Rotator Cuff Tendinitis

CAUSES

• Repetitive overhead activity
• Age-related tendon degeneration
• Impingement of the tendon under the shoulder bones

SYMPTOMS

• Pain in the front or side of the shoulder, worse with overhead reaching
• Night pain, especially lying on the affected side
• Weakness lifting or rotating the arm

IMAGING

Ultrasound can be used for detecting tendinosis or partial tears. MRI provides more detail for full-thickness tears or presurgical planning.

CAN PRP HELP?

ASPN grades PRP for rotator cuff as Level I, Grade B — superior to cortisone injection whether delivered in the joint, into the bursa, or directly into the tendon.

Leukocyte Preparation: Leukocyte-Rich

Dosing: Single or short series

Target Platelet Dose in Studied Protocols: 2–6.75 billion platelets; concentration below roughly 2× baseline underperformed in trials reviewed.

ASPN 2024 CONSENSUS GUIDELINE

One distinction is worth being precise about. The 2025 AAOS rotator cuff guideline update, which restricts PRP as a surgical adjunct, is about a different scenario entirely — PRP mixed in during rotator cuff repair surgery — not the isolated, non-surgical therapeutic injection described here. ASPN’s Level I, Grade B rating is specifically for that non-surgical injection. Dose matters: studies using under roughly 2× baseline platelet concentration underperformed, so we stay at or above the 4–5× threshold the guideline flags as the “true PRP” cutoff. Rotator cuff tendon is a tendon/enthesis target, so ASPN’s tissue-based default is leukocyte-rich preparation, correcting the leukocyte-poor default we’d previously listed here.

Sources: D’Souza et al. (ASPN Consensus), Journal of Pain Research, 2024 · Ye et al. (AAOS guideline interpretation), 2026 · A Hamid & Sazlina, PLoS ONE, 2021

FREQUENTLY ASKED QUESTIONS

Is PRP better than cortisone for rotator cuff tendinitis?

Yes. Studies show PRP works better than cortisone, whether it is injected into the joint, the bursa, or right into the tendon.

Is PRP used in rotator cuff surgery?

That is a different use. Adding PRP during rotator cuff repair surgery is now discouraged by surgery guidelines. The benefit described here comes from a standalone shot, not surgery.

Does PRP dose matter for rotator cuff tendinitis?

Yes. Studies that used a lower dose of platelets did not work as well, so a strong enough dose matters for results.

Leukocyte-rich or leukocyte-poor PRP for the rotator cuff?

Leukocyte-rich is preferred when available because the rotator cuff tendon is a tendon/enthesis target. The downside is a higher risk of postprocedure soreness.