PRP injection for shoulder/rotator cuff pain

jJjburton

Member
AnabolicLab.com Supporter
Who's going to inject the homebrew PRP into their shoulder tendon or any other tendon for that matter? It's not like anyone that I know has a ultra sound, besides any amount of practice shooting into your tendons?

mands
Yes it seems quiet unsettling.
 

Roco Bama

Member
Who's going to inject the homebrew PRP into their shoulder tendon or any other tendon for that matter? It's not like anyone that I know has a ultra sound, besides any amount of practice shooting into your tendons?

mands
Some physicians don't even use ultrasound. It can be hard to locate some tendons like the hamstring tendon without an ultrasound but the shoulder and knee tendons can be located, you just have to know the anatomy of the shoulder. I reviewed lots of videos/pictures of the shoulder anatomy before the procedure.
 

mands

Member
AnabolicLab.com Supporter
Some physicians don't even use ultrasound. It can be hard to locate some tendons like the hamstring tendon without an ultrasound but the shoulder and knee tendons can be located, you just have to know the anatomy of the shoulder. I reviewed lots of videos/pictures of the shoulder anatomy before the procedure.
That might be the case but studies/medical literature and my orthopedic surgeon states for PRP to be successful(If you can even call PRP injections successful) it should be done with ultrasound.

You state that some physicians don't use ultra sound. They key word is physicians. Not your average meat head like myself. @Roco Bama I'm not saying you personally can't do this yourself I just don't know if you should be advocating this type of injection here on meso.

Even if PRP might be slightly successful for a few, everyone should read this study.

Phys Ther Sport. 2016 Jan;17:87-94.
The clinical impact of platelet-rich plasma on tendinopathy compared to placebo or dry needling injections: A meta-analysis.
Tsikopoulos K1, Tsikopoulos I2, Simeonidis E2, Papathanasiou E3, Haidich AB4, Anastasopoulos N3, Natsis K3.

Abstract
OBJECTIVE:

The purpose of this meta-analysis was to compare the impact of platelet-rich plasma with that of placebo or dry needling injections on tendinopathy.

METHODS:
The databases of PubMed, CENTRAL, Scopus, Web of Science, and trial registries, reference lists, and conference abstract books were searched up to December 2014. Adults with tendinopathy in randomized controlled trials were enrolled. The trials compared effect of platelet-rich plasma with that of placebo or dry needling. We used subgroup analysis linked to the anatomical location of the tendinopathy. The primary outcome was pain intensity at two or three and six months after intervention. The secondary outcome was functional disability at three months after treatment.

RESULTS:
Five trials were included. There was a statistically significant difference in favor of the platelet-rich plasma intervention at the second primary outcome time point (SMD -0.48, 95%CIs -0.86 to -0.10, I(2) = 0%, p = 0.01) and at the secondary outcome time point (SMD -0.47, 95%CIs -0.85 to -0.09, I(2) = 0%, p=0.01).

CONCLUSIONS:
Platelet-rich plasma did not provide significantly greater clinical benefit versus placebo or dry needling for the treatment of tendinopathy at a six-month follow-up. However, there was a marginal clinical difference in favor of platelet-rich plasma injections on rotator cuff tendinopathy.

mands
 

hghlover

Member
That might be the case but studies/medical literature and my orthopedic surgeon states for PRP to be successful(If you can even call PRP injections successful) it should be done with ultrasound.

You state that some physicians don't use ultra sound. They key word is physicians. Not your average meat head like myself. @Roco Bama I'm not saying you personally can't do this yourself I just don't know if you should be advocating this type of injection here on meso.

Even if PRP might be slightly successful for a few, everyone should read this study.

Phys Ther Sport. 2016 Jan;17:87-94.
The clinical impact of platelet-rich plasma on tendinopathy compared to placebo or dry needling injections: A meta-analysis.
Tsikopoulos K1, Tsikopoulos I2, Simeonidis E2, Papathanasiou E3, Haidich AB4, Anastasopoulos N3, Natsis K3.

