Rotator Cuff Sign

Rotator cuff tears often result in pain over the front and outer aspect of the shoulder.  The  pain maybe  increased when pushing upwards on the shoulder  or reaching forward. Weakness may also be reported. Unfortunately pain and weakness do not make the diagnosis of a tear in the rotator cuff.

Park et. al., demonstrated that to best way to diagnose full-thickness rotator cuff tears on physical examination is when the painful arc test, the drop-arm sign, and weakness in external rotation were all positive.  These are known as the rotator cuff signs.

The painful arc test is positive if the patient has pain when raising their arm from their side upward beyond the level of their shoulder.

The drop-arm sign is the inability of a patient to hold the arm up at or above the shoulder against gravity.  Please click video for a demonstration of this test.

Weakness in external rotation exam starts with patient seated.  The elbows are flexed at 90°, thumbs turned up, and the arm rotated internally 20°. The patient is then asked to externally rotate the arm against resistance.  If there is weakness or fatigue with external rotation the test is positive.  See example:

Surgery is a common treatment of tears in the rotator cuff.  An alternative is the use of stem cells to regenerate damaged tendons, ligaments and degenerative cartilage.  Regenexx enables a patient to use their own stem cells to regenerate tears in the rotator cuff without surgery, anesthesia or extensive rehabilitation.

Rotator Cuff Patches

Tears of rotator cuff  are commonly repaired surgically where the damaged tendon is sutured or stapled onto bone. 

Failures can occur due to breakdown of the “repaired tendon.“  Rotator cuffs patches offer a possible solution.

Rotator cuff patches are commercial products which  are placed  during surgery over the repaired rotator cuff tendon.  The goal is to reinforce soft-tissue and facilitate tendon healing.  Just as your grandmother might have patched a hole in your jeans with a swatch of cloth, surgeons add a patch over the  repaired rotator cuff.

Several products are available which come from different sources, including  the dermis (skin) and small intestine submucosa from humans as well from porcine (pig) and  bovine (cow) donors.  Insertion of tissue not originating from the patient can result in many problems including inflammation and rejection.  Remember all the problems women suffered from silicone implants despite the fact they were reported to be safe by the FDA?  Another problem is the strength of the patch. One study demonstrated that the elastic strength of all currently-available materials is lower than that of tendon, implying a limited mechanical role in strengthening tendon repair.

Stem cell therapy for regeneration of torn rotator cuffs in now available through Regenexx.  It is a simple needle-in, needle-out procedure which enables the patient to use their own stem cells and forgo the risks of surgery, anesthesia, possible inflammation and rejection of a graft made from the skin or intestine from a cow or pig. Below is MRI demonstrating a tear in the rotator cuff which was successfully repaired using stem cell therapy at Regenexx.

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MRI Images Showing Torn Rotator Cuff

The rotator cuff comprises 4 principal muscles that stablize and support the shoulder joint:  the  supraspinatus, infraspinatus, teres minor and subscapularis.  Tendons are fibrous tissue that connect muscle to bone.  Tears in the rotator cuff can be within the muscle itself or at the site where the tendon attaches to the bone.  There are different types of rotator cuff tears:  parital  tears where only a portion of the muscle or tendon is torn or full thickness tears wheree the tear extends throughout the entire muscle or tendon.  If the injury involves a complete tear through the muscle ot tendon then it is called  a rupture.

The  normal MRI on the left demonstrates the supraspinatus muscle as it attaches on the humerus.  On the right, the same mucle is torn (dark signal). The MRI below also shows a tear in the rotator cuff as noted in the dark signal in the muscle( white arrow).

 

New treatment options for rotator cuff tears include regeneration of the damaged muscle or tendon using stem cell therapy.  Regenexx enables patients the ability to use their own stem cells to heal tears in the rotator cuff.  Regenexx is a simple needle-in, needle-out procedure that enables the patient to avoid surgery, anesthesia and the extensive physical therapy commonly associated with surgical repair.

Please review the MRI below in which a patient had a tear in their rotator cuff.  They underwent stem cell therapy at Regenexx with healing of the tear, 100% resolution of pain and return to normal function.

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Residual Pain After Shoulder Surgery

Pain after shoulder surgery is typically related to the operative procedure, positioning and immobilization following surgery.  For some patients the “shoulder” pain unfortunately never improves despite surgery.  There are several reasons for this but the major one is that the shoulder was not the cause of the pain.  All to often a patient complains of shoulder pain,  obtains an MRI of the shoulder which shows an abnormality and then undergoes surgery with little if any reduction in the shoulder pain.

