Platelet-Rich Plasma, A Viable Alternative for Chronic Shoulder Degeneration and Tendinosis

Case Diagnosis: Chronic Rotator Cuff Tendinopathy

Case Description or Program Description: A 54-year-old male patient followed due to left shoulder pain states pain is constant, exacerbated with active range of motion (ROM), worse with overhead movements and mildly alleviated by pain medications. Patient underwent physical therapy and intra-articular steroid injections without relief. Ultrasound guided platelet-rich plasma (PRP) intra-articular injection was performed using a standardized protocol, with marked improvement in pain, ROM and quality of life.

Setting: Secondary Care

Assessment/Results: Physical exam was remarkable for point tenderness over the greater tuberosity, biceps tendon, acromioclavicular joint, and cervical spine; painful ROM above 90 degrees in shoulder flexion, positive impingement sign, and positive Hawkin’s test. Imaging revealed moderate supraspinatus, infraspinatus and subscapularis tendinosis, partial thickness of insertional subscapularis fibers, degenerative tearing of glenoid labrum, chondral thinning of glenohumeral joint, and severe osteoarthritis.

Discussion (relevance): Rotator cuff tendinopathy is a common cause of shoulder pain, particularly affecting middle-aged adults. Traditional treatments, such as physical therapy and corticosteroid injections, often provide temporary relief and do not address the root problem. PRP therapy offers a potential alternative due to its regenerative properties that promote tissue healing. While research on PRP’s effectiveness for shoulder conditions is still inconclusive, it shows promise in managing chronic rotator cuff tendinopathy by reducing inflammation and enhancing recovery. As interest in non-surgical options grows, PRP injections may be a viable choice for those wishing to avoid surgery.

Conclusions: Although PRP is a regenerative medicine option mostly used for early-stage tendinopathy, studies involving its efficacy in chronic tendinopathy are lacking. This case highlights that it may be a viable option for management of late-stage tendinopathy, potentially delaying or preventing the need for surgery, as seen in this patient with marked improvement in functionality and quality of life. Nevertheless, further long-term studies are needed to confirm its efficacy, refine treatment protocols, and assess management effectiveness.