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.

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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Shoulder Joint Tears

The shoulder joint is compromised of three bones: the clavicle (collar bone), the scapula (shoulder blade) and the humerus. The humerus rests in a socket called the glenoid.

The labrum is a soft fibrous tissue rim that surrounds the socket thereby stabilizing the shoulder joint. The labrum is also the site of attachment of several ligaments.

Tears in the labrum can cause pain, catching, locking, popping, grinding, loss of range of motion and weakness.

Labrum tears are located either above (superior) or below (inferior) the middle of the glenoid socket. A tear above the middle of the socket is referred to as a SLAP (superior labrum, anterior to posterior) lesion. It can be associated with tears in the biceps tendon.

Labrum tears below the middle of the glenoid socket are called a Bankart lesion. This lesion can be associated with tears in the inferior glenohumeral ligament.

Treatment typically involves shoulder surgery where the “damaged” labrum is removed and torn tendons are reattached with suture or wires.

Rather than cutting out the torn portion of the labrum why not regenerate it? Patients now how have that option through Regenexx where their own stem cells are injected into the area of damage to regenerate the injured tissue. Regenexx is a simple needle in-needle out procedure.

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