The Regenerative Spine and Joint Institute Approach

With the advent of new bio-cellular regenerative interventions (BRI), we are able to successfully treat patients with mild to advance shoulder problems without the need for surgical interventions. Our interventions are designed to repair, regenerate, restore tissue to its normal health and function, potentially avoiding recurrent episodes of pain, disability and further surgical interventions .

Rotator Cuff Tears

What is the Rotator Cuff?

Is a group of tendons and muscles in the shoulder, connects the upper arm (humerus) to the shoulder blade (scapula)The rotator cuff tendons provide stability to the shoulder; the muscles allow the shoulder to rotate. The muscles in the rotator cuff include: Supraspinatus, Subscapularis, Teres minor and Infraspinatus.

What are tendons?

Tendons are fibrous tissues, which connect muscles to bones. They are extremely strong and yet can stretch with physiologic loads. Unlike muscle and bone, the blood supply to the tendons is very limited, rendering them more prone to chronic wear and tear injuries. Minor tendon injuries are called strains, while more severe injuries are called tears and tendinosis.

What are Rotator Cuff Tears?

Describes an injury to one the four rotator cuff tendons, caused by chronic wear and tear or an acute injury. Is one of the most common locations for tendon tears seen in sports medicine and general orthopedic practices.

What are the symptoms of Rotator Cuff Tears?

The symptoms mainly depend on the locations and severity of the tendon(s) involved. The pain is mainly localized in the shoulder, but usually radiates to the arm and neck. Is exacerbated by certain overhead arm movements or during athletic activities. With advanced tears, the pain can happen at rest or with minimal arm movements is frequently associated with arm-shoulder loss of range of motion.

How are Rotator Cuff Tears diagnosed?

After a comprehensive history and physical examination, usually X rays are obtained to exclude other conditions that can be present with the same symptoms. Frequently Sonography and MRI are the most accurate diagnostic imaging tools.

How are Tendon Tears and Tendinopathy treated?

  • Conservative
  • Rest in the acute stages (immobilization)
  • Ice, compression, elevation
  • Activity modification with avoidance of triggering factors
  • Physical Therapy
  • Chiropractic Care
  • Nutritional supplements
  • Medications: NSAIDS (non-steroidal anti inflammatory drugs)
  • Correction of muscle imbalance, stretching, Laser therapy
  • Isometrics and eccentric exercises
  • While you recover from your injury, you will need to change your sport or activity to one that does not make your condition worse.

The Regenerative Spine and Joint Institute Approach

With the advent of new bio-cellular regenerative interventions (BRI), we are able to successfully treat patients with mild to advance partial rotator cuff tears without the need for surgical interventions. Our interventions are designed to repair, regenerate, restore tissue to its normal health and function, potentially avoiding recurrent episodes of pain, disability and further surgical interventions .

What are the different types of Bio-Cellular Regenerative Interventions (BRI)?

B.E.T.R. stands for Biologic Enhancement of Tissue Repair and is a specific technique in utilized in the treatment of partial rotator cuff tears.

B.E.T.R Bio Tendon

This technique is used initially to treat patients with symptomatic tendon tears, who are having mild to moderate symptoms and have minimal degenerative changes in the tendon. It consists of injecting a combination of substances called Biologic Stimulants into the damaged tendon. They contain powerful growth factors (substances which stimulates multiple cell functions) capable of decreasing inflammation and producing significant improvement in function and tissue repair. Biologic Stimulants can be highly successful and cost effective in patients with early symptomatic tendon tears.

B.E.T.R. Stem Tendon

Is the most advanced therapy for patients with moderate to advanced partial rotator cuff tears and tendinosis, which have failed conservative or Biologic Stimulant Therapies. It consists of injecting the tendon with a combination Bio-Cellular Grafts (growth factors, scaffolds and mesenchymal stem cells) into the injured or degenerative tendon. This is designed to decrease inflammation, stimulate the growth of new tendon cells, strengthen surrounding tissues and restore function.

For more information see Bio-Cellular Regenerative Therapies.

TENEX TENOTOMY

Is a new procedure designed to remove the damaged tissue in the torn tendons that are swollen and have a significant amount of abnormal tissues. The device is based on ultrasonic technology and is inserted into the tendon through a very small incision. The Tenex Device, cleans and removes damage or injured tissue and creates a healing response. Bio-Cellular Therapies are frequently performed in the tendon, following the Tenex procedure. In our experience, this combination therapy provides the best results.

