Use of Injections and Biologics for the Nonoperative Treatment of Rotator Cuff Pathology

  • Alexander J. Johnson
    Corresponding author. 801 Ostrum St, PPH2-Ortho, Bethlehem, PA 18015.
    Department of Orthopedic Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
    Search for articles by this author
  • Author Footnotes
    1 Present address: 2000 South Colorado Boulevard Tower One, #4500, Denver, CO 80222.
    Hannah Bradsell
    1 Present address: 2000 South Colorado Boulevard Tower One, #4500, Denver, CO 80222.
    Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, CO, USA
    Search for articles by this author
  • Author Footnotes
    1 Present address: 2000 South Colorado Boulevard Tower One, #4500, Denver, CO 80222.
    Rachel M. Frank
    1 Present address: 2000 South Colorado Boulevard Tower One, #4500, Denver, CO 80222.
    Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, CO, USA
    Search for articles by this author
  • Author Footnotes
    1 Present address: 2000 South Colorado Boulevard Tower One, #4500, Denver, CO 80222.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Clinics in Sports Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Yamamoto A.
        • Takagishi K.
        • Osawa T.
        • et al.
        Prevalence and risk factors of a rotator cuff tear in the general population.
        J Shoulder Elbow Surg. 2010; 19: 116-120
        • McMahon P.J.
        • Prasad A.
        • Francis K.A.
        What is the prevalence of senior-athlete rotator cuff injuries and are they associated with pain and dysfunction?.
        Clin Orthop Relat Res. 2014; 472: 2427-2432
        • Parikh N.
        • Martinez D.J.
        • Winer I.
        • et al.
        Direct and indirect economic burden associated with rotator cuff tears and repairs in the US.
        Curr Med Res Opin. 2021; 37: 1199-1211
        • Teunis T.
        • Lubberts B.
        • Reilly B.T.
        • et al.
        A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age.
        J Shoulder Elbow Surg. 2014; 23: 1913-1921
        • Finger L.
        • Dunn R.
        • Hughes J.
        • et al.
        Clinical Outcomes Secondary to Time-to-Surgery for Atraumatic Rotator Cuff Tears.
        J Shoulder Elbow Surg. 2022; 31: S18-S24
        • Khatri C.
        • Ahmed I.
        • Parsons H.
        • et al.
        The Natural History of Full-Thickness Rotator Cuff Tears in Randomized Controlled Trials: A Systematic Review and Meta-analysis.
        Am J Sports Med. 2019; 47: 1734-1743
        • Abdelwahab A.
        • Ahuja N.
        • Iyengar K.P.
        • et al.
        Traumatic rotator cuff tears - Current concepts in diagnosis and management.
        J Clin Orthop Trauma. 2021; 18: 51-55
        • Varkey D.T.
        • Patterson B.M.
        • Creighton R.A.
        • et al.
        Initial medical management of rotator cuff tears: a demographic analysis of surgical and nonsurgical treatment in the United States Medicare population.
        J Shoulder Elbow Surg. 2016; 25: e378-e385
        • Baumer T.G.
        • Chan D.
        • Mende V.
        • et al.
        Effects of Rotator Cuff Pathology and Physical Therapy on In Vivo Shoulder Motion and Clinical Outcomes in Patients With a Symptomatic Full-Thickness Rotator Cuff Tear.
        Orthop J Sports Med. 2016; 4 (2325967116666506)
        • Agarwalla A.
        • Puzzitiello R.N.
        • Mascarenhas R.
        • et al.
        Preoperative Injections May Be an Iatrogenic Cause of Reoperation After Arthroscopic Rotator Cuff Repair.
        Arthroscopy. 2019; 35: 325-331
        • Boland K.
        • Smith C.
        • Bond H.
        • et al.
        Current concepts in the rehabilitation of rotator cuff related disorders.
        J Clin Orthop Trauma. 2021; 18: 13-19
        • Puzzitiello R.N.
        • Patel B.H.
        • Nwachukwu B.U.
        • et al.
        Adverse Impact of Corticosteroid Injection on Rotator Cuff Tendon Health and Repair: A Systematic Review.
        Arthroscopy. 2020; 36: 1468-1475
        • Nuelle C.W.
        • Cook C.R.
        • Stoker A.M.
        • et al.
        In vitro toxicity of local anaesthetics and corticosteroids on supraspinatus tenocyte viability and metabolism.
        J Orthop Translat. 2017; 8: 20-24
        • Murray I.R.
        • Safran M.R.
