PRP vs. Stem Cells for Shoulder Pain: Which Is Right for You?

By Alan Locke, DO, and Roman Berezovski, MD · Spectrum Stem Cell & Regenerative Medicine Center, Wauwatosa, WI

If your shoulder has been bothering you for months, you probably know the routine by now. It aches when you reach into a cupboard. It wakes you up when you roll onto that side. And the cortisone shot that helped last time didn't do as much the second time around.

A lot of the people who call us are at exactly that point. They aren't ready for surgery, and they've heard about PRP and stem cell injections but aren't sure how the two differ. It's a fair question, because they often get lumped together. They aren't the same treatment, and they aren't meant for the same shoulders.

If you only read one paragraph, make it this one. PRP is made from your own blood, and it's usually the first thing we consider for tendon problems like rotator cuff tendinitis, tendinopathy, and smaller partial tears. Stem cell therapy uses cells from your own bone marrow or fat. It's a bigger procedure, and it's usually saved for larger partial tears, shoulder arthritis, or a shoulder that didn't respond well enough to PRP. The right choice depends on your shoulder, and an exam and a look at your imaging tell us which one fits you best.

What is PRP?

PRP stands for platelet-rich plasma. We draw a small tube of blood from your arm, much like a routine lab draw, and spin it in a centrifuge. That concentrates the platelets, which carry the growth factors your body uses to repair tissue. We then inject the concentrate into the injured tendon or joint, using ultrasound or X-ray so it lands exactly where it needs to. Most PRP visits take about an hour.

What is stem cell therapy for the shoulder?

Stem cell therapy for the shoulder also uses your own tissue, just a different kind. We collect a small amount of bone marrow from the back of your hip, or a little fat, under local anesthesia. It's processed while you wait and injected into the damaged part of the shoulder that same day, again under image guidance. At Spectrum we often combine it with PRP and an extracellular matrix, which gives the cells a scaffold to work from. Plan on spending a few hours with us. You'll go home the same day.

PRP and stem cells at a glance

• What's injected: PRP uses concentrated platelets from your blood. Stem cell therapy uses cells from your bone marrow or fat, often combined with PRP.
• How it's collected: PRP takes a simple blood draw. Stem cell therapy takes a bone marrow or fat harvest under local anesthesia.
• Time in the clinic: about an hour for PRP; a few hours for stem cell therapy.
• Usually considered for: PRP for rotator cuff tendinitis, tendinopathy and smaller partial tears. Stem cells for larger partial tears, shoulder arthritis, or when PRP wasn't enough.
• Soreness afterward: a few days with PRP; several days to a week with stem cells, at the shoulder and the harvest site.
• Cost: $750 to $1,200 for PRP; $4,500 for stem cell therapy, including PRP.

What the research says

We'd rather give you the honest version of the research than a sales pitch.

People often ask how PRP stacks up against a cortisone shot. A 2023 review in the Journal of Shoulder and Elbow Surgery pooled nine randomized trials that compared the two head to head. Cortisone worked faster and gave better results in the short term, while PRP came out ahead for long-term recovery of shoulder function. In other words, cortisone offers quicker relief, while PRP offers longer-lasting relief.

There's also a downside to cortisone that doesn't get talked about enough, and that's what it does to the tendon itself. Cortisone calms inflammation, but it also slows down the cells that repair tendon tissue. In a rotator cuff that's already worn or torn, repeated shots can leave the tendon weaker over time. That matters if you end up needing surgery. A review of the research published in Arthroscopy found that a cortisone shot in the year before rotator cuff repair raised the odds of needing a second, revision surgery, with the risk highest when the shot came within six months. Patients who had two or more shots were at even higher risk. A study of nearly 5,000 rotator cuff repair patients found the same pattern. So cortisone may buy you a few good months, but it can cost the tendon something, and that's a big part of why we look at PRP and stem cells first.

Stem cell therapy has shown encouraging results in the shoulder too. One registry followed 102 patients treated with their own bone marrow concentrate for rotator cuff tears and shoulder arthritis. On average, their pain scores fell by about 44% and their function improved by roughly half.