At the Centeno-Schultz Clinic we are committed to identifying the source of a patients pain.  This begins with a thorough physical examination and history.  Radiographic studies are ordered when appropriate.  One of the most common causes of shoulder pain is injury to a joint in the cervical spine or the cervical disc.  How does this occur?  It is called referred pain and the example most people are familiar with is a patient who goes to the ER with arm or jaw pain.  They don’t need to see a dentist or an orthopedist, they need a cardiologist since they are having a heart attack.  Referred pain is pain that is perceived at a site adjacent to or at a distance from the site of an injury’s origin.

The cervical facet is a cartilaginous joint that can be a major source of pain. 

The most commomly injured facet  joints are the C5/6 and C6/7 which Lord et. al., clearly demonstrated refer to the shoulder and shoulder blade. 

At the Centeno-Schultz Clinic this diagnosis is established if there is significant pain relief following the injection of local anesthetic and physicologic doses of steroid into the joint. Therapy for cervical facets include stem cell therapy with regeneration of the damaged cartilage.  Regenexx enables a patient to use their own stem cell to regenerate damaged tendons, ligament and cartilage.

The key is to make sure the the source of one’s pain is clearly identified and that all possible sources are considered.  This is the commitement we stand by at the Centeno-Schultz Clinic.

Pain radiating down my arm after shoulder surgery

Pain radiating down the arm after shoulder surgery can and does occur.  The cause of radiating arm pain can arise from the one of many sources:  inappropriate or prolonged positioning, cervical injury or aggravation  and hematoma.  First and foremost the arm is often positioned such that it is hanging and as such may be exposed to a inappropriate or prolonged traction and tension  placed on the shoulder joint.

This can cause an injury to the shoulder joint and or the brachial plexus, a bundle of nerves that cross the first rib and provide sensation and motor function to the arm and hand.

A second cause of pain radiating down the arm is a cervical disc injury or aggravation caused at time of surgery due to positioning.  The patient is put to sleep while resting on their back but are repositioned after they are asleep to optimize the working conditions for the surgery.  The neck, shoulder and arm are all moved.  If particular attention is not directed to the patient during the positioning, a cervical disc may be injured or aggravated.  The result is a pain radiating down the arm (cervical radiculopathy).

Another cause of pain radiating down the arm is a expanding blood clot otherwise known as a hematoma.  If left untreated the hematoma can compress critical blood vessels and nerves with resultant arm pain.

The morale of the story is that surgery and anesthesia are not without significant risks.  Fortunately patients with shoulder dysfunction now have the opportunity to use stem cell therapy to regenerate damaged ligaments, tendons and worn cartilage in the joint without surgery or anesthesia.   Regenexx is a simple needle-in, needle-out procedure which allows patients to use their own stem cells to regenerate damaged joints, lumbar discs and non healing long bone fractures.

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Post rotator cuff surgery physical therapy

Rotator cuff surgery involves repairing one of the four principal muscles of the rotator cuff. Typically this is accomplished through arthroscopy in which the surgeon visualizes and repairs the defect through a small camera.

Sometimes the damaged muscles and ligaments are too extensive and the shoulder has to be cut open.

Rehabiliation post rotater cuff surgery is extensive. The intital phase is one of immobilization during this time muscles begin to loose their tone and strength (atrophy). The joint can also stiffen due to lack of use.

One week post rotator cuff surgery, physical therapy begins with the goal to regain flexibility and strength . For the first twelve weeks emphasis is placed on optimizing the flexibility and range of motion of the shoulder through gentle stretching exercises. Driving is not recommended for the first month after rotator cuff surgery. After three months strengthening exercises are added.

Repairing partially torn tendons or ligaments in the shoulder is now an option using stem cell therapy. Regeneration of worn or damaged cartilage in the shoulder joint is also an option using stem cell therapy. Regenexx enables patients to use their own stem cells to repair damaged tendons, ligaments and cartilage in the shoulder thereby avoiding surgery, anesthesia and the extensive time, energy and expensive of physical therapy.

Please review the testimonial of a patient who had tears in both rotator cuffs who underwent surgery and extensive rehabilitation for the first shoulder but elected stem cell therapy for the other side.

1 inch supraspinatus rotator cuff tear

The rotator cuff is compromised for four principle muscles:  the supraspinatous, teres minor, subscapularis and infraspinatus.  A rotator cuff tear  is usually the result of a sudden powerful raising of the arm against resistance.  Common examples include heavy weightlifting or falling on an outstretched arm.  Acute tears are associated with severe pain often shooting down the arm, limited range of motion and point tenderness at the site injury.

