologists who have long experience in musculoskeletal imaging and patients were confirmed to have Supraspinatus partial thickness tear.Explaining the whole procedure including the steps,
outcomes and complications.Written consents were taken from the patients according to ethical committee considerations.Patients were evaluated using SPADI scoring system.
A)Pre-procedure instructions:Patients who had scheduled an injection should stop all anti-inflammatory medications for 1 week prior to injection.Patients were prepared to take it easy for about 2-3 days after the injection.
B)Tools used for the procedure:Centrifuge machine to obtain the platelet rich plasma,Ultrasound machine with superficial probe 10 HZ,Syringes(3 -10-20 cm),10 cm sterile test tubes,Citrate dextrose as anticoagulant,
Spinal needle (22 Ga x 9 mm),antiseptic conditions,Lidocaine 2% (local anaesthetic).
C)Preparation of platelet rich plasma(PRP):PRP was prepared using standard techniques.
Patient blood was collected under aseptic conditions in acid citrate dextrose tubes.
20 ml of patient blood was collected.
This blood was put in a centrifuge at 2000 rpm (soft spin).
The whole blood was separated into three layers.
The supernatant layer of plasma and buffy coat were separated and subjected to centrifugation at 3000 rpm (hard spin).
In the final end product,
the upper two-thirds of the tube were containing platelet poor plasma which is removed,
and the lower one-third was PRP enhanced with superficial buffy coat which will be used for injection the procedure was performed by the radiologist(13).
D) Technique of the procedure:(Figure 4)The procedure starts with a diagnostic ultrasound to detect the site of the tear and subcoracoid -subacromiom bursa.
Then patient was positioned in a sitting position and site of injection was decided.
Under aseptic condition,
using sterile surgical gloves,
sterile gel and betadine to sterilize the site of injection and probe surface,
3 cm of local anesthesia were given at the injection site subcutaneously.
Using a 22-gauge spinal needle,
2–3 ml of the PRP product were injected at the tear site,
and under ultrasound guidance.
If there was impingement syndrome,
we can inject PRP as well inside the bursa.
patient’s arms were supported with a simple sling until pain subsides.
Patients were requested to mobilize the shoulder at the earliest.
Data Analysis: All these patients were given PRP injection under ultrasound guidance,
and they were evaluated at 6 weeks and 3 months post-injection using shoulder pain and disability index (SPADI) scoring system.
Statistical Analysis: Data Analysis was completed using SPSS for Windows.
Descriptive statistics (frequencies for dichotomous data and means and standard deviations (SD) for continuous data) were calculated to describe the demographic characteristics of the patients.
Paired t-test was completed at 6 weeks and 3 months for each of the 3 outcome measures to determine whether there was a significant difference in the mean scores between the pre-injection and post-injection values.
The analysis included t values and significance (P) values.