Hello, everyone. My name is Kunal Damaraju, and today I will be discussing our research project that discusses the effects of PRP and corticosteroids on shoulder pain and functionality in shoulder impingement syndrome. So to start off, shoulder impingement syndrome, which goes by other names including swimmer's shoulder, is a musculoskeletal condition in which the soft tissue or the bursa in the shoulder is pinched during the movement of the shoulder blade, which causes pain and discomfort in patients. As of now, there are several treatment modalities for shoulder impingement syndrome, which includes physical therapy, NSAIDs, corticosteroids, and surgery, all of which are of course dependent on the severity of the patient's condition. Platelet-rich plasma has been utilized for this condition, however, there are limited studies available that actually demonstrate how effective PRP is when compared to other modalities including corticosteroids for this condition. The primary objective of this study was to determine if PRP has a more efficacious effect on visual analog scales, which measures pain, and constant Murley scores, which measures shoulder functionality compared to corticosteroids for shoulder impingement syndrome. A systematic review and analysis of multiple databases was completed following the PRISMA 2020 guidelines. Six databases, including PubMed, Embase, Web of Science, Scopus, Cochrane Library, and Google Scholar, were all utilized to find literature regarding the utilization of platelet-rich plasma in the setting of shoulder impingement syndrome, and our focus was on trials that actually utilized the VAS and the CM scores to determine the efficacy of PRP in this condition. After using the preliminary search string in the databases, an initial search yielded 107 articles. After exporting the articles to RAINN, which is an automation tool, the team determined if there were any duplicates among these articles, and this analysis resulted in 77 total duplicates, which were vetted to determine the number of unique articles that were produced, resulting in 45 articles. These 45 articles were then analyzed using the abstract and title for a preliminary review, ultimately leaving six articles for a full literature review, and in terms of this review, the inclusion criteria included usable data for visual analog scale and constant scores at six months, as well as trials comparing the clinical efficacy of PRP and corticosteroids in shoulder impingement syndrome. The exclusion criteria included studies that didn't have viable data and studies that were inaccessible after an extensive search. After undergoing a full literature review using the necessary inclusion and exclusion criteria, five articles remained, comprising of 373 patients in these studies. A statistical analysis was conducted utilizing IBM SPSS statistics for Windows, and via a random effects model that utilized HSG values, the estimated proportion of individuals who experienced improvement in VAS pain scores after a PRP administration was negative 2.32, while for corticosteroids it was negative 3.48. The effect size for this group, for VAS, was negative because the VAS scores decreased between pre- and post-treatments to account for the patient's perceived reduction in pain at the six-month follow-up. Further subgroup analysis between these two populations did show that there was no statistically significant difference between them with a p-score of 0.21. For the constant Murley scores, the estimated proportions for PRP and corticosteroids was 3.2, 3.12, and 2.80, respectively. Again for these two groups, there was no statistically significant difference for the groups with a p-value of 0.77. The results suggest that when compared to each other, there is no statistically significant advantage of either PRP or corticosteroids over the other when it comes to reducing both shoulder pain and increasing shoulder functionality. However, the differences of 1.6 in Hedge's g-value between the PRP and the corticosteroids for visual analog scale suggest that corticosteroids actually has a much greater clinical impact at reducing VAS scores on a six-month timeframe. Additionally, PRP was found to have a slightly greater impact on increasing constant scores on a six-month timeframe since the difference of these Hedge's g-values was 0.32. The funnel plot used to determine if there was any data that fell out of the 95% confidence interval showed that when analyzing the funnel plot for VAS, the PRP data yielded fewer outliers when compared to the corticosteroid data. The opposite was true when interpreting the funnel plot for the constant Murley data. Now, some limitations for the study include the fact that different concentrations of PRP were used for each patient. In addition to the fact that some papers did not disclose the full components of the mixtures that they used, usually PRP consists of cytokines and platelets among other ingredients in their concussions. However, this was not disclosed in all the studies. Additionally, there were variations in the corticosteroid doses that were given in each study and it is unknown whether the different mixtures play a role in corticosteroid impact in shoulder impingement syndrome. The number of outliers in our data collection can be partially attributed to the number of available studies on PRP versus corticosteroids in this condition, and an increased amount of data can centralize and solidify any data on the available treatment options for shoulder impingement syndrome. As a result of these limitations, more clinical trials with standardized concentrations of PRP and corticosteroids are needed to explore and further support these findings. I appreciate you listening and thank you.

platelet-rich plasma

corticosteroids

shoulder impingement syndrome

pain reduction

shoulder functionality