PRP for Rotator Cuff: Evidence, Protocols, and Recovery

Rotator cuff trouble has a way of sneaking into everything you do. Reaching the top shelf, sleeping on your side, swinging a racquet, even putting on a jacket. As a sports medicine clinician, I meet two kinds of rotator cuff patients: the overdoers who strained an otherwise healthy tendon with repetitive load, and the slow burners whose tendons degenerated over years of desk work punctuated by weekend bursts of activity. Both groups ask about platelet rich plasma therapy, often after a cortisone shot wore off or physical therapy stalled. PRP has earned its place in that conversation, but it’s not magic. The details matter: which tendon, the tear type, the PRP formulation, how it’s injected, and what you do for twelve weeks afterward.

This guide walks through the best available evidence, real-world protocols, and the day-to-day realities of recovery. I will also flag where PRP competes with or complements alternatives like corticosteroids and surgery.

PRP stands for platelet rich plasma. It’s a concentrated portion of your own blood, spun in a centrifuge to enrich platelets and the growth factors they carry. Platelets do more than clot. In a tendon, they can release a cascade of signals, recruiting cells, modulating inflammation, and nudging the tissue toward remodeling rather than chronic irritation. That’s the basic pitch behind platelet therapy for healing.

Not all preparations are the same. The two big variables are platelet concentration and whether the product is leukocyte-rich or leukocyte-poor. Leukocyte-rich PRP contains more white blood cells, which may heighten an inflammatory response early on. Leukocyte-poor PRP is gentler. For tendon disease in the rotator cuff, many practices use leukocyte-poor PRP to reduce post-injection flare, though there are studies using both. This nuance partly explains why patients hear conflicting opinions about whether prp treatment works.

We lump a lot under “rotator cuff,” but the rotator cuff is four muscles and their tendons, wrapping the shoulder like a cuff to stabilize the ball-and-socket. The most commonly involved tendon is the supraspinatus. Problems fall into several buckets.

Tendinopathy without a tear looks like thickening, pain with overhead reach, night pain, and tenderness at the greater tuberosity. Partial-thickness tears span a spectrum, from a few millimeters on the bursal or articular side to more substantial tears that still leave some fibers intact. Full-thickness tears create a discontinuity in the tendon. Small full-thickness tears in the right person can be treated non-surgically, but larger tears with retraction and muscle atrophy tend to do best with repair.

PRP is most useful for chronic tendinopathy and some partial-thickness tears. Once a full-thickness tear retracts, no injection can reattach a tendon to bone. Biology helps tissue quality, but mechanics still rule.

Research on PRP for shoulder pain now spans more than a decade. The early studies were small and inconsistent. Over the last five to seven years, better randomized trials and meta-analyses have sharpened the picture.

For rotator cuff tendinopathy and partial tears, PRP often outperforms corticosteroid injections beyond the 3-month mark. Steroids can quiet pain quickly, but they do not improve tendon structure and may weaken collagen with repeated doses. PRP’s pain reduction tends to be slower in onset yet more durable, with functional scores like the Constant and ASES improving over 3 to 12 months. Some studies show ultrasound evidence of improved tendon echotexture and thickness, though imaging correlates are imperfect.

For full-thickness tears managed conservatively, results are mixed. You may see symptomatic benefit, but it rarely changes the natural history of a large tear. For surgical repairs, using PRP at the time of arthroscopy shows varied results. Some trials found lower re-tear rates in large tears when PRP was applied at the bone-tendon interface, while others showed no difference in function or healing. Differences in PRP formulation, application method, and tear size likely account for this.

The take-home: PRP seems to help chronic rotator cuff tendinopathy and partial-thickness tears more than it helps large full-thickness tears. Expect better pain and function at 3 to 12 months compared with steroids or dry needling alone. It is not a guaranteed cure and it depends on proper diagnosis, injection technique, and rehab.

Patients often weigh PRP against a cortisone shot. Cortisone can quiet a hot shoulder quickly, sometimes within days. It’s useful for reactive bursitis or when pain blocks sleep and therapy. But the effect often fades by 6 to 12 weeks, and repeated injections carry cartilage and tendon risks. PRP costs more and results take longer, but it avoids steroid downsides and often provides longer relief.

