The shoulder is where ultrasound guidance earns its keep. Rotator cuff and biceps tendons can be examined in motion and under load, and an injection can be placed into a specific part of a specific tendon rather than into the general area. At Texas Orthobiologics in Dallas, shoulder PRP and bone marrow concentrate injections are performed under live ultrasound by a board-certified orthopedic surgeon who also operates on these problems.
For the wider picture — every category of orthobiologic treatment, and the three questions that separate the credible providers from the rest — start with the main orthobiologics page.
Shoulder problems treated with orthobiologics
- Rotator cuff tendinitis and partial-thickness rotator cuff tears
- Rotator cuff re-tear after previous repair
- Biceps tendinitis — long head of biceps
- Subacromial impingement and rotator cuff bursitis
- Internal impingement, common in throwing athletes
- Shoulder osteoarthritis (glenohumeral) and AC joint arthritis
- Shoulder ligament injury
SLAP and labral tears
Labral tears — including SLAP tears at the superior labrum where the biceps anchors — are a common reason patients look specifically for a biologic option. Not every labral tear is a candidate: a tear producing genuine mechanical instability is a structural problem and an injection does not fix structure. A degenerative or partially symptomatic labral tear in a stable shoulder is a different situation, and that distinction is the whole of the consultation.
Further reading: shoulder labral tear, labral tear with instability, rotator cuff tear.
PRP for the shoulder
Platelet-rich plasma is a patient's own blood, spun down so that the platelets are concentrated into a small volume of plasma and everything unwanted is discarded. Platelets are best known for clotting, but they also carry a large reservoir of the growth factors and signalling proteins the body uses to recruit cells to an injury and start repair. PRP delivers a concentrated dose of that signal directly to the tissue that needs it.
Platelet concentration is the variable worth asking any provider about. Blood carries roughly 200,000 platelets per microliter; current evidence suggests PRP should approach or exceed 1,000,000 per microliter, about a five-fold concentration. PRP here is prepared in the office from blood drawn the same visit, with the centrifuge step taking under ten minutes.
When bone marrow concentrate is considered
Bone marrow aspirate concentrate (BMAC) — the treatment usually marketed as a stem cell injection — is drawn from the patient's own posterior iliac crest in the office under local anesthetic, concentrated for about twenty minutes, and injected the same day.
It is a larger procedure than PRP and a considerably larger investment, so it is not simply the upgrade option. Worth knowing before you are quoted for it: mesenchymal stem cells are a small fraction of what concentrated marrow contains, and no injection available today has been shown to regrow a joint surface. Whether BMAC or PRP is indicated is decided on the tissue problem, the imaging and the prior response.
When the shoulder needs an operation instead
A full-thickness rotator cuff tear that is retracted, a labral tear causing true instability, and a shoulder that has lost motion structurally are not injection problems. Dr. Buford performs shoulder surgery as well as the injections, so that assessment is made by someone who would be doing the operation either way — which is a different incentive from a clinic that only offers one of the two.
Injections are performed under ultrasound guidance
Injections are placed under direct ultrasound guidance rather than by surface landmarks. The needle is visible on screen throughout, and the structure being treated is identified before anything is injected.
This matters more than it sounds. A blind injection relies on the anatomy being where the textbook says it is. Ultrasound shows where it actually is in the patient on the table that day, confirms the needle has reached the intended structure, and shows the injectate spreading where it was meant to go. When the treatment is a single dose of the patient's own concentrated biology, placing it accurately is not a refinement — it is the procedure.
Ultrasound also adds diagnostic information during the visit itself. Tendons can be examined dynamically, in motion and under load, which a static scan cannot show.
What happens after the injection
Most patients have some soreness afterwards that decreases fairly quickly. Plan on avoiding significant physical activity or sport for about a week.
Do not take aspirin, ibuprofen, naproxen or other NSAIDs after the procedure. Anti-inflammatory medication blocks the inflammatory phase that the treatment is deliberately trying to start, so taking it works directly against the injection you just paid for. Acetaminophen (Tylenol) and other pain medicines that do not block inflammation are fine. If you take an NSAID or a blood thinner regularly for another condition, raise it before the procedure rather than after — it changes the plan.
Follow-up is scheduled rather than left to the patient to arrange. Progress is reviewed at intervals so the response can be judged against what was expected, and the plan adjusted if it is not tracking.
Your investment
Worth being direct about, because most sites are not: in the United States, most insurance plans, Medicare and Medicaid do not currently cover orthobiologic treatment. This is an investment you make in your own health rather than a benefit you claim, and you should expect a clear number rather than a vague one.
High-dose PRP
Nationally, the range for a high-dose, single-injection PRP treatment is $1,500 to $3,500.
Lower-dose PRP often requires multiple injections, and clinical outcomes are often not as good. That is why Texas Orthobiologics specializes in the higher-dose PRP protocols — one well-concentrated treatment placed accurately under ultrasound, rather than a series of weaker ones. It is also why the platelet concentration question above is worth putting to any provider you are comparing.
