Shoulder Pain

Stem Cell Therapy for Shoulder Instability and Chronic Dislocation

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Marc Darrow MD,JD

The shoulder comprises a complex matrix of bone and soft tissue that enables an extreme range of motion. But the price the shoulder pays for that range of motion is a greater risk of chronic injury.

The shoulder is held together by soft tissue stabilizers, the ligaments that connect bone to bone. Over the course of time, especially in sports that involve heavy shoulder-to-shoulder contact (such as hockey, lacrosse, football, wrestling, and basketball), the ligaments may stretch out and become “lax.” When the ligaments become lax, the risk of dislocation and separation becomes greater.

In a study published in the British Journal of Sports Medicine, researchers took a look at rugby players with measurable shoulder laxity to gauge the risk of shoulder dislocation. What they found was that 50% of the athletes tested were at significant risk.

It is estimated that 95% of shoulder dislocations occur when athletes suffer a blow to the shoulder that forces the shoulder joint “back” or downward, or occur when they fall to the ground with their arms stretched over their heads.

Chronic Shoulder Dislocation Treatment

Traumatic shoulder dislocation is a frequent injury in the sports population. An acute shoulder dislocation often means a one-time traumatic episode, whereas chronic shoulder instability indicates multiple recurrent dislocations.

Following an initial shoulder dislocation, doctors debate whether or not to perform surgery to prevent recurrence. If there is an accompanying labral or tendon tear, that can be addressed along with tightening of the capsule around the joint. This can lead to a loss of range of motion. I have used Stem Cell Therapy with platelets (both are in the bone marrow) or just PRP from the blood, both with good results, to tighten the shoulder after a failed surgery for chronic dislocations.

If the patient is under 30 years of age, shoulder surgery is typically recommended by surgeons because younger athletes are much more prone to repeated dislocations than older athletes. Until recently, it was common in cases of dislocation to immobilize the shoulder for long periods of time. But studies showed that while immobilization helped alleviate the pain of such injuries, it also
contributed to a general weakening of the ligaments and predominance of “adhesive capsulitis,” where the arm is frozen (frozen shoulder) and can no longer be lifted.

Surgery for shoulder dislocation can be effective for some but, as always, surgery should be considered a last option because of issues of complications, downtime (immobilization), and—for both the “weekend warrior” and the professional athlete—a weakening of the shoulder through the removal of or damage to other connective tissue in the surgical process.

Some athletes may opt for immediate surgery because of the typical six-month healing time (if healing occurs at all) required in the case of a Bankart lesion (an injury of the anterior [inferior] glenoid labrum) without Stem Cell Therapy or PRP. Researchers have pointed out that “[r]epairs of degenerate and torn tissue are often prone to failure due to many intrinsic and extrinsic factors” and that Platelet-Rich Plasma Therapy has been shown to reduce pain and improve recovery in shoulder tears.(1)

The key to avoiding shoulder surgery or shoulder separation requiring surgery is to strengthen the shoulder girdle. This can be accomplished by working the strong shoulder muscle group and by
treating the weakened shoulder ligaments with injections of regenerative medicine.

To understand the importance of having strong ligaments to hold the shoulder together, the patient needs to understand that the severity of the shoulder dislocation is measured by the degree of injury to the ligaments and the amount of instability of the joint.

Shoulder Separation

The acromioclavicular (AC) and the coracoclavicular (CC) ligaments hold the shoulder together at the point where the collarbone (clavicle) and the top (acromion) of the shoulder meet. This joint can also be traumatically separated. I see this most commonly in bicycling accidents in which the patient has flown over the handlebars and landed on the shoulder.

This is a very small joint that heals well with regenerative medicine.

  • In type I level separation, the AC is partially torn; the CC is not.
  • In type II separation, the AC is completely torn; the CC is partially or not torn.
  • In type III separation, both ligaments are completely torn.

With this injury one can often see the collarbone sticking up above the top of the shoulder. Obviously, the more significant the tearing, the longer the athlete is out of their sport. Untreated shoulder instability can lead to an alteration of an athlete’s game to protect the sore shoulder, or, worse, chronic shoulder separation that can keep athletes away from their sport for significant
amounts of time.

Stem Cell Therapy and PRP use the patient’s own cells to repair and rebuild ligaments and the joint itself.

Do you have questions? Ask Dr. Darrow


A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

1 Mei-Dan O, Carmont MR. The role of platelet-rich plasma in rotator cuff repair. Sports Med Arthrosc. 2011 Sep;19(3):244-50.

