By Dr. Steve Derrington, board-certified in physical medicine and rehabilitation
Rotator cuff tendon problems are a very common injury as we get older. Reaching behind you in the car or up into a cabinet can get hard, and sleeping can be very painful. Here is how I think about them.
Start with the diagnosis
A hands-on exam and often ultrasound give me a fuller picture of your shoulder than an imaging report alone. I cover what an evaluation includes in What an Orthopedic Evaluation Should Include Beyond Your MRI Report.
Where PRP may fit
For earlier, milder problems, PRP prepared the right way and at the appropriate dose can be very therapeutic. Earlier, milder problems include smaller rotator cuff problems, other tendon problems and partial ligament injuries. Those typically do really well with PRP.
When I consider bone marrow concentrate
For a larger rotator cuff tear or bigger ligament tears, I consider bone marrow concentrate, on top of or in addition to PRP, because I want to bring something stronger.
With some conditions there are gray areas. A patient who’s a little more cautious might start with PRP, and might do really well. Another might take the step to the stronger bone marrow option. It depends on the extent of the injury and on how you want to approach rehab and getting better. I walk through my thinking in how I choose between PRP and bone marrow concentrate.
Why precise delivery matters
We’re often treating very small problems, sometimes millimeter-sized. If you can’t see where you’re going, you can’t place the treatment in the right spot with certainty. I use image guidance, ultrasound or live X-ray depending on the problem, for both the therapeutic value and for safety near blood vessels and nerves.
Rehab, timing and what to expect
Physical therapy and how you move stay part of the plan, and recovery follows stages that vary from person to person. I describe the usual stages in PRP and bone marrow concentrate recovery: a realistic timeline.
Next step
Learn more about rotator cuff tears and shoulder osteoarthritis at my practice, and if you have an MRI, upload it before your visit.
I see patients at my Carlsbad office (5806 Van Allen Way, Suite 101, Carlsbad, CA 92008) and on Tuesdays at my Laguna Hills office (25411 Cabot Rd, Suite 116, Laguna Hills, CA 92653). You can call (760) 721-4000 or request an appointment online.
Frequently asked questions
Is PRP an option for a rotator cuff problem?
For smaller rotator cuff problems and earlier tendon problems, PRP prepared the right way and at the appropriate dose can be very therapeutic.
When would you consider bone marrow concentrate for the shoulder?
I consider it for larger rotator cuff tears and bigger ligament tears, often on top of or in addition to PRP.
Does shoulder pain affect sleep?
It can. Sleeping can be very painful with rotator cuff tendon problems.
This article is general education and does not replace an exam or medical advice for your situation. Results vary from person to person.
