In a previous blog I discussed the clinical success of rotator cuff repair using expanded stem cell therapy.
Today we had the opportunity to review MRI images of an elderly patient who also underwent the Regenexx procedure 2 years ago for a supraspinatus tear. AB is an 80 y/o patient with neck, headache and shouder pain. Her shoulder pain was severe and she was unable to lift her shoulder. She declined surgery and elected to proceed with mesenchymal stem cell therapy. Her own stem cells were injected into the rotator cuff tear under x-ray guidance.
To understand the differences in pre and post MRI’s, some basic MRI concepts and anatomy is essential.
The image above is the patient’s pre-injection coronal MRI. The rotator cuff tendon is the area of interest. The rotator cuff is compromised of 4 principle muscles. Muscles have two parts: the muscle belly and the attachment of the muscle to bone(tendon). Tears in the rotator cuff commonly involve the tendon.
Above are AB’s pre and post MRI’s . On the left the rotator cuff tendon(red arrows) are bright in color and mottled in appearance. This means that it’s a full thickness tear with severe degeneration. On the right is AB’s MRI 2 year post stem cell injection. The rotator cuff tendon identified by the yellow arrows is better organized and darker in color consistent with significant healing. This is consistent with her clinical improvement. She reports 100% improvement in pain and full range of motion.
The rotator cuff is compromised of 4 principles muscles and their tendons: supraspinatus, infraspinatus, subscapularis and teres minor. Collectively they stabilize the joint and allow for movement . Tendons at the end of the rotator cuff muscles can become torn resulting in pain and restriction in motion. The majority of tears occur in the supraspinatus tendon. Typical presentation includes pain with impaired motion. Surgical treatment often involves arthorscopic repair, subacromial decompression or use of an anchor to secure the tendon to the bone. Surgical complications included fatty atrophy, re-tears of the rotator cuff, infection and failure.
JG is a 32y/o patient at the Centeno-Schultz Clinic who suffered shoulder injury after a motor vehicle accident. Despite surgery in the form of subacromial decompression JG continued to have shoulder pain. Repeat MRI demonstrated near complete rotator cuff tear involving the supraspinatus. He declined surgery and opted to undergo the Regenexx procedure whereby he could use his own mesenchymal stem cells.
2 years after stem cell therapy JG reports greater than 90 % reduction in pain and full range of motion. Post stem cell injection MRI is posted below. The supraspinatus tendon is outlined with red circle. On the left there is a significant tear whereas on the right the tear is significantly improved. This corresponds with JG’s clinical improvement. Other patients have also undergone successful stem cell therapy for rotator tendon tears.
Platelet rich plasma (PRP) therapy has gained increasing attention as a non surgical option for musculoskeletal injuries. Platelets are rich in growth factors which mobilize repair cells, promote cell division and accelerate healing. At the Centeno-Schultz Clinic PRP has been successful in treatment of elbow, hip, knee and heel pain( lateral and medial epicondylitis, piriformis syndrome, patellar tendinopathy and Achilles tendinopathy.
Maximal clinical results are obtained when an accurate diagnosis is established, injection of PRP is performed under ultrasound guidance and a labatory prepated PRP is utilized.
Identifying the source of pain is essential. Delivery of the platelet concentrate must be directly into the area of damage. Ultrasound gives direct visualization of the damaged tissue and the where the injected platelets are going. At the Centeno-Schultz Clinic we have a state of the art laboratory which enables us to prepare a customized platelet concentrate which has a higher number of platelets and less cellular debris than bedside centrifuge units commonly employed by most clinics.