PRP ROTATOR CUFF PROTOCOLS
Rotator Cuff Tear
Patients with partial-thickness rotator cuff tears, who are symptomatic, can be successfully treated non-operatively.
Rotator cuff tears are a common cause of shoulder pain. The causes are both traumatic and degenerative. Even after surgical intervention, tendon residual defects or "retears" often develop.
Platelet-Rich Plasma injections are not often ideal for emergency care. They are ideal for chronic injury.
PRP injection works well when combined with the physical therapy for sports injuries.
A low-volume, single-spin Leukocyte poor PRP kit is ideal for this treatment.
• 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
Please carefully read and have your patient follow these instructions prior to their PRP treatment.
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 let us increase fluid intake
DIET AND FLUID INTAKE • Please increase intake of fluid the day before procedure by
drinking 2 glasses of water in the morning before PRP session, 2 glasses at lunch and 2 glasses at
dinner.
Advise them to eat a normal breakfast or lunch the day of your PRP session. Do not eat for 3 hours prior to
procedure.They should take routine morning medications as long as they are not anti-inflammatory, or
blood thinners please see list above
.
The GHJ can be accessed anteriorly, posteriorly, and from the rotator cuff interval. The techniques for the anterior and posterior approaches will be described. For the posterior approach, the patient is placed in either the sitting or lateral decubitus position with the ipsilateral hand placed on the contralateral shoulder. A linear probe of frequency 6-13 MHz is usually used unless the patient is of very high body mass index or strong muscular build. The ultrasound probe is placed just caudal to the acromion over the infraspinatus tendon (Figure 3). The key structures to identify are humeral head, labrum, infraspinatus tendon, and joint capsule. For the anterior rotator cuff interval approach, the patient is placed in supine position and a high frequency linear probe 6-13 MHz is used. The first scan is similar to the scanning of the long head of the biceps (LHB) tendon 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 have your patient follow these instructions after their PRP treatment. There are minimal restrictions after PRP injections allowing the patient to return to daily activities almost immediately.
The patient should NOT touch, press, rub or manipulate the treated area(s) for at least 12 hours after the 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 1 week prior to and after their treatment. Remember, we are creating inflammation, so any drugs or foods that have anti-inflammatory properties must be avoided, including pain gels such as Voltaren and Salonpas, etc.
If the patient experiences discomfort or pain, they may take Tylenol or other acetaminophen products.
Heat may be applied, to the injected area for 20-30 minutes after the procedure, but it would preferable if they can refrain from this. Ice or cold packs should never be applied to the treated area!
The patient should not wash or take a shower for at least 6 hours after their treatment.
They should not use any lotions, creams, or make-up for at least 6 hours after their 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.
Patients should drink plenty of water for 2 weeks (10 cups per day).
They can return to physical therapy 7 days after treatment.
They 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 their procedure. Important reminder: There should be no fever or purulent discharge (pus) from the site. If there is, have the patient contact you immediately.
