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Sports Medicine

Prolotherapy for Shoulder (Labrum) Pain/Tear.

09/20/2011

Question:

Hello,

I know Prolotherapy is a fairly newer treatment option for many potential conditions, but am hoping to elicit some further opinion(s) via this site. I apparently (according to a non-contrast MRI) have a labrum (SLAP Type II) tear with attending tendonosis of the biceps tendon in my shoulder. My sports medicine doc wants to go right in and start pulling my arm apart and "fixing" whatever is injured via surgery... while my preference as a 36-y.o. father of 3 younguns is to avoid such a debilitating surgery, rehab and substantial time off work for recovery at all costs. I have excellent ROM in the shoulder and decent strength in it, but a somewhat constant pain that I could do without if a less invasive option abounded. Along came Prolotherapy/PRP, and I am very intrigued by what it can potentially do for my pain if it does work. Seems like low risk, great reward compared to comprehensive surgery and recovery that offers equal or even less possible benefits. Your thoughts?

Answer:

The findings on your shoulder MRI scan may - or may not - be the cause for your symptoms. The relevance of those results to your situation needs to be determined by your physician based on your history and physical examination findings.
 
Prior to undergoing shoulder surgery, it is usually preferable to have exhausted nonsurgical treatment options, which may include a number of different types and doses of oral medications, several different topical medications, activity modifications, a course of appropriate therapy, a TNS (transcutaneous nerve stimulation via a portable stimulator) trial, and one or more injections (usually steroid/cortisone, before options such as prolotherapy or PRP -which are usually not covered by insurance - are tried).

If you've already undergone an appropriate and comprehensive nonsurgical treatment program, with the exception of prolotherapy/PRP injections, these could potentially provide benefit, which is more likely when performed by a physician who has considerable experience performing these procedures.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University