A partial rotator cuff tear in St. Louis can usually be treated without surgery. At our office we place platelet-rich plasma (PRP) directly into the frayed tendon under ultrasound, then pair it with rehabilitation and metabolic repair so the tendon rebuilds instead of wearing thinner. Surgery stays on the table if the tear keeps progressing.
A partial-thickness tear is a rope with some of its strands cut. The rope still holds, so you can still lift your arm. Every overhead reach, every night spent lying on that shoulder, pulls on the strands that are left. Leave it alone and the load shifts onto fewer fibers, those fibers fail sooner, and a partial tear walks toward a full one.
The usual answer is a cortisone shot into the bursa. It quiets the pain for a few weeks. It does nothing to rebuild the rope, and steroid slows the cells that make new collagen. You feel better while the tendon gets weaker. That is the trade most patients were never told they were making.
The rotator cuff is four small tendons that hold the ball of the shoulder in its socket while the big muscles move the arm. The supraspinatus, on top, takes the most abuse. A partial tear means the tendon is damaged on the joint side, the bursal side, or inside its substance, without a hole all the way through.
Typical signs:
Ultrasound in the exam room shows us the tear, its depth and the state of the bursa. If the picture does not match the story, we order an MRI.
Tendon has a poor blood supply, and the cuff has a stretch near its attachment with the worst supply of all. Healing there runs on a thin trickle of nutrients. Three forces then decide whether that trickle wins:
The tear is where it hurts. The terrain is why it does not close.
We draw your blood and spin it in an FDA-cleared device to concentrate the platelets. Platelets are the repair workers. They release growth signals that call in new cells, start new collagen and build blood supply. Under ultrasound we place them into the torn section of the tendon, and into the bursa when it is involved. A tendon injection is only as good as its aim, and blind needles miss.
The evidence lines up with the biology. A 2026 meta-analysis of ten randomized trials (591 patients with cuff tendinopathy or partial tears) found cortisone and PRP equal in the first three months. By six months, PRP pulled ahead on pain and shoulder function, with fewer adverse events. A randomized trial that measured tears on MRI found PRP placed in the tear shrank it by about 3 mm over six months, while bursal steroid did not change tear size. The effect is real and modest, which is why the injection never travels alone.
For larger or longer-standing tears, bone marrow concentrate brings the general contractor: cells that organize the repair crew instead of only sending signals. More detail on the options sits on our PRP injections page and the orthobiologics hub.
The procedure is done under local anesthetic. You are awake, there is no sedation, and most patients drive themselves home. Expect soreness for about 48 hours. That soreness is the repair workers starting the job. Protect the area for the first few days and follow the rehab plan.
The number of injections follows clinical need. Some feel better in three weeks; others need a second or third treatment, decided by how the tissue responds. You can’t make a carrot grow faster than it grows, and collagen remodels on a calendar of months.
The injection is not the treatment. It is what makes the treatment possible. Lifestyle and behavioral work is 40 to 50 percent of our protocol:
If your shoulder is also stiff, rule out the diabetic shoulder, which travels with the same metabolic terrain.
Dr. Padda is a licensed physician and surgeon, and surgery has a place. A traumatic full-thickness tear in an active person, real weakness, or a tear that keeps growing on imaging belongs with a surgeon. Orthobiologics are the bridge between failed conservative care and the operating room. If we can rebuild the tendon, you keep it. If we can’t, you go to surgery with a healthier cuff than one softened by repeated steroid.
More on this condition from Dr. Padda on YouTube:
Many can. Healing depends on tear depth, tendon quality, your metabolic health and how the shoulder is loaded. PRP, structured rehab and metabolic repair give the tendon its best odds.
Early on they perform about the same. At six months, pooled trials favor PRP for pain and function, with fewer adverse events. Steroid also slows collagen production in the tendon you are trying to save.
Soreness lasts about 48 hours. Many patients notice change within three to six weeks, and the tendon keeps remodeling for months.
No. We use local anesthetic, you stay awake, and most patients drive themselves home.
PRP is not billed to insurance. HSA and FSA funds are generally eligible.
Lying on the shoulder compresses the cuff against bone, and blood flow to the tendon drops when the arm is still. The pain then breaks the sleep the tendon needs to repair.
A partial tear is a window. Use it while the tendon is still there to rebuild. Over 90% of our accepted case-study patients see significant improvement. That is a practice-reported figure from our own population, not a trial outcome, and individual results vary. Request the orthobiologics guide above, or call our office at 4477 Woodson Rd in St. Louis at (314) 481-5000 and we will tell you plainly whether your shoulder is a candidate.
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