The shoulder joint is more complicated than an average joint. There are many options of treatment for shoulder pain, which can be confusing. We hope we can help with clarifying your possible shoulder pain sources and give you several solutions for shoulder pain treatment.
The shoulder is formed by the interaction of three bones. Two of them are pretty straightforward: the humerus, or long bone of the arm, and the clavicle or collarbone. The third bone, the scapula or shoulder blade, is more unusual: it has triangular blade, two extensions (the acromion and the coracoid process) that form a claw, and a shallow socket on its side, called the glenoid fossa. The humerus connects to the glenoid fossa, and the clavicle connects to one side of the claw, the acromion. The other side fo the claw, the coracoid process, serves as an insertion point for a couple of muscles of the upper arm.
As you can see, this confluence of bones is inherently unstable. This is why the shoulder joint has an intricate stabilizing complex of ligaments, muscles and tendons. These structures not only stabilize the joint, but also act as prime movers of the same joint.
The stabilizing/moving structures you need to understand in relationship with shoulder pain are the ones forming the rotator cuff. The rotator cuff is a collection of four muscles, the supraspinatus, infraspinatus, subscapularis, and teres minor. All four of these muscles start on the back side and wrap around to the front where they attach to the humerus.
Shoulder pain generally comes from either osteoarthritis of the glenohumeral and acromio-clavicular joints ( a disorder of loss of soft tissue in between the bones that form the two joints), or from a rotator cuff injury, which could be as simple as bursitis or tendinitis, or more serious, such as partial or complete tear of one or more tendons.
The first step in addressing shoulder pain is to diagnose the source of pain and extent of injury. We call this anthropometric analysis, and is best done through taking a history, performing a physical examination, and ordering the appropriate radiology tests. If a soft tissue, i.e. rotator cuff injury is suspected and persists beyond the normal natural repair time (3 months), despite physical therapy, chiropractor care, etc, then a MRI is the radiological study of choice for correct diagnosis. Radiological information can be combined with anesthetic injections in the shoulder joints or rotator cuff tendons to establish a correct diagnosis.
The extent of damage is also important in the treatment decision making process. For example, severe glenohumeral joint osteoarthritis (OA) or complete rotator cuff injuries are indications for surgery. However, most of the lesser problems can be treated with a Regenerative Medicine protocol.
When the history and anthropometric analysis are appropriate for regenerative treatment of shoulder pain, the next important decision to be made is what type of regenerative treatment is the best for each individual patient? In this respect, we at Precision Medicine offer a full range of therapies, from dextrose and ozone prolotherapy, platelet rich plasma, bone marrow and adipose derived stem cells, to amniotic fluid, umbilical cord blood, Wharton’s jelly, placental tissues and exosomes. The extent of injury will determine the choice of treatment.
Another important consideration is how and where to deliver the appropriate regenerative cells or growth factors. We use a combination of ultrasound and fluoroscopic imaging for guidance. The anthropometric analysis will also guide our delivery into the shoulder structures. For example, if what we treat primarily is cartilage loss due to OA, we will have to deliver stem cells inside the bone articular surfaces, as well as inside the joints themselves, since cartilage grows from inside the bone and that’s where the stem cells will have their greatest efficacy. If what we treat primarily is a rotator cuff tear, we will deliver the cells precisely in the torn rotator cuff tendon(s).
Finally, regenerative treatment of the shoulder is a comprehensive program that addresses several aspects of patient’s health (in conjunction with the actual injections of stem cells):
This primer will get you started in your journey to make your shoulder pain better. We understand that there are more questions each one of you will have pertaining to your individual case. Customization of care is at the core of Precision (n=1) Medicine, so come in for a conversation!