In June 2010, the WorkSafeBC Evidence-Based Practice Group investigated the effectiveness of ESWT, using low- and high-level energy shock waves to treat calcific supraspinatus or rotator cuff tendinopathy in general. While the mechanism is still unclear, this outpatient procedure is thought to provide long-lasting analgesia and stimulate the healing process. Extracorporeal shock wave therapy (ESWT) has been promoted as an alternative to surgical intervention in treating rotator cuff tendinopathy that fails to respond to conventional and more conservative therapies. One cause of shoulder pain is calcific rotator cuff tendinopathy, which occurs in 7% to 17% of rotator cuff tendinopathies.
Shock therapy thought to ease pain from calcified supraspinatus tendinopathy These studies could not discount the value of co-interventions. However, the only available high-quality evidence showed that PRP injection compared to saline injection did not result in significant improvement in pain and activity. Lower-quality and lower-level studies showed the effectiveness of PRP in treating various tendinopathies. They found five studies of varying quality and design investigating the application of PRP in treating chronic patellar tendinosis and chronic elbow tendinosis, during arthroscopic rotator cuff repair, during Achilles tendon surgery to promote healing, and treating Achilles tendinopathy. In April 2010, the WorkSafeBC Evidence-Based Practice Group conducted a systematic literature review of the effectiveness of PRP in treating tendinopathies. As well, recent evidence suggests varying concentration levels of these growth factors in PRP, depending on the protocol and devices used to spin the blood. To date, the respective role of each type of growth factor requires further exploration.
Tendon healing is a complex process involving many growth factors, such as platelet-derived, transforming, vascular endothelial, insulin-like, and epidermal growth factors, which are detected in higher concentrations in PRP. More recently, the use of platelet-rich plasma (PRP) to treat various musculoskeletal disorders, including tendinopathies, has increased tremendously. The concept of using growth factors contained in activated platelets to help wound healing dates back to the early 1980s. Platelet-rich plasma offers mixed success in treating tendinopathies
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