Steroid Injections may Deplete Tendon Stem Cell Pools

Steroid injections are commonly used for a number of musculoskeletal conditions.  There is increasing evidence to suggest this is not a good idea especially for tendon related problems such as tennis elbow or rotator cuff tendinopathy.  Clinical studies only confirm short term pain relief for cortisone injections.  Basic science studies are now revealing that such injections may deplete tendon stems cells pools or increase the risk of tendon rupture.  (See Abstract Below)

Platelet rich plasma has been shown to be superior to cortisone injection in a double blind randomized trial at least for tennis elbow.  When discussing the value of evolving biologic therapies it is crucial to compare them to commonly used treatments.  In the case of cortisone for tendon related injuries and disorders at least for now PRP is the superior choice based on basic science and clinical publications for tennis elbow.  (Gosens et al Study)

Allan Mishra, MD

@Bloodcure
TotalTendon

J Orthop Res. 2012 Aug 8. 

The effects of dexamethasone on human patellar tendon stem cells: Implications for dexamethasone treatment of tendon injury.

Zhang J, Keenan C, Wang JH.

Source

Abstract

Injection of Dexamethasone (Dex) is commonly used in clinics to treat tendon injury such as tendinopathy because of its anti-inflammatory capabilities. However, serious adverse effects have been reported as a result of Dex treatment, such as impaired tendon healing and tendon rupture...... Dex treatment depletes the stem cell pool and leads to the formation of non-tendinous tissues (e.g., fatty and cartilage-like tissues), which make tendon susceptible to rupture. 

© 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. 

Copyright © 2012 Orthopaedic Research Society.

See Full Abstract

Platelet Rich Plasma better than Prolotherapy for Biceps Tendonitis

In an abstract published by the American Journal of Sports Medicine of a Korean language article, platelet rich plasma was found to be more effective than prolotherapy for proximal biceps tendinitis.  In the study 100 patients were studied in a case-control fashion and then followed for 12 months.  No significant differences were noted between the groups in the first months.  However, significant differences were found between the groups at 3, 6 and 12 months in visual analog pain scores, Korean Shoulder Society score, UCLA score and Constant shoulder score (p < 0.05).  The conclusion of the study was "PRP therapy is more effective treatment than prolotherapy"

The details of this study are not known.  It does provide some data to support the use of PRP for this common problem.  If anyone out there can find and translate this article it would be most helpful.  This dramatically speaks to the importance of finding these articles (in any language) and then coordinating the information for patients and providers.


AM
TotalTendon

"Comparative Studies of Platelet-Rich Plasma (PRP) and Prolotherapy for Proximal Biceps Tendintis"
Moon et al
Department of Orthopaedic Surgery; Gwangju, Korea
Journal of the Korean Orthopedic Association
Quoted in Vol. 40:6 June 2012 of the American Journal of Sports Medicine