[jtwrace]

A very good friend of mine has torn his rotator cuff.  Has anyone had Prolotherapy done here?  The poor guy is in a very bad position as he uses his hands everyday for his work.  He's very nervous that he may loose his business if he stops (12 wk recovery) so he's looking at alternative medicine. 

http://www.getprolo.com
http://en.wikipedia.org/wiki/Prolotherapy

With rotator cuff surgery only ~35% successful (age and other factors) he figures why not try. 

Anyone? 

[golfugh]

Haven't had prolotherapy, but I did receive a series of 3 cortisone shots for a torn right rotator cuff vice surgery (my choice).  Did it help?  Yes, but recovery still takes a long time.  Full use without pain was almost a year.

Within about a week I could use the arm for all functions, but pain persisted for quite a while.

[thunderbrick]

I know several guys who have had the surgery and came out as good as new, including my brother.  I was diagnosed with a rotator cuff tear four years ago, and had been taking the shots with good success.  I recently decided to go in for surgery and scheduled it for last Monday, but stupid insurance company fouled things up.

I haven't heard of any bad results, and I ask everyone I know that has had it.  Among other things I am a wedding photographer, so I have to schedule surgeries around those obligations.

[jtwrace]

Looking at this now...

http://www.regenexx.com/

[Stu Pitt]

I'm an Athletic Trainer (sports med, not personal trainer), so I have a little insight on the topic...

The severity of the tear will dictate if just rehab will be successful vs if surgery is indicated.  Near complete to complete tears need surgery to heal.  They don't heal themselves.  I've seen a lot of people try to get around it, but in the end they ended up getting surgery.   

If the tear is severe, it causes a few other issues.  Most commonly, a bone spur develops where the Suparspinatus muscle sits (supraspinatus is the muscle most often torn in the rotator cuff).  Add a bone spur sticking into a damaged muscle, and you've got significantly more pain.  Adding cortisone to the area repeatedly breaks down healthy tissue, further weakening the area.

I'm not a surgeon, and if I was I couldn't tell if anyone needs surgery over a forum.  I've seen the injury more than enough times to know that if surgery is indicated, it should be done as soon as the surgeon says the patient is ready.  Far less problems in the short term and the long term IMO.

Some injuries can be rehabbed, and some need surgical repair.  The rotator cuff, along with the ACL and meniscus in the knee are the most obvious injuries that do not heal without surgery in my experience. 

Everyone's life situations and circumstances are different.  I'm not saying anyone is stupid for electing to not get surgery.  Just make sure the benefits of not getting it outweigh the consequences. 

[Turk]

Having torn multiple cuff tendons and having impingement, calcium deposits and a detached bicep tendon I can empathize. A total of 5 hours of surgery on two occasions fixed what could be fixed. I agree every situation needs to be evaluated.  Get an MRI as soon as possible.  Physical exams can only tell so much.  After the MRI consult with the orthopedist about the best treatment.  I had 3 complete tears they never healed and the result was damage to the shoulder joint as the RC stabilizes the joint.   

Also, if it is bad enough, the mechanics of your shoulder motion will change as other muscles take over a job they were not designed for and at the same time other critical  shoulder muscles can atrophy and not be brought back.  I also ended up in that situation.

I would not worry about alternative treatments until you have a complete diagnosis.

Good luck,
jerry

[groovybassist]

Not to jump on the bandwagon here, but I have a torn labrum in my left shoulder.  I injured it over 10 years ago and at the time it was mis-diagnosed as bursitis/impingement.  I went through physical therapy, cortisone shots, trigger-point injections, massage therapy, etc. and over that time, the rest of my shoulder structure began compensating for this mis-identified injury.

Where am I now?  After I could barely move my arm a couple of years ago, an MRI revealed the torn labrum, but my shoulder is stable due to the compensations I've developed over the years.  I had arthroscopic surgery to clean up the joint and it's better now, but will never be 100% and I have some kind of pain in it every day.

The moral of the story:  Don't fool around with the shoulder!  It's a complex joint and really helps your everyday life.  I would work hard to be sure I'm confident in the diagnosis and do what needs to be done to fix it.  Had my situation been identified correctly when I injured it originally, it could've been fixed.  Now it's too late.

[Turk]

Ditto.  My injury was 18 years old and had been misdiagnosed due to the HMO's failure to provide an MRI and my being too trusting.  The damage only worsened and became more extensive over time.  I am 60 and had surgery done 4 years ago.  moral: Get an MRI and have good shoulders.