        • LaPrade R.F.
        Biologics in Orthopaedics Concepts and Controversies.
        Bone Joint. 2018; 7
        • Obana K.K.
        • Schallmo M.S.
        • Hong I.S.
        • et al.
        Current Trends in Orthobiologics: An 11-Year Review of the Orthopaedic Literature.
        Am J Sports Med. 2021; (3635465211037343)
        • Thepsoparn M.
        • Thanphraisan P.
        • Tanpowpong T.
        • et al.
        Comparison of a Platelet-Rich Plasma Injection and a Conventional Steroid Injection for Pain Relief and Functional Improvement of Partial Supraspinatus Tears.
        Orthop J Sports Med. 2021; 9 (23259671211024937)
        • Cole B.J.
        • Gilat R.
        • DiFiori J.
        • et al.
        The 2020 NBA Orthobiologics Consensus Statement.
        Orthop J Sports Med. 2021; 9 (23259671211002296)
        • Ren B.
        • Lv X.
        • Tu C.
        • et al.
        Research trends of platelet-rich plasma application in orthopaedics from 2002 to 2020: a bibliometric analysis.
        Int Orthop. 2021; 45: 2773-2790
        • Noback P.C.
        • Donnelley C.A.
        • Yeatts N.C.
        • et al.
        Utilization of Orthobiologics by Sports Medicine Physicians: A Survey-based Study.
        J Am Acad Orthop Surg Glob Res Rev. 2021; 5 (e20 00185)
      1. Platelet Rich Plasma Market (Type: Pure PRP, Leukocyte-rich PRP, and Pure PRF; Origin: Autologous, Allogenic, and Homologus; and Application: Orthopedic Surgery, Cosmetic Surgery, General Surgery, Neurosurgery, and Others) - Global Industry Analysis, Size, Share, Growth, Trends, and Forecast, 2021-2031 [press release]. 2021.

        • Murray JC I.R.
        • Frank R.M.
        • Piuzzi N.S.
        • et al.
        Rogue Stem Cell Clinics.
        Bone Joint J. 2020; 102-B: 148-154
        • LaPrade R.F.
        • Graden N.R.
        • Kahat D.H.
        Editorial Commentary: Platelet-Rich Plasma: The Devil Is in the Details, and the Details Need to Be Better Reported.
        Arthroscopy. 2019; 35: 3114-3116
        • Jazrawi L.M.
        • Baron S.L.
        Editorial Commentary: Sprinkle Some Pixie Dust on It-Are We Really Any Better at Understanding the Benefits of Platelet-Rich Plasma for Rotator Cuff Pathology?.
        Arthroscopy. 2019; 35: 1592-1593
        • DeClercq M.G.
        • Fiorentino A.M.
        • Lengel H.A.
        • et al.
        Systematic Review of Platelet-Rich Plasma for Rotator Cuff Repair: Are We Adhering to the Minimum Information for Studies Evaluating Biologics in Orthopaedics?.
        Orthop J Sports Med. 2021; 9 (23259671211041971)
        • Baria M.R.
        • Vasileff W.K.
        • Flanigan D.
        • et al.
        Is It Time to Revisit the Minimum Information for Studies Evaluating Biologics in Orthopaedics Guidelines: Platelet-Rich Plasma and Mesenchymal Stem Cells.
        Am J Phys Med Rehabil. 2022; 101: e48-e49
        • Michael C.
        • Koester M.
        • Warren R.
        • et al.
        The Efficacy of Subacromial Corticosteroid Injection in the Treatment of Rotator Cuff Disease: A Systematic Review.
        J Am Acad Orthop Surg. 2007; 15: 3-11
        • Coombes B.K.
        • Bisset L.
        • Vicenzino B.
        Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials.
        Lancet. 2010; 376: 1751-1767
        • Mohamadi A.
        • Chan J.J.
        • Claessen F.M.
        • et al.
        Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis.
        Clin Orthop Relat Res. 2017; 475: 232-243
        • Hopewell S.
        • Keene D.J.
        • Marian I.R.
        • et al.
        Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial.
        Lancet. 2021; 398: 416-428
        • Cook T.
        • Minns Lowe C.
        • Maybury M.
        • et al.
        Are corticosteroid injections more beneficial than anaesthetic injections alone in the management of rotator cuff-related shoulder pain? A systematic review.
        Br J Sports Med. 2018; 52: 497-504
        • Roddy E.
        • Ogollah R.O.
        • Oppong R.
        • et al.
