Shoulder Pain - including the Rotator Cuff

The shoulder is a complex series of joints that provide an extraordinary range of motion. The rotator cuff is a group of muscles and tendons that form a cuff over the shoulder. These muscles and tendons hold the arm in its “ball and socket”, called the acromioclavicular joint (AC Joint), and are involved in essentially all shoulder motions. Rotator cuff tears are one of the most common causes of chronic shoulder pain and disability of the upper body, in addition to osteoarthritis. Shoulder injuries from chronic overuse are also common. Small tears of the rotator cuff may even be produced in the young athlete or laborer from repetitive use. With repeated trauma and advancing age tendons, such as the rotator cuff, undergo degeneration. This is most severe near where the tendon inserts on the bone.

Many experts agree that the rotator cuff is the source of the majority of all shoulder pain and that the throwing motion or “overhead” work are often the cause. In diagnosing musculoskeletal injuries, detection of rotator cuff injury by MRI alone can be misleading and should never take the place of a good history and physical examination and correlated to a patients’ pain. Musculoskeletal ultrasound has emerged as an effective non-invasive, cost-effective approach with an accuracy of 85% to 90% in diagnosing rotator cuff tears, with an accuracy rate similar to MRI and the advantage of real time imaging, use of motion to see otherwise undetectable tears, and on site correlation to a patients’ area of complaint. Prolotherapy and Platelet Rich Plasma Prolotherapy have been shown to be effective in the treatment of shoulder injuries and pain.

n x-ray image of a runner montaged with images showing the ligament antatomy of the knee.
The rotator cuff and acromioclavicular joint are the source of the majority of all shoulder pain.

The science on prolotherapy treatments for the shoulder


Effectiveness of prolotherapy in the treatment of chronic rotator cuff lesions (2017)
Prolotherapy is an easy applicable and satisfying auxillary method in the treatment of chronic rotator cuff lesions.

Platelet-Rich Plasma

What is better for rotator cuff tendinopathy, dextrose prolotherapy, PRP or corticosteroid (2020)
Prolotherapy and PRP improved shoulder pain and function. PRP also improved rotator cuff tendon healing, but steroid injections had no effect on healing.

Biocellular (Stem Cell-Rich) Prolotherapy

Intratendinous injection of autologous adipose mesenchymal stem cell for rotator cuff disease (2018)
Adipose stem cell injection into partial rotator cuff tears was safe, improved function, and reduced tears (average 90%). MRI before/after showed regeneration of tendon.

For additional scientific papers and resources on prolotherapy for shoulder conditions visit the Learning Hub

Case Report: Tennis Player

Ray Cros, D.M.D. working on a patient.

“About six years ago, I was told I needed a shoulder replacement. I had played tennis several days a week for 35-plus years and prior to that had spent many years pitching baseball. In short, I had worn out my left shoulder and had several things wrong with my right shoulder as well. On a scale of one to ten, where ten is the worst, the pain in my left shoulder was almost constantly a nine with any use, and my range of motion was reduced to about only 10 to 20 percent of normal. So I put myself on the waiting list to have the replacement surgery. In the meantime, I decided to try Prolotherapy.”

“After five PRP Prolotherapy treatments on my left shoulder, spread out over eight months, I was pretty much pain free, with my range of motion back to 98 percent. Since then, I have continued to improve. I have gone back to playing tennis and am enjoying the game more than I did before. It has now been over four years since my last PRP Prolotherapy treatment, and I am still pain free and doing well!

I am grateful for Prolotherapy. It allowed me to play tennis again and avoid shoulder replacement surgery. That is remarkable, especially given the severity of my injury and long-term damage to my shoulder.”

Name withheld for reasons of privacy.