Side-effects of corticosteroid injections including joint destruction

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Marc Darrow MD,JD

Systemic and local side-effects of corticosteroid injections including joint destruction

A patient will often come into our office with conflicting ideas about cortisone injections. The patient will tell us that his/her other doctors told them that cortisone injections are safe, effective, and will help their pain, if used sparingly. But, intuitively, the patient had doubts and concerns.

But as this patient continued to wait for a surgery, decisions had to be made as to how much pain management would be needed to “hold them over,” until the surgical date.

Corticosteroids are powerful anti-inflammatory substances. They are not used to relieve pain, but rather, to reduce inflammation, which in turn can lessen a patient’s level of discomfort. Numerous studies over the years have shown that prolonged use of cortisone will eventually cause degenerative joint disease in the joints they are injected into.

UNDERSTANDING THE POSSIBLE COMPLICATIONS OF CORTISONE INJECTIONS.

A December 2020 paper in the medical journal Radiology (1) says this:

  • Current management of osteoarthritis is primarily focused on symptom control.
  • Intra-articular corticosteroid injections are often used for pain management of hip and knee osteoarthritis in patients who have not responded to oral or topical analgesics.
  • “Recent case series suggested that negative structural outcomes including accelerated osteoarthritis progression, subchondral insufficiency fracture (stress fractures in the bone beneath cartilage), complications of pre-existing osteonecrosis, and rapid joint destruction (including bone loss) may be observed in patients who received Intra-articular corticosteroid injections .
  • The true cause and natural history of these complications are unclear and require further study. To determine the cause and natural history, large prospective studies evaluating the risk of osteoarthritis or joint destruction after Intra-articular corticosteroid injections are needed.

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Stem Cell Therapy for Shoulder Impingement – Subacromial shoulder pain

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Marc Darrow MD,JD

You go to the doctor with a complaint of severe shoulder pain. The pain is at the top and side of your shoulder. You tell your doctor that the pain is much worse when you do anything where you have to reach over your head. You also have a hard time sleeping at night because the pain is worse when you lay down. You may get an MRI or an examination. Your doctor may be looking for a full range of motion in your shoulder even with pain at every point. For us, in our office, full range of motion, even with pain, is a good sign we can help with stem cell treatments.

Once the pain is determined to come from subacromial space of the shoulder, that is the area of the rotator cuff tendons and the subacromial bursa, then rotator cuff tendinopathy, (shoulder impingement) is often diagnosed. The impingement occurs when the Acromion’s underside, presses against the rotator cuff tendons, wear and tearing at them.

The surgery to fix this is not effective – surgeons suggest not even offering it

In the late 1980’s and early 1990’s Arthroscopic subacromial decompression (ASD) was developed to be able to go in and shave away the Acromion and give the tendon’s more space.

Initial reports indicated good success rate. A 1987 study from the Department of Orthopaedic Surgery, University of California at Los Angeles wrote: “Eighty-eight percent of the cases were rated “satisfactory” (excellent or good), and 12% were rated “unsatisfactory” (fair or poor),” when performed by experienced physicians.(1)
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Rotator cuff tears – Stem cell therapy, PRP, cortisone and surgery

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Marc Darrow MD,JD

We get a lot of emails from people looking at their rotator cuff options. The emails we get center around the possibilities that a surgery can be avoided with regenerative medicine injection options such as stem cell therapy or Platelet Rich Plasma therapy or PRP. There is some new research I will explore with you here on these options.

We know that some people, like someone with a physically demanding job or an athlete, will make their decision as to how to treat their rotator cuff problems based on what treatment they believe will get them back to their job or sport the quickest. This is the great appeal of surgery to some. These people believe that surgery is the fastest way back and they have a lot of confidence that the surgery will make them whole again.

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Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections

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Marc Darrow MD,JD

Getting a shoulder replacement or rotator cuff surgery may require you being on a waiting list. For over 20 years we have been offering regenerative medicine injections including the use of stem cell therapy. Often we will get an email that asks, “is there any research?”

The Darrow Stem Cell Institute has published research on the treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow derived stem cells.The research appears in the peer-reviewed journal Cogent Medicine. The study can be found here in its entirety: Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections with a June 20, 2019 publication date.

Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections
Marc Darrow, Brent Shaw, Nicholas Schmidt, Gabrielle Boeger & Saskia Budgett | Udo Schumacher (Reviewing editor)
Article: 1628883 | Received 02 Jan 2019, Accepted 30 May 2019, Accepted author version posted online: 18 Jun 2019, Published online: 20 Jun 2019

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Stem cell therapy and alternatives to shoulder replacement

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Marc Darrow MD,JD

As many people contemplate waiting for a shoulder replacement and they have the time to review the research, they see that they have three main options to manage their shoulder pain.