        Optimising outcomes of exercise and corticosteroid injection in patients with subacromial pain (impingement) syndrome: a factorial randomised trial.
        Br J Sports Med. 2021; 55: 262-271
        • Zadro J.
        • Rischin A.
        • Johnston R.V.
        • et al.
        Image-guided glucocorticoid injection versus injection without image guidance for shoulder pain.
        Cochrane Database Syst Rev. 2021; 8: CD009147
        • Wei A.S.
        • Callaci J.J.
        • Juknelis D.
        • et al.
        The effect of corticosteroid on collagen expression in injured rotator cuff tendon.
        J Bone Joint Surg Am Vol. 2006; 88: 1331-1338
        • Mikolyzk D.K.
        • Wei A.S.
        • Tonino P.
        • et al.
        Effect of corticosteroids on the biomechanical strength of rat rotator cuff tendon.
        J bone Jt Surg Am volume. 2009; 91: 1172-1180
        • Maman E.
        • Yehuda C.
        • Pritsch T.
        • et al.
        Detrimental Effect of Repeated and Single Subacromial Corticosteroid Injections on the Intact and Injured Rotator Cuff: A Biomechanical and Imaging Study in Rats.
        Am J Sports Med. 2016; 44: 177-182
        • Puzzitiello R.N.
        • Patel B.H.
        • Forlenza E.M.
        • et al.
        Adverse Impact of Corticosteroids on Rotator Cuff Tendon Health and Repair: A Systematic Review of Basic Science Studies.
        Arthrosc Sports Med Rehabil. 2020; 2: e161-e169
        • Forsythe B.
        • Agarwalla A.
        • Puzzitiello R.N.
        • et al.
        The Timing of Injections Before Arthroscopic Rotator Cuff Repair Impacts the Risk of Surgical Site Infection.
        J bone Jt Surg Am volume. 2019; 101: 682-687
        • Weber A.E.
        • Trasolini N.A.
        • Mayer E.N.
        • et al.
        Injections Before Rotator Cuff Repair Are Associated With Increased Rotator Cuff Revision Rates.
        Arthroscopy. 2019; 35: 717-724
        • Traven S.A.
        • Brinton D.
        • Simpson K.N.
        • et al.
        Preoperative Shoulder Injections Are Associated With Increased Risk of Revision Rotator Cuff Repair.
        Arthroscopy. 2019; 35: 706-713
        • Desai V.S.
        • Camp C.L.
        • Boddapati V.
        • et al.
        Increasing Numbers of Shoulder Corticosteroid Injections Within a Year Preoperatively May Be Associated With a Higher Rate of Subsequent Revision Rotator Cuff Surgery.
        Arthroscopy. 2019; 35: 45-50
        • Baverel L.
        • Boutsiadis A.
        • Reynolds R.J.
        • et al.
        Do corticosteroid injections compromise rotator cuff tendon healing after arthroscopic repair?.
        JSES Open Access. 2018; 2: 54-59
        • Bhatia M.
        • Singh B.
        • Nicolaou N.
        • et al.
        Correlation between rotator cuff tears and repeated subacromial steroid injections: a case-controlled study.
        Ann R Coll Surg Engl. 2009; 91: 414-416
        • In-Ho Jeon M.
        • Chang-Hyuk Choi M.D.
        • Jae-Sung Seo M.D.
        • et al.
        Arthroscopic Management of Septic Arthritis of the Shoulder Joint.
        THE JOURNAL BONE JOINT SURGERY. 2006; 88-A: 1802-1806
        • Kunze K.N.
        • Mirzayan R.
        • Beletsky A.
        • et al.
        Do Corticosteroid Injections Before or After Primary Rotator Cuff Repair Influence the Incidence of Adverse Events? A Subjective Synthesis.
        Arthroscopy. 2020; 36: 1476-1484
        • Shams A.
        • El-Sayed M.
        • Gamal O.
        • et al.
        Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears.
        Eur J orthopaedic Surg Traumatol. 2016; 26: 837-842
        • Jones I.A.
        • Togashi R.
        • Heckmann N.
        • et al.
        Minimal clinically important difference (MCID) for patient-reported shoulder outcomes.
        J Shoulder Elbow Surg. 2020; 29: 1484-1492
        • Jo C.H.
        • Lee S.Y.
        • Yoon K.S.
        • et al.
        Allogeneic Platelet-Rich Plasma Versus Corticosteroid Injection for the Treatment of Rotator Cuff Disease: A Randomized Controlled Trial.
