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.
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.
Vulcan Shoulder supports are commonly used for dislocated shoulder, frozen shoulder, broken collar bone, and rotator cuff injuries. In concept the neoprene support provides therapeutic heat, support and shoulder pain relief. The compression and warmth can also provide pain relief following shoulder surgery.
How does it work?
The support fastens securely around the shoulder with the Velcro straps to provide support and re-assurance following injury. If the injury is mild and you are of good health and not taking any know toxins to your own stem cells, it is possible for some of these injuries to improve. Unfortunately as we age, the vitality of our stem cells and their ability to mount a successful response to injury declines. The result is continued pain due to incomplete healing. Immobilizing the joint also goes against the finding supported by Sen who demonstrated mechanical stress led mesenchynmal stem cells to change into cartilage and bone as opposed to fat.
At the Centeno-Schultz Clinic we are committed to identifying and correcting the underlying program. Prolotherapy often used successfully to treat rotator cuff injuries, AC joint and shoulder dislocations if damaged has occurred to the supporting ligaments.
A non-surgical alternative for partially torn rotator cuff tendons, dislocation of shoulders and acromio-clavicular injuries is the use of your own stem cells. At Regenexx a patient’s own bone-marrow-derived stem cells are isolated, expanded and then injected exactly into the area of damage under intermittent x-ray guidance.
Intermittent X-ray to ensure accurate placement of MSC
Utilizing your own stem cells (autologous) prevents the transmission of disease.
Please review testimonial of a patient who had bilateral rotator cuff tears who previously underwent surgery on one side and elected stem cell therapy for the other side.
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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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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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.
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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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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