[Stu Pitt]

I have no idea how these things go misdiagnosed.  Please don't take that like I think I'm better than the physicians who treated you, but I just don't get it.  There's very specific special tests that are routine in a clinical exam.  by special tests, I mean physical exam tests, not imaging.

The empty can test (aka supraspinatus test) and O'Brien's test should be done on everyone with any shoulder pain.  It's impossible to not have significant weakness in an empty can test when the rotator cuff has any deficiencies.  O'Brien's test and a follow up clunk test are pretty much fool proof too.  Anyone with any orthopeadic experience knows these tests and they're more or less the first ones done.  I guess general practicioners who have about a semester of orthopeadic training during the absurd courseload they have in med school tend to forget the special tests.

Most orthopeadic surgeons don't need an MRI to know what's damaged.  They use it to see the exact extent of the damage and the specific location, and use that along with functional testing to determine if surgery is needed, and which procedure would be best.

Were you guys seeing Orthopeadists, or were they general practicioners?  I hate 99% of the GPs out there.  They think they can treat anything and hate referring people out to a specialist.  I think referals are a blow to their ego. 

Here's a similar one...

My brother had severe carpal tunnel syndrome.  His hands were atrophied beyond belief.  He waited and waited to see his GP who told him to wear a brace for 6 months and see how it goes.  We live 3 hours away from each other, so I didn't get a chance to see it until it was too late.  I sent him back to his GP and told him to ask for a hand specialist referral.  He went, and the GP told him I don't know what I'm talking about and he didn't need a referral.  I told my brother to go back and tell his doctor if he doesn't give you a referral, you'll find another doctor.  The guy belittled my brother and finally wrote a referral. 

I got him an appointment with the head of orthopeadic surgery at a teaching hospital.  The surgeon, who's a friend of mine, instantly said he needed surgery ASAP.  Didn't even need to touch him to know how bad it was (not that he didn't do a full evaluation).  No amount of rehab or bracing was going to help.

At the end of the day, everyone's responsible to make sure their doctor isn't messing up.  The only problem with that is how do you really know if they're doing the right thing or not?  Luckily, I know and work with some excellent physicians.  One of which was on Dr. Oz a few weeks ago.  Not everyone does, which really sucks.

[morganc]

Hey guys,
    I am a doc and I specialize in prolotherapy in San Francisco.   Shoot me a pm where your friend lives and I can give you a good referral.   I had shoulder pain also for 15 years and nothing worked better, including surgery and PT.   I have seen a 90+ % success rate with prolotherapy and rotator cuff tears. 

   Prolotherapy is a simple treatment actually, and unlike cortisone shots, you do not get any associated long term weakening of the joint.   The opposite happens.   New tissue is created and the old scar tissue is replaced with a healthy tendon or ligament.   

   It is considered alternative only because it is not covered by insurance.    However, I learned from professors at the UW Madison medical school, and heads of sports medicine training sites.   There are toms of resources online, but they key is to find someone trained by this group:
http://www.hacketthemwall.org/HHF/List_of_Prolotherapists.html
    And your friend is right, he has nothing to lose as long as he goes to a competent well trained prolotherapist.   
   I hope this helps.   
Cheers,
Morgan

[jtwrace]

Hey guys,
    I am a doc and I specialize in prolotherapy in San Francisco.   Shoot me a pm where your friend lives and I can give you a good referral.   I had shoulder pain also for 15 years and nothing worked better, including surgery and PT.   I have seen a 90+ % success rate with prolotherapy and rotator cuff tears. 

   Prolotherapy is a simple treatment actually, and unlike cortisone shots, you do not get any associated long term weakening of the joint.   The opposite happens.   New tissue is created and the old scar tissue is replaced with a healthy tendon or ligament.   

   It is considered alternative only because it is not covered by insurance.    However, I learned from professors at the UW Madison medical school, and heads of sports medicine training sites.   There are toms of resources online, but they key is to find someone trained by this group:
http://www.hacketthemwall.org/HHF/List_of_Prolotherapists.html
    And your friend is right, he has nothing to lose as long as he goes to a competent well trained prolotherapist.   
   I hope this helps.   
Cheers,
Morgan

Thanks!  He did go to a Prolotherapists with his MRI and he actually sent him to the link in post #3

[orthobiz]

Looking at this now...

http://www.regenexx.com/

I'm late to this thread. Regenexx is for arthritis, on one side of the joint only (humerus-ball or glenoid-socket) and would probably not help a rotator cuff problem. It is best suited to the femur side of the knee joint and probably best in patients under the age of 40 with small areas of cartilage involvement. Pretty nonspecific info on their website, no?