Abstract
OBJECTIVE:

The purpose of this meta-analysis was to compare the impact of platelet-rich plasma with that of placebo or dry needling injections on tendinopathy.

METHODS:
The databases of PubMed, CENTRAL, Scopus, Web of Science, and trial registries, reference lists, and conference abstract books were searched up to December 2014. Adults with tendinopathy in randomized controlled trials were enrolled. The trials compared effect of platelet-rich plasma with that of placebo or dry needling. We used subgroup analysis linked to the anatomical location of the tendinopathy. The primary outcome was pain intensity at two or three and six months after intervention. The secondary outcome was functional disability at three months after treatment.

RESULTS:
Five trials were included. There was a statistically significant difference in favor of the platelet-rich plasma intervention at the second primary outcome time point (SMD -0.48, 95%CIs -0.86 to -0.10, I(2) = 0%, p = 0.01) and at the secondary outcome time point (SMD -0.47, 95%CIs -0.85 to -0.09, I(2) = 0%, p=0.01).

CONCLUSIONS:
Platelet-rich plasma did not provide significantly greater clinical benefit versus placebo or dry needling for the treatment of tendinopathy at a six-month follow-up. However, there was a marginal clinical difference in favor of platelet-rich plasma injections on rotator cuff tendinopathy.

mands

Man i dont get PRP.. so many mixed reviews on this shit
 

mands

Member
AnabolicLab.com Supporter
Man i dont get PRP.. so many mixed reviews on this shit
Honestly I was torn about using before and after my surgery. I decided against it after talking to my surgeon and reading a few studies.

IMO currently the only thing I see slightly beneficial could be highly cellular leukocyte-rich PRP (LR-PRP) preparations.

mands
 

4Figgy

Member
That might be the case but studies/medical literature and my orthopedic surgeon states for PRP to be successful(If you can even call PRP injections successful) it should be done with ultrasound.

You state that some physicians don't use ultra sound. They key word is physicians. Not your average meat head like myself. @Roco Bama I'm not saying you personally can't do this yourself I just don't know if you should be advocating this type of injection here on meso.

Even if PRP might be slightly successful for a few, everyone should read this study.

Phys Ther Sport. 2016 Jan;17:87-94.
The clinical impact of platelet-rich plasma on tendinopathy compared to placebo or dry needling injections: A meta-analysis.
Tsikopoulos K1, Tsikopoulos I2, Simeonidis E2, Papathanasiou E3, Haidich AB4, Anastasopoulos N3, Natsis K3.

Abstract
OBJECTIVE:

The purpose of this meta-analysis was to compare the impact of platelet-rich plasma with that of placebo or dry needling injections on tendinopathy.

METHODS:
The databases of PubMed, CENTRAL, Scopus, Web of Science, and trial registries, reference lists, and conference abstract books were searched up to December 2014. Adults with tendinopathy in randomized controlled trials were enrolled. The trials compared effect of platelet-rich plasma with that of placebo or dry needling. We used subgroup analysis linked to the anatomical location of the tendinopathy. The primary outcome was pain intensity at two or three and six months after intervention. The secondary outcome was functional disability at three months after treatment.

RESULTS:
Five trials were included. There was a statistically significant difference in favor of the platelet-rich plasma intervention at the second primary outcome time point (SMD -0.48, 95%CIs -0.86 to -0.10, I(2) = 0%, p = 0.01) and at the secondary outcome time point (SMD -0.47, 95%CIs -0.85 to -0.09, I(2) = 0%, p=0.01).

CONCLUSIONS:
Platelet-rich plasma did not provide significantly greater clinical benefit versus placebo or dry needling for the treatment of tendinopathy at a six-month follow-up. However, there was a marginal clinical difference in favor of platelet-rich plasma injections on rotator cuff tendinopathy.

mands
For the PRP to work all you have to do is make sure the injection is around the injury. Ultrasound makes it easier to see, but depending on where the tendonopothy is on the tendon, all you have to do it get the right spot.

