Shoulder and Rotator Cuff Procedure Outcomes

So How is that Shoulder Labrum Stem Cell Patient Doing?

Monday, March 11th, 2013

A few months ago I blogged on a patient who decided to get her own stem cells injected precisely into the tear in her shoulder labrum rather than pursuing surgery. This is a big differentiator for the Regenexx network of physicians, as we only accept physicians who have advanced interventional skills and who can place stem cells through a needle exactly where they need to go. This means that if a doctor doesn’t know the musculoskeletal system like the back of his hand and can’t place stem cells into a very specific spot using x-ray or ultrasound guidance, he won’t make the cut to get into this provider network. So how is that patient with the shoulder labrum tear faring? She’s now 4 months out from a very precise injection of her own stem cells through Dr. Hanson’s expert hands. The video below shows her progress…

It should be noted that not all patients can expect this type of functional recovery after having their shoulder labrum injected.

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Knee Stem Cells and Hiking/Skiing the Highland Bowl in Aspen

Thursday, March 7th, 2013

knee stem cells skiing

We treat many patients who want to be as active as possible as they age without having to get their joints replaced or major surgery.

DW is a 59 year old patient who is a huge propoent of “hot yoga” and frankly could pass for his mid forties. He has been treated with the Regenexx-SCP procedure in his shoulder and ankle as well as the Regenexx-C procedure for his left knee. His left knee has a bad ACL graft from an old surgery, meniscus tears, and moderate to severe patella-femoral (kneecap) arthritis. For the last few years he’s wanted to ski the Highland Bowl in Aspen (picture above), but his knee has prevented that from happening. While not all Regenexx-C patients will ever be able to do this, this is what he recently wrote me:

“The top of the lift is just off to the right of the picture below.  Then you hike up the ridge for about 30 minutes to get to the peak (12,392 ft).  Then it’s a wonderful 15 minute ski down to the bottom.  I’ve been wanting to do this since I first started going to Aspen 6 years ago.  My knee felt good all the way up and all the way down!”

His picture at the top is below! DW will be coming back for a second treatment of his knee and hopefully we can keep him skiing 50 plus days a season over the next decade!

NOTE: RegenexxCayman is an independently owned and operated medical services provider operating exclusively in the Cayman Islands and is not part of or affiliated with the Centeno-Schultz Clinic or any U.S. Regenexx Network provider. The Regenexx-C procedure licensed by RegenexxCayman is not approved by the U.S. FDA for use in the United States.

skiing knee stem cells

 

Not all patients should expect to be able to ski this run after receiving Regenexx knee stem cell injections!

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A Frozen Shoulder Surgery Alternative Treatment: MUA plus Platelet Lysate

Saturday, February 23rd, 2013

frozen shoulder surgery alternative treatment

Is there a frozen shoulder surgery alternative treatment? A frozen shoulder (a.k.a. Adhesive Capsulitis) is a tough problem. Nobody knows for sure what causes it, yet it can turn a fully functional shoulder into one that can’t move at all in a matter of months. This was the case with a recent long standing patient of mine, who I had seen for other problems. She came in about 6 months ago with her left shoulder completely frozen (no range of motion in almost all directions). Frozen shoulder is often treated with either physical therapy (which she had tried and failed), MUA (Manipulation under Anesthesia), or open surgery where the scarred down joint capsule is cut with a scalpel. MUA is where the doctor puts the patient asleep and then performs aggressive range of motion to free the scarred down portions of the shoulder capsule (the thick leathery covering of the joint that allows normal motion). Through the years I’ve treated about 20 patients with MUA, but have always been disappointed with the results. Basically, all of these patients get some range of motion back, but within weeks the frozen shoulder gets “refrozen”. One of the reasons may be that these MUA procedures often use high dose steroids and anesthetics that are harmful to cartilage, but potent anti-inflammatories. In effect, in my opinion, as soon as these sledgehammer anti-inflammatories wear out, the joint goes back to where it started.

Frozen shoulder treatment with Regenexx-PL

This time I decided to try it differently. Rather than putting in these toxic steroid and anesthetic drugs, I substituted platelet lysate (Regenexx-PL procedure). After 4 MUA procedures with PL, the results are above. Her left shoulder has almost 100% normal range of motion back. Why do I think this worked this time? Rather than putting in drugs that are toxic to the shoulder (essentially making it sicker with each MUA), we placed the healing growth factors from her own blood platelets into the joint.  This is just one patient, but I’m encouraged that this tweak of an existing technique may help other patients get back normal range of motion.

Not all patients treated with PL and MUA should expect to get return of full range of motion!

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Shoulder Cartilage Regeneration with Stem Cells in Philly

Wednesday, November 7th, 2012

shoulder stem cellsWe’re proud of our Regenexx network providers, who have been trained to perform the Regenexx-SD procedures among others. Recently a patient with significant shoulder arthritis was seen by Brian Shiple, our network provider in Philadelphia. The patient was injected with his own stem cells into the large shoulder joint as well as into the shoulder capsule and rotator cuff. A post-op MRI was taken with the above impressive results-”interval regeneration involving 50% of the cartilage thickness in the superior medial humeral head”. Can all patients with shoulder arthritis expect to get such cartilage regeneration or any regeneration of cartilage? No. In fact, we often see great long term improvements in pain and function without any evidence of cartilage regeneration. Dr. Shiple commented that he’d never seen a radiologist read out an MRI report with the word “regeneration”. As cellular therapies and interventional orthopedics get increasingly more sophisticated, we should all expect to see this term more and more.