Oral anti-inflammatories and activity modification can manage flares, and structured physical therapy is foundational. Eccentric and heavy-slow resistance work, scapular mechanics, and thoracic mobility should not be skipped. Surgery remains the right call for significant full-thickness tears in active patients, particularly if there is weakness, loss of function, or retraction on imaging. There is no high-quality evidence that PRP can replace needed surgery for a retracted tear.

Stem cell therapy is a common comparison. The phrase is imprecise and often refers to bone marrow aspirate concentrate rather than true stem cells. Evidence for marrow aspirate in rotator cuff disease is less mature and varies by indication. PRP is better studied, more standardized, and safer in routine practice.

There are three phases: preparation, the platelet rich plasma injection, and the rehabilitation arc. Cutting corners in any of the three reduces the odds of success.

Before the appointment, I screen for red flags: systemic inflammatory disease, significant cervical radiculopathy masquerading as shoulder pain, adhesive capsulitis that dominates the picture, or a full-thickness tear that clearly needs surgical evaluation. We check for anticoagulation and discuss temporary adjustments with the prescribing physician if appropriate. I also ask patients to stop NSAIDs for 5 to 7 days when safe, because nonsteroidal anti-inflammatories can blunt the platelet activation we are trying to harness.

Draw day is straightforward. We typically collect 30 to 60 mL of blood. Using a closed centrifuge system, we obtain a leukocyte-poor PRP fraction in the range of 4 to 6 times baseline platelets, often yielding 3 to 6 mL of injectate. Some clinicians add bicarbonate to buffer acidity and reduce injection sting. I prefer ultrasound guidance for accuracy. For rotator cuff tendinopathy, I target the hypoechoic region of the supraspinatus or infraspinatus and perform a gentle peppering technique through the degenerative tissue. If subacromial bursitis is prominent, a small amount can be directed there as well, though the primary target remains tendon. For partial articular-sided tears, I approach from posterior or lateral, depending on patient anatomy and comfort.

Local anesthesia is a judgment call. Anesthetic within the tendon can impair platelet activation, so we limit it to skin and subcutaneous tissue when possible. Some practices perform a suprascapular nerve block for comfort. The injection itself takes a few minutes. Patients usually feel a deep ache during and for 24 to 72 hours afterward.

After the injection, a short period of relative rest lets the initial inflammatory phase settle. I suggest a sling for comfort during the first 24 to 48 hours, along with ice as needed. We avoid NSAIDs for two weeks. Acetaminophen is fine. Most patients can return to desk work within 2 to 3 days.

PRP is not a standalone cure. Think of it as an upstream nudge, setting the tissue up to respond to the right mechanical signals. The loading strategy that follows is the difference between a durable outcome and a brief improvement.

Over the first two weeks, we keep motion gentle. Pendulum swings, supported range, scapular setting, and light isometrics that do not provoke pain are enough. The cue is discomfort that fades quickly after exercise, not lingering soreness that disrupts sleep.

Weeks three to six bring progressive loading. Eccentric and heavy-slow resistance work target the tendon’s ability to handle tensile stress. I start with isometrics at neutral, then move to short-lever external rotation, scapular retraction and depression drills, and closed-chain variations. By week six, most patients are doing 2 to 3 sets of 8 to 12 heavy-slow reps for supraspinatus and infraspinatus patterns, three days per week. Thoracic mobility and posterior capsule stretching come along for the ride if stiffness is present.

Weeks seven to twelve are about function. Overhead athletes begin a return-to-throw program. Workers return to job-specific tasks, scaled carefully. Pain should trend down, night pain should recede, and range should normalize. If progress stalls at nearby PRP injection clinics any point, we reassess load, look for scapular dyskinesis, consider adjuncts such as manual therapy for the cervical-thoracic junction, and confirm we targeted the right tissue in the first place.

