Case Study: Stem Cell Therapy for Shoulder/Rotator Cuff Repair
The patient is a mid-sixties male who presented with ongoing right shoulder discomfort. He has noticed over time progressive limitations in motion at the level of his right shoulder, with associated pain. A lot of his pain occurs at night. When he is exercising, which he does often, he has decent pain control. However, when he is not exercising and then tries to go throughout his activities of daily living there is pain.
He was seen by two previous medical providers, both of whom suggested shoulder replacement surgery. After evaluation by CROM it was felt that he would be a candidate for regenerative medicine. He does not report any significant neck elbow or wrist pain. He desires reduced pain at night, and improved motion.
Sonographic analysis of the shoulders was performed. A side-to-side comparison was made. Initially, at the left shoulder, the biceps tendon was intact. There were degenerative changes noted at the level of the humeral head. There was a small focal loss of visualization appreciated within the rotator cuff tendon complex. With dynamic motion testing, there was no significant encroachment of the supraspinatus tendon at the anterior/inferior surface of the acromion.
When analyzing the right shoulder, the biceps tendon was quite swollen. There was fraying. There was an area of focal loss of visualization appreciated at the level of the rotator cuff tendon complex. With dynamic motion testing, one could even not gauge encroachment secondary to the patient’s loss of motion. This clearly was secondary to osteoarthritis. There was no subluxating biceps tendon.
Pre-Procedure Evaluation 04/17/2015:
Initial Comprehensive Consultation-Patient’s Perceived Shoulder Function with the Comprehensive Outcomes Management Technology (COMT) Questionnaire
At CROM we track not only the remodeling and regenerative area of the injury, but also the patient’s perspective of their functional gains. We believe that tissue healing should improve the patient’s activity level. The following is the patient’s initial functional questionnaire results. He indicated that his shoulder injury is not allowing him to sleep comfortably, he cannot lift eight pounds, and cannot wash the back of his opposite shoulder.
The patient underwent subsequent follow-up examinations. By July 13, 2015 he is doing great. He scored 11 yeses out of the available 12 questions on the Simple Shoulder Test Questionnaire. One could not get better than this even with a shoulder replacement. He is quite pleased. He wants to move forward with other joints. He is weightlifting better. He has hardly any shoulder pain. He does feel grinding; however, overall, this is “not that bad.”
Clinically, he has minimal crepitation with external/internal rotation with his arm at 90 degrees of abduction. He demonstrates excellent strength. There was excellent thickening within the rotator cuff tendon complex. With extension/internal rotation, there was no fraying or tearing appreciated.