PRP Shoulder Injection: Advanced Platelet-Rich Plasma Treatment for Shoulder Pain and Rotator Cuff Tears
PRP shoulder injection for shoulder pain is an advanced regenerative medicine treatment which has been shown in multiple clinical studies to promote healing and symptom relief without the risks and side effects of other traditional treatments, such as corticosteroid injections.
What is a PRP Injection?
The benefits of PRP can help reduce pain due to rotator cuff disease without the risks of a steroid injection. PRP is obtained from a small sample of your own blood which is processed using a special centrifuge to separate and concentrate the platelets for the injection site. Learn the basics about what is PRP?
How does a platelet-rich plasma injection work?
PRP shoulder injections refers to the use of platetlet-rich plasma under ultrasound guidance, injected into the problem area, such rotator cuff tendons, acromial clavicular joint (AC joint), ligament or biceps tendon under ultrasound guidance for precise placement. Multiple growth factors are released from the PRP, which helps to regenerate the tissue by reducing inflammation, improving blood flow, and recruiting the body’s natural stem cells to the area.
What are the components of platelet-rich plasma?
Quality varies, but PRP injections use a very high concentration of platelets and very few red blood cells or white blood cells (leukocytes).
Are there different types of platelet rich plasma?
Absolutely. The concentration of platelets in different PRP preparations can differ by 100s of times. A weak PRP preparation may have less than 1% of the growth factors of a stronger one. Studies have shown that weak PRP systems, with their lower growth factor concentrations, are far less effective than systems that produce higher concentrations of growth factors and platelet dose.
Click this link to learn more information about the best type of PRP system.
In addition, there are advanced formulations of PRP which have shown even higher regenerative potential such as platelet lysate. Platelet lysate has demonstrated significant improvements in both pain and function for both rotator cuff pathology in the shoulder and knee osteoarthritis.
What is the best type of PRP for shoulder injections?
Ideally, the best PRP for joint problems should have the following characteristics:
- Platelet concentration between 1-2 million per microliter.
- Platelet composition higher than 95% (low red blood cells)
- White blood cell concentration lower than baseline (less than 4,000 per µL)
- Count / Dose : the total dose of platelets should be 5-10 billion per treatment, approximately 4-6 mL at 1-2 million/µL per joint.
- The only way to be sure of the above characteristics is to use a hematology analyzer to check the PRP just before use.
Why choose PRP Medical Aesthetics?
We use only the highest concentration and purity PRP for all our joint injections. We have tested and compared our PRP to others and the results speak for themselves.
We’ve tested Over 10,000 12,000 PRP samples (as of March 2025)
Highest Concentration and Quality PRP in Vancouver
After testing over ten thousand PRP samples we can confidently say that we produce the highest quality and concentration PRP in Vancouver, and probably anywhere. We base this on multiple research papers which have published the quality and concentration of PRP available in the market today.
- Expert, non-rushed physician consultation
- No pressure or obligation
- Personalized treatment recommendations
- Advanced PRP treatments: PRP, Platelet Lysate, PRF, Acell and more.
- All PRP is tested for proper concentration and purity level.
- If the PRP concentration is not high enough, we will not do the treatment (and no charge).
- Ultrasound guided injections by physician
- Knowledgable and experienced
Steps of PRP injection therapy in at PRP Medical Aesthetics
There are several steps to having a PRP Joint Treatment at PRP Medical Aesthetics Clinic:
- Blood draw. We usually start with ~90-120mL of blood. This is 1.5-6x the small amount of blood that most clinics take. This is necessary to have enough platelets in the starting sample.
- With sample, we test your baseline platelet counts using our hematology analyzer. If you have low platelets, we may recommend drawing more blood.
- We carefully proces your blood using a specialized centrifuge. This process usually takes about 2 hours as we have to go through several steps. A double-spin process is needed to obtain the highest possible concentration.
- We use a calibrated hematology analyzer to test the platelet concentration at several steps during this process.
- The final step to ensure quality: We test your sample for concentration, composition (purity), and calculate the final dose of platelets.
- Please note, if the final product is not concentrated enough, we may not perform the treatment as you will likely not see results. This hardly ever happens, but if it does, we can usually still get the procedure done, just not on the same day. We may need to do lab tests to determine if there is an underlying health problem, or sometimes start with more blood.
- Once everything is ready, the area is cleaned and numbed with a small amount of lidocaine.