I get this question often. For chronic rotator cuff tendinopathy, I usually start with one PRP injection and follow progress at six to eight weeks. If improvement is real but not complete, a second injection can be justified, particularly in partial-thickness tears where the first round softened pain enough to allow proper loading. Some protocols schedule two injections spaced four to six weeks apart. I rarely go beyond two, and I avoid stacking PRP with steroid in the same tissue during the same season.

When PRP works, patients typically notice subtle improvement starting around week three or four. Sleep becomes easier, the catch with reaching fades, and pain during rehab drops month by month. The most meaningful gains accrue between weeks six and twelve, with continued improvement into month six. Athletes with disciplined rehab often beat those averages.

It’s worth emphasizing that rotator cuff tendons remodel slowly. Collagen turnover is measured in months. That’s why “how long does PRP last” is the wrong frame. If you use the PRP window to rebuild capacity, improvements often persist well beyond the life of any growth factor pulse.

PRP is autologous, meaning it comes from you. That lowers the risk profile. The common side effect is a transient flare of pain in the first 48 to 72 hours. Bruising at the skin or localized soreness is common. Infection is rare but possible. Bleeding risk rises with anticoagulants. Allergic reactions are very rare since no foreign proteins are introduced, though anticoagulant preservatives in some kits can irritate.

Two edge cases deserve mention. Calcific tendinitis can mimic tendinopathy, and PRP alone may not be best. Ultrasound-guided lavage or needling of the calcium deposit, sometimes followed by PRP, often does better. Adhesive capsulitis, the frozen shoulder, responds unpredictably. If capsular tightness is the dominant driver, hydrodilatation or a carefully guided steroid into the joint capsule may speed motion more effectively than PRP into a tendon.

The cost of platelet rich plasma injection varies widely. In many U.S. markets, a shoulder PRP session ranges from 500 to 1,200 dollars depending on the kit, facility fees, and whether image guidance is used. Most insurance plans still consider PRP experimental for tendinopathy, so it is often paid out of pocket. Ask about the exact preparation (leukocyte-rich or poor), platelet concentration, and the clinician’s ultrasound experience. Skill matters. PRP injection reviews can highlight patient experience, but they rarely reveal the details that predict success.

I caution patients against umbrella promises across body regions: prp injection for knees, prp injection for joints throughout the body, prp for hip pain, or prp for back pain each has its own evidence base. The rotator cuff has better data than some joints and worse than others, such as patellar or lateral elbow tendinopathy where PRP is often helpful. Similarly, prp for arthritis and prp for knee osteoarthritis have mixed but improving evidence, and the protocols differ from tendon work. The same goes for prp for tennis elbow or plantar fasciitis, where technique and rehab dictate outcomes. Not all platelet therapy for healing is interchangeable.

Details in the room can change results. I use ultrasound to confirm the hypoechoic lesion and guide the needle in-plane so I can see the tip. I avoid bathing the subacromial bursa with local anesthetic right before PRP; if a patient needs comfort, a separate suprascapular block keeps anesthetic away from the platelet activation zone. If the tendon is markedly thickened, gentle fenestration can break up sclerotic tissue and create a microenvironment more receptive to the injectate. Conversely, in an articular-sided tear at the footprint, I stay precise and avoid over-aggressive trauma that could worsen the tear.

Patients often ask whether to combine PRP with dry needling or prolotherapy. Dry needling is essentially fenestration without injectate and can be helpful in early or milder cases. Prolotherapy introduces an irritant like dextrose. Both aim to stimulate healing but do not supply growth factors. In my experience, PRP adds more in recalcitrant cases, provided the loading program is sound.

A 46-year-old tennis coach developed persistent lateral shoulder pain over six months. MRI showed a 40 percent thickness articular-sided supraspinatus tear with bursal inflammation. He failed three months of home exercise and one subacromial steroid that helped for four weeks, then wore off. On exam, strength was nearly full but painful above 90 degrees, with positive Hawkins and painful arc. We chose a leukocyte-poor PRP injection, 5 mL, delivered under ultrasound with targeted fenestration at the tear margin.

