By Michael S. Erickson, MD
Injections to treat rotator cuff injuries typically target the small space between the bony acromion that sits on top of the shoulder and the humeral head. Rotator cuff tendons that attach to the humeral head travel through this small space, where degeneration and impingement often occurs.
Steroid injection. Subacromial injections of local anesthetic and cortisone may also be used for pain control, but they do not improve healing.
Platelet Rich Plasma (PRP). This injection therapy may have a role in promoting healing of injured tendons; however, it does not improve (and may briefly worsen) a patient’s comfort.
Preparing PRP requires taking small blood sample from the patient and placing it in a centrifuge, where it is spun at intensely high speeds, causing the blood to separate into layers. The layer of PRP is removed and injected into the injured tendon or bursa.
PRP therapy is currently being researched, and experts are still learning about whether and how it works. The hope is that the injection, which contains concentrated proteins and other natural mediators of healing, will promote the regeneration of cells in the damaged rotator cuff.
Prolotherapy. Treatment involves several targeted injections to the damaged rotator cuff. Typically, these injections contain an irritant such as dextrose or saline (sugar water or salt water). This irritation leads to inflammation and eventually to healing. This treatment remains unproven, though advocates assert that the healing process leads to new tissue, ultimately repairing the rotator cuff.
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Doctors who recommend PRP and prolotherapy typically advise more than one treatment. For example, a patient may get three prolotherapy treatments spaced 2 to 4 weeks apart.
Like PRP and prolotherapy, other injection treatments, such as the injection of autologous blood, are thought to promote inflammation and healing. Different doctors will have different opinions on the efficacy of each type of injection treatment. Experts agree more research is needed in this area.
Patients may consider rotator cuff surgery if they do not get satisfactory symptom relief from non-surgical treatments or injections.
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