黃柏仁醫師 Po-Jen Huang, M.D.: rotator cuff tear

2024年7月14日星期日

Is PRP Really Better for Tendon Tears? A Look at Research from the Orthopaedic Journal of Sports Medicine

l The Challenge of Tendon Tears

Tendon tears are common sports injuries, especially among athletes and manual laborers. Traditional treatments include physical therapy, anti-inflammatory medications, and corticosteroid injections. However, these methods often have limited effectiveness, and long-term use of corticosteroids can lead to side effects.

l What is PRP (Platelet-rich plasma)?

PRP (Platelet-rich plasma) is a treatment that uses the patient’s own blood to extract and concentrate platelets. These platelets are rich in growth factors that promote tissue repair and regeneration. PRP therapy is becoming increasingly popular in sports medicine and orthopaedics, showing significant results in treating tendon tears.

l Is PRP Treatment Really Better?

A 2021 study published in the Orthopaedic Journal of Sports Medicine (IF: 2.4) compared the effects of PRP and traditional corticosteroid injections on partial shoulder tendon tears (primarily the supraspinatus tendon). This randomized controlled trial included 32 patients who received either PRP or corticosteroid injections.

Study Results:

Short-term Effects (1 month post-treatment):

Both groups showed significant improvements in pain (VAS scores) and shoulder function (OSS scores).

There was no significant difference in the level of improvement between the two groups.

Long-term Effects (6 months post-treatment):

1. The PRP group continued to show improvements in pain and function, while the corticosteroid group did not.

2. Compared to the corticosteroid group, the PRP group had significantly better pain relief and functional improvement.

3. Specifically, the PRP group’s VAS (visual analog scale) scores and OSS (Oxford Shoulder Score) scores significantly decreased, indicating greater pain reduction and functional enhancement.

Safety:

⁃ No complications were reported in either group during the study period, demonstrating the safety of both PRP and corticosteroid treatments.

Study Conclusion:

• Both corticosteroid and PRP injections provided similar pain relief and functional improvement at 1 month for patients with partial supraspinatus tears.

• However, PRP showed superior benefits over corticosteroids in the 6-month follow-up.

Dr. Huang's Summary:

l Why Choose PRP?

• Long-term Efficacy: PRP offers better long-term pain relief and functional improvement compared to corticosteroids.

• Natural Components: PRP is derived from the patient’s own blood, reducing the risk of rejection and allergic reactions.

• Promotes Healing: The growth factors in PRP effectively promote the repair and regeneration of tendons and other tissues.

l Does PRP Treatment Suit You?

For patients with tendon tears, PRP injections are an effective and safe treatment option. They not only provide short-term pain relief but also promote long-term functional recovery and improve the quality of life. For those seeking long-term benefits and lower risks of side effects, PRP is undoubtedly the best treatment choice.

[References: https://pubmed.ncbi.nlm.nih.gov/34485587/

2023年10月26日星期四

Doctor, I have "erection problem”: A brief discussion of the classification of rotator cuff tears

"Doctor, my shoulder hurts,

I can't lift my hand..."

Shoulder pain is a common complaint in primary healthcare facilities and sports medicine clinics.

It is estimated that the prevalence of shoulder pain in the general population ranges from 16% to 34%.

Rotator cuff pathology is the most common shoulder condition for which patients seek treatment.

In the United States, rotator cuff problems lead to approximately 4.5 million annual medical visits and around 40,000 surgeries.

In Taiwan, according to a retrospective analysis, 41% of patients with shoulder pain were confirmed to have a rotator cuff tear through joint cavity arthrogram, including 92.2% with a full-thickness tear and 7.7% with a partial tear.

Another 44% of patients showed adhesive capsulitis in their joint imaging results, and only 15% had normal findings.

Even without symptoms, up to 23% of people may have hidden rotator cuff tears, and the prevalence increases with age. (Note 1)

There are several classification methods for rotator cuff tears.

One of the most common classification methods based on the severity of the tear is the Ellman Classification:

l Partial Thickness Rotator Cuff Tear:

Grade 1: Less than 3 millimeters or less than 25% of tendon thickness (< 3mm or < 25% thickness)

Grade 2: 3 to 6 millimeters or 25% to 50% of tendon thickness (3-6mm or 25-50%)

Grade 3: Greater than 6 millimeters or more than 50% of tendon thickness (>6mm or >50%)

l Full Thickness Rotator Cuff Tear

If classified by the location of the tear, it can be divided into the following three types:

l Articular side tear

l Bursal side tear

l Intrasubstance or intratendinous tear

In the past, the diagnosis of rotator cuff tears could only be confirmed using magnetic resonance imaging (MRI), and treatment options were limited to traditional rehabilitation or surgery.

However, now, in addition to real-time dynamic diagnosis using advanced ultrasound, it is also possible to perform ultrasound-guided injections of substances rich in growth factors [such as PRP, dehydrated human amnion/chorion membrane (dHACM)…etc] or STABHA™ (Soft Tissue Adapted Biocompatible Hyaluronic Acid, a tendon-ligament repair agent) to facilitate the healing and repair of the ruptured tendons.

This type of treatment is not only faster and more effective than "traditional rehabilitation" or "post-surgery recovery waiting," but it is also highly safe, eliminating concerns about surgical risks and post-operative complications.

It represents the latest and best treatment method.

(Note 1:

According to a prospective study (https://pubmed.ncbi.nlm.nih.gov/10471998/#full-view-affiliation-1),

in individuals aged 50 to 59, 13% (22 out of 167 patients) had rotator cuff tears;

in those aged 60 to 69, 20% (22 out of 108 patients) had tears;

in those aged 70 to 79, 31% (27 out of 87 patients) had tears;

and in those over 80 years old, 51% of patients (25 out of 49) had tears.)

References:

Prevalence of Rotator Cuff Tears in Elderly Patients with Shoulder Pain-Rural Area at Local South of Taiwan

https://www.airitilibrary.com/Article/Detail/20719833-201405-201502020050-201502020050-7-7

Age-related prevalence of rotator cuff tears in asymptomatic shoulders

https://pubmed.ncbi.nlm.nih.gov/10471998/#full-view-affiliation-1