The supraspinatus originates from the scapula (shoulder blade)  and attaches via a  tendon to the humerus.  It functions to stabilize the shoulder joint and enables one to raise their arm in the plane similar to a jumping jack.

Supraspinatus rotator cuff tears are often treated with surgery where the tendon is reinforced and stapled onto the humerus.  The surgery requires rotator cuff rehabilitation which can be painful and extensive. 

Stem cell therapy is now an alternative therapy for partial tears of the rotator cuff.  At Regenexx patients are able to use their own stem cells to repair partial tears in tendons and ligaments.  Regenexx is a simple needle-in, needle-out procedure which enables patients to forgo surgery and the extensive rehabilitative process typically associated with rotator cuff surgery.

Please see images below where a patient used their own stem cells to repair a partial supraspinatus tear.

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Patellofemoral Dysfunction

The patellofemoral compartment is commonly known as the knee cap joint.  The knee cap (patella)  sits on tops of the thigh bone (femur). 

With activity there is movement or tracking of the knee cap along the femoral groove.  If there is misalignment of the knee cap within the femoral groove, the patient experiences pain.

Lateral release is a common surgical treatment for patellofemoral dysfunction  which involves cutting the lateral retinaculum,  the fibrous tissue that supports the kneecap.  

The goal is to release abnormal lateral tension on the knee cap thereby allowing  normal tracking to occur.  Rehabilitation following surgery is extensive  usually requiring 3-5 months of physical therapy.  Unfortunately the body only requires  adjustments in very small increments such as millimeters.  Regrettably surgeons typically make adjustments in centimeters.  The difference is a 10 fold and the result can be an over adjustment with resultant  pain and deterioration of the cartilage.

Once there is loss of cartilage in the patellofemoral joint another surgery is recommended aimed at repairing the cartilage. 

Fortunately regeneration of cartilage in the knee is now available without surgery.  Regenexx enables patients the opportunity to regenerate cartilage by using their own stem cells.  Centeno et. al., have demonstrated cartilage regeneration using stem cell therapy.  Regenexx is a simple needle-in, needle out procedure that avoids surgery and anesthesia.

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Ligament injuries to the elbow

Ligaments are fibrous tissue that connects one bone to another.

There are two ligaments that stabilize  the elbow joint: the ulnar collateral ligament and the radial collateral ligament.

The ulnar collateral ligament is fan shaped.  It is located on the inside of the joint, extending from medial epicondyle of the humerus to the proximal portion of the ulna. It prevents excessive outward rotation of the elbow joint.

The radial collateral ligament is also fan shaped. It is located on the outside of the joint, extending from the lateral epicondyle of the humerus to the head of the radius. It prevents excessive inward rotation of the elbow joint.

Surgical treatment options include ulnar collateral ligament reconstruction sometimes referred to as Tommy John surgery. 

The surgery involves replacing the ulnar collateral ligament with a tendon that is obtained elsewhere in the body. Common sites include the forearm, knee and hamstring.

Alternatives to surgery include stem cell therapy for regeneration of torn elbow ligaments.  Regenexx enables the patient to use their own stem cells to repair damaged or torn tendons and ligaments.

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Tendon Tears and Treatment Options

Tendons are fibrous tissue that attaches muscles to bone.  A strain is an injury of a muscle and or tendon.  In severe strains, the muscle and or tendon are partially or completely ruptured .  A common example is a tear in the rotator cuff.  The rotator cuff is comprised of four principal muscles which stabilize the shoulder joint:   supraspinatus, infraspinatus, teres minor and subscapularis.

What causes strains?   Strains can result from overuse of muscles and tendons, excessive muscle contraction or trauma.  Medications can also cause tendon damage.  Cholesterol lowering medications  called statins have been linked with tendinitis.  Common statins include Lipitor, Lovastatin and Simvastatin(Zocor).

Antibiotics are also been associated with tendon injury. The FDA has issued an warning for those using Fluoroquinolones which include Cipro, Factive, Floxina and Levaquin which have been associated with tendonitis and tendon tears.

If you have sustained tendon tears as a result of medication or trauma,  surgery is not the only alternative.   Regenexx is a novel therapy that utilizes a patients own stem cells to repair damaged tendons.  It is a simple needle-in, needle-out procedure that allows the patients to avoid the risks of surgery and anesthesia.

Please review the testimonial of a patient who had rotator cuff tears in both of her shoulders, who underwent surgery on one side and opted to treat her other tear with stem cell therapy at Regenexx.

 

 

 

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