A Comparative Study of Platelet-Rich Plasma and Corticosteroid Injections  in the Non-Surgical Management of Partial Rotator Cuff Tears

Pusphanjali, M; Poorna

doi:10.65188/nurexus.1023

Page 1

Journal of MedVerse Research & Practice

nurexus.com

A Comparative Study of Platelet-Rich Plasma and Corticosteroid Injections

in the Non-Surgical Management of Partial Rotator Cuff Tears

Dr. Pusphanjali

1

, Dr. Poorna

2

Postgraduate, Assistant Professor

Department of Anesthesiology, The Tamil Nadu Dr. M.G.R. Medical University, Tindivanam.

Email ID: puspha123anjali@gmail.com

Submission Date: 25.04.2025

Accepted Date: 21.05.2025

Published Date: 31.05.2025

DOI: 10.65188/nurexus.1023

article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits

unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Abstract

Background: Emergence delirium (ED), or emergence agitation, is a common and challenging postoperative

complication in children recovering from general anesthesia. It is characterized by restlessness, inconsolable crying,

thrashing, and confusion, posing risks to patient safety and prolonging the recovery process. This study aimed to

determine the incidence of ED, evaluate management strategies, and identify associated risk factors in pediatric

patients.

Methods: A retrospective cohort study was conducted at the Department of Pediatric Anesthesiology, Indira Gandhi

Institute of Medical Sciences, Puducherry. Medical records of 150 children aged 1–12 years who underwent elective

or emergency general anesthesia between January and June 2025 were reviewed. Data collected included

demographics, surgical and anesthetic details, postoperative behavioral observations, and interventions for ED.

Delirium incidence, severity, and management efficacy were analyzed using descriptive statistics, Chi-square tests,

and ANOVA, with p < 0.05 considered significant.

Results: ED occurred in 31 of 150 children (20.7%). The highest incidence was observed in children aged 4–6 years

(38.6%), followed by 1–3 years (29.5%), while children aged 7–12 years showed the lowest incidence (10.9%). Male

and female patients were affected almost equally (21.6% vs. 19.4%). ED incidence was higher in emergency

surgeries (27.3%) than in elective procedures (17.9%), though not statistically significant. Management strategies

included dexmedetomidine (32.3%, 90% effective), propofol (19.4%, 83.3% effective), parental presence (25.8%,

75% effective), and distraction techniques (22.5%, 71.4% effective), with minimal complications reported.

Conclusion: Emergence delirium affects approximately one in five pediatric patients, with younger age being the

primary risk factor. Both pharmacological and non-pharmacological strategies effectively manage ED, with

dexmedetomidine showing the highest efficacy. Early identification of high-risk children and timely interventions

can improve postoperative safety, reduce agitation, and enhance recovery, highlighting the need for standardized

prevention and management protocols in pediatric anesthesia.

Keywords: Emergence delirium, pediatric anesthesia, dexmedetomidine, propofol, postoperative agitation, risk

factors

Introduction

Rotator cuff injuries are a major contributor, especially in individuals over the age of 60. Studies indicate a

wide range of lifetime prevalence, from 6.7% to 66.7%, depending on the population and diagnostic criteria

used

[1]. These injuries commonly result in reduced shoulder mobility, disrupted biomechanics, and overall

diminished quality of life [2]. As the global population continues to age, the burden of degenerative

ORIGINAL ARTICLE

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shoulder conditions, including partial-thickness rotator cuff tears, is projected to increase significantly [3].

For many patients, particularly older adults or those with comorbidities, non-surgical management is the

first line of treatment for partial rotator cuff injuries [4]. Corticosteroid (CS) injections are frequently used

due to their potent anti-inflammatory properties and ability to relieve pain in the short term. However,

repeated administration of corticosteroids has raised concerns. Several studies have linked them to adverse

effects on tendon structure, delayed healing, and an increased likelihood of tendon re-tears [5-7]. These

risks have prompted clinicians to explore safer alternatives that could offer more sustainable benefits.

