Samuel G Oltman, ND, RMSK
Have you stopped playing pickleball or tennis because of shoulder pain? How about swinging your golf club? Or picking up your child or grandchild? Rotator cuff injury can have an enormous impact on your life even if the tissue damage is mild. Surgery is often not a good option for a number of reasons. While physical therapy helps maintain your daily function, you need something to get you over the hump and actually heal. That is where regenerative medicine comes in.
What is the Rotator Cuff?
The term “rotator cuff” refers to a set of 4 distinct tendon-muscle units that begin on the shoulder blade and wrap around the top of the arm bone (the head of the humerus). Together they provide dynamic stability of the shoulder through all movements. There is one tendon in the front of the humeral head, the subscapularis. There are two tendons in the back, the infraspinatus and teres minor. And there is one tendon on the top, the supraspinatus, which is by far the most commonly injured of the 4 tendons.
Rotator Cuff Damage
When these tendons become damaged either through a single big injury or via repetitive use, it can make any use of the arm painful. The damage can range from tendinitis (inflammation of the tendon) to a complete rupture of the tendon (torn fully through). Most patients are somewhere in between. Ultrasound evaluation, like the kind that every patient at Cascade Regenerative Medicine receives, is a highly accurate method of diagnosing the exact issue in the rotator cuff, at a fraction of the cost of an MRI.
Conventional Shoulder Treatment
Physical therapy (PT) remains the appropriate first-line treatment for rotator cuff issues. Strength is a non-negotiable factor in healing. Therapeutic exercise can improve the tendon injury while also providing optimal compensation in the absence of complete healing. This is why I have trusted PT referrals and PTs that work out of our Cascade Regenerative Medicine clinic.
What if you’re strong and physical therapy hasn’t got you to your goal yet? Surgery? While surgery is absolutely a miracle when you need it, it’s a large leap from physical therapy. The downtime is significant and for issues like tendinitis (as opposed to tears) it’s not appropriate much of the time. This is where regenerative medicine comes in.
Regenerative Rotator Cuff Treatment
The use of PRP and/or MFAT for rotator cuff injury bridges the gap between physical therapy not being enough and surgery being too much. These regenerative treatments help to heal the tissue directly through the stimulation of your body’s own healing response. They are injected directly into the problem areas and can result in full healing of the painful area.
I have seen tears heal and become undetectable many times in my own patients, and there is increasing evidence to back this up. In a study from 2020, rotator cuff tears were injected with adipose tissue (the source of our MFAT procedure) and not only was it superior to cortisone injection for pain relief and function, follow up MRIs showed improvement/reversal in the tears.
Similar to the pattern we see in other conditions, cortisone injections can provide short term relief for rotator cuff injury. However, when compared head-to-head with PRP, PRP provides the best long term relief and restoration of shoulder function. This has been validated in multiple studies and in an increasing number of patient cases.
Lastly, the big caveat with any of the above injections is that they should be ultrasound-guided. Ultrasound is highly accurate for diagnosing rotator cuff issues, but is also the way to ensure the injection, whether it’s PRP or MFAT, gets into exactly the right place. If you have a partial tear in your rotator cuff you don’t want PRP injected nearby, you want it precisely in the tear where it can do its work. This is where my RMSK credential set me apart as an expert in ultrasound (read more about RMSK here).
Do not get stuck thinking that you need to be in pain waiting for it to get bad enough to have surgery. Physical therapy is necessary but not always sufficient. Regenerative injection therapies like PRP and MFAT provide a long term, non-surgical route to heal. Stay in the game by contacting Cascade Regenerative Medicine today.
References
Varacallo M, El Bitar Y, Mair SD. Rotator cuff tendonitis. In: StatPearls. StatPearls Publishing; 2023.
Toliopoulos P, Desmeules F, Boudreault J, et al. Efficacy of surgery for rotator cuff tendinopathy: a systematic review. Clin Rheumatol. 2014;33(10):1373-1383.
Hurd JL, Facile TR, Weiss J, et al. Safety and efficacy of treating symptomatic, partial-thickness rotator cuff tears with fresh, uncultured, unmodified, autologous adipose-derived regenerative cells (Ua-adrcs) isolated at the point of care: a prospective, randomized, controlled first-in-human pilot study. J Orthop Surg Res. 2020;15(1):122.
Sari A, Eroglu A. Comparison of ultrasound-guided platelet-rich plasma, prolotherapy, and corticosteroid injections in rotator cuff lesions. J Back Musculoskelet Rehabil. 2020;33(3):387-396.
Jiang X, Zhang H, Wu Q, Chen Y, Jiang T. Comparison of three common shoulder injections for rotator cuff tears: a systematic review and network meta-analysis. J Orthop Surg Res. 2023;18(1):272.
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