Because (noncalcific)supraspinatus tendons can tear, I tend to avoid steroid injection. This leaves deep frictions that may work 1/2 time but are painful and labor intensive – Though Platelet Rich Plasma needling/injection worked well, dry needling by self did not work so bad either…
Clin Rehabil. 2012 Oct 3. [Epub ahead of print]
Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial.
Rha DW, Park GY, Kim YK, Kim MT, Lee SC abstract here
- 39 cases -6 months pain
- Either supraspinatus tendonosis or less than 1 cm tear
- exclude know rheumatic disease , NSAIDs 2 weeks, or steroid injection, 6 weeks prior
- Using ultrasound, 1 ml 0f 0.5% lidocaine injected with 25 gauge needle
- Needle passed through tendon 40-50 times in both groups
- from 25 mls patient’s blood, 3 mls of double spun PPP was obtained and after the needling, the PPP arm of study was injected with the 3 mls – if too hard to inject into, was injected around tendon
- Did not solidify PPP with Calcium Chloride though mentioned might leave something for tendon to regrow on.
- This was done initially and at 4 weeks; patients were followed up to 6 months
As you can see, took 4 weeks for appreciable difference. The lack of a control group spoils it some though you would not expect much further improvement after 6 months.
Comment – Have been stalling getting a PPP extractor but might need to get one… Many may not be able to afford costs of PPP so dry needling is at least an option. Patient would have to be “patient” as results are quite noticable only after 6 weeks.
Did come across an article discussing deep frictions to shoulder and comparing it with ultrasound:
Bansal K, Padamkumar S.
A comparative study between the efficacy of therapeutic ultrasound and soft tissue massage (deep friction massage) in supraspinatus tendinitis.
Indian J Physiother Occup Ther. 2011;5:80-8http://www.indianjournals.com/ijor.aspx?target=ijor:ijpot&volume=5&issue=2&article=017
- deep frictions – 10– 12 min in “transverse direction with tip of the index finger re-enforced by middle finger, every day for 10 days.”
- Ultrasound – “6– 8 min of pulsed US at 0.6 w/cm2, with 1 MHz frequency, every day for 10 days”
- results – DFM dropped pains 4.4/10 and Ultrasound dropped 3.55/10 and got better abduction as well.
Comment – have done deep frictions Cyriax style; are painful and take forever. I had one case that had calcification as well – that shrunk some with frictions. Some whole books on tendonitis fail to mention it – I presume because it is so much work, they haven’t tried it. It obviously reduced pains by 50%+. You obviously get more with PPP.