Percutaneous Tenotomy with PRP for Rotator Cuff Injuries That Won't Heal
- 1 day ago
- 5 min read
Medically reviewed by Dr. Jeffrey Peng, MD — Board-Certified Sports Medicine Physician
You have done the physical therapy. You have tried the exercises. Maybe you even received a cortisone injection. But your rotator cuff still is not healing — and now you are left wondering whether you simply have to live with the pain or if surgery is the only real option.
Here is something most people do not realize about rotator cuff injuries: if you have a partial tear or chronic tendinopathy, the damaged tissue often will not heal on its own. It is not because physical therapy failed or you did not do enough exercises. The problem is that the injured tissue itself has become biologically stuck — it needs targeted help to regenerate.
Until recently, the options were limited: keep managing the symptoms or proceed directly to surgery. But thanks to advances in minimally invasive, ultrasound-guided procedures, there is now a powerful middle-ground option that most patients — and even many physicians — are not familiar with.
What Is Ultrasound-Guided Percutaneous Tenotomy with PRP?
The procedure is called ultrasound-guided percutaneous tenotomy combined with platelet-rich plasma (PRP). In my practice, I use real-time ultrasound imaging to visualize exactly where the damaged tissue is located within the tendon. Through a small needle, I then break up and remove the scarred, non-healing tissue — think of it as clearing out dead fibers so that genuine healing can finally begin.
Immediately after the tenotomy, I inject PRP — your own concentrated healing factors — directly into the treatment area. PRP jumpstarts the natural repair process that your body could not complete on its own. The entire procedure takes approximately 20 to 30 minutes, is performed entirely in the office under local anesthesia, and you walk out the same day. There are no incisions and no general anesthesia required.
Why Rotator Cuff Injuries Often Fail to Heal on Their Own
Chronic rotator cuff tendinopathy and partial tears present a unique biological challenge. Over time, the injured portion of the tendon accumulates disorganized scar tissue and degenerative changes. This damaged tissue lacks the blood supply and cellular signaling necessary to initiate a proper healing response. Physical therapy can strengthen the surrounding muscles and improve mechanics, but it cannot replace tissue that is structurally compromised at the cellular level.
This is precisely why many patients plateau with conservative treatment. The exercises are helping the muscles around the injury, but the torn or degenerated tendon fibers themselves remain unchanged. Percutaneous tenotomy addresses this problem directly by removing the diseased tissue and creating a fresh wound bed, while PRP floods that area with the growth factors needed to drive regeneration.
What Does the Research Say?
Tenotomy Plus PRP: Randomized Controlled Trial Results
A randomized, controlled, double-blind clinical trial published in Biomedicines compared the barbotage (tenotomy) technique alone versus tenotomy combined with PRP in patients with partial supraspinatus tendon tears. The results were striking. By six months, nearly 80 percent of the PRP group demonstrated complete healing on ultrasound imaging — compared to just 21 percent in the tenotomy-only group. That represents roughly four times the healing rate without surgery (de Castro et al., 2023).
Patients in the PRP group also experienced significantly greater pain reduction and improvements in shoulder function. Their scores on the Western Ontario Rotator Cuff Index — a validated measure of pain, physical function, and quality of life — improved so substantially that the effect size was categorized as large. In clinical research terms, that means the improvement was not just statistically significant but genuinely transformative for the patients involved.
Tenotomy Alone: Meta-Analysis Findings
Even without PRP, percutaneous tenotomy on its own is a highly effective treatment. A meta-analysis published in European Radiology examined 29 studies encompassing over 1,600 patients and nearly 1,900 tendons treated with ultrasound-guided percutaneous needle tenotomy. The analysis found consistent improvements in both pain and function across all follow-up intervals (Shomal Zadeh et al., 2023).
On average, patients saw pain improvements of 2.5 points in the short term, 2.2 points in the mid-term, and 3.6 points in the long term on a standard 10-point pain scale. Functional strength also improved meaningfully, which translated to patients returning to regular activities with less pain and greater confidence. The researchers concluded that percutaneous tenotomy is an appropriate minimally invasive treatment for chronic tendinopathy with a low rate of complications.
Insurance Coverage and Cost Considerations
One of the most common questions I receive is about cost. The ultrasound-guided tenotomy portion of the procedure is covered by most insurance plans, including Medicare, PPOs, and HMOs. However, PRP remains a self-pay component because it is not yet covered by most insurance carriers.
The good news is that even without PRP, tenotomy alone delivers clinically meaningful results, as the meta-analysis data confirms. For patients who are able to add PRP, the research suggests substantially better healing outcomes — but tenotomy on its own remains a powerful, minimally invasive alternative to surgery.
What Does Recovery Look Like After Percutaneous Tenotomy?
The recovery process for both tenotomy and tenotomy with PRP is virtually identical and significantly faster than surgical repair. Here is a general timeline based on what I see in my practice:
Days 1 to 3: Rest and light movement. A sling may be used briefly for comfort, but most patients return to desk work within a day or two.
Week 1: Begin gentle range-of-motion exercises to prevent stiffness and promote blood flow to the treatment area.
Weeks 2 to 6: Progressive strengthening and restoration of movement. Most patients notice significant improvement during this window, particularly between weeks two and four.
Week 6 and beyond: Most patients are ready to resume full activity, including sports, depending on their comfort level and the severity of the original injury. Full recovery typically occurs between 6 and 12 weeks.
Compare this to rotator cuff surgery, which typically involves general anesthesia, surgical risks, and a recovery timeline of six months to a year — and the advantage of this minimally invasive approach becomes clear.
Is Percutaneous Tenotomy with PRP Right for You?
Percutaneous tenotomy with PRP is especially effective for patients with partial rotator cuff tears, chronic rotator cuff tendinopathy, and cases where physical therapy has reached a plateau. It is also an excellent option for patients who want to avoid or delay surgery and the lengthy rehabilitation that follows.
Not every physician offers these advanced ultrasound-guided procedures, but they are increasingly being utilized in sports medicine to help patients recover faster and avoid the operating room.
Schedule a Consultation
If you are dealing with a rotator cuff injury that has not responded to physical therapy and you want to explore whether percutaneous tenotomy with PRP is right for you, schedule an evaluation with Dr. Peng. As a board-certified sports medicine physician specializing in ultrasound-guided and regenerative procedures, Dr. Peng can help you understand your options and develop a personalized treatment plan.
Dr. Jeffrey Peng, MD is a Stanford-trained, board-certified sports medicine physician practicing in Campbell, California (San Francisco Bay Area). He specializes in orthobiologics and ultrasound-guided minimally invasive procedures for musculoskeletal conditions.
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