“Shoulder [problems are] a growing concern for the aging population, athletes, and laborers. Shoulder osteoarthritis and rotator cuff disease represent the two most common disorders of the shoulder leading to pain, disability, and degeneration. While research in cartilage regeneration has not yet been translated clinically, the field of shoulder arthroplasty has advanced to the point that joint replacement is an excellent and viable option for a number of pathologic conditions in the shoulder. Rotator cuff disease has been a significant focus of research activity in recent years, as clinicians face the challenge of poor tendon healing and irreversible changes associated with rotator cuff arthropathy. Future treatment modalities involving biologics and tissue engineering hold further promise to improve outcomes for patients suffering from shoulder pathologies.” (1)

The above research makes some interesting comments in regards to the use of surgical procedures for shoulder pain. Surgery is preferred because, cartilage regeneration is not yet a viable option and that poor tendon healing and inflammation make clinical management of the painful shoulder challenging. Both problems that are actually well addressed by Prolotherapy, Platelet Rich Plasma Therapy, and Stem Cell Therapy.

“Although surgical and pharmaceutical interventions are currently available for treating OA, restoration of normal cartilage function has been difficult to achieve. Since the tissue is composed primarily of chondrocytes distributed in a specialized extracellular matrix bed, bone marrow stromal cells (BMSCs), also known as bone marrow-derived ‘mesenchymal stem cells’ or ‘mesenchymal stromal cells’, with inherent chondrogenic differentiation potential appear to be ideally suited for therapeutic use in cartilage regeneration.” (2) Stem cell therapy may be ideally suited for the patient in need of cartilage regeneration.

In another research paper, shoulder surgery was seen as a further complication of rotator cuff disease. “Secondary rotator cuff dysfunction is a recognized complication following shoulder arthroplasty. We hypothesized that the rate of secondary rotator cuff dysfunction would increase with follow-up and result in less satisfactory clinical and radiographic outcomes.” (3) So here, surgery contributed to the second leading cause of shoulder pain, rotator cuff dysfunction.

Osteoarthritis of the shoulder is characterized by the destruction of the protective cartilage in the joint with painful and restricted motion. There is usually a history of trauma to the shoulder or previous surgery. While plain X-rays can confirm the presence of osteoarthritis in the shoulder, the most common unseen culprit to the development of arthritis is chronic ligamentous laxity. Following trauma to the shoulder, such as a fracture, damaged ligaments may go undetected. The excessive play in the joint may result in the development of bone spur, which is the body’s way of reducing joint motion. When a physician tells you that a bone spur is found on X-ray, it almost universally means that there is ligament laxity. The orthopedic surgeon may convince the patient that the spur must be surgically removed. This, however, does nothing to repair the cause of the spur itself. This whole situation can be prevented if proper shoulder management is followed by the treatment of ligamentous injuries with Prolotherapy, because the cause of the spurs is addressed.

In published research on the effectiveness of Prolotherapy, we treated and followed patients with an average of 53 months of chronic shoulder pain, even those whose medical doctors told them there was no other treatment for their pain or that surgery was their only option. These patients reported less pain, stiffness, crunching sensation, disability, depressed and anxious thoughts, medication and other pain therapy usage, as well as improved range of motion, sleep, exercise ability, and activities of daily living.

Again, this included patients who were told there were no other treatment options for their pain or that surgery. (4)

Do you have questions about shoulder pain treatment? Ask us.

References:

1. Killian ML, Cavinatto L, Galatz LM, Thomopoulos S. Recent advances in shoulder research. Arthritis Res Ther. 2012 Jun 15;14(3):214. [Epub ahead of print]

2. Gupta PK, Das AK, Chullikana A, Majumdar AS. Mesenchymal stem cells for cartilage repair in osteoarthritis. Stem Cell Res Ther. 2012 Jul 9;3(4):25. [Epub ahead of print]

3. Young AA, Walch G, Pape G, Gohlke F, Favard L. Secondary rotator cuff dysfunction following total shoulder arthroplasty for primary glenohumeral osteoarthritis: results of a multicenter study with more than five years of follow-up. J Bone Joint Surg Am. 2012 Apr 18;94(8):685-93.

4. Hauser RA, Hauser MA, A Retrospective Study on Hackett-Hemwall Dextrose Prolotherapy for Chronic Shoulder Pain at an Outpatient Charity Clinic in Rural Illinois. Journal of Prolotherapy. 2009;4:205-216.