Research Spotlight: PRP + Shockwave Therapy for Partial Rotator Cuff Tears
Can combining two different treatment approaches lead to better recovery than using one on its own?
A 2024 randomized study looked at exactly that question in people with partial rotator cuff tears. Researchers compared platelet-rich plasma (PRP) alone with PRP followed by extracorporeal shockwave therapy (ESWT).
What is PRP?
PRP is prepared from a small sample of your own blood.
The blood is processed to concentrate platelets, which contain natural growth factors and signalling proteins involved in healing and tissue repair.
PRP has been studied for a number of musculoskeletal injuries, including tendon problems and partial rotator cuff tears.
What is Shockwave Therapy?
Shockwave therapy uses targeted acoustic pressure waves to stimulate tissue.
Despite the name, it is not an electrical shock.
Researchers believe these mechanical signals may influence circulation, cellular activity, inflammation, and tissue remodelling. In this study, shockwave treatment was performed one week after PRP.
What Did the Study Compare?
The researchers enrolled adults with MRI-confirmed partial rotator cuff tears.
Participants were randomly placed into one of two groups:
PRP + true shockwave therapy
PRP + sham shockwave therapy
The sham treatment looked and felt similar, but did not deliver the actual shockwave energy. This helped researchers determine whether the shockwave itself added any benefit.
What Did They Find?
The important part is that both groups improved.
People in both groups showed improvement in pain, shoulder function, and range of motion over the six-month study period.
However, the group receiving PRP + shockwave had some additional improvements.
At one month, they showed greater improvement in:
Forward shoulder movement
Shoulder abduction, or lifting the arm out to the side
At six months, they also had a statistically significant improvement in total shoulder range of motion compared with the PRP-only group.
The Researchers Also Found Something Interesting in the Blood
The study looked at two inflammatory proteins called S100A8 and S100A9.
Both were lower in the PRP + shockwave group one month after treatment.
These proteins are involved in inflammatory signalling, so the finding suggests that adding shockwave may influence the biological environment involved in recovery.
That is interesting, but it does not prove that shockwave simply “turns inflammation off.” Inflammation is part of normal healing, and the researchers did not prove that the lower protein levels directly caused the improved movement.
Did the Combination Heal the Tendon Better?
That part is not clear.
The study found better functional results in some areas, but it did not show conclusive differences in imaging improvement between the groups.
So, the study suggests that PRP + shockwave may improve certain aspects of shoulder function, but it does not prove that the tendon itself healed more completely.
This is an important distinction when interpreting regenerative medicine research. Feeling better, moving better, and showing structural changes on imaging are different outcomes — and they do not necessarily occur at the same rate.
Why Is This Research Interesting?
PRP and shockwave approach recovery in very different ways.
PRP provides a concentration of your own platelets and their associated signalling factors.
Shockwave provides a controlled mechanical stimulus to the tissue.
The study suggests that combining these two approaches may create a different recovery response than PRP alone.
That does not mean everyone with a rotator cuff injury needs both treatments.
Instead, this research contributes to a much larger question being explored in regenerative and rehabilitation medicine:
Can biological therapies and carefully applied mechanical stimulation complement one another during tissue recovery?
Recovery Is More Than a Procedure
Another important detail from the study is that treatment did not end with PRP or shockwave.
Participants continued activity modification and/or physiotherapy and were introduced to gentle shoulder exercises following treatment.
That matters.
Tissue recovery is influenced by much more than a single procedure. Appropriate movement and loading, rehabilitation, nutrition, sleep, smoking status, metabolic health, and other individual factors can all influence the environment in which recovery occurs.
Regenerative procedures should therefore not be viewed as a replacement for good rehabilitation and healthy lifestyle practices.
A Few Important Limitations
No single study gives us the final answer.
This was a relatively small study involving 55 participants.
The PRP injections were not ultrasound-guided, and the study used one particular shockwave protocol. The researchers also could not conclusively demonstrate greater structural healing on imaging.
They acknowledged that additional research is needed to better understand the findings and determine why the combination produced different results.
Those limitations don't make the research unimportant — they simply help us understand what the study can and cannot tell us.
The Bottom Line
This study suggests that adding shockwave therapy to PRP may provide additional improvements in shoulder movement for some people with partial rotator cuff tears.
Both groups improved, while the combined PRP + shockwave group demonstrated additional benefits in certain measures of range of motion.
Researchers also identified differences in inflammatory signalling proteins, raising interesting questions about how mechanical stimulation and biological therapies may interact during recovery.
The results are promising, but they are not a guarantee of outcome, nor do they mean that PRP, shockwave, or the combination is appropriate for every shoulder injury.
What this research does provide is another piece of a growing scientific conversation about how biology, mechanical stimulation, rehabilitation, and healthy lifestyle factors may work together during tissue recovery.
Research & Education Notice
This article summarizes published scientific research for general educational purposes. Research findings do not establish that a treatment is appropriate, safe, or effective for every individual and should not be interpreted as medical advice or a guarantee of outcome. Research in regenerative and rehabilitation medicine continues to evolve.
Featured Research:Kuo S-J, Su Y-H, Hsu S-C, et al. Effects of Adding Extracorporeal Shockwave Therapy (ESWT) to Platelet-Rich Plasma (PRP) among Patients with Rotator Cuff Partial Tear: A Prospective Randomized Comparative Study. Journal of Personalized Medicine. 2024;14:83.
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