Joint Preservation Blog

January 20, 2009

Rotator Cuff Pain Relief Therapy


rotator cuff pain relief therapy

rotator cuff pain relief therapy

So you’ve torn your rotator cuff, is there such a thing as rotator cuff pain relief therapy without surgery?  Yes.  First the simple stuff.  If you can’t lift your arm, then you’re likely too injured for this particular blog post (more to come).  However, if you just have pain on lifting, then this blog’s for you.  If you’re in this later category, the good news is that you likely have a partial rotator cuff tear, where the muscle is torn, but not through and through.  We frequently use treatment such as IMS to get rid of the muscle knots and help the pain.  This is where a tiny acupuncture needle is used to eliminate painful portions of the muscle (this is very different than traditional Chineese acupuncture where the muscles aren’t treated). In addition, massage therapy of the supraspinatus, infraspinatus, subscapularis, teres, or upper trapezius may help.  Finally, before you consider surgery, look at one of the newer injection based options to heal the tear with less down time.  For example, the patient’s own stem cells can now be injected into the rotator cuff tear under x-ray guidance, so that no surgery is required.  This gets rid of that big blue pillow immobilizer and the long recovery commonly associated with rotator cuff surgery.  You should give your rotator cuff tear a 4-6 weeks to heal and if it’s staying the same, time to get something done.  The big issue you want to avoid is muscle atrophy, so all of this should be performed with rotator cuff exercises.

January 19, 2009

Exercises that Stress the Rotator Cuff

The rotator cuff provides stability to the shoulder.  The most commonly injured muscle of the four muscles that make up the “rotator cuff” (Supraspinatus, Infraspinatus, Teres, Subscapularis) is the supraspinatus.  Exercises that stress the rotator cuff would focus on use of these four muscles more than other surrounding shoulder muscles (like the trapezius).  To stress the supraspinatus, the empty can maneuver is the best way to go.  Place your arm out to the side with the thumb down like you’re pouring out a can of soda.  The arm should be slightly forward.  If you move your arm up and down from the side of your body to just shoulder level, the muscle being stressed is the supraspinatus.  If this is painful and if when you place the thumb up much of the pain goes away, that’s a good indication that your supraspinatus muscle may be torn or injured.  If you can’t do this at all, it may be completely torn and retracted (not connected).  The infraspinatus and teres can be stressed by movements that externally roate the shoulder and arm (if you place your elbow at your side and start with your hand on your stomach and move it out to the side while keeping your elbow tucked in, that’s external rotation).  The subscapularis goes the other way, it brings the hand in with the elbow tucked into the side.  What if exercises won’t heal the problems?  You might consider some of the newer non-surgical methods that use injections of thepatient’s own stem cells to heal the rotator cuff tear.  The recovery times are much shorter and you can avoid the knife!

Nutrition to Heal Rotator Cuff Injury

Nutrition to heal a rotator cuff injury is all about the building blocks for repair and their helpers.  What are the building blocks?  Collagen and GAG’s (hyaluronic acid for instance) are good places to strat.  Foods that are rich in collogen include Jello.  Vitamins that help support collogen include vitamin C.  Other building blocks include glucosamine and chondrotin sulfate, although these are a bit more joint focused.  One of the big problems with rotator cuff repair is often there is limited blood supply to this area, so getting any nutrients to it can be tough.  Activity can help in this process.  Gentle rotator cuff exercises can help.  How do you know if it’s healed?  Take your arm and place it out to your side with the eblow extended and point your thumb to the ground.  This stresses the rotator cuff.  if you can’t do this or it hurts, then it’s not healed.  Is there a way to get it to heal without sugery, yes newer non-surgical procedures are available (click link).

Torn Shoulder Rotator Cuff

Ruth is like many of our patients with a torn shoulder rotator cuff. She’s a health care professional (nurse) who has had the RIGHT rotator cuff treated twice with traditional roator cuff repair surgery. The several month recovery was difficult, the blue pillow immobilization meant that she couldn’t work as an ER nurse. Because of the muscle atrophy (this means that the sutures from the surgery can hurt local muscle cells, causing them to atrophy and die off) she likely experienced with the first RIGHT sided rotator cuff surgery, she had a retear of the same rotator cuff a few years later. The second time she was again off work for several months and unable to earn her salary. Based on her outcome with her first and second surgeries on the RIGHT, when the LEFT rotator cuff tore (while she was transferring a patient as a nurse), she went searching to see if non-surgical alternatives were available. We treated the LEFT by using her MRI to plan our x-ray guided injections of her own mesenchymal stem cells into the tear. It’s should be noted that this time, she remained working and fully active during the procedures. She has had three injections into her torn shoulder rotator cuff with excellent relief of pain and return of full range of motion. Rather than the doctor continuing to tell what happened, best to let the patient tell her own story:

January 6, 2009

recooperation from shoulder surgery

Typical shoulder surgery recovery.