Bone marrow aspirate concentrate (a stem cell injection)
Nationally, the range is $5,000 to $13,000, depending on how many joints are treated and the complexity of the treatment.
What the figure for an individual patient reflects:
- How many joints or sites are treated in one visit
- Which structure is involved — a joint, a tendon, or both
- The complexity of the treatment being planned
- Whether imaging or a diagnostic step is needed first to confirm the source of pain
What you are quoted includes the follow-up care that normally goes with the procedure. It is not a deposit against a series of further visits.
The figure for your own treatment is given plainly at the consultation — the investment for injecting one shoulder with PRP is a single number, not a range, once we know what we are treating.
Every patient leaves the consultation with a clear understanding of the risks, the benefits and the potential investment before making any decision. Nobody is asked to commit to treatment at the visit.
CareCredit is available for patients who prefer to spread the investment over time. Interest rates are typically lower than regular credit card rates, and we offer financing plans up to twelve months in length. Our clinical specialists handle these questions directly, and it is worth speaking to them before you rule a treatment out — there are usually more options than are obvious from the outside.
To discuss the investment for your own treatment, call (877) 777-8883.
What we do not offer, and why
This field has a marketing problem, so rather than just listing exclusions it is worth stating the standard being applied.
We do not use any product that lacks a clear FDA regulatory pathway for use in humans and clear human clinical outcomes data showing that it is safe and that it works for the indication being treated. Both halves, not either one. That single sentence accounts for most of what is on the market and not on the menu here.
Amniotic fluid, Wharton's jelly and exosome products
These are considered unapproved drugs by the FDA and are not approved for any treatment indication. That is a description of their current regulatory status, not a matter of opinion, and it holds whatever the clinic marketing says.
Separately, and just as importantly, there is a significant lack of published human outcomes data for these products in orthopedics — a marked contrast with PRP and bone marrow concentrate, where the human literature is substantial. So both halves of the standard fail, and they are not used here.
Every biologic injection performed at Texas Orthobiologics is autologous — prepared from the patient's own tissue on the day of treatment.
That is deliberately a statement about injections, not a blanket position on donor tissue. Donor cartilage used as a structural graft in cartilage transplantation surgery is a different proposition entirely: it is regulated under an established pathway, it is implanted rather than injected, and it carries decades of published human outcomes data. It meets the standard above. An injectable donor cell product does not.
Adipose (fat) based treatments, also called microfat
An adipose-based biologic is known as microfat because of how clinicians in the United States must process the tissue. It is a different orthobiologic treatment option, and some clinicians have success with it. At Texas Orthobiologics we do not currently offer adipose or microfat based treatments.
A biologic is one option, not the only one
A consultation here is not a pre-decided route to an injection. Some presentations of shoulder pain respond well to an orthobiologic. Some do better with an operation. Some need physical therapy, a change in loading, or time, and would get neither benefit nor harm from a syringe.
Dr. Buford performs both the injections and the surgery, so the recommendation is not shaped by what happens to be on offer. If a biologic is unlikely to help your particular problem, you will be told that at the visit rather than after a course of treatment.
Request an appointment or call (877) 777-8883.
Common questions
Can PRP help a SLAP tear or labral tear?
It can be appropriate for a degenerative or partially symptomatic labral tear in a stable shoulder. A labral tear producing genuine mechanical instability is a structural problem that an injection does not correct, and that is assessed at the examination before any treatment is recommended.
Can PRP help a partial rotator cuff tear?
Partial-thickness rotator cuff tears and chronic rotator cuff tendinitis are among the more common indications. A retracted full-thickness tear is a surgical problem rather than an injection problem.
Why does ultrasound matter for a shoulder injection?
The rotator cuff and biceps tendons can be examined dynamically, in motion and under load, which a static scan cannot show. Ultrasound also confirms the needle has reached the intended part of the intended tendon rather than the general area.
How much does a PRP injection cost?
Nationally, the range for a high-dose single-injection PRP treatment is $1,500 to $3,500. Most United States insurance plans, Medicare and Medicaid do not currently cover orthobiologic treatment, so this is an investment in your own health. The figure for an individual patient reflects how many sites are treated and the complexity of the treatment, and includes the follow-up care that normally accompanies it. Every patient leaves the consultation with a clear understanding of the risks, the benefits and the potential investment before deciding. Call (877) 777-8883.
Can I take ibuprofen afterwards?
No. Aspirin, ibuprofen, naproxen and other NSAIDs block the inflammatory phase the injection is intended to start. Acetaminophen (Tylenol) is fine. Tell the office beforehand if you take an NSAID or a blood thinner regularly.
Who performs the injection?
Don Buford, M.D., a board-certified orthopedic surgeon, performs the injections personally and under ultrasound guidance.
Is the injection made from my own tissue?
Yes. PRP is prepared from blood drawn at the same visit, and bone marrow concentrate from marrow drawn the same day. No donor material, birth tissue, adipose preparation or exosome product is used.
