An Alternative to Shoulder Surgery

The highly mobile shoulder joint is a combination of bones, ligaments, and tendons, enabling a wide range of motion.

The shoulder has three bones, namely:

• • scapula (shoulder blade) 
  • clavicle (collar bone)
  • humerus (arm bone)

There are four joints, such as:

• • sternoclavicular joint (at the centre of the chest that allows clavicular movement)
  • acromioclavicular joint (the point where scapula meets the clavicle that allows raising of arms) 
  • glenohumeral joint (a ball and socket joint where the arm and back movements start)
  • scapulothoracic joint (attaches bone to soft tissue)

Three more structures included in the anatomy of the shoulder are:

• • rotator cuff (a collection of muscles as well as tendons around the shoulder joint to allow support and the full range of motion) 
  • bursa (a small sac of fluid that cushions the tendons of the rotator cuff)
  • labrum (a cuff of cartilage for the humerus to stabilize the ball and socket joint, and prevent shoulder dislocation)

As people use their shoulder joints very often for mobility, they are prone to shoulder injuries. Either accidental trauma or overuse of your shoulder joint area leads to a tear on muscle, tendon or labrum which may be partial or complete. 

The common shoulder injuries are:

• • Frozen shoulder
  • Shoulder dislocation 
  • Shoulder fracture
  • AC shoulder joint injury 
  • Shoulder joint arthritis/osteoarthritis
  • Shoulder impingement syndrome
  • Rotator cuff tear
  • Tendonitis of the rotator cuff
  • Labral and SLAP tears/degeneration
  • Shoulder joint bursitis
  • Thoracic outlet syndrome

You may have common symptoms such as pain while moving your arm, weakness, stiffness, clicking or popping sensation, as well as numbness or burning sensation. 

Your physician can diagnose the shoulder injury by physically examining your shoulders for noticeable signs of injury. You will undergo range-of-motion tests to check the mobility of your joints. Further, your physician may opt for an X-ray, MRI and Electromyography (EMG) test to determine the severity of the injury.

The conventional treatment for shoulder issues includes non-surgical procedures and surgical procedures to improve the strength and function of shoulder joints by controlling the symptoms and avoid further joint damage. Non-surgical procedures include R.I.C.E. Formula (Rest, Ice, Compression, Elevation), activity modification, and physical therapy. Administration of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections provide short-term relief, but they have systemic and local adverse side effects.

Lastly, your doctor may recommend shoulder arthroscopy to treat some of the shoulder injuries. In the case of osteoarthritis, your doctor may recommend arthroplasty (shoulder joint replacement) surgery. But they have a few disadvantages:

1. 1. You will be undergoing a prolonged post-surgical recovery period for 6-12 months. During this time, you may experience pain, discomfort, and swelling in your shoulder [1].
   2. Passive early rehabilitation exercises may also contribute to re-tear [2].
   3. Moreover, a considerable proportion of arthroscopic surgeries do not heal your shoulder properly. It is because your body is unable to use paracrine cell communication to engage circulating regenerative cells of your body towards your shoulder for starting the natural cell restoration cycle. This condition leads to a lack of strength and a weak range of motion, though there is a chance of improvement in function [3]. 
   4. Younger patients who are likely to receive shoulder arthroplasty are prone to undergo a second or revision surgery [4].
   5. Although joint replacement may remain as a treatment option for osteoarthritis condition, there are patients with continuing pain and an increased rate of bone erosion and weakness after 10 years [5].
   6. In the case of rotator cuff/labral tears, the size, progression, and type of the tear play a significant role before opting for arthroscopy. Surgery is advised based on medical history and physical examination. Just an MRI test is not at all considered as the “gold” standard since it is often misleading [6].
   7. Administration of cortisone injections before surgery can cause complications after surgery leading to a huge risk for the need of second surgery [7].

So slowly, the wheels of medicine are changing. Fortunately, regenerative cellular therapies have evolved as an alternative to shoulder surgery. 

The motto of regenerative therapy is your body can heal by itself. If you cut your finger, it bleeds and forms a scab like structure. Ultimately, it is the healing cell beneath the scab that seals the injury and stop the bleeding. Similarly, your body can also examine the signs of damage and repair them using its healing cells. 

Regenerative treatment is a non-surgical procedure that provides long-lasting relief from the symptoms with minimal downtime and enhances recovery within a short period. It has no side effects since the injection involves your blood or regenerative cells harvested from your body. So, there is no chance of rejection or cross-transmission of disease.

Regenerative cellular therapy for cartilage regeneration is the right approach for shoulder joint preservation and acts as an alternative to shoulder replacement. Regenerative treatment can repair cartilage defects and soft tissue injury in the shoulder before it causes osteoarthritis [8]. A research journal published in 2017 revealed that the application of mesenchymal cells and varied growth factors can be a promising approach to enhance the repair of damaged cells [9]. Another research study published in 2019 revealed that bone marrow concentrates can treat shoulder osteoarthritis and rotator cuff tears with symptomatic improvement in pain and functionality [10].

A 2018 research study showed that PRP and bone marrow aspirate can significantly reduce pain and improve shoulder function in patients compared to surgical interventions [11].

Prolotherapy can effectively treat rotator cuff injuries, AC joint injury, tendonitis, labral tears, and shoulder instability. Dextrose prolotherapy can reduce pain, improve shoulder functioning, and enhance patient satisfaction [12].