Q: I have a chronic shoulder "instability." It's not bad enough to justify the expense of surgery yet but it is affecting my daily activities. I've heard that there's a new platelet injection therapy for tendon problems. Would this help me?

A: You may be referring to platelet-rich plasma (PRP) (also known as blood injection therapy). PRP is a medical treatment being used for a wide range of musculoskeletal problems.

Platelet-rich plasma (PRP) refers to a sample of serum (blood) plasma that has as much as four times more than the normal amount of blood platelets. Plasma is the clear portion of the blood in which all the other blood particles such as platelets, red blood cells, and white blood cells travel.

Platelets clump together to form blood clots and plug up holes in areas where there is active bleeding. Besides containing clotting factors, the platelets release growth factors that help start the healing sequence. With a concentrated amount of platelets, larger quantities of these growth factors are released to stimulate a natural healing response.

In some conditions, PRP treatment has been shown to enhance the body’s natural ability to heal itself. It is used to improve healing and shorten recovery time from acute and chronic soft tissue injuries.

Blood injection therapy of this type has been used for knee osteoarthritis, degenerative cartilage, spinal fusion, bone fractures that don’t heal, and poor wound healing. This treatment technique is fairly new in the sports medicine treatment of musculoskeletal problems, but gaining popularity quickly.

One area where the use of PRP has been questioned is in the treatment of chronic musculoskeletal problems like your shoulder instability. But the use of PRP for this type of shoulder problem has not been studied or compared with other types of treatment (e.g., physiotherapy, prolotherapy, nip and tuck surgical procedure to tighten up the joint capsule called plication.

If you have not tried conservative (nonoperative) care under the direction of a physiotherapist, this might be your next step. Talk to your doctor about your difficulties during daily activities. At the very least, the ways in which your shoulder instability is affecting your life should be documented. Any changes in function that occur over time should be recorded. This may help you justify the cost of surgery if and when the surgeon makes a recommendation for operative care.

Reference: Kaye Daugherty and Mary Ann Porucznik. Treating Tendons, Bones, and Cartilage with PRP. In AAOSNow. July 2011. Vol. 5. No. 7. Pp. 1, 17.