        J bone Jt Surg Am volume. 2020; 102: 2129-2137
        • Dadgostar H.
        • Fahimipour F.
        • Pahlevan Sabagh A.
        • et al.
        Corticosteroids or platelet-rich plasma injections for rotator cuff tendinopathy: a randomized clinical trial study.
        J Orthop Surg Res. 2021; 16: 333
        • Kwong C.A.
        • Woodmass J.M.
        • Gusnowski E.M.
        • et al.
        Platelet-Rich Plasma in Patients With Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared With Corticosteroid Injection: A Double-Blind Randomized Controlled Trial.
        Arthroscopy. 2021; 37: 510-517
        • Wasserman A.
        • Matthewson G.
        • MacDonald P.
        Platelet-Rich Plasma and the Knee-Applications in Orthopedic Surgery.
        Curr Rev Musculoskelet Med. 2018; 11: 607-615
        • Collins T.
        • Alexander D.
        • Barkatali B.
        Platelet-rich plasma: a narrative review.
        EFORT Open Rev. 2021; 6: 225-235
        • Schneider A.
        • Burr R.
        • Garbis N.
        • et al.
        Platelet-rich plasma and the shoulder: clinical indications and outcomes.
        Curr Rev Musculoskelet Med. 2018; 11: 593-597
        • Jo C.H.
        • Lee S.Y.
        • Yoon K.S.
        • et al.
        Allogenic Pure Platelet-Rich Plasma Therapy for Rotator Cuff Disease: A Bench and Bed Study.
        Am J Sports Med. 2018; 46: 3142-3154
        • DeLong J.M.
        • Russell R.P.
        • Mazzocca A.D.
        Platelet-rich plasma: the PAW classification system.
        Arthroscopy. 2012; 28: 998-1009
        • Murray I.R.
        • Geeslin A.G.
        • Goudie E.B.
        • et al.
        Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO): Platelet-Rich Plasma and Mesenchymal Stem Cells.
        J bone Jt Surg Am volume. 2017; 99: 809-819
        • Carr J.B.
        Editorial Commentary: Platelet-Rich Plasma Shows Promise for Improving Shoulder Tendinopathy.
        Arthroscopy. 2021; 37: 2754-2755
        • Costa L.A.V.
        • Lenza M.
        • Irrgang J.J.
        • et al.
        How Does Platelet-Rich Plasma Compare Clinically to Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review and Meta-analysis.
        Am J Sports Med. 2022; (3635465211062243)
        • Chahla J.
        • Cinque M.E.
        • Piuzzi N.S.
        • et al.
        A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature.
        J bone Jt Surg Am volume. 2017; 99: 1769-1779
        • Hurley E.T.
        • Hannon C.P.
        • Pauzenberger L.
        • et al.
        Nonoperative Treatment of Rotator Cuff Disease With Platelet-Rich Plasma: A Systematic Review of Randomized Controlled Trials.
        Arthroscopy. 2019; 35: 1584-1591
        • Rossi L.A.
        • Piuzzi N.
        • Giunta D.
        • et al.
        Subacromial Platelet-Rich Plasma Injections Decrease Pain and Improve Functional Outcomes in Patients With Refractory Rotator Cuff Tendinopathy.
        Arthroscopy. 2021; 37: 2745-2753
        • Prodromos C.C.
        • Finkle S.
        • Prodromos A.
        • et al.
        Treatment of Rotator Cuff Tears with platelet rich plasma: a prospective study with 2 year follow-up.
        BMC Musculoskelet Disord. 2021; 22: 499
        • Nejati P.
        • Ghahremaninia A.
        • Naderi F.
        • et al.
        Treatment of Subacromial Impingement Syndrome: Platelet-Rich Plasma or Exercise Therapy? A Randomized Controlled Trial.
        Orthop J Sports Med. 2017; 5 (2325967117702366)
        • Ilhanli I.
        • Guder N.
        • Gul M.
        Platelet-Rich Plasma Treatment With Physical Therapy in Chronic Partial Supraspinatus Tears.
        Iran Red Crescent Med J. 2015; 17 (e23732)
        • Xiang X.N.
        • Deng J.
        • Liu Y.
        • et al.
        Conservative treatment of partial-thickness rotator cuff tears and tendinopathy with platelet-rich plasma: A systematic review and meta-analysis.
        Clin Rehabil. 2021; 35: 1661-1673
        • Lin M.T.
        • Wei K.C.
        • Wu C.H.