I’ve had it all done except PRP. It’s why I’m investing in the supplies to do it myself. For some people, even the chance of it working is worth giving it a shot. And for the price per injection at the doctor you can purchase everything you need to do multiple shots yourself.
 

mands

Member
AnabolicLab.com Supporter
For the PRP to work all you have to do is make sure the injection is around the injury. Ultrasound makes it easier to see, but depending on where the tendonopothy is on the tendon, all you have to do it get the right spot.

I’ve had it all done except PRP. It’s why I’m investing in the supplies to do it myself. For some people, even the chance of it working is worth giving it a shot. And for the price per injection at the doctor you can purchase everything you need to do multiple shots yourself.
I would have to disagree with your "around" the injury statement. It needs to be injected in the actual tendon, not just around the area.

I guess we need to establish what injury means... A tore tendon PRP will do nothing at all as you know. Surgery is your only bet at that point.

It could possibly help with tendinosis. But, most likely only in knee and elbow tendinosis. Rotator cuff or Achilles not so much.

With that said only have I seen data on knee and elbow reducing pain in a 6 and 12 month time frame. Just seems very irresponsible. Not that advising AAS or peptides is either. :)

I personally depending on what and where you are experiencing for teninosis thinks that's it's waste of money and worth it. That's just my IMO.
 

hghlover

Member
I would have to disagree with your "around" the injury statement. It needs to be injected in the actual tendon, not just around the area.

I guess we need to establish what injury means... A tore tendon PRP will do nothing at all as you know. Surgery is your only bet at that point.

It could possibly help with tendinosis. But, most likely only in knee and elbow tendinosis. Rotator cuff or Achilles not so much.

With that said only have I seen data on knee and elbow reducing pain in a 6 and 12 month time frame. Just seems very irresponsible. Not that advising AAS or peptides is either. :)

I personally depending on what and where you are experiencing for teninosis thinks that's it's waste of money and worth it. That's just my IMO.

May i ask why PRP should not work for achilles tendons?

Also your thoughts on HGH and stem cells for tendonosis?
 

mands

Member
AnabolicLab.com Supporter
May i ask why PRP should not work for achilles tendons?

Also your thoughts on HGH and stem cells for tendonosis?
The actions why I could only speculate and haven't read to deep on it. But, what I've read it seems like the two points I mentioned above didn't have any significance differences from placebo. Here is one study.

Efficacy of platelet-rich plasma injections in pain associated with chronic tendinopathy: A systematic review - PubMed

There is a more recent study from 2018 that goes into more depth. It involves multiple locations.

Even the most recent clinical trials state that more studies need to be done.

As far as HGH read this.

GH and mRNA Extracellular Matrix Expression in Skeletal Muscle and Tendon Connective Tissue
GH administration was associated with elevated local IGF-I expression and collagen expression in skeletal muscle during the periods of inactivity and rehabilitation (Fig. 7, A–D). This association between GH and local IGF-1/collagen expression failed to be observed in the patellar tendon, which is probably due to large variation in the limited samples obtained (Fig. 7, E–G). Furthermore, it has to be noted that, in the present study, we only determined mRNA expression and not the local protein concentration of IGF-I, and that we did not measure IGF-I binding proteins. Thus we are not able to directly evaluate the local concentration of free IGF-I. Previous animals studies have demonstrated GH to stimulate IGF-1 and collagen expression in connective tissue, where changes in the level of physical activity were associated with a change in IGF-I and collagen expression (31). Likewise, in humans, it has been found that GH administration led to increased expression of both IGF-I and collagen in muscle and tendon, which occurred in a parallel manner (20). This is further supported by recent data in young healthy men where GH administration clearly leads to increased IGF-I and collagen expression in the musculo-tendinous tissue during short-term immobilization and retraining (9).

