Rotator Cuff Tears: Non-Surgical Treatment Options

The rotator cuff is compromised of 4 major muscles and tendons that act collectively to stabilize the shoulder joint.

The four muscles include the supraspinatus, infraspinatus, subscapularis and teres minor.  Tendons are the fibrous portion of the muscle that anchors the muscle to bone.  This fibrous anchor can be inflamed resulting in a tendinitis or can be  chronically degenerative resulting in tendinosis.  The one of  4 muscles can have a partial or full thickness tear.

At the Centeno-Schultz Clinic ultrasound is utilized to determine the source of pain.  The pain may arise from a tear in one or more of the four rotator cuff muscles or inflammation or degenerative changes in the fibrous tendon anchor. Other explanations exist which will be discussed in another blog.

Rotator cuff tears can be treated with Regenexx SD whereby a patient uses their own mesencymal stem cells.  Tendinosis  can be treated with Regenexx SCP.

The Regenexx family of procedures represent the highest quality stem cell therapy with the largest number of stem cell treatment options in one clinic and which are ICMS certified.

Another Success: Treatment of Supraspinatus Tear with Stem Cells

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.

Studies Showing Rotator Cuff Tears

Patients with shoulder pain unresponsive to conservative therapy often are prescribed radiographic studies for further evaluation.  X-rays can not reveal rotator cuff tears , since tendons are compromised of soft tissue and not bone.    X-rays evaluate bone.

Another diagnostic modality is ultrasonography, which does not expose the patient to radiation and is less costly than MRI studies.   Teefey  demonstrated  that when ultrasonography and magnetic resonance imaging studies are read by radiologists with comparable experience,  they have comparable accuracy for identifying rotator cuff tears.

What if the study is abnormal?  Tempelhof  examined the prevalence of rotator cuff tears in patients WITHOUT shoulder pain.  He evaluated 411 volunteers and divided them into four age groups.   51% of the volunteers who were older than 80 years of age  had a tear in the rotator cuff, yet no pain.   The authors concluded that rotator cuff tears are present in patients without shoulder pain and increase in prevalence with age.

The key is to have a thorough history and physical examination.  Radiographic studies should be used in conjunction with the examination to accurately determine the source of pain.  At the Centeno-Schultz Clinic we are committed to this standard. There are many therapies for rotator cuff tears which include prolotherapy and stem cell therapy.  Utilizing a novel technique, patients are able to use their own stem cells to regenerate torn or damaged ligaments, tendons and cartilage.

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Rotator Cuff Signs: Empty Can Test

The supraspinatus is the most commonly injured rotator cuff  muscle.  It originates from the shoulder blade passes laterally beneath acromion and attaches onto the humerus.

The supraspinatus  stabilizes the shoulder joint and allows one to raise their arm in a plane similar to a jumping jack.

The empty can test assesses the supraspinatus for instability and the presence of tears.  The test is conducted as follows:

The patient raises his arm to 90 degrees and angles the arm forward 30 degrees at the shoulder joint.  The shoulder is then internally rotated as if pouring a can on the floor.  Resistance is applied looking for weakness or pain. The test is positive if there is significant pain or weakness or resistance.

Rotator cuff tears which do not response to physical therapy can be treated with expanded stem cells.  At Regenexx patients use their own stem cells to repair damaged tendons, ligaments, bones and cartilage.

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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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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Rehabilitation from Shoulder Surgery

Patients with tears in the labrum, biceps tendon and inferior glenohumeral ligament often undergone surgery. Tears to the labrum, the fibrous tissue that surrounds the glenoid socket, involve cutting and removing the damaged tissue. If the tendon is torn it is commonly reattached using absorbable tacks, wires, or sutures.

Rehabilitation can be slow and painful.  After surgery the shoulder is immobilized in a sling for 3 to 4 weeks. During this time there can be loss of muscle strength and tone. Physical therapy aims to restore flexibility and muscle strength which requires weeks of therapy and time.

Ligaments, tendons and the labrum can be repaired using cell stem therapy. Regenexx enables patients to use their own stem cells to repair injuries in the shoulder. Regenexx is a simple needle in-needle out procedure which allows the patient to avoid the risks associated with surgery, anesthesia and the time consuming and painful rehabilitative process associated with surgical options.

To see how stem cell therapy can be used for rotator cuff tears please click video.

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Recovery Time From Shoulder Surgery

Recovery time from shoulder surgery varies on the type of surgery performed.  The shoulder is a complex joint made up of ligaments, muscles and cartilage. 

 

 

 

 

 The major muscles are the supraspinatous, infraspinatus, teres minor and the subscapularis, which together comprise the rotator cuff.

 

 

Ligaments are the fibrous tissue that connects bone to other bone.

Recovery time from shoulder surgeryis dependent upon the type of surgery.  Rotator cuff surgery involves cutting one or more of the references muslces and reattaching them.

In patients with loss of shoulder cartilage the surgical options include humeral hemiarthroplasty and total joint replacement.

In all cases there is a significant amount of immobilization which can result in muscle weakness and atrophy. 

 Rehabilitation is aimed at re-strengthening the weakened muscles and restoring function.  Unfortunately this can be a long and painful process.

Patients that have a rotator cuff tear or ligament tear now have an alternative to shoulder surgery and the extensive recovery time.  At Regenexx, a patient’s own stem cells are utilized to repair the damaged muscle or ligament.  It is a simple needle in, needle out procedure that does not expose the patient to the inherent risks of surgery or anesthesia.  The stem cells are placed under x-ray guidance into the area of damage.  This simple needle procedure can replace the scalpel and avoid theextensive recovery time from shoulder surgery.

Please click testimonal of a patient what underwent successfull repair of torn rotator cuff following a failed surgery.

reovery time shoulder surgery.Regenexx. alternatives to shoulder surgery.

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