PRP injections and orthobiologics for neck and shoulder pain in St. Louis

PRP injections, along with bone marrow concentrate and microfragmented fat, place your own repair signals into a worn neck joint, a frayed shoulder tendon or an arthritic shoulder. When neck or shoulder pain has outlasted therapy and cortisone, these orthobiologics are the step we weigh before anyone books surgery.

What are orthobiologics?

Orthobiologics are treatments made from your own body. We take blood, bone marrow or a little fat, concentrate the useful part, and place it where the damage is. Nothing is grown in a lab. Nothing comes from a donor.

The goal is different from cortisone. Cortisone shuts inflammation down for a while. An orthobiologic sends a signal that tells a tired tendon or joint lining to start repair work again. That is slower. It also tends to last longer, because it works with the tissue instead of putting it to sleep.

This site is about the neck, and the neck rarely hurts alone. The shoulder blade, the rotator cuff and the elbow all hang off the same nerves and the same muscles. So the orthobiologic work we do here covers the neck, the shoulder and the arm as one unit.

The three orthobiologics we use

• Platelet-rich plasma (PRP). We draw a tube of your blood and spin it to pull the platelets into a small volume. Platelets carry growth factors. PRP is our first choice for most tendon problems and for mild to moderate joint wear.
• Bone marrow concentrate. We take marrow from the back of the hip bone with a needle, then concentrate it. It brings cells and signals that PRP does not have. We reach for it when a shoulder joint is more worn or when PRP alone has not been enough.
• Microfragmented fat. We take a small amount of fat from the belly or flank and break it into tiny clusters. Those clusters act as a cushion and a slow signal source. It is another choice for a worn joint.

Which one fits depends on the tissue, how badly it is worn, and your general health. We tell you which one we pick and why, in plain words, before anything is drawn.

Where the injection goes

An orthobiologic only helps the tissue it touches. That is why we guide every needle with ultrasound or X-ray and watch it land. There are three main targets.

• Into the joint. The shoulder ball-and-socket, the AC joint on top of the shoulder, or the small facet joints at the back of the neck. This treats worn cartilage and an angry joint lining.
• Into the tendon. The rotator cuff, the long biceps tendon, or the tendon on the outside of the elbow. This treats tendons that have frayed and stopped healing.
• Into the bone under the cartilage. In more advanced shoulder arthritis, the bone just under the joint surface can be inflamed too. Placing treatment there as well as in the joint reaches both layers of the problem.

Conditions we treat with orthobiologics

Each page below explains one problem from the neck-and-shoulder side, including how we test it and where orthobiologics fit.

Neck

• Cervical facet syndrome: worn joints at the back of the neck that no scan can confirm on its own.
• Whiplash: joint and ligament strain from a crash that never fully settled.
• Double crush syndrome: one nerve pinched in two places, often with a worn joint or tendon along the way.

Shoulder

• Shoulder arthritis: a stiff, grinding shoulder that loses motion in every direction.
• Rotator cuff, or the neck?: partial cuff tears and cuff wear, and how to tell them from neck pain.
• Subacromial bursa: the thin sac under the top of the shoulder that hurts when you reach.
• AC joint pain: the small joint on top of the shoulder that you can point to with one finger.
• Biceps tendonitis: pain at the front of the shoulder when you lift or carry.

Elbow

• Tennis elbow: grip pain on the outside of the elbow that keeps coming back.

Pick your guide

Each guide is a short printable checklist. Pick the one that matches your problem and we will email it to you.

• Neck pain and a fusion talk: nine questions to ask before anyone fuses your neck.
• Shoulder, elbow and tendon pain: what your scan says and what to ask before tendon surgery.
• Hurt in a car crash: ten questions before surgery, and how care is billed to a claim or lien.

Who is a good candidate?

The best results come in people who have a clear source of pain that we can find on exam and confirm with a numbing test. A real structure, not a vague label.

• Pain for three months or more that has not settled with good therapy.
• Cortisone that helped for a few weeks and then wore off, or that you would rather not repeat.
• A partial tendon tear, tendon wear, or mild to moderate joint wear.
• Someone told you surgery is next, and you want to know what else is real first.

Orthobiologics are not the answer for a pinched nerve with weakness that is getting worse, for an infection, or for a full-thickness tendon tear that has pulled back. We will say so if that is what we find. Blood thinners, some blood disorders, active cancer and very high blood sugar can change the plan, so bring your medicine list.

What the visit and recovery are like

The first visit is an exam, not a procedure. We test the neck and the shoulder together, because each one can fake the other. If we think orthobiologics fit, we schedule the treatment visit.

On treatment day you stay awake. We numb the skin with local anesthetic and use no sedation, so most people drive themselves home. The draw, the processing and the injection all happen in the same visit.

Expect a deep ache for about 48 hours. Skip ibuprofen and similar pills for a while, since they blunt the signal we just placed. Light motion starts in the first days. Then a rehab plan builds strength over the next weeks. The number of injections depends on how you respond, not on a set package.

All orthobiologic care happens at our regenerative clinic at 4477 Woodson Rd in St. Louis. Our front desk will route you at check-in. PRP is not covered by insurance. HSA and FSA funds are generally eligible.

Why dose and rehab decide the result

Two people can both get “PRP” and have very different results. The difference is often dose. A large review of knee trials found that PRP with a high platelet count gave real pain relief, while low-count PRP did not. A neck trial that used a low-count PRP found it no better than cortisone. We measure what we make, and we make enough to matter.

Then comes the work. An injection gives a tendon or joint a better chance. Loading the tissue in the right order turns that chance into strength. We give you the plan, and we check that the shoulder blade, the neck and the arm are moving well together.

The body around the joint matters too. High insulin, belly fat and poor sleep keep the whole system inflamed. We look at those, because a calmer body heals better from any treatment.

Frequently asked questions

Can PRP help neck pain?

Yes, when the pain comes from a worn facet joint or strained ligaments in the neck. We first confirm the source with a numbing block. PRP does not fix a disc that is pressing hard on a nerve.

How long do PRP injections take to work?

Relief usually builds over several weeks, not days. Gains often keep growing for a few months as the tissue responds and rehab adds strength.

How many PRP injections will I need?

There is no set number. Some people need one, others need more. We decide by how you respond, not by a package.

Is PRP better than a cortisone shot for the shoulder?

Cortisone works faster but fades. In trials, PRP held its effect longer in many shoulder and tendon problems. Repeated cortisone can also weaken tendons over time.

Do I need an MRI first?

Not always. An exam and an ultrasound in the office answer many questions. If you already have scans, bring them. We use them, but we treat what the exam shows.

Does PRP hurt?

The skin is numbed first. Most people feel pressure, then a deep ache for about two days. You stay awake and drive yourself home.

Bring your scans and your story. We will examine the neck and the shoulder in the same visit and tell you plainly whether orthobiologics fit.