Prolotherapy to the Shoulder
It wasn’t until I severely wrenched my right shoulder while lifting weights that I came to understand how medicine had failed pain sufferers and how Prolotherapy was a “miracle.”
An article describing various shoulder problems and the use of Prolotherapy in treating them.
Arthritis to the shoulder is usually triggered by an injury such as a dislocation or separation that has not healed properly. In these cases or even in the cases of past surgical intervention, connection soft tissues–the ligaments, tendons, and cartilage, have not completely healed or have become overstretched (ligament and tendon laxity).
Shoulder impingement syndrome involves one or a combination of problems: inflammation of the bursa located just over the rotator cuff, inflammation of the rotator cuff tendons, (tendinitis), or calcium deposits in tendons—called calcific tendonitis, (caused by wear and tear or injury.) The main problem is usually that the acromium or a bone spur puts pressure on the supraspinatus tendon.
Sometimes the bones in the shoulder joint slip out of normal alignment or are forced out by injury-subluxation and dislocation. For those individuals who suffer from chronic shoulder instability, dislocations may occur frequently.
Chronic shoulder instability syndrome results from trauma caused by subluxations, dislocations, from less detectable micro-trauma caused by repetitive strain on the tissues, or from congenitally loose shoulder joints.
Researchers writing in the Journal of Epidemiology and Community Health say that “Life events and critical life changes are of importance for the risk of neck/shoulder pain…”
From our Radio Show:
Dr. Darrow: If you can lift your arm straight up in the air there is a good chance you can be healed without surgery. So don’t think because you have arthritis that surgery is the only option.
Every single day I have people come in with arthritis. Very
often people come in with arthritis of the right hip which is not as bad as the arthritis in the left hip, but the right
hip hurts, the left one does not.
So get this picture – arthritis in both hips – the hip that
doesn’t have any pain can have worse arthritis. But because of a diagnosis they are going to have surgery on it even though they do not have pain.
And I say to them, “why would you have surgery on the hip that is not painful even with worse arthritis than the other hip with less arthritis that is painful? What does that tell you about pain and arthritis?
Then a lot bulb goes off in their head, it may not be the
arthritis causing them pain.
Every joint has a lot of soft tissue around it, ligaments,
tendons, so pain can come from any of this tissue it may or may not be the arthritis.
So that you say you have arthritis, that may not be the cause of pain and the reason to have a surgery.
Caller: It is too late for me, I already had surgery to my
knees and hips and now it is in my shoulder. My son suggested I listen to your program and talk to you about it.
Dr. Darrow: I think before you have another surgery, you should consider Prolotherapy which is going to stimulate more tissue growth and hopefully get rid of your pain, whether you call it arthritis, or tendonitis, or tendinosis, etc. I really don’t even want to know the diagnosis other than for medical/legal reasons because a diagnosis I believe, often blocks people from healing
by being labeled – they don’t think they can heal because they have arthritis.
So don’t let the diagnosis fool you, don’t let your MRI, your CT Scan, your X-rays fool you, those thing that show up in tests may not be the cause of your pain
Caller:But I have seen X-rays on my knees and there is nothing there.
Dr. Darrow: That is what Prolotherapy does, it stimulates tissue growth.
Discussions from our Radio Show Shoulder Arthritis:
CALLER: I have had a pretty bad banged up shoulder and wrist from years of playing basketball and I probably have the onset of arthritis going on in there as well as bursitis too. I was wonder how Prolotherapy would help?
Dr. Darrow: Well it is a very simple answer that I have, any kind of overuse syndrome, especially in sports like Basketball where you are constantly throwing your arms out (too defend) and to throw that ball as far as you can. When you throw the arm out, there is an end point so there is a snapping motion in the shoulder that takes place, and that wears down a lot of the tissues in the superspinatus tendon which comes out of one of the back muscles and holds the rotator cuff together. That is the cuff that surrounds the shoulder. What we do is inject into the shoulder where it is causing pain and what (Prolotherapy) does is rebuild a lot of that tissue. It is a very, very common injury in all athletes especially in those playing basketball, baseball, swimmers, weight lifters where overhand motion is needed. We get all kind of athletes and the weekend warrior, even for some one who doesn’t do sports, someone who is getting older, there can be a breakdown in the tendon and that can happen from lifting something too quickly, and just happens as we get older. The collagen material that we have in our bodies starts drying out and wearing down so as we age it starts thinning out and it is much easier to be injured.
