How is biceps teninopathy treated?

Conservative approaches—like rest, anti-inflammatory medications,
physical therapy, and corticosteroid injections—are usually the first
line of treatment. While these options can be helpful, they don’t always
resolve the issue. For patients with chronic or treatment-resistant
tendinitis, injection-based regenerative therapies have emerged as promising alternative before turning to surgery, and include:

• Platelet-Rich Plasma (PRP) therapy

• Prolotherapy (a type of regenerative injection therapy)

But which one actually works better?

How does PRP compare to Prolotherapy Head-to-Head?

Researchers from Chosun University in South Korea conducted a prospective clinical study on 100 patients diagnosed with early-stage biceps tendinitis. These patients:

• Had shoulder pain lasting more than 3 months

• Showed inflammation around the biceps tendon on MRI

• Didn’t respond to conservative treatments

Participants were randomly assigned into two treatment groups:

All of the injections were performed using ultrasound guidance to ensure precision, and researchers tracked patients over 12 months.

In the short term at the 1-Month Follow-Up results were similar.

• Both PRP and prolotherapy groups saw initial pain relief (~40% reduction).

• No statistically significant difference between the two groups.

Long-term outcomes at 3, 6, and 12 Months PRP outperformed prolotherapy with greater improvements in pain (Visual Analog Scale or VAS).

• PRP continued to improve over time, and showed sustained, long-term relief, while the benifit of prolotherapy plateau and then decline in effectiveness after the first month.

Why did PRP work better for pain than prolotherapy?

PRP therapy involves injecting a concentrated dose of your own platelets, rich in growth factors like:

• PDGF (Platelet-Derived Growth Factor)

• TGF-β1 & β2 (Transforming Growth Factors)

• VEGF (Vascular Endothelial Growth Factor)

• bFGF (Basic Fibroblast Growth Factor)

These compounds promote tissue repair, reduce inflammation, and enhance blood flow, which likely contribute to its longer-lasting effects.

Prolotherapy, while effective in stimulating local healing responses, doesn’t offer the same robust intrinsic healing factors as PRP.

Key Takeaways for this study for Patients:

• PRP was more effective long-term than prolotherapy for biceps tendinitis.

• Prolotherapy provides short-term relief but lacks sustained improvement.

• Ultrasound guidance improves accuracy and safety for both injections.

Learn more about PRP and prolotherapy for chronic biceps tendon pain at:

(781) 591-7855

info@BSBortho.com

20 Walnut St

Suite 14

Wellesley MA 02481

References:

Moon YL, Ha SH, Lee YK, Park YK (2011) Comparative studies of platelet-rich plasma (PRP) and prolotherapy for proximal biceps tendinitis. Clin Should Elbow 14: 153-158.