Concentrated with platelets and growth factors, has emerged as a promising regenerative therapy [8-10].

PRP is thought to promote tissue repair, control inflammation, and encourage natural healing processes,

without the degenerative effects associated with corticosteroids. Despite its growing popularity in

orthopaedic and sports medicine, the clinical effectiveness of PRP compared to corticosteroids remains

uncertain. Studies to date have produced inconsistent outcomes, often limited by small sample sizes,

diverse patient profiles, and variability in PRP formulation methods [11-13]. While some evidence points

toward better long-term recovery and fewer complications with PRP, the data are not conclusive.

For instance, Shams et al. reported that patients treated with PRP experienced greater pain relief and

improved function at three months compared to those receiving corticosteroids, although the difference

diminished by the six-month mark [14]. Garg et al. also noted better short-term functional improvements

with PRP at 12 weeks [15]. By evaluating their impact on pain, functional outcomes, and patient

satisfaction over an extended period, this research seeks to clarify the role of each treatment in conservative

shoulder injury management and guide evidence-based clinical decision-making.

Materials & Methods

Study Design

A prospective cohort study was conducted to compare the effectiveness of platelet-rich plasma (PRP)

injections and corticosteroid injection in patients with rotator cuff tendinopathy or partial-thickness rotator

cuff tears.

Study Setting & Duration

The study was conducted over a period of 12 months at a teaching hospital affiliated with The Tamil Nadu

Dr. M.G.R. Medical University, Chennai. Patients were recruited from the Orthopaedics and

Anaesthesiology outpatient and inpatient services.

Study Population

The study included 60 patients diagnosed with rotator cuff tendinopathy or partial-thickness rotator cuff

tears, confirmed clinically and through imaging. Consecutive sampling was used until the required sample

size was achieved. The participants were divided into two treatment groups, with 30 patients in each group.

Inclusion Criteria

Adults aged 18–90 years with clinically and radiologically confirmed rotator cuff tendinopathy or partial-

thickness tears, a baseline Visual Analog Scale (VAS) pain score of 30–100, and considered suitable for

conservative treatment were included. Only patients who provided written informed consent and agreed to

attend the scheduled follow-up assessments were enrolled.

Exclusion Criteria

Patients with full-thickness or traumatic rotator cuff tears, concomitant neurological or musculoskeletal

disorders, systemic diseases, pregnancy, previous shoulder surgery, or recent corticosteroid injections were

excluded from the study.

Data Collection Procedure

Baseline demographic characteristics, clinical findings, and radiological imaging were documented before

initiation of treatment. Group A received three PRP injections administered at two-week intervals, whereas

Group B received a single corticosteroid injection. Both groups underwent an identical physiotherapy

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protocol throughout the study. Follow-up assessments were performed at 6, 12, and 18 months after

intervention. Pain was assessed using the Visual Analog Scale (VAS), shoulder function was evaluated

using the Western Ontario Rotator Cuff Index (WORC), and shoulder range of motion (ROM) was

measured using a standard goniometer. Outcome assessments were performed by evaluators blinded to

treatment allocation to minimize assessment bias.

Ethical Considerations

The study received prior approval from the Institutional Ethics Committee of The Tamil Nadu Dr. M.G.R.

Medical University. Written informed consent was obtained from all participants before enrollment, and the

study was conducted in accordance with applicable ethical principles.

Statistical Analysis

Data were analysed using SPSS software version 26.0. Statistical tests were selected according to the

distribution and type of variables. The independent t-test, Mann–Whitney U test, Chi-square test, Wilcoxon

signed-rank test, and repeated measures ANOVA were used as appropriate for comparison of the study

variables. A p-value <0.05 was considered statistically significant.

.