Injuries for the most part are stretch injuries or wearing out injuries sometimes traumatic injury where you get smashed, (like in contact sports) where the collagen gets damaged.
I think that the chances of your shoulder being healed is like 80-90% with a series of Prolotherapy injections. We would ask that you stop playing basketball while we are healing you up. A future article will go into detail concerning Shoulder Impingement rehab as well.
You know weekend warriors get the worst injuries it seems because they are not in the best of shape and they go out and blast all of a sudden and they do not have the muscle or tendon strength to do these things.
Dr. Darrow: Do you have any pain that goes down your arms or legs?
Caller: Down my arms especially on one side, the left side
Dr. Darrow: (If it is a nerve problem) One of the first things I would try (even before Prolotherapy) is spinal decompression therapy. Spinal decompression therapy is like traction except it pulls you in different directions. What it does is pull on the spine and open up the foramen which are the holes in the spinal cord which the nerves pass through that go down the arm and very often with a series of decompressions, you can aleviate the problem by in essence, giving the nerve more room to breath.
The other thing is that there are trigger points often that can cause these radiating pains down the limbs and even though you say you a herniated disc, that doesn’t mean that that is causing your pain or the pain radiation, because there are trigger points that can create the referral pain patterns just as well as what we call radiculopathy or pinched nerve, so you need to go to someone who understands these different mechanisms and just doesn’t follow the allopathic medical model of “herniated disc – go to surgery.”
We find that most of the people that have these problems with radiating pain is that the radiating pain actually goes away by itself, even without doctors over a period of time, now it can be cyclical thing and come back but often times I have had patients who have fought me and gone to surgery and not only winding up with pain in one limb, but pain going down the other limb as well probably because of scar tissue that forms. Return to Radiculopathy main page
Discussion from our Radio Show:
CALLER: I have a question regarding a shoulder injury, I do not know if it is a rotator cuff, but I would say about two years ago I injured it, I am not sure exactly how, I did the old work through it thing trying to get it better. It never got better. Went and got an MRI done because it was really aggravated so thankfully I had no tears or injuries but problem is I am still in a tremendous amount of pain and I am not really doing anything to lay off it and it is not getter better.
Doctor Darrow: The good news is there is nothing major going on, based on what you are telling is, from the MRI, the problem is the MRI doesn’t tell you what the problem is, which automatically tends to mean that you have an impingement syndrome or that the top of the shoulder is either digging into the tendons or you have a bursitis or an inflammation of the tendon in that area. I do not know if you ever had a steroid injection.
CALLER: No I never had one, in my experience I have been told that cortisone shots is something that you want to avoid.
Dr. Darrow: We don’t like to do repeat injections of steroids or cortisone but sometimes doing it one time is a very good diagnostic test to see where the problem is coming from. Once we find out where the problem is coming from, and we isolate the area, and the needle is telling us, your pain goes away immediately, that is the area where you need tissue rebuilt and grown and then we go and use Prolotherapy after that. Shoulders typically heal with a month to six weeks.
Discussions from our Radio Show:
CALLER: I had a 4th degree shoulder separation accident from a bicycle ride, I had surgery on it. I have full range of motion but the bone does stick out. But occasionally I have aches from it and it feels like it almost feels like it is “asleep,” there is a strange deadness feeling in it.
Doctor Darrow: What probably what happened was as the bone separated, some of the nerves may have been stretched out or been torn. They may have been very superficial nerves that are not major nerves because you are probably as strong as you were before.
CALLER: My arm seems a little bit shortened, it is harder to stretch it out. My main question (my therapist) said that one of the ways other than the strengthening exercises to alleviate the pain was to actually put a lot of pressure on it by hanging from a bar and that would seem to me counter-intuitive because I thought it would hurt it, but it actually does help it when I actually hand and put a lot of weight on it.
Doctor Darrow: There are several things going on, when you stretch it you are allowing the area to open up a little bit, it may be “congested” or jammed together after the surgery and you may be stretching out all the scaring.
The good news is that you have a functional shoulder after that and that was a pretty bad separation.
You can get Prolotherapy to the joint area where the separation was and that would gain more collagen to the area, stimulate the natural growth of collagen there, it is very easy to do, nearly painless with a small, thin needle, see Prolotherapy injections.
Doctor Marc Darrow, M.D., J.D.
Discussions from our Radio Show:
Caller: I have a tear in my labrum, I had surgery a few years ago and I am still getting a lot of pain there and I am desperate to avoid another surgery.
