New therapies for advanced shoulder issues

Wear and tear, injury, certain medical conditions, and age can take a toll on shoulder function. Oftentimes, surgery can be avoided, with many people responding well to nonoperative treatments, such as physical therapy or injections, to decrease their pain and improve the use of their shoulder. Sometimes, surgery to repair the torn tendons may be necessary.

But other times, the condition of the shoulder has advanced beyond those options. In the past, this may have resulted in chronic pain and debility. Now, there are new treatments designed especially for more advanced shoulder issues.

Inserting a balloon or patch for stabilization

When a rotator cuff tear is so severe that it can’t be repaired, an orthopedic surgeon may use a subacromial balloon spacer. This small device is inserted into the space where the damaged rotator cuff lies using minimally invasive arthroscopic surgical techniques. Once in place, the device is inflated with saline to cushion and stabilize the joint. The balloon typically dissolves within six to 12 months.

Alternatively, a surgeon may implant a special donated tissue graft to cover or “patch” the top of the ball part of the shoulder joint. This procedure, called tuberoplasty, acts similarly to the balloon to provide a cushion in place of the rotator cuff.

After surgery, a physical therapist will help a patient retrain muscles to move the shoulder using more optimal mechanics. Recovery from these procedures tends to be faster since the tendons don’t need to heal as they would in traditional rotator cuff surgery.

Using 3D printing for shoulder replacement

Reverse shoulder replacement is another surgical option for treating patients with severe arthritis, irreparable rotator cuff tears or other shoulder damage. By using specially designed implants, a surgeon can change the mechanics of the shoulder to allow other muscles to move it.

Since no shoulder is the same, how closely the replacement implant fits the shoulder’s anatomy and how the implant is placed play key roles in the success of a reverse shoulder replacement. The surgeon is able to choose from metal and plastic implants that are available in a few different shapes and a range of sizes. A 3D-printed model of the shoulder can help the orthopedic surgeon precisely place the implant.

The process begins with a CT scan before surgery to create a 3D model of the shoulder on a computer. This allows the surgeon to see how the implant should be placed, how to preserve as much bone as possible and how to identify the best way to secure the implant. A 3D guide is printed that duplicates the template from the computer.

During surgery, the surgeon places the 3D guide on the bone so the implant can be placed precisely as planned.

3D modeling also helps the surgeon determine if a patient needs a customized implant.

Creating a customized implant

In most cases, the surgeon can choose a standard implant that will give the patient the shoulder function they need. But for some patients, their anatomy or bone damage won’t allow a standard implant to fit appropriately. An implant that doesn’t fit well can fail, leading to more surgery.

In these cases, an implant can be created to precisely fit a patient. Using a computer-generated 3D model, the custom implant designed for the patient is printed using the same materials as a standard implant. While this is only used in special cases, it may become the standard in time.

Robotic surgery

While robotics has been used in many other surgeries, including hip and knee replacements, for some time, the use of robotic surgery in the shoulder is just beginning. The technology is new and specialized.

As mentioned before, putting the implants in the right position is important, and the robot helps the surgeon do this exactly as planned. During a shoulder replacement, the surgeon can use a robot to help reshape the socket precisely to get the best placement and position of the implant to help provide the optimal outcome. Although this technology is new, it may become the future of shoulder replacement.

Stem cells and biological treatments

Stem cells and other therapies such as platelet-rich plasma are new and promising treatment options known as regenerative medicine. These are often called orthobiologics as they are made from the patient’s body.

Stem cells are cells that have the potential to heal and transform into more specialized cells such as muscle, tendon or bone cells. They are harvested from tissues in the body such as blood or fat. Platelet-rich plasma takes blood from the arm and separates out the red blood cells, keeping healing and anti-inflammatory factors.

When injected, these therapies try to stimulate the body’s cells to promote a healing response in the tissue. They have shown potential benefit in treating pain from arthritis, helping heal and recover from tendinopathies or muscle strains, and improving healing after surgery.

While both treatments show promise in helping to decrease pain and potentially improve healing, they unfortunately will not regrow cartilage or tendons, and they will not “cure” arthritis.

Though promising, the data are still inconclusive, and further studies are needed to determine the best uses for them. Additionally, since they are considered experimental, they are rarely covered by insurance and can be very costly.

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