Platelet-Rich Plasma — PRP/Needle Fenestration for Rotator Cuff

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Sling x2 days then PRN Phase I

Key Restrictions

Avoid ALL NSAIDs and topical pain-relieving gels/creams (no iontophoresis) through Phase IV; limit/avoid ice through Phase IV; avoid eccentric exercises until Phase IV (pain <3/10); avoid compensatory movement patterns (e.g., scapular hiking with overhead motion) Phase III

Timeline & Phases

Phase I, Tissue Protection (0-1 wk): sling x2 days then as needed, avoid all NSAIDs/topical pain-relieving gels/creams (no iontophoresis), limit ice, minimize pain, improve/maintain ROM, relative rest, gentle AROM per procedure-specific handout, Tylenol PRN, no weight training; Phase II, Early Tissue Healing (1-2 wks): avoid eccentric exercises, avoid NSAIDs/topical agents, limit ice, aerobic exercise allowed (avoid WB/loading treated area), gentle stretching, proximal stability/strengthening (scapular strengthening/stabilization); Phase III, Facilitation of Collagen Deposition (2-6 wks): avoid eccentric exercise, avoid NSAIDs/topical agents, avoid ice, full pain-free ROM, avoid compensatory movement patterns (e.g., scapular hiking with overhead shoulder motion), low-weight high-rep isometrics, soft tissue work to treated area, dynamic stretching, joint mobilizations as needed, core strengthening, open kinetic chain strengthening and proprioceptive activities (late stage, 5-6 wks post-procedure); Phase IV, Collagen Strengthening (6-12 wks): expect 30% improvement by wk6, avoid NSAIDs/ice, improve strength, return to function, eccentric exercises if pain <3/10, closed kinetic chain exercises, plyometrics/proprioceptive training/sport-specific exercises, return to work/sport, resume full activity; Phase V, Return to Activity (3+ months): reassess improvement (consider repeat PRP if not >75% improved by 3 months), return to work/sport, resume full activity, progress to functional sport-specific activities with increasing load as pain allows, max out eccentric exercises, may return to sport if pain <3/10

Notes

OSMS Rehabilitation Guidelines; PRP derived from centrifuged autologous venous blood delivering concentrated growth factors (platelet-derived growth factor, TGF-beta, VEGF) to stimulate healing and reduce inflammation; needle fenestration technique; distinct from and more restrictive than UW Health's multi-region PRP protocol regarding NSAID/ice avoidance duration

Published

2024-06