Platelet-rich plasma
Platelet-rich plasma (PRP) is a treatment made from a small sample of your own blood that’s processed to concentrate platelets—cells best known for clotting, but also rich in naturally occurring “growth factors” and signaling proteins involved in tissue repair. The goal of PRP is to deliver a higher concentration of these healing signals directly to a painful or injured structure (like a tendon or joint) to support recovery.
What is PRP?
- PRP is blood plasma enriched with platelets.
- Platelets release growth factors and cytokines that may help stimulate healing in soft tissue and bone.
- Most PRP is prepared by drawing blood and using a centrifuge to separate and concentrate platelets before injection into the target area.
Where PRP can be used in shoulder care
In shoulder-focused sports medicine and orthopedics, PRP is commonly used for:
- Rotator cuff tendinopathy (chronic “tendonitis”) / subacromial pain
PRP can be injected into the subacromial space or around the affected tendon region—often with ultrasound or fluoroscopic guidance to improve accuracy. - Partial-thickness rotator cuff tears (small-to-medium)
PRP may be used as a non-surgical option aimed at reducing pain and improving function, sometimes in a short “series” of injections depending on protocol. - Glenohumeral osteoarthritis (“shoulder joint arthritis”)
PRP can be injected into the shoulder joint (glenohumeral joint), typically under ultrasound or fluoroscopic guidance, as a conservative (non-surgical) option to help pain and function. - During rotator cuff surgery (as an adjunct)
PRP may also be applied at the time of surgery to improve tendon healing and reduce re-tear risk, particularly in certain repair techniques.
When PRP is most often considered
PRP is usually discussed when:
- Symptoms persist despite basic measures like activity modification and physical therapy, and a patient wants to explore non-surgical options (or delay surgery).
- A patient is weighing injection choices (e.g., corticosteroid vs Ketorolac vs PRP vs hyaluronic acid) based on goals such as pain relief, functional improvement, and tissue considerations.
- Corticosteroids may be undesirable for a given patient (for example, due to contraindications or concern about tendon-related risks), making PRP a reasonable alternative to discuss with a clinician.
What research says for common shoulder uses
(see below for further information)
- For partial-thickness rotator cuff tears, one randomized trial found that PRP improved outcomes, and a combination of hyaluronic acid (HA) + PRP performed better than HA alone or PRP alone in pain and function at 12 months.
- For rotator cuff tendinopathy, research is mixed: one trial found PRP performed similarly to corticosteroid overall but with greater improvement in pain and range of motion, while another trial found a single PRP injection produced better pain and functional improvement at 12 months than a single corticosteroid injection.
- For shoulder osteoarthritis, one randomized trial found PRP and HA both improved pain and function, with no major difference between them after a single injection.
- In surgical rotator cuff repair, a 2025 evidence review suggested PRP may reduce short-term re-tear rates and improve certain outcomes, especially in some repair techniques.
What the appointment usually looks like
Most PRP visits follow a predictable flow:
- Blood draw (from you).
- Centrifuge processing to concentrate platelets.
- Injection into the target (often ultrasound-guided for joints/tendons).
Aftercare & timing:
- It’s common to have temporary soreness after PRP.
- Some guidance recommends avoiding aspirin/NSAIDs after PRP because they may interfere with the intended inflammatory/healing response; some clinicians also ask patients to pause NSAIDs beforehand—follow your treating clinician’s instructions.
- Improvement can take weeks, not days, and some people feel more discomfort early on.
Safety and practical considerations
- PRP is generally considered low-risk, with common short-term effects like soreness or bruising at the injection site; less common risks include bleeding, infection, tissue damage, or nerve injury.
- Because PRP is made from your own blood, allergic reaction risk is lower than with many medications—though any procedure has risks.
- Insurance coverage is often limited. Many clinics note that PRP may not be covered by Medicare/Medicaid or many insurance plans, and major medical centers also point out that lack of broad FDA approval for most indications can contribute to limited coverage. The cost can range from $1000-$1500 per injection.
