Shoulder Pain and Stem Cell Therapy

By Edward G. Loniewski, DO, FACOS, FAOAO

Three Important Points About Shoulder Pain and Cell Therapy:

1. Some common orthopedic shoulder conditions are due to a natural reduction of stem cells which occur over time.

2. Platelet Rich Plasma (PRP) and bone marrow stem cell therapy can help reduce chronic inflammation and pain.

3. Partial rotator cuff tears, bursitis and tendonitis of the shoulder may respond to cell based therapies either if given alone or with/after surgery.

Shoulder Pain and Cell Therapy

Some of our most mobile and flexible joints tend to also be some of our most frequently injured joints. Your shoulder is an amazing mechanical device. Even sophisticated robotic arms have trouble matching the speed, skill, accuracy and synchronicity of the human shoulder!

However, because of this wonderful fluid movement in many different directions, it is more prone to injury. Almost 4.5 million people in the United States alone see a medical professional regarding shoulder pain each year.

T. A. B. Explains Most Shoulder Pain

Some of the most common shoulder injuries can be memorized with the acronym T. A. B.:

• Tendonitis
• Arthritis
• Bursitis

We also must add in the infamous rotator cuff tears, which are most commonly the result of chronic tendonitis and bursitis.

The cause of these aforementioned conditions is multifactorial. Some researchers and clinicians claim that many shoulder conditions are due to sports, bodily trauma, or even occupation. A handful of studies evaluating specific occupations such as fishing and sports such as baseball have shown a higher risk for the development of certain disorders of the shoulders such as tendonitis[1].

However, other researchers and leading orthopedic surgeons might argue that many shoulder conditions are the result of continual loss of stem cells in and around some of the major bones of the shoulder.

Loss of Stem Cells May Cause Shoulder Pain

As we age, stem cells tend to migrate from the tips of our toes and fingers to the central areas of our bodies. Common areas include the breast bone and pelvis.

One famous researcher measured the number of stem cells in each area of our bodies as we age and discovered that by the time we are about 50 years old, most of the stem cells in our upper extremities have moved to our sternum. In fact, the area of the shoulder where many patients suffer a rotator cuff tear was found to have a significant decrease in stem cells between 30-70%![2]. This research team found that all the patients who had rotator cuff ruptures also had a decrease in stem cells at the area of the injury; thus, a relationship existed between the severity of the tear and degeneration to the number of stem cells.

This same research team also found that replacing the stem cells in this area of the shoulder utilizing a similar method as Cellular Healing resulted in 100% of the repairs augmented with stem cells to heal completely, while only 67% of the repairs without the stem cell therapy. These benefits lasted for an extremely long time.

When researchers followed patients for over 10 years and repeated both MRI and ultrasound tests to these repairs, 87% of the stem cell repairs were still intact, but only 44% of the non-stem cell repairs were intact.[3]

So, we can conclude that rotator cuff injuries seem to be related to a decrease in the number of stem cells, and replacement of these cells seem to help with the repair process and the prevention of future tears.

Cell Therapy and Other Shoulder Conditions:

Shoulder conditions such as tendonitis and partial rotator cuff tears can also respond to cell-based therapies. One study compared Platelet Rich Plasma (PRP) to commonly used corticosteroid injections (also known as steroid or cortisone injections) on partially torn rotator cuffs. They found that PRP was superior in its ability to relieve pain and restore function at 12 weeks after the injection. However, there were no differences at 6 months.[4]

Another uncontrolled study evaluating tendonitis of the biceps found that a single injection of PRP in a small group of 12 patients followed for an average just under four years showed good relief of pain and return of function and strength.[5] In conclusion, PRP can also help some common shoulder conditions even without surgery.

Pain Associated with Cell Therapy for Shoulder Conditions:

Pain associated with cellular therapy is something we take very seriously. To the best of our abilities, we work to reduce the discomfort of this procedure as much as possible and offer many different modalities and options.  I (Dr. Loniewski) have had this procedure done twice, and can personally testify to the safety, comfort and efficacy of this treatment.