Shoulder Osteoarthritis (OA)

What is Shoulder OA?

Osteoarthritis or OA of the shoulder is the most common form of arthritis and is related excessive wear and tear of the joints, ultimately damaging the joint the cartilage (which is the smooth, firm material which covers the ends of the bones in the shoulder joint). It can be associated with aging, overuse, infection or trauma. With time, the cartilage become stiff, less effective in absorbing loads and damage ensures, causing inflammation. The tendons and ligaments around the joints begin to stretch and the pain worsens. Ultimately the cartilage wears out and the bones start to rub against each other, creating spurs and deformity in the shoulder joint. Shoulder OA is usually present in patients with a long history of rotator cuff tears.

What are the symptoms of Shoulder OA?

Patients with shoulder OA usually complain of pain associated with certain arm and shoulder positions and movements. The symptoms frequently overlap with rotator cuff tears symptoms. As the condition progresses, the pain will occur at rest and significant limitation of the shoulder range of motion will ensue.

How is Shoulder OA diagnosed?

After a comprehensive history and physical examination, usually X rays are obtained to confirm the diagnosis. MRI can yield more specific information about the degree of cartilage loss and other pathologic conditions usually associated with shoulder OA such as labral and ligament tears, bursitis and cartilage defects. Occasionally fluid is drained in order to analyzed for possible infection or gout.

How is Shoulder OA treated?

  • Conservative
  • Rest in the acute stages
  • Activity modification with avoidance of triggering factors
  • Physical Therapy, Bio-mechanical training
  • Nutritional supplements
  • Medications: NSAIDS (non-steroidal anti inflammatory drugs)
  • Correction of muscle imbalance, stretching, Laser therapy
  • Lifestyle changes

The Regenerative Spine and Joint Institute Approach

With the advent of new bio-cellular regenerative interventions (BRI), we are able to successfully treat patients with mild to advance shoulder arthritis without the need for surgical interventions. Our interventions are designed to repair, regenerate, restore tissue to its normal health and function, potentially avoiding recurrent episodes of pain, disability and further surgical interventions .

What are the different types of Bio-Cellular Regenerative Interventions (BRI) used to treat Knee OA?

B.E.T.R. stands for Biologic Enhancement of Tissue Repair and is a specific technique in utilized in the treatment of shoulder arthritis.

B.E.T.R Bio Joint

This technique is used initially to treat patients with symptomatic shoulder arthritis, who are having mild to moderate symptoms and have minimal degenerative changes in the joint. It consists of injecting a combination of substances called Biologic Stimulants into the damaged joint. They contain powerful growth factors (substances which stimulates multiple cell functions) capable of decreasing inflammation and producing significant improvement in function and tissue repair. Biologic Stimulants can be highly successful and cost effective in patients with early symptomatic shoulder arthritis.

B.E.T.R Stem Joint

This system was designed for patients who have failed the above interventions or have moderate to advanced shoulder arthritis. It consists of using a proprietary method for injecting the arthritic or damaged joints with a combination of Bio-Cellular Grafts (growth factors, biologic scaffolds and mesenchymal stem cells obtained from your own bone marrow or adipose tissue). It is considered the most advanced regenerative treatment available for patients with painful shoulder arthritis.

See Bio-Cellular Regenerative Therapies.

Labral Tears

What are Labral Tears?

The labrum is a piece of fibrocartilage (soft tissue) attached to the rim of the shoulder socket that helps keep the ball of the joint in place. When this cartilage is torn, it is called a labral tear. Labral tears may result from injury, or sometimes as part of the aging process.

There are different types of tears according to the location and degree of damage. Degenerative tears of the inner rim are very common and rarely symptomatic. Other tear are more severe and the labrum may be separated from the bone , some are called SLAP lesions.

What are the symptoms of Labral Tears?

Because labral tears are present along with other conditions, the symptoms can be non-specific. Sometimes the patients feel clicking or popping in the shoulder, along with pain on throwing motions. Overhead arm movements can be painful and may be present with a general feeling of weakness and shoulder instability.

How are Labral Tears diagnosed?

