Shoulder pain that wakes you up at night
StemWave plus ultrasound-guided PRP at FirstCall DPC, Santa Rosa Beach
See if I'm a candidateFor a shoulder, that means we look at each rotator cuff tendon, check for a full tear, and look for calcium in the tendon, which shows up clearly on ultrasound and changes the plan entirely. A shoulder that needs a surgeon should see a surgeon. We will tell you.
Is this you?
- You cannot sleep on that side. You wake up every time you roll over.
- Reaching behind you, into the back seat or for a seatbelt, stops you cold.
- Your serve or your swing has lost a gear and your shoulder is the reason.
- You have had physical therapy. It helped some. Not enough.
- A cortisone shot bought you a couple of months and that was it.
If you have a full-thickness rotator cuff tear, PRP is not the fix and we will say so at the exam. That is a conversation with a surgeon, and we will help you have it.
How it works
1.Exam and ultrasound
I move the shoulder through its range with resistance, then scan each tendon of the cuff and the bursa above it. We are looking for a partial tear, a worn tendon or a calcium deposit. Each one gets a different plan.
2.StemWave sessions
Six StemWave sessions over three to four weeks before the injection, aimed at the tendon we mapped on ultrasound. This is the one place where the acoustic wave has its own track record, especially where there is calcium in the tendon.
3.PRP under ultrasound
We draw your blood, spin it, and place the platelet layer into the tendon or the partial tear while watching the needle. In a shoulder, a blind injection usually ends up in the bursa, not the tendon. Guidance is the whole difference.
4.Loading plan
Within a week you start a cuff and scapula program with real resistance. The shoulder is a joint that depends on its muscles for stability. The injection helps the tendon. The program keeps it from coming back.
For rotator cuff tendinopathy we use the Rebuild package: six StemWave sessions, then one ultrasound-guided PRP injection within two or three days of the last session, then the cuff program. Partial tears or two problem tendons may call for Elite Recovery, which adds a second injection. Most people sleep better within six weeks. Strength takes three months.
What the evidence says
The shoulder evidence is more mixed than the elbow. For partial rotator cuff tears and tendinopathy, PRP has beaten placebo and cortisone in some trials and matched them in others. For calcific tendinitis, an ultrasound-guided lavage of the calcium is often the better first move, and we do that too. I will tell you which one your ultrasound points to.
“If I ever have to exaggerate the evidence to justify offering something, I probably shouldn't be offering it.”Dr. Petersen
What it costs
- Reset3 StemWave sessions + 1 ultrasound-guided PRP injection$1,395
- Elite Recovery10 StemWave sessions + 2 ultrasound-guided PRP injections$2,995
FirstCall DPC members get 15% off every package.
Both sides or a second site: add $600 per PRP site and $500 per StemWave region.
The exam and the ultrasound are included. HSA and FSA accepted. Financing available.
Dr. Petersen chooses the package at the exam based on what the ultrasound shows. If a single ultrasound-guided PRP injection without StemWave is the right call for you, that is offered through the main practice and he will say so.
A shoulder that wakes you up at night is telling you the tendon is irritated and the space above it is crowded. Most of the time that gets better with the right exercise program and patience. Some of the time it does not, and that is when we look at the tendon on ultrasound and decide what it needs.
I would rather tell you that you need a surgeon than take your money for an injection that was never going to work.
Meet the physicians
Erik Petersen, DO
Board-certified in Internal Medicine. Twenty years of emergency medicine, and the person holding the ultrasound probe.
Co-founder of FirstCall DPC. Former All-American football player who still thinks a loading program beats a shortcut.
Will Carlson, MD
Board-certified in Internal Medicine. Emergency medicine experience, and the slower, more careful half of this partnership.
Co-founder of FirstCall DPC. He is the one who asks what happens if we are wrong, which is why we rarely are.