Pushpanjali et al | DOI: 10.65188/nurexus.1023
Nurexus | Journal of MedVerse Research and Practice | Volume 3 | Issue – 05 | May 2025
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Journal of MedVerse Research & Practice
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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
Copyright © 2025. The author(s). Published by Journal of MedVerse Research and Practice. This is an open-access
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
Pushpanjali et al | DOI: 10.65188/nurexus.1023
Nurexus | Journal of MedVerse Research and Practice | Volume 3 | Issue – 05 | May 2025
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diminished quality of life [2]. As the global population continues to age, the burden of degenerative
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
This prospective cohort study was carried out over 12 months at a teaching hospital affiliated with The
Tamil Nadu Dr. M.G.R. Medical University in Chennai. Patients diagnosed with rotator cuff tendinopathy
or partial-thickness tears, confirmed both clinically and through imaging, were recruited from the
Orthopaedics and Anaesthesiology outpatient and inpatient services. A consecutive sampling method was
utilized to enroll patients until the desired sample size was reached. Based on prior statistical calculations
and accounting for a 10% dropout margin, a total of 60 participants were included, with 30 patients
assigned to each treatment group.
Inclusion criteria comprised adults aged 18 to 90 years who had a baseline pain score of 30 to 100 on the
Visual Analog Scale (VAS) and were considered appropriate candidates for conservative (non-surgical)
treatment. Only those who gave written informed consent and committed to follow-up assessments were
included in the study. Patients were excluded if they had full-thickness or traumatic tears, concurrent
neurological or musculoskeletal disorders, systemic diseases, were pregnant, had a history of prior shoulder
surgery, or had received corticosteroid injections within the recent past.
Participants were divided into two treatment groups based on the intervention administered. Group A
received three PRP (platelet-rich plasma) injections, spaced two weeks apart. Group B was treated with a
single corticosteroid injection. Both groups followed an identical physiotherapy protocol throughout the
study duration to ensure consistent rehabilitation support.
At the start of the study, baseline data, including demographic information, clinical findings, and radiologic
imaging, were recorded. Follow-up assessments were conducted at 6, 12, and 18 months post-intervention.
The outcome measures included pain (measured using the VAS), shoulder function (evaluated through the
Western Ontario Rotator Cuff Index [WORC]), and shoulder range of motion (ROM), which was measured
using a standard goniometer. To minimize bias, outcome assessments were performed by evaluators who
Pushpanjali et al | DOI: 10.65188/nurexus.1023
Nurexus | Journal of MedVerse Research and Practice | Volume 3 | Issue – 05 | May 2025
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were blinded to the participants’ treatment allocations.
The study obtained ethical approval from the Institutional Ethics Committee of The Tamil Nadu Dr.
M.G.R. Medical University, Tindivanam (Ref No: IEC/TNMMU/2024/21584). A detailed Participant
Information Sheet was provided to all participants, and written informed consent was obtained prior to their
participation in the study.
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
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
Pushpanjali et al | DOI: 10.65188/nurexus.1023
Nurexus | Journal of MedVerse Research and Practice | Volume 3 | Issue – 05 | May 2025
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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.
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
Pushpanjali et al | DOI: 10.65188/nurexus.1023
Nurexus | Journal of MedVerse Research and Practice | Volume 3 | Issue – 05 | May 2025
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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.
Study Limitations: This study, however, is not without limitations. Treatment groups were formed based on
patient preference rather than random allocation, which introduces a potential selection bias. Additionally,
although 18 months of follow-up allowed for meaningful comparisons, even longer-term data would be
valuable for evaluating recurrence and tendon integrity. Finally, variations in PRP composition and
injection protocols may affect reproducibility, limiting the broader applicability of these findings.
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
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