Stem Cell & PRP Treatment of Shoulder
Experience: With thousands of injections performed as part of a prospective study begun in 2010 we are one of the most experienced Orthopaedic Centers in the use of this treatment.
Results : Overall most, but not all, patients show significant benefit. Through statistical analysis of our extensive database we are able to show patients the likely success rate for treatment for their particular disorder and its level of severity. Numerous peer reviewed published research papers have shown beneficial results. Our own internal data has also shown significant benefit. We are preparing several papers for publication to share our extensive experience.
Adverse Events : Although theoretically possible, we have had no infections or significant adverse events.
COST : Neither insurance companies nor medicare pay for PRP or Stem Cell injections. However our out of pocket cost of treatment is among the lowest in the country. We endeavor to make this treatment available to all, not just people of wealth
How PRP & Mesenchymal Stem Cells Work : Platelets and Stem Cells contain growth factors, such as Platelet Derived Growth Factor and Transforming Growth Factor Beta that enhance healing of damaged tissue; and anti-inflammatory cytokines - hormone like substances, such as interleukin 1 receptor antagonist - that decrease inflammation and tissue destruction naturally. They also contain lubricin, a naturally occurring substance that decreases friction in the joint.
How PRP Is Prepared : 40cc of blood (3 teaspoons) of blood is drawn. It is then twice centrifuged to remove red blood cells and then excess plasma to reduce the volume to 4cc of plasma with the platelet count roughly quintupled. Studies have shown this to be in the optimal range for clinical efficacy. The PRP is then treated in the Adilight which has been shown to increase the amount of Interluekin 1 receptor antagonist. Some other single spin techniques do not raise the concentration to this level and may not be as effective. From blood draw to injection the total elapsed time is generally under one hour
How Stem Cells and Fat Are Prepared : The patient lays face down and the posterior iliac crest (a pelvic bone behind the “love handle” area) is steriley cleaned. This bone serves as an attachment point for muscle, but has no weight bearing function. The hip and spine are not involved. A thin needle then injects lidocaine into the skin and the periosteum, the surface of the bone, to numb it. Then a larger needle is tapped into the space between the outer and inner hard bone where a small amount of bone marrow is aspirated. There is little if any pain involved in this process. No sedation is used or needed. Then the patient is turned on their side and a thin cannula is used to inject saline/lidocaine solution into the fat of the love handle and buttock area to numb it and partially liquefy fat. Very little discomfort occurs. Then another thin cannula withdraws a little over a teaspoon of fat generally with no pain at all. This fat is washed, sized, gently centrifuged, and treated with the adilight – all in accordance with FDA regulations – in preparation for injection.
What Is Injected : We have found PRP to be sufficient for tendon injuries. For Shoulder arthritis we inject either PRP or PRP with Stem Cells and Fat
How Injections Are Performed : The area to be injected is numbed superficially with lidocaine. The deeper area, either tendon or the joint, does not have lidocaine injected because there is evidence lidocaine can inhibit efficacy of the injection. Ultrasound is used to guide the injection. Injection of the joint usually produces very little discomfort. Injection of tendon can produce more discomfort.
What To Expect After Injection : Ice on the affected area and Tylenol are sufficient for post injection discomfort in almost all patients. Joints are usually back to baseline in 2 -3 dyas, the rotator cuff tendon usually is back to baseline in 7 – 10 days. Tramadol is prescribed occasionally as needed. Non steroidal anti-inflammatory drugs (nsaid’s) which include, motrin, advil, aleve, meloxicam and diclofenac are avoided due to their anti-healing properties. Aspirin for the heart or circulation is not a problem but is otherwise better avoided.
Patients On ANTI-Coagulants: We are able to inject patients with PRP or Stem Cells who are on Coumadin, Plavix or other anti-coagulants without difficulty and do not recommend stopping them.
What Parts Of The Shoulder Are Injected
- Shoulder (GLENOHUMERAL) Joint: A single injection for arthritis or labrum tear
- Rotator Cuff Tendons: One injection into the top of the tendon, another on the undersurface to bathe the entire tendon with growth factors and cytokines
- Biceps Tendon: One injection into the sheath surrounding the tendon
- A-C (ACROMIOCLAVICULAR) JOINT: One injection into the joint
- Combinations: We often inject two or three areas simultaneously, with minimal discomfort since many patients have damage in multiple areas. In these cases we simply draw 90 cc of blood to produce the larger injectate