Paul

[orthobiz]

I have no idea how these things go misdiagnosed.  Please don't take that like I think I'm better than the physicians who treated you, but I just don't get it.  There's very specific special tests that are routine in a clinical exam.  by special tests, I mean physical exam tests, not imaging.

The empty can test (aka supraspinatus test) and O'Brien's test should be done on everyone with any shoulder pain.  It's impossible to not have significant weakness in an empty can test when the rotator cuff has any deficiencies. 

Surprisingly, strength can be well-maintained with a torn supraspinatus if the front and back cables, the subscapularis and infraspinatus are intact. It forms a kind of suspension bridge over the top of the shoulder so the drop-arm test and empty can tests show paradoxical strength. Check out Stephen Burkhart, MD's articles on "margin convergence" or "massive cuff repair" dating back to 1997. It's a technique of massive cuff repair where the supraspinatus is so atrophied that it cannot be brought back to the humerus and the repair consists of sewing the subscap to the infraspinatus.

Among orthopods, the O'Brien's maneuver/test, while helpful, is often equivocal and is not always specific/sensitive for a torn labrum.

Having fixed hundreds of rotator cuff tears arthroscopically (and open, prior to 7 years ago when techniques allowed me to switch), I can tell you from personal experience that you'd be surprised. And while I don't always get things right, I don't consider myself a chronic misdiagnoser!

Good thread!

Paul

[Stu Pitt]

Surprisingly, strength can be well-maintained with a torn supraspinatus if the front and back cables, the subscapularis and infraspinatus are intact. It forms a kind of suspension bridge over the top of the shoulder so the drop-arm test and empty can tests show paradoxical strength. Check out Stephen Burkhart, MD's articles on "margin convergence" or "massive cuff repair" dating back to 1997. It's a technique of massive cuff repair where the supraspinatus is so atrophied that it cannot be brought back to the humerus and the repair consists of sewing the subscap to the infraspinatus.

Among orthopods, the O'Brien's maneuver/test, while helpful, is often equivocal and is not always specific/sensitive for a torn labrum.

Having fixed hundreds of rotator cuff tears arthroscopically (and open, prior to 7 years ago when techniques allowed me to switch), I can tell you from personal experience that you'd be surprised. And while I don't always get things right, I don't consider myself a chronic misdiagnoser!

Good thread!

Paul

Interesting stuff, Paul.  But, between a history (accurate history), O'Brien's, clunk test, and a grind test, it's pretty hard to miss a labral tear IMO.  I can't say I've been right 100% of the time, but I've never had someone come back and say I've missed it, nor have I had someone come back after an MRI and say there was no tear.

I've been an ATC for close to 15 years now.  Not pretending to be an expert, nor have anywhere near the knowledge of an orthopeadic surgeon by any means.  I see a few a year.  I'm sure you see a few every day!

[groovybassist]

You guys may all be right re the various tests, but I can tell you unequivocally they missed my labral tear.  This was mid-late 1990's.  I heard a "pop" when it happened (playing golf of all things) and after about 6 weeks of pain and diminishing movement, finally went to the doc.  They did an x-ray, some range of motion tests and proclaimed it bursitis.  I had arthroscopic surgery 2 and 1/2 years ago (2008) to remove frayed tissue and clean up the joint, but they did not repair my labrum (I have a DVD of the procedure, showing the disconnected tissue).  Doc felt the cure was worse than the disease for me at this point and I believe him.  I went to someone routinely referred to as the top shoulder person in Seattle by many peers.

[orthobiz]

I'm cool 

Paul

[Stu Pitt]

The more I think about it, I'm dealing with a different population, so my findings may be off.  I solely deal with NCAA Div. I athletes.  Arthritic and aging changes could lead to a false positive and/or make the tests far less fool-proof than they are in my setting.

Again, I'm no surgeon, nor do I see the volume that they see.  Just going by my somewhat skewed experience. 

[orthobiz]

I think you are spot on. I see the mix including workers, smokers, the unathletic, deconditioned along with the motivated athletes. They come in with MRIs ordered elsewhere showing little abnormalities in the labrum and become focused on it as the sole cause of everything.

I've seen so many different things over the years that I try to remain humble about my own skills and patient about frustrations with other doctors' missed diagnoses.

Too bad we don't have an AC community where we could use all our skills together and then spin tunes afterwards!

Paul