        Effectiveness of Platelet-Rich Plasma Injection in Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
        Diagnostics (Basel). 2020; 10
        • Lui M.
        • Shih W.
        • Yim N.
        • et al.
        Systematic Review and Meta-Analysis of Nonoperative Platelet-Rich Plasma Shoulder Injections for Rotator Cuff Pathology.
        PM R. 2021; 13: 1157-1168
        • Dragoo J.L.
        • Shapiro S.A.
        • Bradsell H.
        • et al.
        The essential roles of human adipose tissue: Metabolic, thermoregulatory, cellular, and paracrine effects.
        J Cartilage Joint Preservation. 2021; 1
        • Narayanan G.
        • Nair L.S.
        • Laurencin C.T.
        Regenerative Engineering of the Rotator Cuff of the Shoulder.
        ACS Biomater Sci Eng. 2018; 4: 751-786
        • Carvalho AdM.
        • Badial P.R.
        • Álvarez L.E.C.
        • et al.
        Equine tendonitis therapy using mesenchymal stem cells and platelet concentrates: a randomized controlled trial.
        Stem Cell Res Ther. 2013; 4
        • Hernigou P.
        • Merouse G.
        • Duffiet P.
        • et al.
        Reduced levels of mesenchymal stem cells at the tendon-bone interface tuberosity in patients with symptomatic rotator cuff tear.
        Int Orthop. 2015; 39: 1219-1225
        • Kim S.J.
        • Song D.H.
        • Park J.W.
        • et al.
        Effect of Bone Marrow Aspirate Concentrate-Platelet-Rich Plasma on Tendon-Derived Stem Cells and Rotator Cuff Tendon Tear.
        Cell Transplant. 2017; 26: 867-878
        • Bianco S.T.
        • Moser H.L.
        • Galatz L.M.
        • et al.
        Biologics and stem cell-based therapies for rotator cuff repair.
        Ann N Y Acad Sci. 2019; 1442: 35-47
        • Charles M.D.
        • Christian D.R.
        • Cole B.J.
        The Role of Biologic Therapy in Rotator Cuff Tears and Repairs.
        Curr Rev Musculoskelet Med. 2018; 11: 150-161
        • Goldenberg B.T.
        • Lacheta L.
        • Dekker T.J.
        • et al.
        Biologics to Improve Healing in Large and Massive Rotator Cuff Tears: A Critical Review.
        Orthop Res Rev. 2020; 12: 151-160
        • Kim S.J.
        • Kim E.K.
        • Kim S.J.
        • et al.
        Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with partial tear of the rotator cuff tendon.
        J Orthop Surg Res. 2018; 13: 1
        • Jo C.H.
        • Chai J.W.
        • Jeong E.C.
        • et al.
        Intratendinous Injection of Autologous Adipose Tissue-Derived Mesenchymal Stem Cells for the Treatment of Rotator Cuff Disease: A First-In-Human Trial.
        Stem Cells. 2018; 36: 1441-1450
        • Jo C.H.
        • Chai J.W.
        • Jeong E.C.
        • et al.
        Intratendinous Injection of Mesenchymal Stem Cells for the Treatment of Rotator Cuff Disease: A 2-Year Follow-Up Study.
        Arthroscopy. 2020; 36: 971-980
        • Hurd J.L.
        • Facile T.R.
        • Weiss J.
        • et al.
        Safety and efficacy of treating symptomatic, partial-thickness rotator cuff tears with fresh, uncultured, unmodified, autologous adipose-derived regenerative cells (UA-ADRCs) isolated at the point of care: a prospective, randomized, controlled first-in-human pilot study.
        J Orthop Surg Res. 2020; 15: 122
        • Chun S.W.
        • Kim W.
        • Lee S.Y.
        • et al.
        A randomized controlled trial of stem cell injection for tendon tear.
        Sci Rep. 2022; 12: 818
        • Dragoo J.L.
        • Guzman R.A.
        Evaluation of the Consistency and Composition of Commercially Available Bone Marrow Aspirate Concentrate Systems.
        Orthop J Sports Med. 2020; 8 (2325967119893634)
        • Murray I.R.
        • Chahla J.
        • Safran M.R.
        • et al.
        International Expert Consensus on a Cell Therapy Communication Tool: DOSES.
        J bone Jt Surg Am volume. 2019; 101: 904-911
        • Murray I.R.
        • Robinson P.G.
        • West C.C.
        • et al.
        Reporting Standards in Clinical Studies Evaluating Bone Marrow Aspirate Concentrate: A Systematic Review.