NOTE:  Regenexx-SD is a medical procedure and like all medical procedures has a success and failure rate.  Not all Regenexx-SD patients can expect to experience regeneration of cartilage.

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Update on Chondrolysis Patient and Stem cells

Wednesday, April 4th, 2012

shoulder chondrolysis treatment

I blogged on KH about 2 months ago. He’s a 38 year old male with the great misfortune of having the cartilage in his shoulder joint dissolved by a pain pump during a labral repair surgery. He came in with a destabilized AC joint from the initial surgery, so our first goal was to stabilize that joint through injections. The next issue was his lost cartilage, and based on the severity of the cartilage loss in chondrolysis patients, I wasn’t optimistic, but based on his great initial response we agreed to try a Regenexx-SD injection. He’s now about 6 weeks out from that procedure and feels dramatically better since we placed his own concentrated stem cells into the shoulder joint. The biggest testimony is that he just spent his whole weekend digging out a sprinkler system in his yard, now with only minimal next day soreness. What’s amazing is that he came to us not being able to lift a gallon of milk out of the refrigerator and being told that he needed an immediate shoulder joint replacement! We’re happy to see KH is doing well and is now able to do things like lift his 5 year old girl and use his shoulder more like a healthy young man. While we couldn’t guarantee this result to all chrondolysis patients, we’re encouraged.

NOTE:  Regenexx-SD is a medical procedure and like all medical procedures has a success and failure rate.  Not all Regenexx-SD patients experience the same results.

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4 Year Follow-up on Stem cell Treatment for Shoulder Rotator Cuff

Tuesday, February 21st, 2012

shoulder stem cells

We always get asked by patients how long we think the effects of a shoulder stem cell injection can last. One of the advantages of the Regenexx stem cell procedures is the long-term follow-up on our patients when these specific stem cell treatment protocols are used. AB is now 82 year old woman who we treated 4 years ago for severe rotator cuff tendinitis with partial tears in the rotator cuff. At three months out her MRI showed significant improvement and at two years out her shoulder was significantly improved as well. So did it last? I just saw her in clinic for another unrelated issue and had the opportunity to examine her shoulder. She still has no shoulder complaints and the physical examination on that shoulder is indistinguishable from the good side. The upshot? This is an elderly woman treated with the Regenexx-C stem cell injection procedure instead of more invasive and risky shoulder surgery. While not every Regenexx-C patient experiences the same results, she’s had a durable effect and is still very happy about the result at four years out.

NOTE:  The Regenexx-C procedure licensed by RegenexxCayman is not approved by the U.S. FDA for use in the United States.  RegenexxCayman is an independently owned and operated medical services provider operating exclusively in the Cayman Islands and is not part of or affiliated with the Centeno-Schultz Clinic or any U.S. Regenexx Network provider.

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Saving a Young Man’s Damaged Shoulder with Interventional Orthopedics

Friday, February 10th, 2012

shoulder chondrolysis treatment

KH is a 38 year old male whose shoulder problems began with a labral tear in 2004. He had surgery for the labral tear and they used a pain pump, which dissolved his cartilage (chondrolysis). He ultimately went to see another surgeon who told him he needed a shoulder replacement. When he was first evaluated in September of 2011, he felt his shoulder was unstable. This made sense, as they had performed a distal clavicle resection when they operated on his labral tear, a surgery that often leaves the shoulder unstable. He was getting pain from the shoulder up to his neck and had significant pain at rest, with nothing that would totally relive his pain which could be as high as an 8/10. While it was clear he had no cartilage and our only other option outside of shoulder replacement would be a Regenexx-SD or Regenexx-C shoulder stem cell procedure, more importantly, just fixing the obvious joint problem (if that were even possible-not certain due to the severe cartilage loss) may not solve his disability. This was because another key issue in the shoulder was also severe instability. Our interventional orthopedics philosphy (read Orthopedics 2.0 our practice’s book how interventional orthopedics will change musculoskeletal care) required that we first deal with the instability before using stem cells. This is because putting stem cells or any other biologic into an unstable shoulder joint is like putting new tires on a car with a wobbly rim, the tires will just quickly wear out again. As a result, I began using proliferant injections under ultrasound guidance into what was left of his coraco-acromial ligaments, AC joint capsule, and posterior inferior glenohumeral ligament. After four of those treatments plus cleaning up the trigger points in the neck and shoulder, his pain is way down and his function is way up. As an example, we recently had two feet a snow here and he was dreading having to shovel it, because he knew from experience that shoveling snow would put his shoulder out of commission for a week. After we stabilized the shoulder through injections, he shoveled the snow and while he felt sore that night, the shoulder felt fine the next morning. Now that the shoulder is stable, we can move onto step 2, trying to help the joint cartilage. While we’re just halfway through his treatment, he’s a good example of why an interventional orthopedics approach makes sense. Rather than “blindly injecting magic stem cells” into the joint and hoping the pixie dust works, understanding the biomechanics of why the shoulder hurts is as important as any stem cell therapy.

NOTE:  Proliferent injections are a medical procedure, and like all medical procedures have a success and failure rate.  Not everyone will experience the same results.

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