In conclusion, GH administered in healthy, elderly individuals appears to attenuate muscle volume loss during short-term immobilization and stimulates muscle growth during subsequent retraining due to either water retention or muscle tissue maintenance. At the same time, GH administration was found to stimulate collagen expression, tendon size, and stiffness during the rehabilitation phase following short-term inactivity. The present data indicate that GH can influence the connective tissue metabolism in musculo-tendinous tissue and tendon biomechanical properties during short-term immobilization and subsequent rehabilitation in elderly humans.

I believe certain types of STEM cells could help but I cannot tell you which ones off the top of my head. There are a few out there.

mands
 

hghlover

Member
The actions why I could only speculate and haven't read to deep on it. But, what I've read it seems like the two points I mentioned above didn't have any significance differences from placebo. Here is one study.

Efficacy of platelet-rich plasma injections in pain associated with chronic tendinopathy: A systematic review - PubMed

There is a more recent study from 2018 that goes into more depth. It involves multiple locations.

Even the most recent clinical trials state that more studies need to be done.

As far as HGH read this.

GH and mRNA Extracellular Matrix Expression in Skeletal Muscle and Tendon Connective Tissue
GH administration was associated with elevated local IGF-I expression and collagen expression in skeletal muscle during the periods of inactivity and rehabilitation (Fig. 7, A–D). This association between GH and local IGF-1/collagen expression failed to be observed in the patellar tendon, which is probably due to large variation in the limited samples obtained (Fig. 7, E–G). Furthermore, it has to be noted that, in the present study, we only determined mRNA expression and not the local protein concentration of IGF-I, and that we did not measure IGF-I binding proteins. Thus we are not able to directly evaluate the local concentration of free IGF-I. Previous animals studies have demonstrated GH to stimulate IGF-1 and collagen expression in connective tissue, where changes in the level of physical activity were associated with a change in IGF-I and collagen expression (31). Likewise, in humans, it has been found that GH administration led to increased expression of both IGF-I and collagen in muscle and tendon, which occurred in a parallel manner (20). This is further supported by recent data in young healthy men where GH administration clearly leads to increased IGF-I and collagen expression in the musculo-tendinous tissue during short-term immobilization and retraining (9).

In conclusion, GH administered in healthy, elderly individuals appears to attenuate muscle volume loss during short-term immobilization and stimulates muscle growth during subsequent retraining due to either water retention or muscle tissue maintenance. At the same time, GH administration was found to stimulate collagen expression, tendon size, and stiffness during the rehabilitation phase following short-term inactivity. The present data indicate that GH can influence the connective tissue metabolism in musculo-tendinous tissue and tendon biomechanical properties during short-term immobilization and subsequent rehabilitation in elderly humans.

I believe certain types of STEM cells could help but I cannot tell you which ones off the top of my head. There are a few out there.

mands

Thanks for the reply
 

lilhawk

Member
Don't do this on your own. Use ultrasound and have someone that knows what they're doing do it for you. I had an NP do it in the office and he hit a nerve in my elbow. Lost feeling and fingers in my hand were contracted for a good 4 hours. Scared the shit out of me, and him. On the bright side this was about 3 years ago, and the pain in my elbow has never returned.
 

ShaunieC

Junior Member
I had a few PRP injections on knee tendinopathies through a local general doctor. 100 quid, injected near the back of the patella tendon. Did nothing for me but also who knows how the sample was prepared. I had 2 or 3 done and maybe one sclerosing injection also.

Also - injecting into the tendon? It would seem to make sense from an initial repair viewpoint but surely direct tendon injection is rupturing the tendon and the start of a crack basically? Is that not the accepted medical narrative? I dont know of many studies suggesting PRP has any measurable positive impact on degenerative tendons - admittedly I havent checked in a few years now but a few years back it was quite inconclusive.
 

mands

Member
AnabolicLab.com Supporter
Also - injecting into the tendon? It would seem to make sense from an initial repair viewpoint but surely direct tendon injection is rupturing the tendon and the start of a crack basically? Is that not the accepted medical narrative?
Yes directly into the tendon in some applications. Others are very specific and precise injection points. I mentioned earlier ultrasound should be used because of these very specific points.

