Effectiveness of Ultrasound Guided Platelet Rich Plasma Injection in Comparison with Corticosteroid Injection on Improving Pain and Function in the Treatment of Biceps Tendinopathy: A Randomized Controlled Trial

Title: Effectiveness of Ultrasound Guided Platelet Rich Plasma Injection in Comparison with Corticosteroid Injection on Improving Pain and Function in the Treatment of Biceps Tendinopathy: A Randomized Controlled Trial. Background: Bicipital tendinosis is an inflammatory process of the long head of the biceps tendon and is a common cause of shoulder pain due to its position and function. Patients with biceps tendinitis often complain of a deep, throbbing pain in the anterior shoulder that is intensified when lifting and usually localized to the bicipital groove. The first line of treatment comprises nonoperative therapeutical means as rest, ice, restriction of overhead activities, nonsteroidal antiinflammatory drugs (NSAIDs), and physical therapy. Local anesthetic and corticosteroid injections have been advocated as additional treatment options but with known side effects. Platelet rich plasma (PRP) is believed to be a promising alternative safer and effective treatment option. Objectives: To determine the effectiveness of ultrasound guided Platelet rich plasma injection in comparison with corticosteroid injection on improving pain and shoulder function in the treatment of biceps tendinopathy. Study design: Randomized controlled trial. Methods: Thirty two athletes with biceps tendinopathy meeting the inclusion and exclusion criteria were selected for this study and randomized into 2 treatment groups: platelet rich plasma injection under ultrasound guidance (PRP group; n = 16), and corticosteroid injection under ultrasound guidance (CS group; n = 16). The outcome measures were visual analog scale (VAS) and Single Assessment Numerical Evaluation (SANE) for pain and Quick DASH for assessment of shoulder function. Both the groups underwent rehabilitation programs. For descriptive statistics mean, standard deviation and frequency were used. Continuous variables were analysed by student’s t-test. Categorical variables were analysed using Chi-square test. Within the group comparison (baseline and follow-up data of each group) was done by Repeated measures ANOVA. Between the group comparison was analysed using student’s t-test. A p-value < 0.05 was taken as significant. Results: The 2 groups were homogeneous in terms of their baseline characteristics like age, gender, duration of symptoms and side of affection. Within the group comparisons showed significant improvement in outcome measures in the PRP group at all follow ups. In the Corticosteroid group, improvement in outcome measures was found only at 4 weeks and 12 weeks follow up. Between the groups comparisons showed that the improvement in outcome measures was more in the corticosteroid group in the short term i.e. at 4 weeks and 12 weeks. However, over the long term, PRP was found to be superior to corticosteroids in improving outcome measures at 24 weeks. Conclusion: Ultrasound guided injection of platelet rich plasma lead to significant improvement in pain and function over the long term in comparison with corticosteroid injection in athletes with Biceps tendinosis and thereby enabling faster return to sports.