THU0495 ROLE OF PLATELET RICH PLASMA IN TREATMENT OF ROTATOR CUFF TENDINOPATHY AND PARTIAL THICKNESS TEAR: FOLLOW UP BY ULTRASOUND

Abstract

Background: Shoulder pain is the third most common musculoskeletal reason for seeking medical care. The diagnosis of Rotator Cuff Tendinop‐athy (RCT), with supraspinatus partial thickness tendon tears and tendo‐nosis, constitutes more than 50% of adult cases presenting with shoulder pains at any time. Platelet rich plasma (PRP) injections are nowadays being used as an alternative for treating the tendinopathies, who have failed to be managed by conservative management. Objectives: This work aimed to asses the effect of PRP injection under musculoskeletal ultrasound (MSUS) guidance in patients with rotator cuff tendinopathy, and partial thickness tear in comparison with those who received a rehabilitation program only. Baseline assessment and after three months was done using clinical, functional and ultrasonographic evaluation. Methods: Our study included 60 patients with RCT diagnosed both clinically and by MSUS. Patients were divided into two groups (gI, gII); group I included 30 patients who received a Supervised Rehabilitation Program and group II included 30 patients who received PRP injection. Patients in both groups were assessed clinically, functionally [(VAS), (WORC) and (SPADI)] and sonographically at baseline and after 3 months. Rehabilitation Program included: hot packs, (TENS), and (therapeutic ultrasound). The Exercise Programs (supervised and home‐based) were applied, including: (ROM, stretching and strengthening exercises of the rotator cuff and scapular muscles). PRP injection was prepared under complete sterile conditions by whole blood centrifugation with specific protocol; blood was centrifuged firstly at 1000 rpm for 10 minutes. The plasma was then transferred to a new glass tube and centrifuged at 3000 rpm for 15 minutes. Platelets will form a pellet at the bottom of the tube. Finally, a pure platelet rich plasma was obtained with a concentration 4 times greater than baseline. Ca gluconate was mixed with PRP (in a ratio of 0.3 ml ca gluconate/ml PRP) immediately before the injection. Under ultrasound guidance, 3ml PRP was injected slowly into the bursa without usage of local anesthetics prior to injection. Post injection, patients were advised to rest, use cold packs and were allowed to do light range of motion exercises 2‐5 days post injection. Acetaminophen was allowed for intolerable post injection pain. Results: Statistical analysis was made to 60 patients. Intragroup analysis showed statistical significant difference in both groups at follow up compared to baseline regarding clinical, functional and radiological data. Inter‐group analysis showed more significant results in PRP group regarding clinical assessment (p <0.0001), functional assessment (SPADI (PS, DS and total) and WORC scores (p <0.0001) and sonographic assessment in (subscapularis tendinopathy, supraspinatus tendinopathy, supraspinatus fibrillar tendon disruption and supraspinatus tendon thickness) (p <0.0001) and sonographic subacromial subdeltoid bursitis (p= 0.001). Conclusion: Single PRP injection is an effective mean of treatment of RCT as it improves patients' quality of life clinically, functionally and structurally, better than traditional physical therapy program.