"PRP preparation and injection technique
20 ml of peripheral blood in total was drawn from all patients into four 5 ml trisodium citrate tubes, and the preparation of a PRP concentrate was performed by a validated method leading to a 29–39 fold increase in platelet concentration without leucocytes.13 Centrifugation of tubes was conducted with a single spin, at 460 g for the period of 8 min. Under laminar airflow, the plasma fraction exactly above the buffy coat (1.5 ml) was aspirated from all tubes and dispensed into an empty tube. The addition of 22.8 mM of calcium chloride into the solution was performed before the injection. Following this, the activated concentrate was injected as the needle was gradually withdrawn towards the skin into the peritendinous area before coagulation.

Lateral and medial epicondyle
The prepared 3 ml of PRP was injected with an 18-gauge needle into the common extensor or flexor tendon as well as the insertions into bone, using a peppering technique. This technique involved a single skin portal followed by 5 penetrations of the fascia while injecting equal amounts of platelet-rich plasma. Injections were administered at the point where maximal pain was present.

Patellar tendon
Approximately 2 ml of PRP was injected directly into the area of maximum tenderness. Then the remaining 2 ml PRP was injected by the investigator using an 18-gauge needle into the patellar tendon origin on the patella with a peppering technique. This technique involved a single skin portal and then five penetrations of the tendon.

Rotator cuff
Approximately 5 ml of PRP was injected under the posterolateral aspect of the acromion, directly into the subacromial space. No repeated needling (tenotomy) was done.

Achilles
Approximately 3 ml–5 ml of PRP was injected into the Achilles tendon using a peppering technique always in local anesthesia, with patient prone. This technique involved a single-skin portal followed by five penetrations of the tendon.

Hamstring
The patient was positioned in a lateral decubitus or prone position. An 18-gauge spinal needle was inserted through the skin. The needle was directed toward the ischial tuberosity using direct palpation. The needle was then withdrawn a few millimeters, and approximately 3 ml–5 ml of PRP was administered into the muscle origin.

Gluteus medius
Point of maximal tenderness identified on the lateral aspect of the greater trochanter. A 22-gauge spinal needle was advanced perpendicular to the skin to the level of bony contact, then withdrawn 2 mm; approximately 3 ml–5 ml of PRP were injected.

Hip adductor
Point of maximal tenderness identified on the medial aspect of the groin. A 22-gauge spinal needle was advanced perpendicular to the skin to the level of bony contact, then withdrawn 2 mm; approximately 3 ml–5 ml of PRP were injected.

Peroneal tendons
The peroneal tendons were localized by palpating along the posterior aspect of the inferior lateral malleolus. An 18-gauge spinal needle was then introduced in a superior to inferior direction, parallel to the long axis of the peroneal tendons, approximately 3–4 cm proximal to the distal tip of the fibula. The needle was advanced until the tip penetrated the superficial aspect of the peroneal tendons. Then approximately 3 ml of PRP were injected."

mands
 

Demondosage

Member
First off, IMO PRP and stem cell is some overly hyped bullshit and a waste of money. You would be better off using HGH.
 

Demondosage

Member
You should check out the joe rogan podcast with mel gibson
I'll have to watch that one. I've had prp done before, it didn't do jack shit. Stem cells, prove it!! The prices they are charging for this kind of shit are outrageous and the feedback is totally inconclusive and across the board, almost placebo type shit
 

hghlover

Member
I'll have to watch that one. I've had prp done before, it didn't do jack shit. Stem cells, prove it!! The prices they are charging for this kind of shit are outrageous and the feedback is totally inconclusive and across the board, almost placebo type shit

Good points.

Yeah it's insanely expensive for sure
 

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