Platelet Rich Plasma Therapy – New Treatment for Shoulder Pain and Rotator Cuff Injuries

Platelet rich plasma has been used for over a decade in treatment of individuals affected with injured and torn ligaments, tendons as well as knee pain due to torn meniscus or arthritis. Shoulder impingement is a painful condition that causes shoulder pain due to tendonitis or bursitis at the acromioclavicular joint or tendonitis of the rotator cuff. The acromioclavicular joint is where the clavicle articulates with the front part of the scapula.The theory is the that excessive impingement associated with rubbing of the rotator cuff tendons under the clavicle and over the scapula causes shoulder pain. Impingement syndrome is commonly over-diagnosed and surgery too readily offered for relief. Again, like back pain a majority of cases of shoulder pain can be successfully treated with a few weeks of conservative therapy. MRI scanning can help in assessing the degree of tissue injury in a shoulder joint or rotator cuff. Unless there are major findings that clearly will not improve with conservative therapy, surgery would best be avoided. Many patients that undergo arthroscopic shoulder surgery continue to have pain after the procedure. Additionally, they must have weeks, if not months of rehabilitative therapy. Even with this, shoulder pain can continue.


Arthroscopic surgery for “impingement syndrome” including A-C joint or rotator cuff injuries has become a standard, commonly performed procedure in the United States, on the premise that this will relieve the patient’s shoulder pain. The use of arthroscopic surgery for this condition was developed in the 1970s.. With arthroscopic shoulder surgery, the orthopedic surgeon will shave away some of the bone and “trim” any fraying of the cartilage in the area of the A-C joint and shoulder cartilage. The thinking is to make more room for the rotator cuff and relieve the pressure. The problem is that these problems are not always the cause for shoulder pain. Shoulder pain has many causes, many of which are not always easy to identify – very similar to low back pain. Like low back pain, surgery is frequently not the answer to relieving pain. Conservative therapy with shoulder rehabilitation should always be tried first, using anti-inflammatory agents, physical therapy and holding off on certain activities that are exacerbating the pain. Home stretching exercises should be done regularly. Cortisone injections can provide lasting relief as well.


Platelet rich plasma (PRP) can offer patients an alternative treatment for their shoulder pain and rotator cuff injuries. Platelet rich plasma works by the body’s own natural healing process. Your own blood is drawn and processed in a sterile technique. The PRP is drawn off, with concentrations of platelets of up to 700% of baseline. It is the platelets that contain the growth factors, proteins and cytokines that trigger the cascade of healing and tissue regeneration. PRP is injected into the area of tissue damage or “impingement.” Macrophages (white blood cells) come into the area of injected PRP and clean out the damaged tissue. A protein matrix is formed for new tissue to attach to. Fibroblasts form new, stronger collagen fibers to rebuild the damaged cartilage, tendons or ligaments. Stem cells are recruited into the area and will differentiate into the tissue needing to be healed. This all occurs naturally over a 6-8 week period.


There are major advantages to PRP. Importantly, this is an outpatient, in-office procedure which takes about an hour. There is no down time or need for rehab. It is not surgery. PRP uses your own blood components to achieve natural, stronger healing. PRP regenerates new, stronger tissue to repair the tissue damage in the shoulder joint. This novel therapy is so effective that major league sports teams have adopted this as a first line therapy for their professional athletes. Major league baseball pitchers have received PRP for shoulder injuries common to this sport. PRP can be successful in painful shoulders as well as in patients who have had failed arthroscopic surgery.

In conclusion, shoulder pain is a common pain complaint seen in many patients. Conservative therapy is indicated for most patients. Surgery provides no guarantee of success and many patients end up with little or no pain relief. Platelet rich plasma will frequently provide pain relief and heal damaged tendons, ligaments and cartilage in the shoulder joint and rotator cuff without the need for surgery or prolonged physical therapy.