Every patient has different pain thresholds and different concerns about medical procedures. For this reason, the staff at Cellular Therapy offers patients a variety of options to experience this procedure. The majority of patients choose to have therapy done in our office while under oral sedatives, narcotics, and a local anesthetic. Many patients have found this multimodal method of pain reduction to be very acceptable; however, if you would prefer to be unconscious for this procedure, this can be done under the care of a board-certified anesthesiologist at a local surgical center for a very reasonable extra cost.

If you would want to have a personal one on one conversation with Dr. Loniewski about your shoulder pain and how cell therapy can help, call 810-299-8552 for an appointment.

Footnotes

1 - van Rijn RM, Huisstede BM, Koes BW, Burdorf A. Associations between work-related factors and specific disorders of the shoulder--a systematic review of the literature.

Scand J Work Environ Health. 2010 May;36(3):189-201. Epub 2010 Jan 22. Review. PubMed [citation] PMID: 20094690

2 - Hernigou P, Merouse G, Duffiet P, Chevalier N, Rouard H. Reduced levels of mesenchymal stem cells at the tendon-bone interface tuberosity in patients with symptomatic rotator cuff tear.

Int Orthop. 2015 Jun;39(6):1219-25. doi: 10.1007/s00264-015-2724-8. Epub 2015 Mar 12. PubMed [citation] PMID: 25757411

3 - Hernigou P, Flouzat Lachaniette CH, Delambre J, Zilber S, Duffiet P, Chevallier N, Rouard H. Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study. Int Orthop. 2014 Sep;38(9):1811-8. doi: 10.1007/s00264-014-2391-1. Epub 2014 Jun 7. PubMed [citation] PMID: 24913770

4 - Shams A1, El-Sayed M2, Gamal O1, Ewes W3. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Eur J Orthop Surg Traumatol. 2016 Dec;26(8):837-842. Epub 2016 Aug 20.

5 - Sanli I1, Morgan B2, van Tilborg F3, Funk L2, Gosens T4. Single injection of platelet-rich plasma (PRP) for the treatment of refractory distal biceps tendonitis: long-term results of a prospective multicenter cohort study. Knee Surg Sports Traumatol Arthrosc. 2016 Jul;24(7):2308-12. doi: 10.1007/s00167-014-3465-8. Epub 2014 Dec 11.

[1] van Rijn RM, Huisstede BM, Koes BW, Burdorf A. Associations between work-related factors and specific disorders of the shoulder--a systematic review of the literature.

Scand J Work Environ Health. 2010 May;36(3):189-201. Epub 2010 Jan 22. Review. PubMed [citation] PMID: 20094690

[2] Hernigou P, Merouse G, Duffiet P, Chevalier N, Rouard H. Reduced levels of mesenchymal stem cells at the tendon-bone interface tuberosity in patients with symptomatic rotator cuff tear.

Int Orthop. 2015 Jun;39(6):1219-25. doi: 10.1007/s00264-015-2724-8. Epub 2015 Mar 12. PubMed [citation] PMID: 25757411

[3] Hernigou P, Flouzat Lachaniette CH, Delambre J, Zilber S, Duffiet P, Chevallier N, Rouard H. Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study. Int Orthop. 2014 Sep;38(9):1811-8. doi: 10.1007/s00264-014-2391-1. Epub 2014 Jun 7. PubMed [citation] PMID: 24913770 [4] Shams A1, El-Sayed M2, Gamal O1, Ewes W3. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Eur J Orthop Surg Traumatol. 2016 Dec;26(8):837-842. Epub 2016 Aug 20.[5] Sanli I1, Morgan B2, van Tilborg F3, Funk L2, Gosens T4. Single injection of platelet-rich plasma (PRP) for the treatment of refractory distal biceps tendonitis: long-term results of a prospective multicenter cohort study. Knee Surg Sports Traumatol Arthrosc. 2016 Jul;24(7):2308-12. doi: 10.1007/s00167-014-3465-8. Epub 2014 Dec 11.