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.
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.
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
by: Jeff Driban
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