HY 05/07: Regrowing a Torn Shoulder | Lehigh Valley Hospital

Anyone who’s had shoulder repair surgery will tell you it’s a long, painful recovery—and Gary Davis had endured it twice. The third time was dramatically different for the 57-year-old Easton man, thanks to an exciting new procedure at Lehigh Valley Hospital and Health Network. “We’re now able to actually regenerate the damaged tissue,” says ortho-pedic surgeon James Hoffman, M.D.

Davis had his first experience with a torn rotator cuff seven years ago in a work-related injury; he later injured the other shoulder in a fall. In both cases he had traditional surgery and lengthy physical therapy. And in both cases, he says, “I took a lot of pain medication, didn’t sleep well even in a recliner, and didn’t start feeling normal for at least a year.”

With his most recent shoulder problem, the pain was more gradual—but the injury turned out to be extra chal-lenging. “Dr. Hoffman told me the rotator cuff had completely detached and recoiled due to the arthritis I’d developed in my shoulder,” Davis says.

People with such massive or chronic injuries didn’t have many options before. But Hoffman was able to offer Davis a creative solution: regenerative rotator cuff (or “graft jacket”) surgery. “Traditional surgery relies on scar formation to solidify the repair,” Hoffman says. “But scar tissue doesn’t stretch, its blood supply isn’t very good, and it doesn’t act like normal tissue.”

Regenerative surgery uses a combination of stem cells (cells whose purpose is not yet defined) from the patient’s bone marrow and specially processed human tissue. The tissue acts as a scaffold for blood vessels and stem cells to grow into. It also contains growth factors that “tell” the stem cells what kind of cells to become. “If you do a biopsy later, you find normal rotator cuff tissue, not scar tissue,” Hoffman says.

It all sounded “really neat” to Davis, and the outcome has been even better than he expected. “I was immobile for a long time after my other surgeries, but three weeks after this one I could lift my arm straight up over my head,” he says. That’s typical, Hoffman says: “These patients tend to heal with less pain, and there’s a sharp advance in rehabilitation.” Davis’ shoulder feels so good he has to remind himself not to overdo it.

Regenerative shoulder surgery is only being used for major injuries at present, Hoffman says. “But the approach also is being applied to knee and ankle repairs, burn treatment, diabetic ulcers and more,” he says. “The whole concept is fantastic.”

Rotator Cuff—A Common Problem Area

Sometimes it’s an obvious twinge (say, after chopping wood), other times the pain creeps up gradually. But however it happens, “rotator cuff injury is extremely common, especially with age,” says Christina Smith, M.D., family medicine physician specializing in sports medicine at Lehigh Valley Hospital and Health Network.

The shoulder is a complex system of muscles and tendons designed more for range of motion than for stability, she says: “While the hip is a solid ball and socket, the rotator cuff is more like a golf ball on a tee.” If you overuse it, you can develop tendinosis —degeneration causing weakness, achiness and pain when you reach—or a partial or full tear.

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Treatment often begins with a corticosteroid injection to calm irritation, and physical therapy to strengthen muscles. If your shoulder is very weak or there was a known injury, your doctor may order an MRI to see if it’s torn and how badly. “A full tear often needs to be repaired surgically to avoid muscle shrinking or atrophy,” Smith says.

You can help prevent shoulder problems by staying active, building strong back muscles and practicing good posture.

Want to Know More about shoulder-strengthening exercises? Call 610-402-CARE.

Regrowing a Torn Shoulder

New surgery uses patient's own cells to regenerate injured tendon

Rotator Cuff—A Common Problem Area