After a comprehensive history and physical examination, usually X rays are obtained to obtain a general assessment of the bony structures.

Physical examination although very important, is somewhat limited according to the type of tears. Some experts consider a shoulder MRI or CT arthrogram as the gold standard. They can yield more specific information about the degree of cartilage loss and other pathologic conditions usually associated with labral tears.

How are Labral Tears treated?

Initially all patients are treated conservatively, mostly rehabilitating the shoulder rotator cuff and addressing other conditions which may be present. According to the type of lesion, patients may need surgical repairs. However, most patients can benefit from a combination of shoulder rehabilitation and Bio-Cellular Regenerative Therapies.

The Regenerative Spine and Joint Institute Approach

With the advent of new bio-cellular regenerative interventions (BRI), we are able to successfully treat patients with mild to advance shoulder labral tears without the need for surgical interventions. Our interventions are designed to repair, regenerate, restore tissue to its normal health and function, potentially avoiding recurrent episodes of pain, disability and further surgical interventions .

What are the different types of Bio-Cellular Regenerative Interventions (BRI) for Shoulder Labral Tears?

B.E.T.R. stands for Biologic Enhancement of Tissue Repair and is a specific technique in utilized in the treatment of shoulder labral tears.

B.E.T.R Bio Labrum

This technique is used initially to treat patients with symptomatic labral tears, who are having mild to moderate symptoms and have minimal degenerative changes in the labrum. It consists of injecting a combination of substances called Biologic Stimulants into the damaged tear and joint. They contain powerful growth factors (substances which stimulates multiple cell functions) capable of decreasing inflammation and producing significant improvement in function and tissue repair. Biologic Stimulants can be highly successful and cost effective in patients with early symptomatic tendon tears.

B.E.T.R. Stem Labrum

Is the most advanced therapy for patients with moderate to advanced shoulder labral tears, which have failed conservative or Biologic Stimulant Therapies. It consists of intra-articular and labral injections of a combination Bio-Cellular Grafts (growth factors, scaffolds and mesenchymal stem cells) into the injured or degenerative labral tears. This is designed to decrease inflammation, stimulate the growth of new cartilage, strengthen surrounding tissues and restore function.

For more information see Bio-Cellular Regenerative Therapies.

Shoulder Instability (Ligament Sprains)

What Is Shoulder Instability?

Shoulder instability is a term use to describe weakness or laxness in the ligaments that surround the shoulder joint. It is a fairly common condition, especially in people who play sports (basketball, football, volleyball) or secondary to trauma. Usually, shoulder instability is the result of recurrent ligament tears and sprains, damaging the ligaments and creating an unstable joint.

What are ligaments?

Ligaments are fibrous tissue bands that connect bones to bones, giving joints mobility and stability. Due to its poor blood supply they are prone to non- healing conditions from repetitive injuries. There are different types of ligaments in the shoulder. Glenohumeral(keeps the shoulder capsule tight and prevent dislocations), Coraco-acromial, Coraco-clavicular.

What causes Shoulder Instability?

It is usually caused by shoulder trauma leading to dislocation. This stretching of the ligaments , along with impaired healing capacity can predispose the patient to non-traumatic recurrent dislocations. Swimming, tennis, volleyball and other jobs that require repetitive overhead motions can lead to ligament laxity and instability.

What are the symptoms of Shoulder Instability (Ligament sprain)?

Shoulder pain, frequent dislocations, and common episodes of the shoulder giving out and a feeling of having a loose shoulder.

How is Shoulder Instability diagnosed?

After a comprehensive history and physical examination, usually X rays are obtained to assess for other changes. MRI and Sonography can yield more specific information about the degree of the tears and other pathologic conditions in the ligaments, which can be present.

How is Shoulder Instability treated?

At the RSJI we believe that conservative therapies should be utilized in every patient prior to more advanced regenerative interventions or surgical options. Most patients with chronic ankle instability due to ligament tears can be successfully treated with this approach.

