Shoulder Pain & Rotator Cuff · Non-Surgical Care · Glastonbury, CT
Rotator cuff tendinopathy and shoulder arthritis evaluated with the same evidence-first approach used since 2007 — starting with live ultrasound diagnosis and treatment matched to the shoulder you actually have not the one an X-ray report describes.
Quick answer
Most shoulder pain — rotator cuff tendinopathy, calcific tendinitis, and mild to moderate arthritis — is treated without surgery: physical therapy and activity modification first, then, when that isn't enough, ultrasound-guided treatment such as needling for calcium deposits, PRP, or BMA. Only a small minority of patients with rotator cuff calcific tendinitis go on to need surgery. Full-thickness tears, significant instability, and cases that fail a genuine trial of conservative care are where a surgical discussion becomes appropriate.
Most common conditions
Rotator cuff tendinopathy, calcific tendinitis, osteoarthritis
Diagnosis method
Live, dynamic ultrasound examination
Non-surgical options
Needling, PRP, BMA, MFAT, prolotherapy
Return to activity
Usually within days; depends on treatment
First results
Weeks 4 to 16, depending on treatment
Who treats you
Dr. Tortland personally, every visit
When surgery is right
Full-thickness tears or significant instability
Insurance
Not covered; but HSA / FSA applicable
Definition
And why the right diagnosis matters more than the treatment you pick.
Shoulder pain has several distinct sources — a degenerated rotator cuff tendon, a calcium deposit within the tendon, arthritis in the joint itself, or instability from repeated overhead motion. Two patients with similar symptoms can have very different problems underneath. Confirming which structure is actually failing on live ultrasound, rather than assuming from an X-ray report alone, is the starting point for any treatment plan.
Not every painful shoulder needs an injection, and not every injection is appropriate for every shoulder. Whether physical therapy, needling, PRP, a cellular treatment like BMA or MFAT, or a referral for surgery is the right next step depends on the specific structure involved, how large a calcium deposit is, and whether the rotator cuff tendon is partially or fully torn.
Indications
The shoulder conditions seen most often in this practice, treated without surgery whenever the evidence and the ultrasound findings support it.
Step by step
01
Before anything is injected, the joint or tendon is examined dynamically on ultrasound so the treatment target is confirmed rather than assumed. This is a separate visit from treatment.
02
Whereas most facilities only draw 30-60mL of blood, Dr. Tortland uses a tailored High-Concentrate blood draw, 60 to 250+mL depending on the target. Volume is chosen for the condition being treated, the patient's age, and platelet count.
03
Your blood is spun in office with a double-spin protocol to separate and concentrate the platelet fraction. Preparation takes 20-30 minutes while you wait in the room.
04
The patient's blood platelet count is analyzed by a Cell Counter. The PRP platelet concentration is tailored to each patient's injury, age, and baseline platelet count. Dr. Tortland's High-Concentrate process derives an average blood platelet count of at least 12-15x the patient's baseline platelet count, where most standard kits derive only 2-6x baseline platelet count -- not enough to even be considered true PRP.
05
The area is numbed with local anesthetic, then the needle is advanced under live MSK ultrasound and / or fluoroscopic guidance into the exact structure(s) at fault. You can watch the screen as it happens.
06
You leave with a written loading schedule. Expect two to five days of soreness — that inflammatory response is the treatment working. No anti-inflammatories for two weeks.
07
Follow-up at six to ten weeks with repeat ultrasound and / or an updated MRI to compare tissue appearance and patient symptom progression against baseline and decide whether a second PRP procedure adds value.
Candidacy
Comparison
Frequently asked
Sources
01
Mulvaney SW, Tortland PD, Shiple B, Curtis K. Regenerative medicine options for chronic musculoskeletal conditions: a review of the literature. Endurance and Sports Medicine. 2018.
02
Dai WL, et al. Efficacy of platelet-rich plasma versus hyaluronic acid in knee osteoarthritis: meta-analysis of randomized controlled trials.
03
Filardo G, et al. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: evidence and indications.
04
Mishra AK, et al. Platelet-rich plasma for chronic tennis elbow: randomized controlled trial with two-year follow-up.
05
Bennell KL, et al. Effect of intra-articular platelet-rich plasma on knee pain and cartilage volume: randomized clinical trial.
06
Everts P, et al. Platelet-rich plasma: new performance understandings and therapeutic considerations for classification and dosing.
This page is written for patient education and does not constitute medical advice or establish a physician-patient relationship. Treatment decisions require an in-person examination. Orthobiologic procedures are not FDA-approved drug therapies; they are performed as autologous same-day procedures under the practice of medicine. Dr. Tortland reports no financial interest in the products or devices described on this page.
Candidacy for PRP is determined on ultrasound, not over the phone. Bring your imaging and get an honest answer in one visit.