- Dr. Yam will use an ultrasound machine to carefully inject the PRP into the proper area of the joint.
An example of PRP we prepared for joints, with the hematology analysis report for it:
We would consider this an ideal sample of PRP to use in the joint, as the concentration is approximately 2.3 million platelets/µL, and it is 98.2% pure with only 1.7% RBC and 0.1% WBC. With 5 mL available, this is a dose of 11.4 billion platelets, which is enough for a proper treatment.
How Can PRP Injections Help with Shoulder Pain?
Several studies have demonstrated that PRP can be effective in improving pain and function in patients with rotator cuff tendinopathy and tears. A systematic review and meta-analysis by Chen et al. found that PRP significantly improved short-term and long-term outcomes and reduced retear rates in patients with rotator cuff abnormalities.
Another study by Rossi et al. showed that subacromial PRP injections significantly decreased pain and improved functional outcomes in patients with refractory rotator cuff tendinopathy.
Another meta-analysis by Hamid and Sazlina concluded that PRP is a safe and effective intervention for long-term pain control and shoulder function improvement in patients with rotator cuff disorders.
What conditions besides osteoarthritis can benefit from PRP treatment?
While PRP is probably best studied in joints for knee pain and arthritis, it can also treat many other conditions such as shoulder pain, rotator cuff tears, tennis elbow, golfer’s elbow (medial and lateral epicondylitis), tendonitis, ankle injuries, jumper’s knee, and more.
How effective are PRP injections for chronic shoulder pain?
In general, PRP seems to be a very effective treatment for many chronic shoulder pain conditions. However, each case is different, and there are many factors to consider, such as the degree of injury, age and health of the patient, other medications, the concentration, dose and type of the PRP, whether or not ultrasound guided injections are used, etc.
What is the rotator cuff and its tendons?
The rotator cuff is a group of four tendons that stabilize the shoulder joint and facilitate its movement. These tendons include the supraspinatus (assists with abduction of the arm), infraspinatus (assists with external rotation of the arm), subscapularis (assists with internal rotation), and teres minor (assists with external rotation).
What is a Rotator Cuff Injury ?(Tendinopathy or tear)
Rotator cuff injuries, such as rotator cuff tendinopathy and tears, are common causes of shoulder pain. Rotator cuff tendinopathy involves the degeneration of the tendons, while tears can be partial or full-thickness. These injuries can result from acute trauma or degenerative changes, particularly in individuals over 40 years of age. Risk factors include age, male sex, smoking, heavy manual labor, and certain genetic predispositions.
What Should You Expect During PRP Injection Therapy?
During PRP injection, we wil draw a small sample of your own blood, and carefully process it by separating into its cellular components of platelets, red blood cells (erythrocytes), and white blood cells (leukocytes). We analyze every PRP sample to create a customized, very high concentration and dose of platelets. The preparation process usually takes a few hours. Once we’re ready to inject, we carefully prepare the area with antiseptic solution, use lidocaine for numbing, and ultrasound guidance for the actual injection.
What is the procedure for a PRP injection?
Intially, after we draw your blood sample, you will have a few hours to yourself when you can leave the clinic and come back once we’ve processed your sample. The injection process takes around 30-40 minutes after you return.
Is ultrasound-guided platelet-rich plasma injection necessary for shoulders?
Ultrasound guided injections are much more accurate than blind or landmark guided injections. The improved accuracy of ultrasound guided injections has been demonstrated in several studies. For example, a systematic review and meta-analysis by Aly et al. found greater accuracy of ultrasound guided injections across a variety of targets in the shoulder, including :
- Biceps tendon sheath: 87% accurate with ultrasound guided vs only 27% accurate without ultrasound;
- Glenohumeral joint: 93% accurate with ultrasound guided vs. 73% without ultrasound.
Additionally, another systematic review by Soh et al. found greater improvements in pain and shoulder function at 6 weeks following shoulder injections when ultrasound guidance was used compared to landmark-guided.
How many injections are typically needed?
Since every case is unique, it’s not possible to say how many injections are needed. However, the majority of our patients feel at least 80% better 4-6 weeks after a single treatment. It’s important to note that we customize the platelet concentration and dose for each treatment to the patient’s needs and we use a much higher concentration and dose than most other clinics.
Are There Risks or Side Effects of PRP Injections?
