In this article, we will discuss partial tears of the supraspinatus tendon and injection therapy.
Injection therapy is one of the current treatment options for partial rupture of the supraspinatus tendon.Whether or not to choose this treatment depends on one's sense of values.The following is not a research paper, but a case report on what happened. It is about what happened from case reports.
It may be helpful for those who value the feeling of being pushed back by a single experience.
Case Report
March 2018
・A 55-year-old right-handed woman.
The main complaint was pain and functional limitation in the left shoulder.
She came to the clinic for physical therapy and rehabilitation (continued for 2 months).
No systemic or hereditary disorders.
No trauma, no surgical intervention.
No allergies.
No history of smoking.
This woman was suffering from hypothyroidism and was being treated with levothyroxine sodium.
And she had been doing exercises twice a week as a habitual practice.
At this point, she was treated for shoulder pain with rest and non-steroidal anti-inflammatory drugs, but without improvement, she was treated with physical therapy.Based on physical examination, we suspected the involvement of a left supraspinatus tendon rupture.
X-rays ruled out osteoarthritis of the shoulder joint.
Ultrasound of the shoulder performed by a radiologist with over 20 years of experience in skeletal muscle in the United States revealed a partial thickness tear of the articular surface of the supraspinatus tendon. (Grade II according to Ellman classification)It was decided to treat the patient with a series of four US-guided intratendinous injections of 2 ml porcine type I collagen at weekly intervals in combination with physical therapy.
After a complete and clear explanation of the study, the patient was offered to sign an informed consent form.
The injections were performed by a single physician with more than 10 years of experience, using an anterior approach.The patient was seated in a chair with the arm internally rotated to expose as much of the supraspinatus tendon as possible.
This limb position was done by placing the patient's arm behind his or her back.
A 22-gauge needle was directed into the tear of the supraspinatus tendon, following US guidance until the tip of the needle appeared to be in the correct position, after which collagen was slowly injected.
Physical exercise therapy began with the first injection and was performed 3 times/week for 1 month, with 30min/1 session.It consisted of motor re-education and intrinsic sensory exercises with the aim of restoring range of motion and strength of the shoulder.
Patients were assessed using the Constant- at enrollment (T0), just prior to the third injection (T1), one month after the last injection (T2), three months (T3), and 18 months (T4).
Patients were amenable to these interventions and no adverse events were reported during the period.
Point
The sensitivity of ultrasonography in diagnosis has been reported to be in the range of 46% to 95% and specificity in the range of 50% to 95%.
The sensitivity and specificity of ultrasonography are reported to be in the range of 46% to 95% and 50% to 95%, respectively, so ultrasonography may be overlooked because it depends on the number of clinical cases performed by the operator.
In general, conservative therapy is the treatment of choice, but if no change is seen within 6 to 12 weeks, surgical treatment may be considered.The combination of physical therapy and injection therapy is a common option, but provides only short-term results.
Although various injection methods have been investigated, tendon culture studies have shown a decrease in type I collagen and a proliferation of type III collagen, so the results in this case of type I collagen were positive.However, there are some limitations in the present case, based on the fact that no other injection therapy was performed and it is difficult to believe that type I collagen alone could have been effective.
Bruno Corrado, Ilenia Bonini, Vincenzo Alessio Chirico, Nicola Rosano, Pietro Gisonni, Use of injectable collagen in partial-thickness tears of the supraspinatus tendon: a case report, Oxford Medical Case Reports, Volume 2020, Issue 11, November 2020, omaa103,
Conclusion
In my clinical experience, I have encountered similar cases.
The site of injury and duration of intervention were different, but the combination of conservative therapy and injections resulted in one in which there was a significant reduction in pain.Although rare, I have also seen cases in which the duration of intervention was misjudged, resulting in a situation in which the pain could have been reduced but was not, and cases in which the injury was not identified, resulting in the spread of the injury.
From the patient's point of view, I would like to recommend that when trying one treatment, it should be separated by two weeks to three months.Some people are looking for miracles and hope that their pain will disappear in one try, but the reality is that this is rarely the case.
It is also not a good idea for medical providers to seek miracles and give up just because the method they used once did not work.When there are no results, the method itself may not be good, but there is also a lack of mastery in the method itself.
That's what I told myself.
