PRP LABRAL TEAR PROTOCOLS
Patients with labral tears that produce chronic pain and some shoulder instability (that are poor surgical candidates) can be treated non-operatively.
The two most common types of labral injuries are SLAP tears (superior labrum from anterior to posterior) tears and Bankart lesions/tears.
SLAP tears occur where the biceps tendon attaches to the superior glenoid.
Bankart tears, on the other hand, typically occur with shoulder dislocation; the head of the humerus either shifts toward the front of the body, leading to “anterior instability,” or the back of the body, called “posterior instability.”
Both types of torn labrum are usually accompanied by chronic dull pain and difficulty performing normal shoulder movements.
With Bankart tears in particular, patients experience apprehension that the shoulder may slip out of place or dislocate in certain positions.
Patients with SLAP tears may experience pain at the front of the shoulder near the biceps tendon.
A low-volume, single-spin Leukocyte poor PRP kit is ideal for this treatment. 5 to 7 cc of volume is injected into the Glenohumeral joint.
• Ultrasound guided, high-frequency linear transducer at 9 mhz or greater
• 10 cc Syringe
• 20 gauge spinal needle for injection
• 5-7 cc of Leukocyte poor PRP
I use the posterior approach to inject into the glenohumeral, intra-articular area.
The patients must be advised to:
AVOID: Aspirin, Motrin, ibuprofen, Aleve (all non-steroidal and steroidal anti-inflammatory agents), curcumin, turmeric, Gingko biloba, garlic, flax oil, cod liver oil, vitamin A, vitamin E, or any other essential fatty acids at least 1 week prior to and after treatment. This includes pain gels such as Voltaren and Salonpas, etc. for pain relief.
Remember, we are creating inflammation.
Screen patients for systemic steroids such as; Prednisone, Hydrocortisone, etc. for at least 2 weeks prior to procedure. This includes epidurals and other steroid injections.
Please advise the patients to avoid vigorous exercise, sun, and heat exposure for at least 3 days prior to treatment
They should also avoid alcohol, and cigarettes for 3 days before and after treatment.
The hardest part of the procedure maybe to draw blood! So, increase fluid intake!
DIET AND FLUID INTAKE: Please increase intake of fluid the day before the procedure by
drinking 2 glasses of water in the morning before the PRP session, 2 glasses at lunch and 2 glasses at dinner.
Advise patients to eat a normal breakfast or lunch the day of your PRP session. Do not eat for 3 hours prior to the procedure. They should take routine morning medications as long as they are not anti-inflammatory or
blood thinners. Please see the list above.
The glenohumeral joint can be accessed anteriorly or posteriorly.
I will describe the techniques for the anterior and posterior approaches.
For the posterior approach, the patient is placed in either the sitting or lateral decubitus position with the side of the shoulder you are injecting placed on the opposite shoulder. A linear probe of frequency approximately 9 MHz is usually used unless the patient is a heavy or muscular build. If so, a lower frequency can be used. The ultrasound probe is placed just above the acromion, over the infraspinatus tendon (Figure 3). The key structures to identify are the humeral head, the labrum, the infraspinatus tendon, and the joint capsule.
For the anterior rotator cuff interval approach, the patient is placed in supine position and a high frequency linear probe of 6-13 MHz is used. The first scan is similar to the scanning of the long head of the biceps tendon (LHB) at the bicipital groove. Following this scan, the LHB is traced in the cephalad and medial direction until it is seen in between the supraspinatus and subscapularis muscle underneath the coraco-humeral ligament
The drawing of three main recesses of the joint (left): A=the biceps tendon sheath; B=the axillary pouch; C=the subscapular recess; and the corresponding radiographic (arthrogram) appearance (right). Reprint with permission from usra.ca.
Please carefully read and follow these Instructions after your PRP treatment. There are minimal restrictions after your
PRP injections allowing you to return to your daily activities almost immediately.
Do NOT touch, press, rub, or manipulate the treated area(s) for at least 12 hours after your treatment.
AVOID: Aspirin, Motrin, ibuprofen, Aleve (all non-steroidal and steroidal anti-inflammatory agents), curcumin, turmeric,
Gingko biloba, garlic, flax oil, cod liver oil, vitamin A, vitamin E, or any other essential fatty acids at least 3 days -1 week
prior to and after your treatment. Remember, we are creating inflammation. This includes pain gels such as Voltaren
and Salonpas, etc. for pain relief.
If you experience discomfort or pain, you may take Tylenol or other acetaminophen products.
You may apply heat, if you wish, to the injected area for 20-30 minutes after the procedure, but we would prefer if you
can refrain from this. Do not apply ice to treated area!
Do not wash or take a shower for at least 6 hours after your treatment.
Do not use any lotions, creams, or make-up for at least 6 hours after your treatment
AVOID: Vigorous exercise, sun, and heat exposure for at least 3 days after your treatment
AVOID: Alcohol, caffeine, and cigarettes for 3 days before and after your treatment.
Smokers do not heal well, problems recur earlier, and results may take longer.
Drink plenty of water for 2 weeks (10 cups per day)
You can return to physical therapy 7 days after treatment.
You may return to the gym 10 days after treatment.
It is normal to experience: Bruising, redness, itching, soreness, and swelling that may last from 3-10 days following your
procedure. Important reminder: There should be no fever or purulent discharge (pus) from the site. If there is, please
contact us immediately
