Part 3 The Final Results

Platelet Rich Plasma (PRP) Therapy is a process whereby a medically trained professional can draw your own blood, spin it in a centrifuge, and separate its components. The healing part of the blood will separate to the top, leaving the other parts at the bottom (read more in my previous blogs). The medical practitioner then draws the white blood cells (WBC) and PRP out from a syringe and re-injects into the patient’s injured body part.

As you may know from reading the previous installments on the topic, I went through a series of PRP injections this year and wrote about the process, what PRP is, and why I tried it.

In my case, it was the shoulder. The shoulder is a complex region of the body and is comprised of three bones: the scapula (shoulder blade), clavicle (collarbone), and humerus (upper arm bone).

There are three joints that join these bones: the glenohumeral (GH) joint (the ball and socket of the humerus); the sternoclavicular joint (where the sternum meets the clavicle); and the acromioclavicular (AC) joint (where the clavicle meets the acromion process of the scapula).

The focus of my treatment was on the GH joint, the connective tissue supporting it, and the rotator cuff muscles. The GH joint has what are called multiple degrees of freedom.

The joint is classified as a ball and socket joint and can move through all three axes (frontal, sagittal, and horizontal). In technical terms, it’s considered a multiaxial joint and has three degrees of freedom, i.e., it moves a lot! The intention of this blog is truly to write a follow up on how the shoulder is after the treatment and how well the treatment impacted it, but a grasp on the anatomy is helpful to understand the outcome.

My Personal Experience With PRP

I went through three rounds of injections, the first in January 2019. Each subsequent round of injections was done two weeks following the last one, respectively. Research indicates that PRP tends to be more effective over a period of time, its results peaking 6-9 months after the final injection. I would be seeing optimal results by now.

Due to the large region of the shoulder and its three degrees of freedom, the outcome was unfortunately not very favorable. The doctors who performed the procedure informed me that the shoulder is a challenging joint for PRP because the injected treatment (my own platelets) didn’t have a chance to stay within the joint long enough to “work their magic”. Despite resting afterward and limiting movement, the qualities of the shoulder joint make success difficult. While I don’t feel worse, I don’t feel better either.

I don’t fault the doctors since this was a trial and we adhered to current research stating the benefits to PRP therapy.

While PRP is not a new treatment, the use of it in this capacity is relatively new. There is some supporting research that PRP treatment can be beneficial to augment rotator cuff treatment but that its use for a stand-alone treatment in rotator cuff tears is inconclusive.

There is actually very little research for its use in the GH joint itself and my specific condition (which was a diagnosed tendinosis) and we must also take into consideration that my injury had a long-standing history. There is research done on a case study of using PRP to successfully treat tendinitis in a patient, yet the case study used didn’t have the history with her injury that I did.

Despite the lackluster results of the PRP treatment in my shoulder, it was beneficial to try it. The procedure was minimally invasive and the research does support its safety when using it in the adult human population. There is also research supporting PRP’s results in terms of improving pain, disability, and shoulder range of movement in patients with adhesive capsulitis of the shoulder.

The Unexpected Outcome

I want to add more to this story, lending to a happier ending. While I only highlighted my PRP therapy done on my shoulder, I also had an ankle injury that was treated with PRP before I ventured to have the series done on my shoulder. Having suffered a grade 1 inversion ankle sprain of my left lateral collateral ligament complex in 2017 that was successfully treated with physical therapy, corrective exercise, and PRP injections.

I used the same docs for my ankle injury as I did for the shoulder treatment. I talked to them about why the treatment went well for the ankle. They said chiefly that the ankle is a smaller, less mobile joint, so the medication (my PRP) could sit in the joint and do its work longer than in a larger joint such as the shoulder.

Also, the ankle joint (or talocrural joint) is a synovial joint formed by the bones of the leg (fibula and tibula) and the foot (talus). It’s classified as a hinge joint (allowing for dorsiflexion and plantarflexion), thus has fewer degrees of freedom than the shoulder (the ankle joint has 2 degrees of freedom). Since it has less movement, is a smaller/tighter area, the PRP was able to saturate it more.

The doctors additionally discussed the probability that since the injury was more recent and not a chronic, recurring injury, it may have had better results. Research supports these statements; PRP has been shown to be an effective treatment for the treatment of acute lateral ankle sprains.

My PRP Takeaway

The purpose of this blog series wasn’t to put PRP on the ‘chopping block’ or put the onus onto my docs or even the therapy for the failed shoulder outcome. The fact is, the PRP worked beautifully on my ankle and in retrospect, I wish I’d been able to include that experience in my account from the start. Since it had worked so well on the ankle, we tried it on the shoulder, and with fingers crossed, given available research.

Overall, I felt it was worth the investment in money and time despite no improvement in my shoulder. Given my experiences, both noteworthy and disappointing, any fit pro would benefit from being informed on the topic. There’s some amazing treatment modalities out there and our clients look to us, inquiring about the latest and greatest all the time.

We can’t draw general conclusions based on my experience alone and make a blanket statement that PRP is not effective in larger regions of the body or ball and socket joints. Obviously, we didn’t try it on my hip joint!

Other factors to consider:

  • My ankle injury had been acute and fairly recent, whereas I had struggled with the shoulder injury for years.
  • We have discussed doing more injections in the shoulder region or even the stem cell procedure. For now, though, I have yet to make that decision. Perhaps additional treatments will be more effective?
  • I’m continuing to do corrective exercise techniques for my shoulder and making sure it stays in optimal positioning during my training so as not to make it worse.

There’s plenty of reading and implementation on the shoulder courtesy of some articles on assessing and preparing the shoulder for pull-ups and strengthening it. Don’t forget proper warm-up techniques for the shoulder before starting a training session is the best way to improve mobility and prevent injury.


References:

Barber, F. A. (2018). PRP as an Adjunct to Rotator Cuff Tendon Repair. Sports Medicine & Arthroscopy Review, 26(2), 42-48.

Barman, A., Mukherjee, S., Sahoo, J. Maiti, R., Rao, P.B., Sinha, M.,….& Bag, N.D. (2019). Single intra-articular platelet-rich plasma versus corticosteroid injections in the treatment of adhesive capsulitis of the shoulder: A cohort study. American Journal of Physical Medicine & Rehabilitation, 98(7), 549-558.

Biel, A. ( 2015). Trail Guide to Movement: Building the Body in Motion. Books of Discovery: Boulder, CO.

Blanco-Rivera, J., Elizondo-Rodríguez, J., Simental-Mendía, M., Vilchez-Cavazos, F., Peña-Martínez, V., & Acosta-Olivo, C. (2018). Treatment of lateral ankle sprain with platelet-rich plasma: A randomized clinical study. Foot and Ankle Surgery (2019).

Ebert, J. R., Wang, A., Smith, A., Nairn, R., Breidahl, W., Zheng, M.H., & Ackland, T., (2018). A midterm evaluation of postoperative platelet-rich plasma injections on arthroscopic supraspinatus repair: A randomized controlled trial. American Journal of Sports Medicine 46(13), 2965-2975.

http://www.leeds.ac.uk/chb/lectures/anatomy4.html

Seijas, R.,  Ares, O., Alvarez, P.,  Cusco, X.,  Garcia-Balletbo, M. & Cugat, R. (2012). Platelet-rich plasma for calcific tendinitis of the shoulder: A case report.  Journal of Orthopaedic Surgery, 20(1), 126-30.