الفهرس 
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Abstract
Patients with rotator cuff tendonopathies (RCT) comprise a sizeable portion of the subpopulation, its prevalence increases with age and with occupations involving overhead activities as in athletes and manual workers. Rotator cuff diseases (RCD) not only result in numerous visits to medical care facilities and significant time loss, but they can also cause long-term disability and have a major impact on health care costs and resources. Rotator cuff disease has been described as a progressive disorder of the rotator cuff tendon beginning with acute tendinitis, progressing to tendinosis with degeneration and partial-thickness tear, and can end in full-thickness tear.
The biochemical and molecular events leading to RCD and tears have not yet been defined and still a matter of debate. The cytokine networks play a principle role in the pathogenesis of RCT particularly the pro-inflammatory cytokines (as IL-1β) and angiogenesis- related cytokines (as VEGF).
Most of the rotator cuff pathologies can be treated with conservative therapy. Lack of healing response and the limited ability of rotator cuff tendons to regenerate is the main cause of unsatisfactory results of conservative management. Therefor growth factors and platelet rich plasma (PRP) have been suggested to be used to influence the healing process and promote tendon regeneration.
The present study was designed to investigate the effect of PRP injection on functional improvement on RCD and to assess the role of pro-inflammatory and angiogenesis-related cytokines as a pathogenic factor and if possible as objective factor for improvement in RCD.
This study was performed on 40 patients diagnosed with rotator cuff disease. All patients underwent full medical history taking, thorough clinical and musculoskeletal examination. All patients received two doses of ultrasound guided PRP injection with 4 weeks between the first and second injection. A 3-week exercise program was done between the two doses followed by a further 3-week exercise program after the second dose for a total 6-weeks exercise program. Clinical, laboratory and radiological assessments were done before, 4 weeks after the first injection and after 3 months from the first injection. Assessment included clinical scoring system, cytokine assay and diagnostic musculoskeletal ultrasound.
By the end of injection protocol there was a clinical and functional improvement of high statistical significance in all included patients; this improvement was assessed by decrease in pain and improvement of ROM, power and functional state. In addition, there was a statistically high significant decrease of cytokines serum levels (VEGF and IL-1β). Furthermore, there was a statistically highly significant increase in the number of patients that improved regarding musculoskeletal ultrasound grading after 3 months.
Our results showed that there was a statistically highly significant positive correlation between the serum levels of cytokines (IL-1β and VEGF) and VAS score before injection. In addition, there was a statistically significant negative correlation between the serum levels of cytokines and other clinical scores before injection. Furthermore, there was a statistically significant positive correlation between the changes of the serum levels of the cytokine and the changes in VAS score after 4 weeks from the first injection. These correlations prove the role of these cytokine in pathogenesis of RCD and also reflect that the levels of these cytokines are correlated with advanced stage of disease.