Replace the ball and socket of the shoulder joint. The reason a shoulder replacement can be tricky is that the joint is more a golf ball and tee than a ball and a socket like the hip. This, as we will see from the research, can make shoulder replacement a technically challenging surgery.

Manage the shoulder with “conservative non-surgical treatments,” such as painkillers, anti-inflammatories, cortisone, physical therapy, and other remedies for as long as you can until the pain or loss of function becomes unbearable.

Try regenerative medicine such as stem cell therapy and platelet rich plasma therapy.

When someone comes into our institute it is usually after the “conservative treatments,” have failed and that a surgery is being strongly recommended. What people, perhaps one day like yourself, who come into our office want is a realistic plan to get them to a pain-free range of motion in a functioning shoulder. Many times we can get people to this goal, many times we come close to getting people to this goal with significant improvement to their quality of life. There are times when we can only help a little. There are times we cannot help at all. People we cannot help would be significantly advanced cases of degenerative shoulder disease. Perhaps 10 to 20% of patients who seek regenerative medicine will not be good candidates. This is why I invite people to email me to discuss before they make an appointment. You can do so as well by using the form below. Read More

Stem cell and PRP treatments for tendinopathy

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Marc Darrow MD,JD

I frequently see patients with an MRI of a tendon tear or an MRI of a problem of chronic tendinopathy. Tendinopathy is a more recent term to describe a chronic pathology of a tendon that causes pain. The problem of Tendinopathy can be It is divided into two broad categories:

  • Tendinitis means inflammation of the tendon. This is the characteristic swelling that comes with a worsening wear and tear or acute injury.
  • Tendinosis is the “old, nagging injury.” The tendon is injured but the body has given up trying to heal it. It is an injury without inflammation. Why did the body give up? In some of the people we see, it comes as the result of a long and extensive anti-inflammatory or cortisone treatment history.

Anti-inflammatory drugs and cortisone injections are effective at reducing pain and inflammation, but do not have a healing effect. Worse, their detrimental effects may lead to complete tendon rupture which usually requires surgical repair. For more on this and supportive research, I invite you to review my articles:

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Stem Cell Therapy for shoulder labrum repair and biceps tenodesis

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Marc Darrow MD,JD

Many emails that come in from this website, come from people asking about SLAP tear surgery. Some people want to know if they can avoid surgery. Some people are looking for options because they cannot get a SLAP tear surgery. Why can’t they get the surgery? Because their doctor/surgeon does not hold out good hope that surgery will be effective for them. Who are these people? From the emails we get, they are usually people with multi-directional shoulder instability, or, people who already had the surgery and despite it being a successful surgery, the person still had pain and range of motion issues.

Before we get into the research, here is my story. I have a labral tear in my right shoulder. I have a supraspinatus and subscapularis tear as well. I also have NO pain. How do I know I have the tears? Because I looked at my shoulder under ultrasound when I was having shoulder pain, one day especially, when I had a frozen shoulder from hitting too many golf balls. I am a very repetitive motion type athlete.
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PRP and Stem Cell Therapy for Slap Tears

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Marc Darrow MD,JD

Many emails that come in from this website, come from people asking about SLAP tear surgery. Some people want to know if they can avoid surgery. Some people are looking for options because they cannot get a SLAP tear surgery. Why can’t they get the surgery? Because their doctor/surgeon does not hold out good hope that surgery will be effective for them. Who are these people? From the emails we get, they are usually people with multi-directional shoulder instability, or, people who already had the surgery and despite it being a successful surgery, the person still had pain and range of motion issues.

Before we get into the research, here is my story. I have a labral tear in my right shoulder. I have a supraspinatus and subscapularis tear as well. I also have NO pain. How do I know I have the tears? Because I looked at my shoulder under ultrasound when I was having shoulder pain, one day especially, when I had a frozen shoulder from hitting too many golf balls. I am a very repetitive motion type athlete.
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You have an MRI that says you need shoulder surgery

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Marc Darrow MD,JD

We often get a phone call or an email from someone who has a digital shoulder MRI file that shows damage. They have been told recently, the “only way,” to fix this damage is with surgery, and as we will see from the research below, the surgery may not offer the results the patient is hoping for.

My Shoulder MRI is bad, my doctor says surgery

Sometimes, someone will have a bad shoulder and a bad MRI and surgery may be the best answer. However, shoulder MRIs may present faulty or inaccurate information. In our many years experience, we have found that when MRI is the sole governing tool relied upon by doctors to recommend treatment, a patient will often be sent to a surgery with a shoulder that is not that bad.
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