Results

Figure 1: VAS Score Presentation

At baseline, both the PRP and steroid groups had similar pain levels, around 74 (p = 0.82). By 18 months,

the mean VAS score was 19.4 in the PRP group compared to 37.8 in the steroid group, indicating that PRP

provides better and long-lasting pain relief.

Table 1: VAS Score Comparison (Mean ± SD)

(Lower scores indicate less pain)

Time Point

PRP Group (n = 30)

Steroid Group (n = 30)

p-value

Baseline

74.2 ± 6.8

73.8 ± 7.1

0.82

6 months

39.6 ± 7.4

49.2 ± 8.5

< 0.001

12 months

28.7 ± 6.3

42.3 ± 9.2

< 0.001

This table shows the comparison of VAS (Visual Analog Scale) scores between the PRP and Steroid groups

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at different time points. At baseline, both groups had similar pain levels (around 74), with no significant

difference (p = 0.82). Over time, both groups improved, but the PRP group showed significantly greater

pain reduction at 6, 12, and 18 months (p < 0.001 at each point). By 18 months, the PRP group's mean VAS

score dropped to 19.4, compared to 37.8 in the steroid group, indicating superior and sustained pain relief

with PRP treatment.

Table 2: WORC Score Comparison (% Score, Mean ± SD)

(Higher scores indicate better function)

Time Point

PRP Group (n = 30)

Steroid Group (n = 30)

p-value

Baseline

46.3 ± 7.5

47.1 ± 6.9

0.67

6 months

68.9 ± 8.3

60.7 ± 9.6

0.003

12 months

75.6 ± 7.9

64.2 ± 10.4

< 0.001

This table presents the WORC (Western Ontario Rotator Cuff) score, which reflects shoulder function, with

higher scores indicating better outcomes. At baseline, both groups had comparable functional impairment

(p = 0.67). By 6 months, the PRP group showed significantly better improvement in function compared to

the steroid group (68.9 vs. 60.7, p = 0.003). The difference widened further at 12 and 18 months, with the

PRP group achieving markedly higher functional scores (p < 0.001). These results suggest that PRP leads

to superior and sustained improvement in shoulder function over time.

Table 3: Range of Motion (ROM - Flexion in Degrees, Mean ± SD)

(Higher degrees indicate better mobility)

Time Point

PRP Group (n = 30)

Steroid Group (n = 30)

p-value

Baseline

115.2 ± 12.4

116.5 ± 11.9

0.64

6 months

141.3 ± 10.1

133.6 ± 11.8

0.01

12 months

151.7 ± 9.5

139.8 ± 10.7

< 0.001

This table summarizes the changes in shoulder flexion range of motion (ROM) in degrees over time. At

baseline, both the PRP and steroid groups had similar ROM (approximately 115°), with no significant

difference (p = 0.64). At 6 months, the PRP group began to show better improvement (141.3° vs. 133.6°, p

= 0.01). This difference became more pronounced at 12 and 18 months, where the PRP group achieved

significantly greater shoulder mobility (p < 0.001). These findings indicate that PRP therapy provided

superior long-term improvement in shoulder joint flexibility compared to corticosteroids.

Table 4: Patients Requiring Surgical Intervention by 18 Months

Group

Number of Patients

Percentage

p-value

PRP Group

1

3.3%

0.04

Steroid Group

5

16.7%

This table shows the number of patients in each group who required surgical intervention by 18 months. In

the PRP group, only 1 patient (3.3%) required surgery, whereas in the steroid group, 5 patients (16.7%)

eventually needed operative treatment. The difference is statistically significant (p = 0.04), suggesting that

PRP therapy may reduce the likelihood of progressing to surgery compared to corticosteroid treatment in

rotator cuff tears.

Discussion

This study evaluated and compared the effectiveness of platelet-rich plasma (PRP) and corticosteroid (CS)

injections in the conservative treatment of partial rotator cuff tears. Over an 18-month follow-up period,

PRP demonstrated significantly better clinical outcomes than corticosteroids in terms of pain reduction,

functional improvement, shoulder mobility, and avoidance of surgical intervention.