The risks and side effects depend greatly on the quality and concentration of the PRP preparation. Overall, PRP is very safe, especially compared to cortisone injections.[Prodromos] However, a lot depends on the way the PRP is prepared. PRP with high levels of contamination with red blood cells (“red PRP”), or are leukocyte-rich tend to be much more inflammatory, which contributes to a lot of post-procedure pain and inflammation, especially if tendons are being injected. At our clinic, we target less than 3% contamination with red blood cells and a very leukocyte-poor preparation with all of our PRP preparations, and verify this using a hematology analyzer.
Platelet lysate is an advanced form of PRP with much higher levels of growth factors which seems to have much easier and faster recovery after injection as well as better tissue regeneration.
Who should avoid PRP injection treatment?
- Patients with platelet disorders, such as very low platelet counts
- Patients with active cancer or infection
- Patients with bleeding disorders
- Patients with uncontrolled chronic disease
How can complications be minimized?
Complications from PRP can be minimized by following the provided instructions prior to having a PRP treatment. These include avoiding alcohol and smoking, and certain anti-inflammatory medication. Maintaining a healthy diet and activity level and being well hydrated prior to a PRP treatment is important.
Comparing PRP Injections to Other Shoulder Pain Treatments
Platelet-rich plasma (PRP) injections have been compared to other treatments for shoulder pain, such as corticosteroid injections, physical therapy, and surgery, in terms of effectiveness and safety for conditions like rotator cuff tendinopathy and tears.
Effectiveness:
• PRP vs. Corticosteroids: PRP injections have shown superior long-term improvements in pain and function compared to corticosteroid injections. For example, a study by Vaquerizo et al. demonstrated that PRP provided significantly better outcomes in the University of California Los Angeles (UCLA) scale, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Constant-Murley test at 6 and 12 months. Similarly, Rossi et al. found that PRP led to greater pain relief and functional improvement at 12 months compared to corticosteroids.
• PRP vs. Physical Therapy: Physical therapy remains a cornerstone of conservative management for rotator cuff disorders. While PRP can provide additional benefits, particularly in the long term, physical therapy alone has been shown to be effective in improving pain and function in many patients. The combination of PRP with physical therapy may offer enhanced outcomes, but direct comparisons are limited. Jain, Birinci Olgun]
• PRP vs. Surgery: Surgery is typically reserved for patients who do not respond to conservative treatments, including PRP and physical therapy. Surgical repair can provide significant improvements in pain and function, particularly in younger patients with smaller tears. However, PRP may reduce the need for surgery by promoting healing and improving symptoms in the long term.
Safety:
• PRP: Generally considered safe, PRP injections can cause transient pain, swelling, and, in rare cases, complications like frozen shoulder. The risk of adverse effects is relatively low.
• Corticosteroids: While effective for short-term pain relief, corticosteroids carry risks such as tendon degeneration and potential negative effects on subsequent surgical outcomes.
• Physical Therapy: Safe with minimal risks, physical therapy can occasionally cause mild discomfort or transient pain.
• Surgery: Shoulder surgery carries significant risks include infection, stiffness, and complications related to anesthesia, though these are relatively rare.
In summary, PRP injections offer a viable alternative to corticosteroids with better long-term outcomes and fewer risks. They can complement physical therapy and may reduce the need for surgery in some patients.
Can PRP injections be combined with other treatments?
PRP can be combined with other treatments, eg. physical therapy. We do not usually recommend that PRP is combined with corticosteroid injections, due to other risks associated with steroid injections. However, hyaluronic acid (eg. Durolane or Synvisc), may enhance the effect of PRP.
One systematic review and meta-analysis found that the combination of hyaluronic acid and PRP was superior to steroids for short-term pain relief in patients with partial rotator cuff tears within the first 3 months of treatment.
What is the typical recovery time for athletes using PRP injections in sports medicine?
The typical recovery time for athletes after receiving a PRP injection depends on the severity of the injury being treated and the type of PRP treatment used (concentration, dose and composition). Many athletes seem to recover within a few weeks, but full benefits may not be seen for a few months. A systematic review and meta-analysis by Zhu et al. indicated that PRP injections provide significant improvements in shoulder function and pain relief at follow-up times of 8-12 weeks and beyond.
PRP Shoulder Injections: Expert Consultation
In conclusion, PRP shoulder injections is a treatment which has shown benefit in many clinical studies for both treating symptoms and improving function of the rotator cuff and other shoulder areas. To find out more about PRP shoulder injections we invite you to contact us or schedule a complimentary consultation with our doctor.