How to Treat the Shoulder with Stem Cells
Adult adipose stem cells that are harvested from your body are injected into the shoulder joint with x-ray guidance, utilizing local anesthesia. Once inside the shoulder joint, stem cells have the capability to fix cartilage in several ways.
Stem cells excrete various soluble factors which amend tissue microenvironment by:
- Cytokines – controls joint inflammation.
- Growth factors that stimulate repair and restoration of cartilage.
Stem cells can propagate and divide into cartilage cell lines.
Osteoarthritis of Shoulder
Osteoarthritis is also known as degenerative joint disease. This occurs when the cartilage that covers the top of the bones, known as articular cartilage, degenerates or wears down. This causes swelling, joint pain, stiffness, and decreased range of motion. Damage from mechanical stress with insufficient self-repair by joints is believed to be the primary cause of osteoarthritis.
Osteoarthritis most often occurs in people who are over 50. In younger people, osteoarthritis can result from an injury or trauma such as a fractured or dislocated joint. Rarely, osteoarthritis may also be hereditary.
Osteoarthritis of the shoulder is most commonly seen in patients who have experienced shoulder dislocations, fractures involving the humeral head and glenoid portions of the joint, long term strenuous use of the shoulder above the horizontal, and other posttraumatic conditions. The most common initial symptom of shoulder osteoarthritis is joint pain, stiffness, weakness, and loss of shoulder motion. Shoulder cracking, catching, and rarely instability, can develop.
Tendonitis / Tendinosis
Tendinitis refers to inflammation of a tendon, a flexible band of tissue that connects the muscles to the bones. The pull of the muscles is transmitted to the bone by the tendons which allow movement. When the tendons are inflamed and irritated, the pulling action of the muscle is impaired with loss of function of the joint. Symptoms can vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding the joint. With this condition, the pain is usually worse during and after activity, and a tendon and joint area can become stiff the following day, as muscles tighten from the movement of the tendon.
Tendinosis is a chronic injury caused by an accumulation of small tears in the tendon that have failed to heal properly over time. Patients commonly find it almost impossible to keep from restraining the tendon, because even when the pain is gone, the tendon still hasn’t fully healed.
Tendinitis around the shoulder commonly occurs in individuals that frequently require extending the arm overhead, such as individuals involved in sports, and work related activities. This can result in rotator cuff tendinitis with impingement syndrome. This is a condition characterized by pinching or compression of soft tissue such as the rotator cuff tendons and the subacromial bursa between the upper arm bone (humerus), and the roof of the shoulder (acromion), during certain movements of the shoulder, such as arm elevation. Biceps tendinitis is inflammation in the main tendon that attaches the top of the biceps muscle to the shoulder. The most common cause is overuse from certain types of work and sports activities.
Rotator Cuff Injury
A rotator cuff injury can include any type of irritation, overuse, or tear of one or more of the tendons of the four rotator cuff muscles of the shoulder. The tendons of the rotator cuff, not the muscles, are most commonly involved, and of the four, the supraspinatus is most frequently affected. The rotator cuff is responsible for stabilizing the glenohumeral joint, and when shoulder trauma occurs, the functions become compromised.
The most common presentation for rotator cuff injuries or tears is shoulder pain or discomfort. This may occur with activity, particularly shoulder activity above the horizontal position, but may also be present at rest in bed. Pain and restricted movement above the horizontal position may be present, as well as weakness with shoulder motions.
Individuals who perform recurrent lifting and overhead motions are at risk for rotator cuff tears.
People having jobs that involve overhead work, such as carpenters, painters, custodians and servers are at risk of also experiencing a rotator cuff tear. People who play sports that involve overhead motion such as swimming, volleyball, baseball, tennis and football are at greater risk of experiencing a rotator cuff tear.
Bursitis is the inflammation or irritation of a bursa, which is a closed, fluid-filled sac that functions as a cushion, and provides a gliding surface to reduce friction between tissues around joints. Essentially, a bursa provides a slick surface, so that tendons and ligaments can slide across a bony prominence so it doesn’t catch or rub against the bone. The major bursae are located adjacent to tendons around large joints throughout the body.
Once a bursa becomes inflamed, the condition is known as bursitis.
Once a bursa becomes irritated and inflamed, recovery can be surprisingly long, requiring reduction in activity for an extended period of time to allow the person to heal. It can often be difficult or next to impossible to keep from reinjuring the bursa, because it is not possible to stop everything and immobilize the joint entirely. Everyone has demands on them that keep them going, and therefore the normal process of bursitis healing is short-circuited. Thus we continue to irritate the injured bursa prolonging the healing time more and more as we carry out our everyday activities. If bursitis persists and is left untreated, calcium deposits can form within the bursa. These calcium deposits limit range of motion and can lead to permanent joint stiffness and recurrent joint pain.
The diagnosis is primarily based on the person’s signs and symptoms, with the assistance of x-rays and laboratory testing.
Rheumatoid arthritis (RA) is a long-lasting autoimmune disorder that primarily affects joints. It commonly results in warm, swollen, and painful joints. Although most commonly, the wrist and hand are involved, the disease also affects other parts and joints of the body. Although the cause of rheumatoid arthritis is not completely clear, it involves a combination of genetic and environmental factors. The underlying mechanism involves the body’s immune system attacking joints. This affects the underlying bone and cartilage.
RA typically presents with signs of inflammation with the affected joints being swollen, warm, painful and stiff, particularly early in the morning upon awakening, or following prolonged activity. Increased stiffness early in the morning is a prominent feature of this disease, and typically last for more than an hour. As the pathology progresses, the inflammatory activity leads to tendon tethering with erosion and destruction of the joint surface. This ultimately impairs range of movement and can lead to deformity. RA also can involve the skin, lungs, kidneys, heart and vessels, as well as multiple other body systems. RA reduces lifespan an average from 3 to 12 years, but a positive response to treatment may indicate a better prognosis.
RA involving the shoulder causes swelling, pain, and adversely affects range of motion and functional ability to perform everyday tasks. The shoulder joint typically becomes red and hot as well, with progressive shoulder pain and stiffness. Use of disease modifying ant-rheumatic drugs are the primary treatment for shoulder R.A.
A SLAP tear or lesion is an injury to the glenoid labrum, which is a fibro-cartilaginous rim attached around the margin of the glenoid cavity (the socket of the shoulder joint). A SLAP tear occurs when there is damage to the most superior (uppermost) area of the labrum. Tears involving the labrum itself, are also common in individuals performing overhead activities or throwing activities.
Symptoms include dull, throbbing, ache in the shoulder joint brought on by strenuous exertion, or even simple household chores. There may be difficulty sleeping due to shoulder discomfort, as these SLAP and labral lesions decrease the stability of the joint causing the shoulder to drop. Any applied force overhead or pushing directly into the shoulder can result in impingement or tensing sensation.