PROLOTHERAPY & Shoulder Injuries
Ross Hauser, M.D.

Shoulder injuries and pain are quite common in golfers, swimmers, and tennis players. Shoulder pain may be due to acute bursitis, also known as an inflammation of the gel-like cushion in the shoulder. This results in extreme pain in the upper arm and shoulder region. Pain may even extend down the arm and can be quite severe. These patients find it almost impossible to lie on the shoulder. 
 

Rest and ice therapies are the usual treatments that are recommended by traditional orthopedists and are the treatments that the patients can tolerate. Massage usually irritates the area further. Acute bursitis is actually quite rare and many cases diagnosed as bursitis are actually due to rotator cuff tendonitis. Acute bursitis is characterized by severe unremitting pain, redness, and swelling in the shoulder. It is so painful that patients will not even let doctors go near the area to touch or inject it.
 

The rotator cuff tendons are the most common structures affected in shoulder sports injuries. Particularly common are injuries to the supraspinatus tendon. Onset of its symptoms is usually quite gradual. Pain and weakness occur during shoulder motion, particularly when the arm is moved from the body to the side, between 80 and 120 degrees. Treatment of supraspinatus rotator cuff injuries involves avoidance of repetitive over arm motion and the use of a conditioning program to stretch and strengthen the rotator cuff muscles. If the symptoms persist, Prolotherapy on the attachment of the supraspinatus tendon to the humerus can be quite helpful in facilitating further shoulder rehabilitation. 
 

The rotator cuff is especially prone to degeneration as a person ages. Sports injuries to these tissues are thus much more likely in older adults. The aging process itself has been found to do the following to the rotator cuff: disruption of the integrity of the attachment of the tendon to the bone, loss of cellularity and fragmentation of the tendon, diminution of the vascularity of the tendon, and a decrease in the amount of fibrocartilage. Rotator cuff tendon degeneration can even be seen in individuals in their 20s.
 

Another common shoulder condition that can be helped by Prolotherapy, is acromioclavicular ligament sprain. A partial tear of the ligament that holds the acromium to the clavicle can be extremely painful. The pain and tenderness is located over the outer tip of the collarbone. Pain worsens as the arm is moved across and in front of the body. Generally the shoulder is stable but painful. Instability in the acromioclavicular joint is one of the factors that causes rotator cuff injury. This gives the athlete another reason to treat the acromioclavicular sprain with Prolotherapy.
 

X-rays are often ordered to determine the severity of the injury. Frequently the x-rays are taken with the patient holding a light weight, because this can help to more accurately reveal the extent of the injury. In addition to Prolotherapy, a rehabilitation program to strengthen the dynamic shoulder stabilizers (rotator cuff muscles) is also helpful. If the athlete does not address the acromioclavicular sprain and rotator cuff injury immediately, a Frozen Shoulder may develop. This occurs because an athlete stops moving his/her shoulder through the full range of motion because of pain. The shoulder joint capsule then becomes scarred. Prolotherapy is helpful to strengthen the weakened tissues in such an instance, but massive amounts of physiotherapy will be needed to regain the motion. It is important that athletes do not ignore pain. Pain always occurs for a reason. Prolotherapy is typically the treatment that gets rid of the pain and any subsequent problems that might have arisen.
 

Shoulder Arthroscopy:
It is a favorite activity of orthopedists to stick scopes into athletes' shoulders when they do not know what is wrong with the patient. The innocent phrase, "We'll just take a look," could not be further from the truth. The second the eager orthopod sees some inflamed or frayed tissue, the annoying sound of a blade starts. Ffffrrrmm. Ffffrrrmm. If the athlete is awake for this, it will not be a sound soon forgotten. Because it is this sound, more than any other, that ends an athlete's career.

The following study is an example of the truth of the above statements. In this study, 43 athletes under age 40, more than half of which were collegiate or professional athletes, with partial rotator cuff tears were treated arthroscopically and observed for a minimum of 24 months. Fourteen of the 43 athletes had acute traumatic injuries and 64 percent returned to their pre-injury sports activity after arthroscopy. The other 29 athletes had more insidious injuries. They involved overhead activities, like throwing, and came on gradually. Of these athletes, only 45 percent returned to their pre-scope athletic level. In those athletes who had some looseness in the joint, only 25 percent of them returned to their sport. (Burns, Thomas. Arthroscopic treatment of shoulder impingement in athletes. American Journal of Sports Medicine. 1992; 20:13-16.)

Rotator Cuff Tears: Scope versus Prolotherapy

The sad part about this study is that rotator cuff tears are the most common shoulder injury experienced by athletes. This is because the rotator cuff muscles allow the athlete to throw a ball. This is one of the easiest injuries to treat with Prolotherapy. Most Prolotherapists have a 90 percent success rate with rotator cuff injuries. The athletes who have partial rotator cuff tears can generally be almost guaranteed that Prolotherapy will put them on the road back to their sports.
 

Glenoid Labrum Tears

Other shoulder conditions treated arthroscopically are glenoid labrum tears. The glenoid labrum helps keep the shoulder joint in place.
 

It would make sense that arthroscopic shaving or debridement would make the athlete worse. How will shaving a torn tissue help strengthen the injured area? The labrum is needed to help stabilize the shoulder. By removing this structure via debridement with the scope, the athlete's problem is only made worse. One study, following patients who had debridement of the labrum tear with arthroscopy, showed that at one year only 30 percent of those with anterior tears had an excellent result and this decreased to 25 percent after two years.

Do we refer patients for arthroscopy? We refer only in very selected, appropriate situations. We have never referred a patient for knee arthroscopy, but have occasionally referred patients for shoulder arthroscopy. Some people have a partial rotator cuff tear because of a bone spur on the acromial process or the clavicle. Debridement of the bone spur is very effective for this condition. In the few cases of patients who have had this procedure, the orthopedists have commented on how beautiful the patients' rotator cuffs look, despite the impingement on them by the bone spur. The patients knew why this was true. They had received Prolotherapy to their rotator cuffs prior to the surgery. The same can be done for the glenoid labrum and any other tissue in the shoulder.