At the Centeno-Schultz Clinic, we understand that a rotator cuff injury can be a game-changer. It can erode your competitive edge and well-being. When physical therapy (PT) doesn’t seem to be helping your rotator cuff heal, this can be concerning as many believe surgery may be their next step. In most cases, however, surgery isn’t necessary. So why isn’t your rotator cuff healing with PT, and what can you do about it? Before I explain, let’s take a look at the rotator cuff.
What You Need to Know About the Rotator Cuff
The rotator cuff is compromised of four muscles and their respective tendons: supraspina tus, infraspinatus, subscapularis, and teres minor. The rotator cuff tendons provide strength and stability during motion of the shoulder. A rotator cuff tear may be associated with pain, instability, and restriction in range of motion. First-line conservative therapies include massage, heat, ice, and physical therapy. In many cases, however, these conservative treatments do not work.
Why? The answer lies in the reduction of local healing stem cells.
Rotator Cuff Tears Associated with Reduction in Stem Cells, the Body’s Natural Healers
Hernigou et al demonstrated that the number of mesenchymal stem cells in patients with rotator cuff tears are reduced. He analyzed the data of 125 patients with symptomatic rotator cuff tear and 75 control patients without rotator cuff injuries. He noted a significant reduction in the MSC content at the tendon-bone interface in those patients with tears as compared to controls. In severe tears, there was greater than 70% reduction in MSC content. Other factors associated with reduced MSC in patients with rotator cuff injuries include lag time from tear to treatment, number of tears, and fatty infiltration stage.
In patients with large or multiple rotator cuff tears, there is a reduction in the number of repair cells (stem cells) to heal the injuries. With fewer repair cells, healing oftentimes is unsuccessful.
If Surgery Isn’t the Answer, What Is?
Is rotator cuff surgery an option when conservative measures fail? Unfortunately, a recent study demonstrated that only half of professional and competitive athletes are able to return to an equivalent level of play after surgical repair. Surgical repair is also associated with a very high incidence of retears.
An effective alternative is bone marrow-derived stem cells. At the Centeno-Schultz Clinic we understand the importance of stem cell therapy in rotator cuff injuries. Through a precise injection of stem cells, we have been able to heal rotator cuff tears and help patients avoid surgery.