The rotator cuff is a group of muscles and tendons that help to stabilize the shoulder joint. Rotator cuff disease is a condition that affects these muscles and tendons, causing pain, weakness, and stiffness in the shoulder.
There are several different types of rotator cuff disease, including:
- Tendinosis: This is a more chronic condition that causes degeneration of the tendons in the rotator cuff.
- Rupture: This is a tear in the tendons of the rotator cuff.
Rotator cuff disease can be caused by a number of factors, including:
- Repetitive use: Activities that require repetitive overhead motions, such as swimming, tennis, and baseball, can put stress on the rotator cuff and lead to disease.
- Age: The rotator cuff tendons tend to weaken with age, making them more susceptible to injury.
- Injury: A fall or other traumatic event can also injure the rotator cuff.
The symptoms of rotator cuff disease can vary depending on the severity of the condition. Mild cases may only cause occasional pain with overhead activities. More severe cases can cause constant pain, weakness, and decreased range of motion in the shoulder.
In recent years, injections have become more popular as a treatment option for shoulder pain.
There are a variety of injections that can be used for the shoulder including:
- Cortisone injections: Cortisone is a powerful anti-inflammatory medication that can be injected into the shoulder to relieve pain and inflammation.
- Hyaluronic acid (HA) injections: Hyaluronic acid is a natural substance that helps to lubricate joints and cushion tissues. Hyaluronic acid injections can be used to treat pain and inflammation in joints, such as the knee and hip.
- Platelet-rich plasma (PRP) injections: PRP is a concentrated form of platelets that are extracted from the patient’s own blood. PRP injections are thought to help to stimulate healing and repair in damaged tissues.
This month’s blog aims to compare the three different injection therapies for rotator cuff disease.
Cortisone vs PRP
A systematic review compared the effectiveness of cortisone injections vs PRP when treating rotator cuff lesions. They found that the corticosteroid injection yielded statistically significant superior functional recovery and pain relief compared with PRP injection for rotator cuff lesions during the short-term follow-up period (3–6 weeks). However, at the medium-term (8–12 weeks) and long-term (over 12 weeks) follow-up, no statistically significant difference was identified between the two groups. Regarding shoulder function, no significant difference was found between the two groups during the whole follow-up period (3 weeks-24 weeks).
HA vs Cortisone vs Placebo
The corticosteroid injections gave a better result from the start of the trial and were significantly better at six weeks than placebo. They produced a faster reduction in pain than hyaluronic acid and placebo in the first three to 12 weeks. No significant differences were shown at 26 weeks, at which point the placebo group showed the best mean improvement in pain and functional mobility. However, the mean reduction in pain achieved at 26 weeks was 20% in the corticosteroid group, 15% in the hyaluronic acid group and 21% in the placebo group. The authors of the study concluded that the reason the HA injection wasn’t as effective as cortisone or placebo was due to the HA having a sustained effect on the inflammatory environment as opposed to reducing inflammation.
HA vs PRP
The results show significant improvement in VAS Scale (pain) on weeks 4 and 6-month follow-up post injection for both PRP and HA. It was noticed that the PRP group has a significant improvement in pain levels in comparison to the HA group (P = 0.01) only on weeks 4. The PRP and the HA groups had a significantly lower SPADI (shoulder function) on 4-week and 6-month follow-up.
The PRP injection and the HA injection are found to be effective in improving quality of life, pain, and disability in patients with chronic shoulder pain. In this study, injections were performed once. It is uncertain whether more than one injection would be more beneficial. An additional injection may be beneficial for the patients who did not show favorable outcomes or only partial therapeutic effects.
Overall, cortisone injections have been shown to be more effective in the short term when treating rotator cuff disease however in the long term no significant difference was found regarding shoulder pain levels and function. When comparing HA to the other injection options conflicting evidence was found making it difficult to identify if it really does help shoulder pain and function. Although in one of the studies PRP did show improvements in shoulder function and pain there was no long-term significant improvements in shoulder function and pain when compared to cortisone.
As established in our previous blog, additional research is necessary to further establish the long-term effectiveness and safety of these treatments. When deciding whether to undergo injection therapy it should be discussed with your health care providers as collaboration is key to ensure your best outcomes.
