Shoulder pain is epidemic in the United States.
Patients of all ages can be affected. This goes for the younger, athletic crowd
who overdo their exercise (weight) routines or in older individuals who have
varying degrees of shoulder arthritis, wear and tear of life and who may also
be engaged in some type of regular exercise program. Whatever the activity, it
is the repetitive action of raising the arm overhead that triggers the cascade
to impingement. The shoulder joint is one of the most complex joints in the
body, in that it performs a number of functions, not the lease of which is
being able to move in a wide plane of directions. There are severe structures
in the shoulder that are subject to impingement, with the main one being the
rotator cuff. The rotator cuff is a tendon that connects four of the main
shoulder girdle muscles together. These include the Supraspinatus, Infraspinatus,
subscapularis and teres minor. These are the muscles that form rounded shoulder
joint and surround the joint itself. The muscles themselves are subject to
sprain injuries as well.
The acromion is the front outer edge of the
scapula (shoulder blade) and can impinge on the rotator cuff. It also
articulates (is connected to) the outer head of the clavicle (the
acromioclavicular joint.) The AC joint is held together by a ligament which
itself is subject to strain and injury. The AC joint can become strained
or even separated, both painful conditions. Additionally, there is a bursa
overlying the rotator cuff, which can become inflamed, resulting in bursitis.
Minor rotator cuff tears can cause pain. Even after surgical repair of rotator
cuff tears or various shoulder impingement syndromes, pain can persist.
Standard therapy including rehabilitation and anti-inflammatory agents can be
helpful. Cautious use of cortisone injections may be tried but repeated
injections are not to be encouraged due to the risk of tissue breakdown, bone
breakdown or pathological tendon rupture.
Treatment of these various conditions can take
months to weeks to heal, particularly if surgery is involved. As with any
surgical procedure, absolute results are never a certainty. Unfortunately,
patients are not uncommonly left with residual pain that has not responded to
any conservative treatment. Platelet rich plasma has been approved for use for
over 20 years. This is an excellent pre or post surgical options for patients
with shoulder pain that has no responded to other treatment modalities. Through
careful examination (and possibly an MRI of the shoulder) the doctor determines
the structure(s) of the shoulder that are involved. Then using standard PRP
technique, with sterile preparation of the skin and local anesthesia, PRP is
injected into the tender areas, peppering the PRP around the site that requires
healing. The platelets are then
activated using thrombin, thereby releasing potent bioactive proteins that
begin the healing process. The platelets clump together forming a matrix
skeleton that fibrinocytes can migrate into and start laying down collagen
fibers to heal the area. Powerful cytokines send out chemical signals that
recruit stem cells into the area, furthering the healing process. The PRP graft
initially causes a mild inflammatory response with all the different healing
blood cells and bioactive proteins in the area. This can cause mild swelling and
tenderness that can be controlled with ice and Tylenol products. It is
important not to take anti-inflammatory agents for a week prior to and 6 weeks
after PRP injection as this will limit the healing process. Ice should be
stopped after the first week. The PRP graft healing continues for up to six
weeks. If patients continue to have significant pain, a second PRP graft can be
given 4 weeks after the first injection. Unlike cortisone, there is no limit to
the number of PRP injections that can be given. This FDA approved therapy is
safe and effective. The very nature of PRP has an antimicrobial action, as
there are white blood cells in PRP that fight infection. Like all injections
there can be pain, swelling, injury to adjacent neurovascular structures and
failure to control pain although these problems are minimal with PRP. If you have shoulder pain, ask your doctor if
PRP therapy could be of benefit to you. Conatact Sarasota Neurology for
platelet rich plasma consultation.
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