Shoulder pain is commonly seen chief complaint in a rehabilitation outpatient clinic. When patients suffer from problems such as supraspinatus tendon partial or total thickness tear, prolotherapy and autologous platelet rich plasma (aPRP) may be considered as the suitable treatment options. In a recently published article, it mentioned that the injection of aPRP in the treatment of supraspinatus tendon partial tear may in fact cause adverse effects. This can be due to the fact that aPRP is in liquid form. The injection of liquid form aPRP to the tear site may cause further tearing of the supraspinatus tendon.
　　This talk will discuss thoroughly on how to apply prolotherapy (dextrose solution) and aPRP to the supraspinatus tendon tear sites. In patients with supraspinatus total thickness tear, the injection of dextrose solution and aPRP in hoping the supraspinatus tendon to regrow or repair itself most likely will not occur. In patients with partial tear, dextrose solution of more than 12.5% in concentration should be applied. Only small volume is indicated, with a volume not exceeding 0.5 mL. Do not expect the injection to be effective with only one dosage of prolotherapy. Multiple injections may be needed and there should be at least 2 – 3 weeks intervals before the next injections. In terms of aPRP, injection of the buffy coat layer is recommended. Alternatively, injection of gel or semi-gel like aPRP to the tear site is highly recommended as liquid form may cause further tendon tears. All injection procedures should be done under musculoskeletal ultrasound guidance.