Dr. Darrow: Often times a torn labrum will show up on an MRI, but it will not be the reason for someone’s pain, something else maybe causing the pain.
The labrum is a little lip on the inside of the glenoid (the socket in the shoulder blade) which the ball of the humerus (the upper arm bone) goes in, the labrum is the soft tissue that helps hold the ball in the socket and very often it gets torn, I see them all the time.
We had a patient, he was a lacrosse player that use to fly in from the east coast once every couple of weeks. Initially he could barely move his arm, I saw his MRI, it was the worse MRI I had ever seen.
We did Prolotherapy injections to the proliferate or growth new tissue in the area and we tried to heal it up that way. After about three times he was back to playing Lacrosse again.
The thing is he probably STILL has a torn labrum but that was not the cause of his pain. My point is that you cannot look at an MRI to decide to do surgery, you have to find where the pain is coming from, the best way I think of doing that is a diagnostic injection of lidocaine to see if it can numb up the area, and if it can numb it and then put some dextrose with it then we know that the proliferent is going with the numbing agent. I think there is very good hope for you even with the torn labrum can heal you up. A future discussion will focus on a rotator cuff tear and other similiar injuries.
Dr. Marc Darrow, M.D., J.D.
Chronic shoulder instability syndrome results from trauma caused by subluxations, dislocations, from less detectable micro-trauma caused by repetitive strain on the tissues, or from congenitally loose shoulder joints. Recurrent pain or tenderness in the shoulder joint and weakness in the arm are two of the more common symptoms, but severe examples include patients whose shoulders pop in and out of joint. Frequent shoulder dislocations stretch the brachial plexus, the nerves that run from the neck down the arm. This process can cause permanent nerve damage, pain, and loss of use of the arm.
Sometimes the bones in the shoulder joint slip out of normal alignment or are forced out by injury-subluxation and dislocation. For those individuals who suffer from chronic shoulder instability, dislocations may occur frequently. This occurs because first dislocations usually require a significant amount of force as in anterior dislocations, in which the anterior static shoulder stabilizers are stretched or torn away from the bone. Approximately 95% of shoulder dislocations are this type and typically occur when a person falls on their outstretched hand, or sustains a downward motion blow to the shoulder.
Until recently it was common in cases of dislocation to immobilize the shoulder for long periods of time. But studies showed that while immobilization helped alleviate the pain of such injuries, it also contributed to a general weakening of the ligaments and predominance of adhesive capsulitis.
In one alarming study of 245 patients who had suffered a combined 247 shoulder dislocations, about half of those treated with immobilization had recurring dislocations within the 10 year period of the study. The problem was much greater in the study’s younger people (teens and twenties). This is one of the few situations where older folks have an advantage, because their connective tissue are less elastic, the risk of dislocation is less likely.
Surgery for shoulder separations can be effective for some but as always, surgery should be considered a last option because of issues of complications, down time (immobilization), and for the “weekend warrior,” or professional athlete, a weakening of the shoulder through the removal of and damaging of other connective tissue in the surgical process.
There are many types of arthritis, but most often in the shoulder, it is triggered by an initial trauma. It can also involve “wear and tear” of the tissues of the joint, causing inflammation, swelling and pain. Often people will react by instinctively limiting their shoulder movements in order to lessen the pain. This can lead to a tightening or stiffening of the soft tissue parts of the joint, resulting in yet further pain and restriction of motion. In the worst cases, adhesive capsulitis occurs and the arm can not be moved.
The musculature of the shoulder area is fertile ground for trigger points, as is evidenced by the prevalence of a “stiff neck” and referred pain radiating anteriorly, laterally or posteriorly from all three of the major scalene muscles into the arms, chest or vertebrae. Trigger points from the trapezius muscles can refer pain to the head and down the arms.
Okay, You Know About The Problems and Pain, Now What?
A proper diagnosis of shoulder pain is essential to determine the root cause of the problem and the proper method of treatment. Because many shoulder conditions are caused by specific activities, a detailed medical history is an invaluable tool. A physical examination should also include screening for physical abnormalities—swelling, deformity, muscle weakness, and tender areas—and observing the range of shoulder motion—how far and in which directions the arm can be moved.
Since it’s been proven to strengthen the connective tissues, and has the benefit of over fifty years of testing to back it, Prolotherapy is arguably one of the best choices of treatment in cases of dislocation, rotator cuff tendonitis, muscle tissue impingement or recurring instability.