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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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:

• Systemic effects of corticosteroid injections
• How anti-inflammatories accelerate degenerative knee disease.

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Marc Darrow MD,JD

Many times a prospective patient will come into our office for a consultation and ask if we can do both Platelet Rich Plasma injections and Stem Cell injections at the same time. The idea comes from visits to other clinics where it is discussed with patients that Platelet Rich Plasma injections either prior to or at the same visit will make stem cell therapy more effective. The answer we give is no, the use of bone marrow concentrate more commonly bone marrow stem cell therapy contains a rich source of blood platelets. Simply, it is getting both treatments at once.

Give me a chance to back this up with some research.

Let’s start with a 2012 study. (1) Here the research team wanted to determine whether platelet-rich plasma (PRP) could be made into a bioactive scaffold capable of endogenous (using the body’s own healing and response system), growth factor release for cartilage repair. In essence these researchers made a patch of platelets.

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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.

Sometimes the bones in the joint slip out of normal alignment or are forced out by injury-subluxation and dislocation. For those individuals who suffer from chronic shoulder instability, dislocations may occur frequently. This occurs because first dislocations usually require a significant amount of force as in anterior dislocations, in which the anterior static shoulder stabilizers are stretched or torn away from the bone. Approximately 95% of shoulder dislocations are this type and typically occur when a person falls on their outstretched hand, or sustains a downward motion blow to the shoulder.

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.

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.

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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 corticosteroid injections

Here are some of the most recent papers reminding doctors about the possible side effects of corticosteroids:

A January 2021 (1) study issued this statement:

“The current evidence would suggest that the use of corticosteroids provides moderate short-term benefit for reducing pain and improving functioning. These benefits generally last several weeks without long-term effectiveness. In addition to its limited short-term effectiveness, there are multiple potential adverse effects including toxicity to articular cartilage and numerous systemic side effects such as increases in blood glucose levels, a reduction in immune function, and an increased risk of infections.”

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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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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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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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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