Sports Medicine Research: In the Lab & In the Field: Platelet-Rich Plasma Falls Short Compared with Exercise Therapy (Sports Med Res)
Monday, July 3, 2017

Platelet-Rich Plasma Falls Short Compared with Exercise Therapy

Treatment of Subacromial Impingement Syndrome: Platelet-Rich Plasma or Exercise Therapy? A Randomized Controlled Trial.

Nejati P, Ghahremaninia A Naderim F,Gharibzadeh S, Mazaherinezhad A. Orthop J Sports Med. 2017;X(X):1-12.

Take Home Message: Exercise therapy was superior to platelet-rich plasma injections for reducing pain and improving shoulder range of motion and function among adults with subacromial impingement syndrome.

Subacromial impingement syndrome is the most common disorder in the shoulder and may be treated with many nonsurgical treatment options. The use of platelet-rich plasma (PRP; blood plasma with a high platelet concentration that can release growth factors to help tissue repair) is becoming popular; however, few studies have tested if it is superior to other treatment options. Therefore, the authors randomized 62 adults with subacromial impingement syndrome to test if PRP was more effective than exercise therapy. They randomized participants into either a PRP (2 injections, 1 month apart) or exercise therapy group (supervised visits once a week for 3 months, then home exercises for 6 months). The authors included adults who were at least 40 years old complaining of pain for at least 3 months (no radiating pain), had a platelet count > 100,000, and had a positive test on at least 3 impingement assessment tests (Empty Can, Speed Test, Jobe Test, Neer Impingement Sign, Hawkins-Kennedy Test). Adults were excluded from the study if they had surgery or physical therapy within the prior 6 months, presence of comorbidities, a cortisone injection within 3 months, or a fear or contraindication to magnetic resonance imaging (MRI). The authors assessed range of motion, muscular force, as well as pain and functionality (Disabilities of the Arm, Shoulder, and Hand [DASH] and Western Ontario Rotator Cuff Index [WORC]) at 1-, 3-, and 6-month follow-ups. The authors collected MRIs at baseline and after 6-months. While both groups reported a decrease in pain and increase in functionality, the exercise group had better results at 1 and 3 months (e.g., pain, WORC score, abduction range of motion, and internal rotation force). At 6 months, the exercise group still had better self-reported pain/function (WORC) and abduction range of motion. Upon MRI examination, the authors found that none of the patients underwent any change in the pathology of the biceps or the acromiohumeral distance.

The authors demonstrated that PRP injection therapy or traditional exercise may reduce pain and improve shoulder range of motion and function. However, exercise therapy could improve shoulder abduction and pain/function (WORC score) better than PRP. The participants with exercise therapy incurred more improvements at 3-months compared to PRP, but most of these improvements did not continue at the 6-month follow-up, which could be attributed to discontinuing the supervised visits. It is also noteworthy that despite clinical improvements after the treatments the MRI findings did not change. It would be interesting to see if these patients continue to get better or if they suffer from subacromial impingement syndrome again after the effects of the therapy wears off. It will be necessary to determine if PRP corrects the biomechanical/neuromuscular issue that caused the condition, and not just acting as a temporary fix to alleviate pain. Future research should also consider if PRP coupled with exercise therapy would help treat the condition more effectively. Currently, medical professionals should recognize that PRP is still in its early phase and there is no one set formula being used. Additionally, exercise therapy may be helpful for up to six months for patients with subacromial impingement syndrome.

Question for Discussion: Have any of your patients received PRP injections? If so, what where their thoughts? Would you use or recommend PRP therapy?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

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3 comments:

Dan R. said...

It is good to see that there are more and more studies coming out with regard to the effectiveness of PRP injections. Right now, I am quite skeptical about the effectiveness of these injections. They seem to be a sort of "designer" treatment at this point because there are so many different types, and everyone claims that theirs is the best.

It can be said that in the unmotivated, non-athletic patient, they are simply looking for a quick fix treatment such as a pill or PRP injection, when in reality conservative treatment may actually work better. As clinicians, I think it is extremely important that we educate our patients on the importance of conservative treatment like supervised exercise because just because something like a pill or PRP injection is considered medicine, doesn't mean that it will automatically work. Overall, unless I have absolutely exhausted all other forms of treatment, I really don't feel comfortable referring my patients for a PRP injection as a first line of defense.

Adrienne Dembeck said...

This is a very interesting study and I agree with Dan that it is cool to see new things like this coming out, especially with the technology that we have available to us. However, I am curious to know what the long term effects of a treatment like this might be like. PRP injections to help tissue growth repair seem like a great idea, but can there be something like that without consequences alter on? I also agree with Dan that I would exhaust all conservative methods to treat an injury before moving forward with an injection. I would feel more comfortable knowing that I did all that I could conservatively before doing anything even moderately invasive. It was also mentioned that this is not a quick fix, and that the patient may continue to suffer from the impingement after the treatment wears off, so it is again important to weigh the benefits. I would be more for it if the MRIs showed improvements after the injection, but there is still more research needed. Overall I think this has great potential, especially as a supplement to rehabilitation. If this could be used before rehabilitation exercises to help improve advances in range of motion, etc, I think that this could be a great advance in our field.

Jane McDevitt said...

Dan & Adrienne,

I think you bring up some great points regarding the concerns of the growing popularity of PRP injections. I agree that I think that it is great that we are still trying to come up with new innovative treatment techniques; however, we really need to know the short and long term effectiveness before we deliver or suggest such treatments. It seems that considering that PRP injections are more invasive then conservative treatment, they do not show any physiological improvement via the MRI like Adrienne recalled, and there are so many different formulas that Dan pointed out that treatment does not hold up against what we are currently using to rehab this type of injuries. We will have to see what the future research suggests.

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