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At baseline, both groups reported similar pain levels. However, the PRP group showed a more substantial

and sustained decrease in pain scores, as measured by the Visual Analog Scale (VAS), across all follow-up

points 6, 12, and 18 months. These results echo findings from Shams et al. (2016) [10], who documented

superior pain control with PRP in the early stages of treatment, particularly within the first three months.

Similarly, Garg et al. (2020) [14] reported enhanced pain relief at 12 weeks in patients treated with PRP,

reinforcing the sustained analgesic effect of this intervention.

WORC also showed notable improvement in the PRP group. Although both groups started with comparable

functional limitations, patients receiving PRP experienced significantly greater gains at each follow-up

point (p < 0.001). These outcomes are in line with studies by Annaniemi et al. (2022) [13] and von Wehren

et al. (2016) [11], which observed functional benefits with PRP use, particularly in earlier phases of

recovery. While Annaniemi et al.’s findings didn’t always reach statistical significance, they suggested a

favourable trend toward improved shoulder function with PRP.

A significant difference was also observed in range of motion, especially in forward flexion. By the end of

the 18-month follow-up, patients in the PRP group achieved a greater increase in ROM (160.2° vs. 144.3°;

p < 0.001). This supports the regenerative capabilities of PRP in enhancing tendon flexibility and joint

mobility. Although ROM hasn’t been the central outcome in most earlier investigations, our results add

compelling evidence that PRP contributes meaningfully to restoring shoulder mechanics over time (Jo et al.

2018 [6]; Pauly et al. 2018 [7]).

A critical finding was the reduced need for surgical intervention in the PRP group. Only 3.3% of these

patients required surgery compared to 16.7% in the corticosteroid group, a statistically significant

difference (p = 0.04). This suggests PRP not only alleviates symptoms but may also alter the natural disease

course, delaying or even preventing the need for operative treatment. This observation aligns with the work

of Nejati et al. (2017) [12], who showed that PRP, even when compared to exercise therapy, led to

meaningful reductions in pain and disability factors closely tied to surgical decision-making.

Taken together, these findings provide strong support for the use of PRP as a conservative treatment

modality for rotator cuff disorders. While corticosteroids are readily available and cost-effective, their

short-term benefits are overshadowed by concerns over tendon weakening and an increased risk of re-tears

(Mohamadi et al. 2017 [3]; Maman et al. 2016 [4]; Freire et al. 2016 [5]). PRP, by contrast, creates a more

biologically conducive environment for tissue repair, offering longer-lasting relief with a reduced side

effect profile.

Strengths of the Study

The prospective design allowed systematic assessment of treatment outcomes over time. The study

included standardized clinical and functional outcome measures, including VAS, WORC, and shoulder

ROM, with follow-up extending to 18 months. The use of blinded outcome assessors helped minimize

assessment bias, while the identical physiotherapy protocol in both groups provided consistency in

rehabilitation support.

Limitations of the Study

The study had a relatively small sample size of 60 participants, with 30 patients in each treatment group,

which may limit the generalizability of the findings. The study was conducted at a single teaching hospital,

potentially limiting applicability to other healthcare settings. The use of consecutive sampling may also

introduce selection bias. Additionally, the study duration for recruitment was 12 months, although

participants were followed up to 18 months after intervention.

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Conclusion

The findings of this study highlight that platelet-rich plasma (PRP) injections provide more favourable and

lasting outcomes than corticosteroid therapy in the conservative management of partial rotator cuff tears.

Patients treated with PRP experienced greater reductions in pain, improved shoulder function, enhanced

joint mobility, and were less likely to require surgical intervention. These results underscore the potential of

PRP as a more effective and biologically supportive alternative for individuals seeking long-term, non-

surgical solutions for rotator cuff injuries.

Conflict of Interest: Nil

Fund source: Nil

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