  • Conservative
  • Rest in the acute stages
  • Activity modification with avoidance of triggering factors
  • Physical Therapy, Bio-mechanical training
  • Nutritional supplements
  • Medications: NSAIDS (non-steroidal anti inflammatory drugs)
  • Correction of muscle imbalance, stretching, Laser therapy
  • Lifestyle changes

The Regenerative Spine and Joint Institute Approach

With the advent of new bio-cellular regenerative interventions (BRI), we are able to successfully treat patients with mild to advanced partial ligament tears without the need for surgical interventions.
Our ultrasound guided BRI offers a non-surgical, minimally invasive alternative, by allowing us to visualize accurately the damaged ligaments, without the need for an open surgical procedure.

What are the different types of Bio-Cellular Regenerative Interventions (BRI) utilized in the treatment of Shoulder Instability?

B.E.T.R. Bio-Ligament

Stands for biologic enhancement of tissue repair and is a specific technique in which Biologic Stimulant Therapies are injected inside and around the ligaments.

Biologic Stimulants Therapies (BST)

This technique is used initially to treat patients with symptomatic ligaments sprains and tears, who are having mild to moderate symptoms and have minimal degenerative changes in the ligaments. It consists of injecting a combination of substances called Biologic Stimulants into the damaged tear and joint. They contain powerful growth factors (substances which stimulates multiple cell functions) capable of decreasing inflammation and producing significant improvement in function and tissue repair. Biologic Stimulants can be highly successful and cost effective in patients with early symptomatic ligament sprains and small tears.

B.E.T.R. Stem-Ligament

Most preferred method of treatment for patients who do not respond to the above interventions or have moderate to advanced degenerative changes or injuries. It consists injecting a combination of growth factors, scaffolds and mesenchymal stem cells into damaged or injured ligaments.

For more information see Bio-Cellular Regenerative Therapies.

Osteonecrosis of the Shoulder or ABN (Avascular Bone Necrosis)

  • What is Shoulder ABN?

    Osteonecrosis is a disease caused by reduced blood flow to the bones in the shoulder joints, specially the humeral head . With too little blood, the bone starts to die, slowly collapsing, causing cartilage damage and ultimately leading to significant joint arthritis and collapse .

    What are the symptoms of Shoulder ABN ?

    When osteonecrosis first begins, you may not have any symptoms. You may start to feel pain on certain shoulder movements. As the disease gets worse, you may have more pain and the joint may hurt even when you rest. Pain may be mild or severe.

    If the bone and joint start to break down, you may have severe pain and not be able to have full range of motion, and may cause loss of shoulder function. The time from the start of symptoms to losing use of the joint can range from months to more than a year.

    How Is Shoulder ABN diagnosed?

    After a comprehensive history and physical examination, usually X rays are obtained to confirm the diagnosis. MRI can yield more specific information about the degree of bone loss. Sometimes Computed Tomography and Bone Scans are necessary.

    How is Shoulder ABN treated?

    Treatments depend on the patient’s age, stage of the disease and osteonecrosis and related causative factors. The goal is to stop or reverse the actual damage, improve the use of the joint and protect the joints and bone.

    • Conservative
    • Rest in the acute stages
    • modification with avoidance of triggering factors
    • Physical Therapy, Bio-mechanical training
    • Nutritional supplements
    • Medications: NSAIDS (non-steroidal anti inflammatory drugs)
    • Range of motion exercises
    • Electrical Stimulation
    • Weight reduction

    The Regenerative Spine and Joint Institute Approach

    With the advent of new Bio-cellular Regenerative Interventions (BRI), we are able to successfully treat patients with mild to moderated (pre joint collapse stage) Osteo-necrosis without the need for more aggressive surgical interventions. The treatment depends on the type, size of the lesion and presence of joint collapse.

    Our ultrasound and fluoroscopically guided BRI, accurately pinpoint the precise location of the bone defect. This allows the treatment to be performed through a percutaneous approach, without the need for an open surgical intervention.

    Minimally Invasive Core Decompression with Bio-Cellular Therapy

    In patient with failed conservative therapy or early non-collapse joints with osteonecrosis, the most effective intervention is a combination of stem cell therapy with core decompression.

    Core Decompression consists of inserting a bone marrow needle into the damage bone decreasing the pressure. Afterwards, Bio-Cellular Grafts with mesenchymal stem cells are injected into the area containing the dead bone.

    For more information see Bio-Cellular Regenerative Therapies.

Surgical Options:

In patients with advance Ankle ABN that do not respond to the above interventions or have significant joint collapse, a Total Joint Arthroplasty is usually necessary.