Choose shoulder care by what hurts and what still moves

Keep the arm moving without forcing it

Move the arm only as far as it goes without a hard push. Hold light objects close and break repeated reaching into shorter periods. Add movement slowly as the soreness settles.

Strength work must fit the part that hurts. The rotator cuff is four small muscles and attached tendons that circle the shoulder. If an exercise sharply worsens the ache, stop and ask a clinician to adjust it.

Show the painful movement at the visit

Tell the clinician whether soreness came slowly or followed a fall. Show the high reach, low lift, or bed position that causes trouble. Take your current medicines, earlier X-rays, and a short record of past care.

The exam checks how far the arm moves and how much strength remains. Those findings help decide whether home changes, physical therapy, medicine, or another procedure fits. Ask what improvement would mean for sleeping, dressing, lifting, and reaching.

Discuss surgery when strength drops suddenly

A new tear after a fall can cause sudden weakness and may need a quick surgical opinion. Severe arthritis can also make surgery worth discussing when sleep and basic arm use keep getting worse. Surgery isn't a failure when the shoulder has a clear reason for it.

Many shoulder tendon problems that begin slowly can improve without an operation. That doesn't mean every tear can wait. New weakness, a misshapen shoulder, or an arm that won't rise needs care sooner.

Sources

1. In the MOON Shoulder prospective cohort of 452 patients with symptomatic, ATRAUMATIC full-thickness rotator cuff tears, physical therapy succeeded in more than 70% of patients at 10 years: only 115 (27.0%) had surgery at any point over the decade. Patient-reported outcomes improved with physical therapy and did NOT decline over 10 years in those who never had surgery. The strongest predictor of early surgery was low patient expectation of physical therapy, not tear anatomy.

   Kuhn JE, et al. — The Predictors of Surgery for Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears Change Over Time: Ten-Year Outcomes of the MOON Shoulder Prospective Cohort.. J Bone Joint Surg Am, 2024. DOI: 10.2106/JBJS.23.00978.

2. A 2026 meta-analysis of 10 randomized trials (n=591) found PRP and corticosteroid indistinguishable at 3-6 weeks and 3 months, with PRP pulling ahead at 6 months: ASES +10.8 (95% CI 4.71-16.80), Constant-Murley +10.7 (1.21-20.27) and VAS pain -0.8 (-1.45 to -0.18), plus fewer adverse events (RR 0.66, 0.44-0.99). The authors describe the benefit as statistically significant but CLINICALLY MODEST.

   Yuwarungsikul C, et al. — Platelet-rich plasma provides modest but durable functional benefit over corticosteroid for rotator cuff tendinopathy: A systematic review and meta-analysis of randomized controlled trials.. Knee Surg Sports Traumatol Arthrosc, 2026. DOI: 10.1002/ksa.70416.

3. A meta-analysis of nine randomized trials (469 patients) found corticosteroid superior to PRP in the SHORT term on Constant, Simple Shoulder Test and ASES scores, no difference at mid-term, and PRP superior in the LONG term on Simple Shoulder Test and ASES. The authors state explicitly that none of these differences reached the minimal clinically important difference.

   Peng Y, et al. — Comparison of the effects of platelet-rich plasma and corticosteroid injection in rotator cuff disease treatment: a systematic review and meta-analysis.. J Shoulder Elbow Surg, 2023. DOI: 10.1016/j.jse.2023.01.037.

4. A meta-analysis of 36 randomized trials and 2,443 patients found that PRP used as augmentation during surgical rotator cuff repair significantly REDUCES the retear rate (p<0.001) while producing NO benefit on any clinical outcome at short or medium/long term; PRP injected in conservatively treated patients showed no clear advantage at all, with high heterogeneity.

   Feltri P, et al. — Platelet-rich plasma does not improve clinical results in patients with rotator cuff disorders but reduces the retear rate. A systematic review and meta-analysis.. Knee Surg Sports Traumatol Arthrosc, 2023. DOI: 10.1007/s00167-022-07223-9.

5. A systematic review and meta-analysis of randomized trials found that augmenting arthroscopic rotator cuff repair with platelet-rich plasma reduces the retear rate and improves clinical function scores, whereas platelet-rich FIBRIN gives no clinically meaningful benefit - with the authors cautioning about the small number and heterogeneity of studies. The shoulder's best biologic evidence is for PRP used ALONGSIDE a repair operation, not as a substitute for one.

   Peng Y, et al. — Efficacy of platelet-rich plasma and platelet-rich fibrin in arthroscopic rotator cuff repair: A systematic review and meta-analysis.. PM & R : the journal of injury, function, and rehabilitation, 2023. DOI: 10.1002/pmrj.13049.

6. The Cochrane review of exercise for knee osteoarthritis found high-quality evidence that land-based therapeutic exercise provides short-term benefit in pain and physical function, sustained for at least 2-6 months after the programme ends, with mild transient soreness the only reported adverse effect across 45 trials. It is the best-evidenced treatment for this condition and it costs nothing per injection.

   Fransen M, et al. — Exercise for osteoarthritis of the knee.. The Cochrane database of systematic reviews, 2015. DOI: 10.1002/14651858.CD004376.pub3.

7. FDA states verbatim that stem cell, stromal vascular fraction, umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products 'have [not] been approved for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' The only FDA-approved stem cell products in the United States are blood-forming (hematopoietic progenitor) cells from umbilical cord blood, approved only for disorders of blood production, and there are currently NO FDA-approved exosome products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA (Center for Biologics Evaluation and Research), 2020.