My Non-Surgical Quest for a Pain-Free Shoulder Part 2

By Wendy Crawford


NOTE: This is a personal recount of a shoulder problem written in laymen’s terms. The author is not a medical professional. For medical advice, please consult your physician for the best course of action pertaining to your condition.
 
In a previous article, ”My Non-Surgical Quest for a Pain-Free Shoulder - Part “, I wrote about my attempts of trying to eliminate pain in my shoulders caused by calcific tendonitis and additionally, a slight tear in my rotator cuff tendon on my left WITHOUT surgery. Eventually, through a combination of ultrasound guided barbotage, TENEX procedures and exercise, my right has improved to the point that I am now pain-free and functioning normally.

Ultrasound guided barbotage is a technique using an ultrasound guided needle that breaks up calcium deposits under local anesthetic.Tenex is a procedure that uses ultrasound waves, inserted through a small incision in the skin, to identify and break up calcification and chronic tendinosis. It was much more aggressive than the ultrasound guided barbotage and according to my orthopedist, extremely effective. Right after the procedure, it was necessary for a cortisone shot to help with inflammation to promote healing. After 2 weeks, I started to introduce exercise slowly and gradually built up to full resistance, avoiding all overhead exercises.The theory is that once the calcification is broken up and the majority removed, the remaining particles will gradually disappear with exercise. Upon providing a letter of medical necessity, my insurance covered these procedures.

As happy as I was with the results of my right shoulder, I was still struggling with pain on my left. X-rays and an MRI revealed that there was very little calcification remaining but there was a slight tear. As mentioned in Part 1, my orthopedist was strongly against surgery and wanted to explore EVERY option available. He said that there was no guarantee that surgery would work and could in fact, make my shoulder worse. He was also worried that I may damage it unintentionally, during the recovery because it’s such a long process and is difficult for wheelchair-users to not use it inadvertently.

The cortisone shots were becoming more frequent (every 3 months) and less effective. I was so limited with exercising that I knew that my strength was decreasing. I appreciated that he wasn’t pro-surgery right away but I was starting to think that perhaps, it was my only option and maybe I should take the risk.  I scheduled an appointment and told him that I was frustrated and wanted to move forward with surgery. He paused and sounded so reluctant to schedule the surgery that I changed my mind! I went home determined to find another option and then through divine intervention, a coincidence or whatever you want to call it, an alternative appeared!

Days later after my last appointment, I was visiting my friend’s organic farm when I happened to meet another wheelchair-user at the market. I had seen him before but usually I was leaving in my car when he would arrive. We started chatting and somehow my shoulder came up in conversation. He told me that he had been in the chair for over 40 years and had very similar issues with his shoulder.  He had declined surgery and instead tried stem cell injections which were not yet FDA approved. Now, he could transfer in and out of his car and was pain free. This concept was completely new to me! The company that he went through was called Regenexx and I immediately called for more information from the local doctor that performed the procedure.
Photo taken during the PRP injections
I learned that there was a 2-part process once I was evaluated to see if I was a candidate. The first step involved extracting stem cells from my hip which then would be injected into my shoulder, with the intention of reducing inflammation and possibly healing the tendon. After reviewing my medical records, an assistant explained to me that the doctor did not feel comfortable harvesting the stem cells from me since I had a higher level spinal cord injury and it could cause autonomic dysreflexia. Because the procedure is not approved by the FDA, it is performed in a clinic and could not be done in the hospital where he would have access to medical resources, if needed. He was however, willing to inject platelet rich plasma (known as PRP) which can be extracted through centrifugation, from my own blood. Platelets are commonly known for clotting blood but also have proteins called growth factors which are extremely important in the healing of injuries.

After discussing the pros and cons with my orthopedist, I decided to give it a shot (no pun intended!). Although I didn’t want to spend the money, if it worked, it would be worth every penny. On May 9, the platelets were injected into several locations in and around my shoulder. Although I was numbed prior, it still was probably the most painful procedure out of all that I’ve had. 

I went through a similar recovery as TENEX but eased into the exercise a little more slowly. It takes three months to get the full result so I’m almost there. Although I have not had a cortisone shot for over 6 months (and not allowed post-procedure), the pain has reduced significantly and I’m able to exercise at full strength! I must admit that some exercises still cause it to flare up but then I take it easy and gradually, it feels better again.

How long will it last? Will I need to repeat the procedure? Will I eventually need surgery? These are questions that run through my head and probably no one can really answer. After all these years and procedures, being pain free had seemed like an unattainable goal so I do know that for me, this journey was worth it.

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