Typical shoulder surgery recovery.

As a doctor, recooperation from shoulder surgery can be tough. The problem is that the severe degree of immobilization that’s needed (that big blue pillow) makes that arm/hand useless. Is there a better way? Well, if you have a rotator cuff tear, newer and much less invasive methods of treatment may be the answer, as with less trauma from the procedure comes quicker recovery times (read no blue pillow). How can this be possible? Trade the scapel for a needle. Rather than trying to sew ligaments back together or sewing a torn rotator cuff tendon, get stem cells to repair the damge. The doctor simply places the cells in the damaged area with an injection. Little trauma, little recovery. Sounds like science fiction? Not really, as this procedure using your own stem cells to repair the damage is now being used reduce recooperation times. No surgery, less recovery. To learn more, click the video below:

August 28, 2008

Rotator Cuff Surgery

Thinking about rotator cuff surgery? What’s done and why? How invasive is this? What’s a doctor’s perspective? Rotator cuff surgery usually involves stiching back together the torn ends of the rotator cuff tendon(s) or muscle(s). This means that the surgeon will open an arthroscopic port and place an arthroscope about the size of a ball point pen into the shoulder joint cavity. Under direct visualization, the torn ends will be brought back together and the repair stitched. Sounds simple? Not so fast. The immobilization needed to allow the stitches to mend the tissue also can cause major atrophy of the rotator cuff muscles (read muscle shrinkage). This is why as doctors, we often see patients after these surgeries who have lost function and don’t seem to return to high level activities. Sure they can use the arm again, but it’s never quite the same.

Is there another way? One of the problems with even a small tear is that the blood supply and resources to heal it are often inadequate. What if you could supply building blocks to aide normal healing and increase the blood supply. One candidate for this is mesenchymal stem cells. These are adult stem cells that can turn into (differentiate into) muscle and tendon cells. They also help orchestrate a repair response by bringing in new blood supply to the area. While this may sound like science fiction, it’s already being done. The Center for Regenerative Medicine will harvest these cells, grow them to bigger numbers in culture, and inject them back into the tear. While large, full thickness tears may not be a candidate for this type of injection based treatment, patients with partial tears are good candidates to avoid rotator cuff surgery.

So how do you avoid the pitfalls of rotator cuff surgery? Just skip the surgery part!

Shoulder Surgery Recovery

As a doctor, because we use our upper extremities for everything, shoulder surgery recovery can be very difficult. Have you seen someone walking around in a sling with a big blue pillow between their arm and chest? Shoulder joint replacement surgery is notorious for a long, painful recovery. Rotator cuff surgery is also a very long and tough recovery, mostly because the stitches placed into the tendon must be kept immobile while the tear heals. So why all this suffering? Is there a better way? This post will explore if shoulder surgery recover from a rotator cuff tear can be shortened and if there is an alternative to shoulder joint replacement surgery.

The rotator cuff is simply a group of muscles that help to stabilize the shoulder. Think of them as the muscles that help keep the ball of the shoulder in it’s shallow joint while allowing for maximum alignment and mobility. When one of these muscles and/or their tendons (like the supraspinatus) gets torn, it’s a big problem. Patients often can’t lift their arm and have pain with any movement. This can be diagnosed on an MRI. If the tear is small, then sometimes it’ll heal on it’s own with therapy. However, many partial and complete tears fail to heal. When this happens, the traditional treatment is simply sewing up the tear and immobilizing the area. This is where the recovery problems begin. Immobilizing the shoulder is tough. Hence the crazy blue pillow shown below:

Typical shoulder surgery recovery.

Typical shoulder surgery recovery.

What happens when you immobilize the muscle for this long? Regrettably, it often causes to atrophy. This means the muscle starts to die off and this atrophy is associated with a poor outcome. How can you get around this atrophy? How about skipping the immobilization? Can you do this? Yes, the Regenexx procedure allows patients with partial rotator cuff tears to shorten their shoulder surgery recovery. Why, because it starts by skipping the surgery step. In this breakthrough procedure, your adult stem cells are injected into the rotator cuff tear under fluoroscopy (real time x-ray). Less trauma to fix the tear means less recovery. In addition, unlike simply sewing the tear and hoping for the best, the joint preservation team at The Center for Regenerative Medicine at the Centeno-Schultz Clinic places repair cells in the tear.

Shoulder Surgery Recovery

Shoulder Surgery Recovery

Check out the MRI pics above. Stem cells placed into the tear helped the tear heal without surgery. So if you want to avoid a lengthy recover with a crazy blue pillow, trade the surgery for a needle!

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