Bottom line
PRP is a blood-derived injection designed to concentrate your body’s own healing signals and deliver them directly to injured tendon or arthritic joint tissue. In the shoulder, the best-supported uses are in selected rotator cuff problems (tendinopathy and partial-thickness tears), shoulder osteoarthritis, and as an adjunct during certain rotator cuff surgeries—with results that vary by diagnosis, injection protocol, and PRP formulation.
Evidence in Depth:
Cai, Y., Sun, Z., Liao, B., Song, Z., Xiao, T., & Zhu, P. (2019). Sodium hyaluronate and platelet-rich plasma for partial-thickness rotator cuff tears. Medicine & Science in Sports & Exercise, 51(2), 227–233. doi:10.1249/MSS.0000000000001781
Link (free full text):
https://journals.lww.com/acsm-msse/fulltext/2019/02000/sodium_hyaluronate_and_platelet_rich_plasma_for.1.aspx
Cai, Y., Sun, Z., Liao, B., Song, Z., Xiao, T., & Zhu, P. (2019). Sodium hyaluronate and platelet-rich plasma for partial-thickness rotator cuff tears. Medicine & Science in Sports & Exercise, 51(2), 227–233. doi:10.1249/MSS.0000000000001781
Who it studied:
Adults (18–55) with MRI-confirmed small-to-medium, bursal-sided partial-thickness rotator cuff tears (supraspinatus), early course (within ~6 months). Participants were randomized into 4 groups.
What they did:
A double-blind randomized trial comparing ultrasound-guided subacromial injections given once weekly for 4 weeks:
- Normal saline (placebo)
- Sodium hyaluronate (HA/SH)
- PRP
- HA + PRP (combined)
Outcomes included Constant score, ASES, and pain VAS through 12 months, plus MRI tear-size assessment at 1 year.
What they found:
PRP and HA+PRP groups improved pain and function more than saline.
HA+PRP produced the best 12-month outcomes, outperforming HA alone and PRP alone on pain and function.
MRI findings showed tear size decreased most in HA+PRP, with improvement also seen in PRP.
What it means:
For small-to-medium partial-thickness tears, a short series (4 injections) of PRP can help—and combining HA + PRP may help more than either alone.
Link (free full text):
https://journals.lww.com/acsm-msse/fulltext/2019/02000/sodium_hyaluronate_and_platelet_rich_plasma_for.1.aspx
Dadgostar, H., Fahimipour, F., Pahlevan Sabagh, A., Arasteh, P., & Razi, M. (2021). Corticosteroids or platelet-rich plasma injections for rotator cuff tendinopathy: A randomized clinical trial study. Journal of Orthopaedic Surgery and Research, 16, 333. doi:10.1186/s13018-021-02470-x
Who it studied
58 patients with rotator cuff tendinopathy (tendinitis or incomplete tear on MRI), typically >40 years old, with symptoms lasting >3 months.
What they did:
A randomized double-blind clinical trial comparing:
- PRP injections: ultrasound-guided injection into the subacromial space plus an injection at the tendon tear site
- Corticosteroid injection (Depo-medrol + lidocaine) into the subacromial space
Both groups also followed an exercise/scapular program. Follow-up went to 3 months.
What they found:
- Both groups improved in pain, function scores, and range of motion over time.
- PRP showed greater pain improvement over 3 months and better gains in some ROM measures (notably adduction and external rotation).
- Other outcomes (including some functional scores and supraspinatus thickness on ultrasound) were similar.
What it means:
In this study, PRP performed about as well as a steroid shot overall, with some advantages for pain and certain ROM in the short term. This is especially relevant when clinicians want to avoid steroids (e.g., concerns about tendon effects or patient-specific contraindications).
Link (free full text):
https://link.springer.com/article/10.1186/s13018-021-02470-x
Kirschner, J. S., Cheng, J., Creighton, A., Santiago, K., Hurwitz, N., Dundas, M., Beatty, N., Kingsbury, D., Konin, G., Abutalib, Z., & Chang, R. (2022). Efficacy of ultrasound-guided glenohumeral joint injections of leukocyte-poor platelet-rich plasma versus hyaluronic acid in the treatment of glenohumeral osteoarthritis: A randomized, double-blind controlled trial. Clinical Journal of Sport Medicine, 32(6), 558–566. doi:10.1097/JSM.0000000000001029
Who it studied:
70 patients with chronic glenohumeral (shoulder) osteoarthritis, including many with severe OA, tracked for up to 12 months.
