Surgery Doesn't Have To Be The Only Option

Shoulder Pain

Non-Surgical Shoulder Pain Treatment Options

Shoulder Pain

Why you may not need shoulder surgery: Even with a Bad MRI

Many people that come to see us for shoulder pain will tell us that their doctor has described for them one of the “worst MRIs” they have ever seen.

Yet, some of these people are really not good surgical candidates. How can that be?

The simple reason for some is that the tear is not progressing enough to cause new or significant pain. But a tear still exists on MRI. Should it be operated on?

For appropriate candidates, surgery can be avoided in these conditions:

  • Rotator cuff tendinitis
  • Shoulder Impingement 
  • Shoulder instability
  • Shoulder labrum tear 
  • Shoulder osteoarthritis
  • Frozen shoulder

Treatment Options

Bone marrow aspirate concentrate

In our practice we have found PRP and bone marrow concentrate to be effective and reliable treatments in certain patients for various shoulder ailments. Many people who seek these treatments have already been advised to consider surgery.

Bone marrow concentrate or bone marrow aspirate concentrate is the injection into the damaged, injured area of the shoulder. The injection contains stem cells that have been drawn from the patient’s own bone marrow. These cells are “de-differentiated pluripotent” cells, which mean that they continue to divide to create more cells that can “morph” into the tissue needing repair—for our purposes, collagen needed for cartilage, ligaments, tendons and bone.

Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections

We have published research on the treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow derived stem cells. The research appears in the peer-reviewed journal Cogent Medicine. The study can be found here in its entirety: Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections with a June 20, 2019 publication date.

Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections

Abstract

Background: Human bone marrow has shown promise as a minimally invasive approach in treating a variety of musculoskeletal conditions due to the presence of stem cells, platelets, and growth factors in solution. This study examines the clinical effect of whole bone marrow (WBM) and bone marrow concentrate (BMC) injections in patients who were diagnosed with rotator cuff tears or shoulder osteoarthritis.

Methods: Forty-seven patients and fifty shoulders with rotator cuff tears or shoulder osteoarthritis underwent one or two BMC or WBM treatments. These patients were grouped based on number of treatments and pathology for analysis. The patients who were injected twice received them approximately 22.33 days apart. Outcomes of resting pain, active pain, upper extremity functionality scale and overall improvement percentage were compared to baseline and between groups.

Results: Patients who received either one and two treatments reported significant improvements in resting pain, active pain, and functionality score when compared to baseline. These groups also experienced a 42.25% and 50.17% overall improvement respectively. The group that received two treatments experienced statistically significant improvements in active pain when compared to the group that received one injection. There were no significant outcome differences between RCT and OA patients.

Conclusions: Our study demonstrated that patients diagnosed with shoulder osteoarthritis or rotator cuff tears experienced symptomatic improvements in pain and functionality when injected with BMC or WBM. Further randomized control studies are needed to validate these findings.

PRP treatments are injection treatments. The treatments are derived from your own healing and growth factors found in your blood. The treatment involves collecting a small amount of your blood and concentrating it in a centrifuge to separate the blood platelets from the red blood cells. The collected platelets are then injected back into the injured area of the shoulder to stimulate healing and regeneration to the soft tissue structures that stabilize the spine.

Platelet Rich Plasma Therapy

We have published research on the treatment of shoulder pain with Platelet-Rich Plasma Therapy. The research appears in the peer-reviewed Journal of Orthopaedics Spine and Sports Medicine. The study can be found here in its entirety: Treatment of shoulder pain with Platelet-Rich Plasma Therapy.

Background: Platelet-rich plasma (PRP) is a minimally invasive surgical alternative that uses platelets from a patient’s own blood to heal musculoskeletal conditions. The objective of this study was to report the outcomes of patients with unresolved shoulder pain in response to PRP injections.

Methods: 52 patients and 61 shoulders underwent a series of one through seven PRP injections for unresolved shoulder pain. Patients were separated into three groups based on number of PRP treatments received. Group 1 received 1 treatment, Group 2 received 2 treatments and Group 3 received 3 or more treatments. Patients in Group 2 received a series of treatments 20.22 days apart and patients in Group 3 received treatments 20.00 days apart. Outcomes of resting pain, active pain, upper functionality scale and overall improvement percentage were compared to baseline and between groups. Group 1 reported outcomes a mean 4.79 months after treatment, Group 2 reported outcomes a mean 6.97 months after treatment, and Group 3 reported outcomes a mean 7.38 months after treatment.

Results: Patients who received one treatment experienced significant improvements in active pain and functionality when compared to baseline and also experienced 38.35% total overall improvement. Patients in Groups 2 and 3 experienced significant improvements in resting pain, active pain, and functionality score in addition to experiencing 48.33% and 55.53% total overall improvement respectively.

Conclusions: These results are encouraging and provide evidence that PRP may be an effective treatment modality for un- resolved shoulder pain and warrants further investigation.

Alleviating shoulder pain

Dr. Marc Darrow uses non-surgical methods to treat pain. Bone marrow concentrate and Platelet-Rich Plasma (PRP) therapy have demonstrated significant improvements in shoulder pain. Please contact Dr. Darrow so we can begin our assessment of your candidacy for treatment.