Who tends to do well

The patients who do best with these treatments usually have:

• A rotator cuff tendinopathy or partial tear that shows up on MRI or ultrasound
• Mild to moderate arthritis in the shoulder
• Pain that has lasted three months or more despite physical therapy, anti-inflammatories, or a cortisone shot
• A real interest in avoiding or putting off surgery

Surgery may be the better route if you have a large full-thickness tear where the tendon has pulled back, bone-on-bone arthritis, or a shoulder that keeps dislocating. Some blood disorders, an active infection, or active cancer can also rule them out. If that's where you are, we'll tell you plainly and help you get a surgical opinion.

What a visit to Spectrum looks like

It starts with a phone call. One of our Care Coordinators will ask about your symptoms and any X-rays or MRIs you've had, usually within two hours of hearing from you.

Next, you'll come in so a physician can examine your shoulder and go over your imaging with you. This is where we figure out whether PRP, stem cells, or neither is the right call.

If you go ahead, every injection is guided by ultrasound or fluoroscopy, which is a live X-ray. We numb the area first, and nitrous oxide is available if you'd like help relaxing.

Afterward, expect your shoulder to be sore for a few days. Most people are back to light daily activity within a day or two and start a rehab program soon after. Improvement comes on gradually, over 6 to 12 weeks, so give it time before you judge the result.

What it costs

PRP and stem cell therapy aren't covered by insurance, and that includes Medicare, so they're paid out of pocket. A PRP injection runs $750 to $1,200, depending on the injury. Stem cell therapy, which includes PRP, is $4,500. If you're treating a second joint at the same time, the second one is 40% off. You'll get an exact quote before anything is scheduled. If you'd like to spread the cost out, financing is available through CareCredit or Cherry. Both take a few minutes to apply for, and Cherry checks eligibility without a hard credit pull.

Questions we hear a lot

Does stem cell therapy actually work for shoulder pain? Many patients get meaningful relief. Studies of people treated with their own bone marrow cells show meaningful drops in pain and better function on average. Your exam and imaging show us whether you're a good candidate.

How long does recovery take? Most people are doing light activity within a day or two, and the soreness usually settles within a week. The real improvement shows up over the next 6 to 12 weeks, especially if you stick with your rehab.

Is PRP better than a cortisone shot? It depends on what you're after. Cortisone works faster. PRP comes out ahead for long-term recovery and spares the tendon the wear that repeated cortisone shots can cause. Some people care most about quick relief and others about the long run, and we'll help you weigh it.

Will insurance or Medicare pay for it? No. Both treatments are self-pay, but monthly financing through CareCredit or Cherry is available.

How many injections will I need? Many patients need only one. Some do better with a second round, depending on the injury and how the shoulder responds.

Can it help me avoid rotator cuff surgery? For many patients with partial tears and tendon injuries, it can. For a large full-thickness tear, surgery is often the better choice, and if that's your situation we'll say so.

Have another question? Our Stem Cell Q&A covers more of what patients ask us.

Talk with our team

If your shoulder is getting in the way of work, sleep, or the things you enjoy, call us at (262) 202-8312 or request a free phone consultation online. A Care Coordinator will usually get back to you within two hours. You'll find us at 2500 N. Mayfair Rd., Suite 630, in Wauwatosa, and we see patients from across the Milwaukee area.

References

• Comparison of the effects of platelet-rich plasma and corticosteroid injection in rotator cuff disease treatment: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery, 2023. Link
• Puzzitiello RN, et al. Adverse impact of corticosteroid injection on rotator cuff tendon health and repair: a systematic review. Arthroscopy, 2020. Link
• Traven SA, et al. Preoperative shoulder injections and revision rotator cuff repair (4,959 patients). American Orthopaedic Society for Sports Medicine annual meeting, 2018. Coverage
• Centeno CJ, et al. A prospective multi-site registry study of a specific protocol of autologous bone marrow concentrate for the treatment of shoulder rotator cuff tears and osteoarthritis. Journal of Pain Research, 2015. Link