Tears in The Rotator Cuff: Articular and Bursal Sided Tears

Stem cell therapy is an alternative to shoulder rotator cuff surgery.

Shoulder surgery is associated with risks.  Extensive rehabilitation is often needed after a rotator cuff repair surgery due to the immobilization needed to help the sewn rotator cuff muscle or tendon to heal.  A recent study demonstrated that less mobilization and faster rehabilitation is better.

Woman have more problems with rotator surgery in part due to differences in stem cell numbers.  Regenexx C is an option that can increase the total number of stem cells at a site of injury.

The rotator cuff is compromised for 4 major muscles and tendons: the supraspinatus, infraspinatus, subscapularis and teres minor.

Most rotator cuff tears involve the supraspinatus tendon.  The anterior aspect of the distal supraspinatus is a common site of injury.  Accurate localization of the tendon tear is essential.  At the Centeno-Schultz Clinic MSK ultrasound and MRI are used to identify rotator cuff injuries.  Most tears are on either  the articular or bursal surface.  This is illustrated below in both longitudinal and  transverse views.

Repair of Rotator Cuff Tear with Stem Cells

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.

Non-Surgical Options to Shoulder Osteoarthritis

JM is 47 y/o athletic patient who had a 1.5 year history of severe shoulder pain and restriction in movement.  He was unable to shave or lift objects from the kitchen cabinet with the affected arm.  MRI was significant for advanced osteoarthritis, degeneration of the labrum and tears in the rotator cuff.  Total joint replacement was the only option presented.  This is a major surgery with extensive rehabilitation and relatively poor outcomes.

Patient elected to undergo a non- surgical stem cell therapy:  the Regenexx procedure. The patient’s own stem cells (autologous) were injected into joint, labrum and rotator cuff tears.  Mesenchymal stem cells have significant repair and regeneration properties. JS made significant improvement after multiple sessions.    13 months after starting the Regenexx procedure, an MRI was obtained for comparison. The most striking changes are below.  The top picture show multiple tears in the supraspinatus tendon identified by the red arrows. The extensive light-colored areas in the tendon represent swelling and tears.  The bottom picture is significant.  It shows significant reduction in rotator cuff tendon swelling  as evidenced by the much improved dark-colored signal in the tendon which is identified by the yellow arrows.  The corresponds with JS’s clinical improvement.  JS was able to avoid a major surgery through the use of his own stem cells.

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.

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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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.