Rotator Cuff Tear TreatmentJanuary 30, 2017 January 30, 2017
Doctors in South Korea say that a combination treatment of bone marrow derived stem cells and platelet rich plasma therapy accelerates tendon repair in tendinopathy, including in the rotator cuff, by stimulating tendon derived stem cells to multiply and repair.1 This is the latest in a line of studies suggesting stem cells can accelerate biological repair of rotator cuff damage.
In another new study, doctors at the University Hospital Bern, Switzerland found:
- Despite advances in surgical reconstruction of chronic rotator cuff tears leading to improved clinical outcomes, failure rates of 13-94% have been reported.
- Using stem cells to biologically augment the reconstruction of the tears might have a great potential since these cells can differentiate into various cell types that are integral for healing.2
Medical studies have shown that the re-tear rate of a surgically repaired shoulder could be anywhere from 20 – 90% depending on the patient circumstance. Recently Australian researchers, presenting at the American Academy of Orthopaedic Surgeons (AAOS) 2012 Annual Meeting (February 2012) reported that the failure rate they measured in 500 patients was 57%.
In approaching five years since this study, not much has changed.
- Doctors in Canada reported that “despite improvements in rotator cuff surgery techniques, re-tear rate remains above 20% and increases with tear severity.”3
- University of Parma in Italy reports: Arthroscopic rotator cuff repair has good results for some, not for others. The rate of tendon healing is 80% in small tears with a decrease to 30% in large and massive tears. 4
What is Torn Rotator Cuff?
Rotator cuff tears are tears of one, or more, of the four tendons of the rotator cuff muscles. Most tears involve the supraspinatus (a relatively small muscle of the upper arm that runs from the scapula (shoulder blade) to the humerus).
Furthermore, other ligaments and tendons in the shoulder (such as the biceps tendon) may become damaged when the rotator cuff is injured.
A tear in the rotator cuff produces pain and also contributes to instability in the shoulder joint. If severe, there may be weakness or an inability to lift the arm. Torn rotator cuffs may happen either acutely – as a result of an injury – or may be degenerative from wear and tear over age.
The most common symptoms of a rotator cuff tear include:
- Pain at rest and at night, particularly if lying on the affected shoulder
- Pain when lifting and lowering the arm or with specific movements
- Weakness when lifting or rotating the arm
- Crepitus or crackling sensation when moving your shoulder in certain positions
Because most rotator cuff tears are largely caused by the normal wear and tear that goes along with aging, people over 40 are at greater risk, as are those who do repetitive lifting or overhead work.
Athletes are especially vulnerable to overuse tears, particularly tennis players and baseball pitchers. Painters, carpenters and others who do overhead work also have a greater chance for tears. In young adults, most torn rotator cuffs are caused by a traumatic injury, like a fall.
While it is commonly believed that MRI is the gold standard for determining injury, a careful physical examination will frequently reveal damage that may not show on an MRI.
Platelet Rich Plasma for Rotator Cuff Tears
There is an amazing amount of research centered on the use of Platelet rich Plasma in accelerating the healing of rotator cuff tears. Please refer to our article on Platelet Rich Plasma Therapy for an understanding of the treatment.
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine: the problem of muscle atrophy with fatty degeneration is often seen in rotator cuff muscles with torn tendons. PRP promotes proliferation of myoblast cells, (cells that make muscles while suppressing fatty degeneration).5
- Department of Orthopaedic Surgery, University of Michigan: Current literature has exhibited that PRP injections are relatively safe and can potentially accelerate or augment the soft tissue healing process. in the treatment of rotator cuff tears.6
- Combined university research lead by Drexel University College of Medicine: The single injection of PRP resulted in safe, significant, sustained improvement of pain, function, and MRI outcomes in the “difficult to treat” Rotator Cuff Tendinopathy patients. 7
- In a recent paper (Sports medicine and arthroscopy review), even after surgical intervention, tendon residual defects or “retears” often develop. Platelet-rich plasma therapy may be able to positively enhance rotator cuff tendon healing. 8
At the Magaziner Center for Wellness, we conduct a thorough physical evaluation to determine the nature and extent of an injury. When pain persists past conventional treatments – and provided the patient is otherwise in good health – we use regenerative orthopedic procedures to naturally repair damage and eliminate related pain. Both treatments are natural and non-surgical.
Additionally, we use innovative manual therapies to realign the shoulder joint to help ensure proper shoulder motion, and also pay careful attention to ligament and joint capsule tissue that is often injured at the time of a rotator cuff tear.
These safe, natural techniques – which have allowed the Magaziner Center for Wellness to help world-famous athletes return to the field, court or ice – continue to gain traction. In fact, combined, the doctors at the Magaziner Center perform thousands of these procedures each year.
Do you have questions about Rotator Cuff Tears?
Contact Dr. Greenberg and Dr. Magaziner via info@DrMagaziner.com or
Call US 856-324-6033
1 Kim SJ, Song DH, Park JW, Park S, Kim SJ. Effect of Bone Marrow Aspirate Concentrate Platelet-Rich Plasma on Tendon Derived Stem Cells and Rotator Cuff Tendon Tear. Cell Transplant. 2017 Jan 20. doi: 10.3727/096368917X694705. [Epub ahead of print]
2 Zumstein MA, Lädermann A, Raniga S, Schär MO. The biology of rotator cuff healing. Orthop Traumatol Surg Res. 2016 Dec 30. pii: S1877-0568(16)30191-8. doi: 10.1016/j.otsr.2016.11.003.
3 Haering D, Blache Y, Raison M, Begon M. Mechanical risk of rotator cuff repair failure during passive movements: A simulation-based study. Clin Biomech (Bristol, Avon). 2015 Dec;30(10):1181-8.
PubMed PMID: 26320977.
4 Di Benedetto P, Di Benedetto ED, Beltrame A, Gisonni R, Cainero V, Causero A. Arthroscopic rotator cuff repair with or without PRP: our experience. Acta Biomed. 2016 Apr 15;87(1 -S):75-83. PubMed
5 Takase F, Inui A, Mifune Y, Sakata R, Muto T, Harada Y, Ueda Y, Kokubu T, Kurosaka M. The effect of platelet-rich plasma on degeneration change of rotator cuff muscles: In vitro and in vivo evaluations. J Orthop Res. 2016 Sep 29. doi: 10.1002/jor.23451. PubMed PMID: 27684960.
7 Scarpone M, Rabago D, Snell E, Demeo P, Ruppert K, Pritchard P, Arbogast G, Wilson JJ, Balzano JF. Effectiveness of Platelet-rich Plasma Injection for Rotator Cuff Tendinopathy: A Prospective Open-label Study. Glob Adv Health Med. 2013 Mar;2(2):26-31. doi: 10.7453/gahmj.2012.054.
8 Barber FA. Platelet-rich plasma for rotator cuff repair. Sports Med Arthrosc. 2013 Dec;21(4):199-205. doi: 10.1097/JSA.0b013e31828a7c6a.