Rotator Cuff injuries are the most common cause of shoulder pain with 16 to 34 percent in the general population having shoulder pain enough to seek treatment in their lifetime.
The Rotator Cuff is the name given to the muscles and tendons that surround the shoulder joint which head of your upper arm bone firmly within the shallow socket of the shoulder. The Supraspinatus muscle is strained or torn more often in high intensity type activities, such as throwing a baseball requently.
A rotator cuff injury is usually due to overuse or direct trauma. Rotator Cuff injuries can cause a dull ache in the shoulder, which often worsens when you try to sleep on the involved side. Range of motion is usually limited especially in lifting the arm above the head.
Many MDs recommend steroid injections for the pain, but steroids can delay healing in some cases and mask pain enough to prevent the patient from being careful in movements: this can worsen the tear.
Recently a surgical colleague had a rotator cuff tear and was surprised by the pain relief provided by some external manipulations (ie, intense massaging) given to his muscle area of his shoulder by a DO. It was not a cure but it helped improve his range of motion.
More research is now being done on stem cell injections. While not fully proven in a randomized, controlled, double blinded large scale study, some of the papers below note possible benefits of stem cells injections.
Most studies use:
1. PRP.
2. Amniotic products
3. Bone marrow-derived mesenchymal stem cells (BM-MSCs) and bone marrow aspirate concentrates (BMACs)
4. Adiopose-derived Stem cells with or without use of collagenase.
BM-MSCs and BMACsare good cell sources for use in the repair of damaged structures and have been used to enhance the healing of rotator cuff tears in animal and clinical studies (Reference 1,2). However, in the absence of an adequate scaffold, the survival, reparative capacity, and differentiation capacity of BM-MSCs and BMACs were inadequate to enhance the healing of rotator cuff tears completely (Reference 3,4).
Platelet-rich plasma (PRP) is plasma enriched with platelets that harbor many growth factors and has been used in thousands of patients with rotator cuff tears. PRP has been used as a therapeutic material to promote regeneration and also as a scaffold to enhance the proliferation and multipotency of BMACs. Since studies have been conducted using combinations of PRP with BMACs in settings like diabetic ulcers, osteochondral issues,and spinal cord injury, some surgeons are using PRP PLUS Bone Marrow Aspirate Concentrates with “good success.”
Still many studies have no control group in the rotator cuff tear experiments with which to compare the improvement of symptoms and tear size improvement. However, rotator cuff tears generally do not improve spontaneously, many papers argue. A control group and ideally a control of the other patient’s shoulder with a similar degree of rotator cuff pathology would be the best study.
References:
1 Yokoya S, Mochizuki Y, Natsu K, Omae H, Nagata Y, Ochi M. Rotator cuff regeneration using a bioabsorbable material with bone marrow-derived mesenchymal stem cells in a rabbit model. Am J Sports Med. 2012; 40:1259–68.
2 Kim YS, Lee HJ, Ok JH, Park JS, Kim DW. Survivorship of implanted bone marrow-derived mesenchymal stem cells in acute rotator cuff tear. J Shoulder Elbow Surg. 2013; 22:1037–45.
3 Mora MV, Iban MA, Heredia JD, Laakso RB, Cuellar R, Arranz MG. Stem cell therapy in the management of shoulder rotator cuff disorders. World J Stem Cells 2015; 7:691–9.
4 Kim SJ, Lee SM, Kim JE, Kim SH, Jung Y. Effect of platelet-rich plasma with self-assembled peptide on the rotator cuff tear model in rat. J Tissue Eng Regen Med. 2017; 11(1):77–85.
Cell Transplant. 2017 May 9;26(5):867-878. doi: 10.3727/096368917X694705. Epub 2017 Jan 20.
Effect of Bone Marrow Aspirate Concentrate-Platelet-Rich Plasma on Tendon-Derived Stem Cells and Rotator Cuff Tendon Tear.
Bone marrow aspirate concentrates (BMACs) and platelet-rich plasma (PRP) are good sources to control the differentiation of tendon-derived stem cells (TDSCs), but there has been no study about the effect of the BMAC-PRP complex on TDSCs and tendinopathy. The aim of this study was to investigate the effect of BMAC-PRP on the TDSCs and to find the therapeutic effect of BMAC-PRP on the rotator cuff tendon tear. The chondrogenic and osteogenic potential of TDSCs decreased, but the adipogenic potential of TDSCs revealed no significant difference when they were cocultured with BMAC-PRP. Cell proliferation was significantly greater in TDSCs cocultured with BMAC-PRP than in TDSCs. The degree of wound closure (percentage) was different between TDSCs and TDSCs with BMAC-PRP. There was no significant difference in expression of collagen type I and type III in immunocytochemical staining in the presence of BMAC-PRP. Initial visual analog scale (VAS) score was 5.8 ± 1.9, which changed to 5.0 ± 2.3 at 3 weeks and 2.8 ± 2.3 at 3 months after the BMAC-PRP injection (p < 0.01). The American Shoulder Elbow Surgeon score changed from 39.4 ± 13.0 at baseline to 52.9 ± 22.9 at 3 weeks and 71.8 ± 19.7 at 3 months after the injection (p < 0.01). The initial torn area of the rotator cuff tendon was 30.2 ± 24.5 mm2, and this area was reduced to 22.5 ± 18.9 mm2 at 3 months, but the change was not significant (p > 0.05). The data indicate that BMAC-PRP enhances the proliferation and migration of TDSCs and prevents the aberrant chondrogenic and osteogenic differentiation of TDSCs, which might provide a mechanistic basis for the therapeutic benefits of BMAC-PRP for rotator cuff tendon tear.
