Shoulder SLAP Lesion and Labral Tears

We have had great success in treating SLAP tears and labral tears with either prolotherapy or autologous, culture expanded mesenchymal stem cell transplants. The focus of this article will be prolotherapy.

This is a case of SK, a 52 year old male who had a partial SLAP lesion tear and was told that surgery was the only option. When I first examined this patient he had severe pain with any kind of bicep use and couldn't lift anything with that arm or swim (his primary form of exercise). The patient underwent 3 injections of x-ray guided prolotherapy injections into the biceps anchor at the superior labrum. He is now able to lift 25 pound dumb-bells with that arm and has only minor intermittent pain. To understand why this would work, one needs to understand some anatomy. The biceps tendon anchors at the top of the socket of the ball and socket shoulder joint. When it gets torn partially away from that bony anchor, it's called a partial SLAP lesion. In this case the x-ray allowed us to place medication at this exact site (which wouldn't be possible without x-ray or "blind" in the office) to kick off a brief inflammatory healing cycle. This gave his body more tries at healing the site. I've attached the x-ray picture to show this unique approach, the needle shown as the dark line and the dark medication/contrast mix covering that SLAP lesion.

The moral of the story is that this gentleman didn't need surgery (with his arm in an immobilizer brace for weeks), all he needed was some injections in the exact spot to help heal the area. During this time he remained completely active, which beats sporting a blue pillow and a shoulder brace.

Chronic Thoracic Pain After a Fall

Just discharged a patient with a one year history of thoracic pain after falling on his mid back. He failed PT and was told by workman's comp doctors that he couldn't be helped. We discharged him pain-free, what did they miss?

The thoracic spine is particularly big in the ligament department. This means that ligaments hold much of it together like duct tape. There are ligaments that hold the back of the spinal bones together (supra-spinous and inter-spinous ligaments) and ligaments that hold the ribs to the spine (costo-transverse and costo-vertebral joints). In addition, there are many muscles that attach to the ribs and help guide or anchor movement like guy wires on a sail boat mast. So in a patient with chronic thoracic pain due to a fall or car crash (in many cars there is a seat stiffener in the seat that can damage upper back ligaments in a rear-ender), you think of ligaments first.

This gentleman had a ligament injury that we treated with prolotherapy. This involves injecting some substances into the ligaments to help kick off a natural healing cycle. His problem was that he got "one bite" at the apple, meaning his body had one cycle to heal his ligament injury after his fall and it was too big to heal. The prolotherapy allowed him to get a few more healing cycles in and heal the area. While this sounds simple, regrettably our medical system rarely identifies or treats sub-failure (not completely torn) ligaments. This is regrettable, as hundreds of millions are wasted annually by the medical care system as it spins it's wheels trying to help patients who aren't getting diagnosed correctly with ligament issues (especially in the spine).

This gentleman was also helped with IMS, a technique that involves getting rid of muscle knots with an acupuncture needle. Again, another easy technique which can help allow more normal motion. In the ribs this can help because there is a big muscle around where the rib connects to the spine. When this locks up, so does normal rib motion. This then causes a myriad of other problems from perceptions of shortness of breath to lack of upper back movement).

For more information on how a full spectrum of pain management procedures, click here.