Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

Are they any closer to using stem cells to repair a torn rotator cuff? I'd like to find a way to regain full use of my shoulder without surgery. Wondering if stem cell research is going to provide the answer.

Answer:

More time, effort, and money is being spent on exploring nontraditional treatment of shoulder arthritis. Nonsurgical, biologic treatment includes the use of medications, injections, cytokines, growth factors, platelet rich plasma, and stem cells. Stem cells are the basic cells that can turn into any other kind of cell, including tendon. Utilizing stem cells to repair damaged tendons by the regeneration of tendon cells in rats and rabbits have shown mixed results. This is one of several biologic treatment tools that may yet be used but much more research is needed before the hows and whats of tendon regeneration via stem cells is ready for human use. Right now, physicians continue to rely on the old standbys to control the painful symptoms of rotator cuff pathology including acetaminophen or Tylenol, nonsteroidal antiinflammatories, and corticosteroids. Studies show that acetaminophen remains a popular choice for relief of mild shoulder pain due to osteoarthritis. Acetaminophen combined with Tramadol (Ultram), a more narcotic-like (stronger pain reliever) is used for patients with severe pain. Nonsteroidal antiinflammatory drugs (NSAIDs) offer better pain relief than acetaminophen but newer studies have shown some problems with rotator cuff tendon healing when taking these medications. NSAIDs seem to help most by improving patients' ability to sleep and participate in physical therapy. The use of oral (by mouth) steroids has fallen out of favor as studies show these medications provide only very short-term improvement in pain. Comparing groups of patients with shoulder pain taking steroids versus a placebo -- 12 weeks later, the placebo group actually had better results. Until stem cell research finds a safe and effective way to use this tool for tendon regeneration, conservative care will remain pharmacologic (medications). If and when that doesn't yield the desired results, then injections may be the next step. Corticosteroid injections directly into a joint offer short-term pain relief, which in turn, gives patients better motion and function. There is some evidence that corticosteroids also reduce inflammation and may work better than nonsteroidal antiinflammatory drugs (NSAIDs) for some causes of shoulder pain (e.g., rotator cuff disease, bursitis). Other types of injections include hyaluronate and botulinum toxin or BOTOX. Hyaluronate increases fluid within the joint and makes motion smoother and easier with less compression and shearing of the joint surfaces. Studies show that hyaluronate is a safe and effective treatment for shoulder osteoarthritis that has not responded to more traditional treatment with medications. However, the FDA has not yet approved hyaluronate for treatment of shoulder osteoarthritis. BOTOX actually paralyzes muscles but also stops pain at the nerve endings. Although BOTOX has not been approved for use with shoulder pain, there appears to be little risk in using this injection therapy. This may be another nontraditional treatment technique for future use. Bringing more tools to the conservative side of treatment for shoulder pain from arthritis is important as more and more younger people are affected by this problem. Pain relief and improved function are the short-term goals. Finding ways to enhance healing of the rotator cuff (especially after surgical repair) remain a challenge for future research studies. Biologic agents such as growth factors, stem cells, pharmacologic agents (or some combination of these) may have a central role in future treatments for shoulder pain but are not widely available at this time. Arya Varthi, et al. Biologic Treatments for Shoulder Pain. In Current Orthopaedic Practice. July/August 2013. Vol. 24. No. 4. Pp. 360-364.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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