He used acetaminophen and ice for two days, a sling for comfort. At one week, pain was still present but sleep improved. At four weeks, he felt 30 percent better and could train clients without guarding. We introduced heavy-slow resistance at week four, with 3 sessions per week. At eight weeks, he returned to shadow swings at half speed. By 12 weeks, he resumed match play with minimal discomfort. At Pensacola prp injection six months, he played a full weekend tournament. PRP did not make the tear vanish, but it quieted pain enough to complete the progression without setbacks.

PRP is not for everyone. If your primary barrier is a large, retracted tear with weakness, it is the wrong tool. If you cannot commit to three months of progressive rehab, you may not harvest the benefits. If your pain is acutely unbearable and you need function in days, a cortisone injection may be the better short-term bridge. On the other hand, if you have a stubborn partial tear or tendinopathy that recurs each time you increase load, and you prefer to avoid repeat steroids or surgery, PRP belongs on the shortlist.

For the first week, avoid heavy lifting, overhead work, and repetitive strain. Keep the shoulder moving gently. Sleep with support, often a pillow under the elbow. Skip NSAIDs for two weeks if your doctor agrees. Gradually resume cardio that does not jar the shoulder.

Here is a concise plan many of my patients follow well:

You’ll see PRP marketed for a long list of problems, from prp for muscle injury to prp for ligament injury, prp for meniscus tear, or prp for cartilage repair. Some of those claims are aspirational. Others are better supported. Shoulder-wise, prp for shoulder pain and prp for shoulder tear usually refers to the same rotator cuff tendinopathy and partial tear population described above. Outside the shoulder, tendons like the common extensor origin in tennis elbow respond well, and some joint conditions such as early knee osteoarthritis show meaningful benefit with intra-articular platelet rich plasma injection.

On the cosmetic side, prp injection for face, prp for skin rejuvenation, prp facial, prp microneedling, and the so-called prp vampire facial aim at collagen regeneration injection and skin tightening prp effects. The mechanisms overlap but the tissues and endpoints are different. The same goes for prp therapy for hair loss, prp for hair restoration in male pattern baldness, and scalp prp therapy. Results vary, and protocols differ in frequency and volume. It’s fine to be curious about these, but they should not be conflated with regenerative injection therapy for tendons.

Is PRP safe? For most people, yes. It is autologous and has a favorable safety profile when performed in a sterile environment by trained clinicians.

Does PRP work? For chronic rotator cuff tendinopathy and partial tears, the odds of meaningful improvement are good, especially when paired with a diligent rehab plan. For large full-thickness tears, it is not a substitute for repair.

How many PRP sessions? Often one. Sometimes two if there is progress but not enough. More than two rarely adds value.

How long does PRP last? Think of it as enabling the tendon to remodel while you build capacity. If you complete that process, gains can persist for many months to years. If you return to overuse without strength, pain can recur.

Is PRP painful? The injection can ache. The first 72 hours can be sore, then pain usually subsides. Most patients consider it manageable.

Can I exercise after PRP? Yes, with a plan. Keep it gentle for two weeks, then progress. The right loading is part of the therapy.

What is the prp injection cost? Expect several hundred to just over a thousand dollars per session in many markets. Ask for a clear quote that includes ultrasound guidance and follow-up.

PRP vs cortisone injection? Steroids act fast but fade and may harm tendon with repetition. PRP acts slower but is often more durable and tendon-friendly.

PRP vs stem cell therapy? PRP is better studied for common tendon problems and simpler to deliver. “Stem cell” offerings vary widely and are often misnamed.

If you want the highest return on a platelet plasma intervention for rotator cuff problems, take these points seriously: get the diagnosis right, choose a clinician who uses ultrasound and understands tendon loading, and commit to twelve weeks of progressive rehab. Respect the biology. The platelet cell regeneration treatment is only as good as the tissue environment you create for it.

I have watched ambitious people rush back to overhead work in week two and blame PRP when pain returns. I have also seen patient, steady progress transform a shoulder that failed everything else. In that second group, PRP didn’t do all the work, but it tipped the balance toward healing. That is the role it plays best.

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