What they did:
A randomized, double-blind controlled trial comparing a single ultrasound-guided glenohumeral joint injection of:
- Hyaluronic acid (HA) (6 mL), vs
- Leukocyte-poor PRP (LP-PRP) (6 mL)
Outcomes included SPADI, ASES, and numeric pain ratings at multiple time points to 12 months, plus satisfaction and side effects.
What they found:
- There were no meaningful differences between HA and LP-PRP at any time point up to 12 months.
- Both groups improved: pain and function scores improved significantly starting around 1–2 months, with benefits persisting to 12 months.
- Side effects were uncommon and similar; satisfaction was broadly similar.
What it means:
For shoulder arthritis, this trial suggests either HA or LP-PRP can help pain and function—but LP-PRP wasn’t clearly superior to HA here. Practical decision drivers may include cost, availability, clinician preference, and patient response history.
Link (free full text):
Rossi, L. A., Brandariz, R., Gorodischer, T., Camino, P., Piuzzi, N., Tanoira, I., & Ranalletta, M. (2024). Subacromial injection of platelet-rich plasma provides greater improvement in pain and functional outcomes compared to corticosteroids at 1-year follow-up: A double-blinded randomized controlled trial. Journal of Shoulder and Elbow Surgery, 33, 2563–2571. doi:10.1016/j.jse.2024.06.012
Who it studied
100 patients (18–50 years old) with MRI-confirmed supraspinatus tendinopathy (not full tears), who failed conservative treatment and were followed for 12 months.
What they did:
A double-blind randomized controlled trial comparing a single ultrasound-guided subacromial injection of:
- Leukocyte-poor PRP, vs
- Corticosteroid injection
Patients reported pain and function at 1, 3, 6, and 12 months (VAS pain, ASES, SANE, and sleep quality index). Treatment “failure” included needing another injection due to persistent symptoms.
What they found:
- Steroid patients tended to improve faster early (notably at 1 month).
- By 12 months, PRP produced greater pain relief and better functional outcomes across multiple patient-reported scales.
- Failure rate was higher with steroid than PRP over the year.
What it means:
For younger patients with isolated rotator cuff tendinopathy, a single PRP injection may provide more durable improvement than a single steroid injection—while steroids may still offer quicker short-term relief.
Link (PubMed abstract is free; full text may require journal access)
Yin, S., Zhang, B., Li, T., Li, X., Xie, Z., Tang, H., Wang, Y., Wen, T., Jia, Z., & Wu, Y. (2025). Platelet-rich plasma in arthroscopic repair of full-thickness rotator cuff tears: A cross-sectional analysis of overlapping meta-analyses. Orthopaedic Journal of Sports Medicine, 13(5), 23259671251337481. doi:10.1177/23259671251337481
Who it studied:
This paper didn’t enroll new patients directly—it analyzed overlapping meta-analyses of randomized trials in people undergoing arthroscopic repair of full-thickness rotator cuff tears.
What they did
A systematic approach (“cross-sectional analysis of overlapping meta-analyses”) to identify the most reliable summary of evidence comparing rotator cuff repair with PRP vs without PRP. They assessed review quality (AMSTAR) and used a decision algorithm to select the strongest evidence set.
What they found:
The best-supported evidence set suggested that adding PRP during surgery was associated with:
- Lower retear rates in the short term (≤12 months)
- Lower short-term pain scores
- Better short-term functional scores, with the benefit appearing especially in single-row fixation techniques. Some effects appeared less pronounced at longer follow-up, depending on the outcome and repair technique.
What it means:
If you’re having rotator cuff repair surgery, PRP used as an adjunct during the procedure may improve early healing metrics (including retear risk) and short-term outcomes—particularly in certain repair constructs. This is different from PRP used as a standalone injection for tendinopathy.
Link (free full text):