Straight answers can help your sore shoulder

Sources

1. A 2025 Bayesian network meta-analysis of exercise for rotator cuff-related shoulder pain (15-16 studies, 913-947 participants) ranked CONCENTRIC strengthening training first for both pain and shoulder dysfunction; eccentric and traditional training were moderately effective and significantly better than motor-control and scapula-focused training.

   Zhang W, et al. — Effects of seven types of exercise in the treatment of rotator cuff-related shoulder pain (RCRSP): a systematic review and Bayesian network meta-analysis.. J Orthop Surg Res, 2025. DOI: 10.1186/s13018-025-06514-4.

2. The Cochrane review of manual therapy and exercise for rotator cuff disease included 60 trials and 3,620 participants but could perform no meta-analysis because of clinical heterogeneity and incomplete outcome reporting; risk of bias was high in 43 of the 60 trials. The single high-quality placebo-controlled trial (120 participants) found manual therapy plus exercise no better than inactive ultrasound at 22 weeks on overall pain.

   Page MJ, et al. — Manual therapy and exercise for rotator cuff disease.. Cochrane Database Syst Rev, 2016. DOI: 10.1002/14651858.CD012224.

3. 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.

4. A systematic review of sleep quality in rotator cuff tear patients found the majority had sleep disturbance, most marked before surgery, with general improvement afterwards. Sleep quality correlated with pain, and comorbidities, forced sleeping position, and preoperative and prolonged postoperative narcotic use were identified as contributing factors.

   Longo UG, et al. — Sleep Disturbance and Rotator Cuff Tears: A Systematic Review.. Medicina (Kaunas), 2019. DOI: 10.3390/medicina55080453.

5. 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.

6. 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.

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.