Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN
People get confused with PRP treatment because they think it is “just like cortisone, only safer.” PRP is NOT just like cortisone. Cortisone has an immediate pain-reducing effect for many people, but not all because it is reducing pain brought on by chronic inflammation. Nothing is being healed. PRP brings healing through inflammation. When tissue is repaired, the inflammation goes away.
- PRP or Platelet Rich Plasma treatment takes your blood, like going for a blood test, and re-introduces the concentrated blood platelets and growth and healing factors from your blood into the shoulder.
Before we get to the research, it is important to realize that we offer a very comprehensive PRP treatment, not a single one-time injection. In much of the research on PRP, there is a one or two-time treatment and that is the measurement of success. In our patients, we rarely find that one or two treatments can reverse years of degenerative damage such as is found in shoulder impingement.
The research:
A December 2019 (1) study from medical university researchers in Brazil suggests that in a head-to-head, one-shot vs. one-shot competition, PRP would be a better treatment option for patients. Here is what they said: “The efficacy of PRP as a therapeutic modality still needs to be better clarified, but its characteristics make it a promising therapy in the treatment of rotator cuff tendinopathy. Corticosteroids, although well studied when their efficacy and side effects, remain a rising concern in their chronic use in clinical practice.”
Doctors in the Czech Republic thought that PRP injections could help people with Shoulder Impingement Syndrome. They thought that it would take three injections, given one week apart, to achieve the desired results. They also wanted to see how these three PRP injections did against a single injection of cortisone. Their findings were reported to the Czech society for orthopedics of traumatology. (2)
- After treatment patients were followed at 6 weeks, 3 months, and 6 months. Based on follow-up, the researchers concluded that platelet-rich plasma administered through a series of 3 injections applied in the subacromial space in patients with shoulder impingement syndrome has positive effects on daily activities superior to cortisone.
In May 2017, researchers published a study “Treatment of Subacromial Impingement Syndrome: Platelet-Rich Plasma or Exercise Therapy? A Randomized Control Trial.” (3) In this study published in the journal Orthopaedic journal of sports medicine, doctors looked at patients who would receive exercise therapy or PRP injections for their Subacromial Impingement Syndrome.
In this study, the patients who received PRP had two treatments, two injections at each treatment. The first treatment was at the onset of their research participation and the second injection, was one month later.
Here are some of the learning points of this research:
- “The main finding of the present research was that the shoulder pain emanating from Subacromial Impingement Syndrome can be reduced through either PRP injection or exercise therapy. At the final follow-up, there was no significant difference between the 2 groups in our primary outcome measure (pain), but the exercise therapy group had significantly higher Western Ontario Rotator Cuff (Rotator Cuff motion) scores and abduction ROM (the ability to move your arm away from your body).”
- Despite other studies showing limited or no benefit of PRP, “In the current study, 2 PRP injections were given 30 days apart. The injections were made both into areas of tendinopathy and into the bursa. The continued clinical improvement seen in our patients could be related to the difference in PRP technique.”
The researchers suggest that they were able to achieve better results because the patients were injected twice in the same visit as opposed to once.
- According to the researchers: “This study showed that both PRP injection and exercise therapy can significantly reduce pain and improve shoulder ROM and functionality in patients with Subacromial Impingement Syndrome, with these beneficial effects lasting for 6 months. In spite of our hypothesis, exercise therapy was found to be more effective than the other treatment option until 3 months after initiation. Moreover, neither treatment choice significantly improved shoulder muscle force. What is more, even though the treatments resulted in clinical improvement, MRI findings did not change.”
A June 2022 study in the journal Cureus (4) assessed patient outcome data of 20 patients who had a single injection of platelet-rich plasma (PRP) for shoulder impingement syndrome. These patients also failed to respond to standard non-operative treatments. The researchers concluded the PRP injection provided significant decrease in pain and improvement in the range of motion and an overall excellent functional outcome in shoulder impingement syndrome.
A November 2025 study (5) of 150 patients over the age of 40, compared the effectiveness of subacromial injections of PRP, corticosteroids, and normal saline on pain relief in chronic subacromial impingement syndrome. Data published in the Journal of orthopaedic case reports followed patients randomly divided into three groups of 50 each: PRP Group, Steroid Group, and Normal Saline Group. A single subacromial injection was administered. Pain scores and overhead activities at 4, 12, and 24 weeks post-injection were kept.
- Significant pain reduction was observed in the PRP group across 4, 12, and 24 weeks post-injection compared to the steroid and saline groups. The steroid group showed early pain relief, which diminished over time, while the saline group showed minimal change. PRP injections demonstrated superior and sustained pain relief.
Related articles
References
1 Barreto RB, Azevedo AR, Gois MC, Freire MR, Silva DS, Cardoso JC. Platelet-Rich Plasma and Corticosteroid in the Treatment of Rotator Cuff Impingement Syndrome: Randomized Clinical Trial. Revista Brasileira de Ortopedia. 2019 Dec;54(6):636-43. [Google Scholar]
2 Šmíd P, Hart R, Komzák M, Paša L, Puskeiler M. Treatment of the Shoulder Impingement Syndrome with PRP Injection. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca. 2018;85(4):261-5. [Google Scholar]
3 Nejati P, Ghahremaninia A, Naderi F, Gharibzadeh S, Mazaherinezhad A. Treatment of subacromial impingement syndrome: platelet-rich plasma or exercise therapy? A randomized controlled trial. Orthopaedic journal of sports medicine. 2017 May 19;5(5):2325967117702366. [Google Scholar]
4 Asif A, Saran JS, Kumar NA. Comparison of Pain Relief from platelet-rich plasma, Steroid, and Saline Injections in Chronic Shoulder Impingement using Visual Analog Scale. Journal of orthopaedic case reports. 2025 Nov;15(11):427-32. [Google Scholar]
5 Saurav S, Aggarwal AN, Shahi P, Kamal S, Bansal K, Singla S. Efficacy of single injection of platelet-rich plasma in shoulder impingement syndrome. Cureus. 2022 Jun 7;14(6). [Google Scholar]