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  • Writer's pictureAdam Whatley

Treating chronic shoulder tendonitis and rotator cuff injuries. Dynamic Osteopaths Solihull

Shoulder tendinitis and rotator cuff injury is extremely common and causes huge disability. Over time, modern stresses and strains and even sedentary postures causes slow damage or even degradation of these tissues. They eventually become irritated and swollen. Chronic irritation then tends to lead to inflammation and pain and even tears. Often the tendons can become swollen and pinched causing shoulder impingement syndrome.

Most often than not this painful shoulder can be treated conservatively with manual therapy, physical therapy and good pastoral advice. However, if Conservative management fails then you may be a candidate for injection or worse case even surgery.

It is understood that certain rotator cuff tears are at a higher risk of failure after surgery however.  Natural biological treatments such as Platelet rich plasma (PRP) offers an exciting option to accelerate and enhance healing of tendons. It is safe, non-invasive, simple and affordable. It is also regularly used as an orthobiologic for arthroscopic rotator cuff repairs in revision surgerical cases and those with poor quality rotator cuff tendons.

With regards to shoulder impingement the injury involves rotator cuff dysfunction resulting in a mechanical impingement and compression of the shoulder bursa, Resulting in bursitis. Subsequent pain, further rotator cuff damage and further impingement results. This leads to the vicious cycle of an impingement syndrome.  

Shoulder injection 

In this article we will not include commonly used corticosteroid injection, as we know the side-effects are high with this treatment and it is not good for tissues long-term.

Hyaluronans(Hyaluronic acid injection)

Hyaluronic acid injection is safer to the rotator cuff tendons. Hyaluronans are a normal substance of the fluid with inside a joint and as a joint lubricant,  does reducing friction and further irritation. Hyaluronic acid injections also have been shown to have an anti-inflammatory effect - both mechanical as well as biochemical. They also tend to have a barrier affect coating the pain receptors on the synovial surfaces forming a protective barrier. They have also been shown to stimulate endogenous Hyaluronan production and therefore having a longer period of activity than corticosteroids. Platelet Rich Plasma (PRP) 

Another substance that has received a lot of press over recent years is platelet rich plasma (PRP) treatment. Platelets are used to stimulate tissue healing, with a high concentration of growth factors. Platelet Rich Plasma (PRP) is a high concentrate of platelets taken from a patient. These have the ability to manage the immune system and reduce pain. The process involves withdrawing blood from the patient and centrifuging the platelets into a concentrate. The platelets are then activated and injected into the area of injury. 

There is a lot of clinical evidence for the benefits of PRP and evidence for the rotator cuff is continuing to build. There is good clinical evidence for tendonopathies, particularly tennis elbow and Achilles tendon.  Many athletes with partial thickness or joint sided rotator cuff tears not severe enough to undergo surgery are good candidates for PRP treatment along with a good rehabilitation program. 

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