        Arthroscopy. 2018; 34: 1366-1375
        • Chang R.W.
        • Tompkins D.M.
        • Cohn S.M.
        Are NSAIDs Safe? Assessing the Risk-Benefit Profile of Nonsteroidal Anti-inflammatory Drug Use in Postoperative Pain Management.
        Am Surg. 2021; 87: 872-879
        • Sardana V.
        • Burzynski J.
        • Hasan K.
        • et al.
        Are non-steroidal anti-inflammatory drug injections an alternative to steroid injections for musculoskeletal pain?: A systematic review.
        J Orthop. 2018; 15: 812-816
        • Shapiro P.S.
        • Rohde R.S.
        • Froimson M.I.
        • et al.
        The effect of local corticosteroid or ketorolac exposure on histologic and biomechanical properties of rabbit tendon and cartilage.
        Hand (N Y). 2007; 2: 165-172
        • Riggin C.N.
        • Tucker J.J.
        • Soslowsky L.J.
        • et al.
        Intra-articular tibiofemoral injection of a nonsteroidal anti-inflammatory drug has no detrimental effects on joint mechanics in a rat model.
        J Orthop Res. 2014; 32: 1512-1519
        • Min K.S.
        • St Pierre P.
        • Ryan P.M.
        • et al.
        A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid versus NSAID in patients with shoulder impingement syndrome.
        J Shoulder Elbow Surg. 2013; 22: 595-601
        • Taheri P.
        • Dehghan F.
        • Mousavi S.
        • et al.
        Comparison of Subacromial Ketorolac Injection versus Corticosteroid Injection in the Treatment of Shoulder Impingement Syndrome.
        J Res Pharm Pract. 2017; 6: 223-227
        • Kim Y.B.
        • Lee W.S.
        • Won J.S.
        The effects of a single-dose subacromial injection of a nonsteroidal anti-inflammatory drug in geriatric patients with subacromial impingement syndrome: a randomized double-blind study.
        Clin Shoulder Elb. 2021; 24: 4-8
        • Goyal T.
        • Paul S.
        • Sethy S.S.
        • et al.
        Outcomes of ketorolac versus depomedrol infiltrations for subacromial impingement syndrome: a randomized controlled trial.
        Musculoskelet Surg. 2022; 106: 29-34
        • Di Martino A.
        • Di Matteo B.
        • Papio T.
        • et al.
        Platelet-Rich Plasma Versus Hyaluronic Acid Injections for the Treatment of Knee Osteoarthritis: Results at 5 Years of a Double-Blind, Randomized Controlled Trial.
        Am J Sports Med. 2019; 47: 347-354
        • Rezasoltani Z.
        • Esmaily H.
        • Dadarkhah A.
        • et al.
        Low Molecular-weight Hyaluronic Acid Versus Physiotherapy for the Treatment of Supraspinatus Tendinopathy: A Randomized Comparative Clinical Trial.
        J Am Acad Orthop Surg. 2021; 29: e979-e992
        • Osti L.
        • Berardocco M.
        • di Giacomo V.
        • et al.
        Hyaluronic acid increases tendon derived cell viability and collagen type I expression in vitro: Comparative study of four different Hyaluronic acid preparations by molecular weight.
        BMC Musculoskelet Disord. 2015; 16: 284
        • Shibata Y.
        • Midorikawa K.
        • Emoto G.
        • et al.
        Clinical evaluation of sodium hyaluronate for the treatment of patients with rotator cuff tear.
        J Shoulder Elbow Surg. 2001; 10: 209-216
        • Alireza Moghtaderi S.S.
        • Khosrawi S.
        • Dehghan F.
        • et al.
        Effect of subacromial sodium hyaluronate injection on rotator cuff disease: A double-blind placebo-controlled clinical trial.
        Adv Biomed Res. 2013; 2: 1-5
        • Chou W.Y.
        • Ko J.Y.
        • Wang F.S.
        • et al.
        Effect of sodium hyaluronate treatment on rotator cuff lesions without complete tears: a randomized, double-blind, placebo-controlled study.
        J Shoulder Elbow Surg. 2010; 19: 557-563
        • Vangsness Jr., C.T.
        • Adamson 3rd, T.C.
        • Daley M.J.
        Consequences on Private Insurance Coverage: The AAOS Clinical Practice Guidelines and Hyaluronic Acid Injections.
        J bone Jt Surg Am volume. 2020; 102: 920-926