PRP Injection

Many individuals dealing with persistent shoulder discomfort seek non-surgical solutions to help restore their mobility and quality of life. In the evolving landscape of orthopedic care, one treatment has emerged as a promising option: platelet-rich plasma, or PRP, injections. This therapy uses your body's own biological resources to encourage healing in damaged tissues. In this post, we’ll explore the science behind PRP injections, how the procedure works, and the potential benefits they may offer.  

Key Takeaways

• PRP therapy is a regenerative treatment that uses a concentrated solution of a patient's own platelets to stimulate healing in injured tendons, ligaments, and cartilage.

• The procedure is minimally invasive, involving a blood draw, processing in a centrifuge, and a precise injection into the affected area of the shoulder.

• The goal of the therapy is to promote natural tissue repair and reduce pain, offering a non-surgical option for patients.

Understanding the Shoulder: A Complex and Mobile Joint

The shoulder is a ball-and-socket joint, where the head of the upper arm bone (humerus) fits into a shallow socket (glenoid). Stability relies heavily on soft tissues. The rotator cuff is a group of four muscles and their tendons that work together to stabilize the joint and allow for lifting and rotating the arm. The labrum is a ring of cartilage that deepens the socket, providing additional stability. Finally, smooth articular cartilage covers the ends of the bones, allowing them to glide against each other. When any of these structures are damaged, pain and limited function can result.

Common shoulder conditions that may benefit from a PRP injection include:

• Rotator Cuff Tendinopathy: Chronic inflammation or degeneration of the rotator cuff tendons, often caused by repetitive overhead activities.

• Partial Rotator Cuff Tears: PRP for rotator cuff tears may be recommended when the tendon is damaged or frayed but not completely severed from the bone.

• Shoulder Osteoarthritis: The "wear-and-tear" arthritis where the articular cartilage breaks down, leading to pain and stiffness.

• Biceps Tendinopathy: Inflammation of the tendon of the long head of the biceps muscle, which runs through the shoulder joint.

What Exactly is a PRP Injection?

The Power of Platelets

Platelet-rich plasma, or PRP, is a concentration of platelets derived from your own blood. Platelets are best known for their role in blood clotting. However, they are also packed with hundreds of proteins called growth factors. These growth factors are the body's natural messengers that initiate and regulate the healing process. When an injury occurs, platelets rush to the site. They release these growth factors, which essentially send a signal to the body to start repairing the damaged tissue.

The Preparation Process

Creating the PRP solution is a straightforward, three-step process performed in the clinic.

1. Blood Draw: A small amount of blood is drawn from your arm, similar to a standard blood test.

2. Centrifugation: The drawn blood is placed into a specialized device called a centrifuge, which spins the blood at high speeds. The spinning process separates the blood components based on their density. The blood separates into three layers: red blood cells, platelet-poor plasma (PPP), and the highly concentrated PRP.

3. Extraction: Your physician carefully extracts the PRP layer, containing a high concentration of platelets. 

The Science Behind the Healing

A challenge in treating many shoulder injuries, especially those involving tendons and ligaments, is the limited blood supply to these tissues. Tendons, in particular, are notoriously slow to heal because they do not receive the rich flow of nutrients and healing factors that other tissues do. The PRP injection aims to help overcome this biological limitation. The goal with the PRP is to reach a threshold of 8 billion platelets for the injection. This number of platelets has been shown in the literature be what is needed to treat the musculoskeletal conditions with PRP.

Initiating the Repair Cascade

When the concentrated PRP is injected into the injured area, the platelets become activated and release their growth factors. These growth factors are thought to promote the formation of new blood vessels, a process called angiogenesis, helping to improve the local blood supply. They also may stimulate the proliferation of reparative cells, such as fibroblasts, which are responsible for producing collagen, the main structural protein in tendons and ligaments.

The growth factors may also attract stem cells from the surrounding tissue. These stem cells have the potential to mature into the specific cell types needed for repair, such as tendon or cartilage cells. Essentially, the PRP injection acts as a powerful biological signal, telling the body to ramp up its natural healing mechanisms in a targeted way.

The Role of Inflammation

After the procedure, you will likely experience some soreness or mild swelling. This is a common and expected response as the body reacts to the injection and begins the healing process. For this reason, your doctor may advise you to avoid non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen for a period before and after the injection. These medications can suppress the very inflammatory response that the PRP is meant to trigger. Instead, your doctor may recommend other non-NSAID pain relievers if needed.

The PRP Injection Procedure: Step-by-Step

Step 1: Consultation and Diagnosis

An experienced orthopedic specialist will review your medical history, perform a detailed physical examination, and analyze imaging studies. The consultation is necessary to determine if your specific injury is a good candidate for a PRP injection.

Step 2: Blood Draw and Processing

Once the decision is made to proceed, a small amount of blood is drawn from your arm. The blood is then immediately placed into the centrifuge. The processing time typically takes about 15 to 20 minutes. During this time, the red blood cells are separated from the plasma, leaving the concentrated PRP solution ready for injection.

Step 3: The Precision Injection

To ensure the PRP is delivered exactly to the site of the damaged tissue, the injection may be performed under ultrasound guidance. The injection itself is quick. You may feel a sensation of pressure as the fluid is injected. The entire injection procedure, from preparation to completion, often takes less than an hour.

Post-Injection Care and Recovery

Immediate Post-Procedure

It is common to experience increased soreness, aching, or a feeling of fullness in the shoulder for the first few days. This is a normal and expected response. Your doctor will provide specific instructions for managing this temporary discomfort. As mentioned, avoiding NSAIDs is typically recommended during this initial phase. 

The Role of Physical Therapy

A PRP injection is rarely a standalone treatment. To achieve optimal results, a structured physical therapy and rehabilitation program may be recommended. Physical therapy can help to restore range of motion, rebuild strength, and ensure that the newly healed tissue is properly loaded and conditioned. 

Timeline for Results

Patience is often key when it comes to regenerative medicine. The benefits of a PRP injection generally develop gradually. While timelines and results vary significantly, patients may begin to notice a meaningful reduction in pain and improvement in function several weeks after the procedure. Continued progress is often seen over a period of three to six months as the tissue regeneration process continues. Your doctor will schedule follow-up appointments to monitor your progress and adjust your rehabilitation plan as needed.

Summary

Platelet-rich plasma therapy represents an advancement in regenerative medicine. By concentrating and delivering your body's own powerful growth factors, a PRP injection may help stimulate the natural repair of damaged tendons, ligaments, and cartilage in the shoulder. Consulting with an experienced shoulder specialist is the best way to determine if this innovative treatment is right for you.

Frequently Asked Questions

Is the PRP injection procedure painful?

The procedure is generally well-tolerated. You may feel some pressure during the injection. It is common to experience soreness or aching in the shoulder for the first few days afterward. 

How long does it take to see results from a PRP injection?

Since the PRP injection stimulates a biological healing process, results are not immediate, and improvements develop gradually. The most significant gains are typically seen over a period of three to six months.

How many PRP injections will I need?

The number of injections needed can vary depending on the severity and chronicity of your condition. Some patients achieve results with a single PRP injection. However, some conditions may benefit from additional injections, usually spaced several weeks apart. Your doctor will discuss a personalized treatment plan with you.