Rotator Cuff Healing May Depend On Your Genes

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rotator cuff healingAs I’ve said many times, the structural model of orthopedics that depends on sewing things together to help pain is on its deathbed as study after study show that these types of surgeries are ineffective. That same paradigm shift holds true in rotator cuff repair, where recent research shows that the surgery was unable to beat physical therapy. Now a new research study shows that rotator cuff healing likely depends on how your genes behave.

A Primer On What We Know About Rotator Cuff Healing

The rotator cuff is a group of muscles that help to both move and stabilize the main shoulder joint. As we age, one or more of these muscle tendons can be torn just by an innocuous activity—something like reaching overhead for a carry-on in an airplane. We used to think that rotator cuff injuries were like any other tear in any other structure, and just a good sewing job during surgery would do the trick. However, many times, that doesn’t work so well. For example, we know that surgery for big rotator cuff tears will often fail (here’s another study showing that large rotator cuff tear surgery fails more often than not). Why is this happening?

First, we all take for granted that the native stem cell content of any body part is related to its ability to maintain and heal itself—meaning more local stem cells means better healing ability. In rotator cuff tears, fewer stem cells are usually present. In addition, adding stem cells to a surgical rotator cuff repair will improve outcome. 

We also know that one of the common treatments given to patients with shoulder rotator cuff tears is a steroid shot to reduce swelling and pain. While this is a potent anti-inflammatory, the steroid also hurts the tendon cells. In addition, we also know that shoulder rotator cuff surgery patients who receive steroid shots have tendon cells that are in poorer health than those patients who never got the shots. In fact, the new research focuses on this same concept—how cells in certain patients are different from those in other patients.

What Is Gene Expression?

You’ve heard that you have genes, which are the instruction set for everything in your body. How those genes are used (i.e., which chapter and verse of the genetic manual that your body reads from) is called gene expression. As an example, you may have a gene that tells your body how to make a certain protein. As your body reads those instructions to make that protein, this is called gene expression.

How Rotator Cuff Healing Depends On Gene Expression

The new study took samples of cells from the torn rotator cuff tendons that had experienced small or large tears and looked at gene expression in these versus normal tendon cells. Interestingly, the cells from rotator cuff tear patients were in the process of using their genes to make proteins that broke down tissue (matrix metalloproteinases). They were also specifically not using their genes to make new tendon. In addition, the cells from the tears showed a lessened ability to call for new cells to help repair (lessened chemotaxis).

The upshot? The reason why so many surgical repairs fail is that the tendon cells that are supposed to help heal the tear can’t do what they need to. Sometimes that’s because a physician, who hasn’t gotten the memo that steroid shots are bad news, poisons the cells by injecting this nasty anti-inflammatory. Sometimes it’s because the local area doesn’t have enough normal stem cells to help healing, or those have, again, been poisoned by a steroid shot.

So if you have a rotator cuff tear, realize that the correct move is to do something to ramp up the healing ability of the area. We’ve successfully used precise injections of the patient’s own stem cells for years to help patients avoid surgery altogether—which decreases downtime and allows a faster return to activity!

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8 thoughts on “Rotator Cuff Healing May Depend On Your Genes

  1. Craig

    I have a slight tear in my labrum and rotator cuff but isn’t bad enough that it needs surgery. It only bothers me when I throw and some weightlifting exercise. Would a PRP procedure work to strengthen without the full stem cell procedure?

    1. Regenexx Team Post author

      Craig,
      Many different factors go into determining a treatment plan, so whether stem cells, platelets or a mixture of both is the best treatment would be based on a physical and ultrasound exam. You could get an idea of what treatment would most likely be needed in the Candidacy Evaluation by filling in the Candidate Form. This would set up a phone chat with one of our Doctors, giving them a chance to look at your MRI’s, take a medical history, and learn more about what’s been going on with your shoulder. Generic PRP from a bedside centrifuge is unlikely to help. See: http://www.regenexx.com/blog/shoulder-labral-tear-pros-cons/ http://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/

  2. Pamela Chester

    Ripped rotation cuff 1994. GP Dr gave 3 steroid inj over a period of two months. Then ortho Dr said instead of surgery that PT could help. ( I did not participate in sports….but enjoyed house chores with great gusto!) I am now 72 and shoulder is in pain more than out of pain with limited ability. I would consider Regenexx if I thought it would help me.

    1. Regenexx Team Post author

      Pamela,
      “Enjoyed house chores with great gusto!” is the favorite line of the day! All things considered, it sounds like you’ve fared well, especially with the steroid shots, as they’re so toxic to local stem cells and tissue they generally escalate the situation. It also sounds like you had a wise Ortho. But now that it’s limiting your ability and causing pain most of the time, it would be important to intervene. Often what happens is the underlying instability results in bone spurs. But all of that is treatable. To see if you’re a Candidate for a Regenexx Procedure, please fill out the Candidate form so we can see how we can help. See: http://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/ and http://www.regenexx.com/blog/shoulder-surgery-side-effects/ and http://www.regenexx.com/shoulder-labral-tear-surgery-pros-cons/

  3. Dennis

    Off topic from rotator cuff injuries, but I read an interesting article about how Major League pitcher Garrett Richards has just had a stem cell injection instead of Tommy John surgery. He said he’s “listening to his body” (or more specifically, his elbow that still felt good) rather than an MRI report. He reportedly had opinions from five different surgeons. It’ll be interesting to see if this works and he can prevent invasive surgery.

    1. Regenexx Team Post author

      Dennis,

      It will be interesting!

  4. Mike

    Would it be safe to assume that the genes that may impede rotator cuff healing would also affect all the tendons throughout ones body ? I seem to be very susceptible to tendon issues throughout my body and yeah they dont seem to heal that well either. I asked my orthopedist about it and he said “well some people wear out faster than others”. Its frustrating to suffer from these problems and hear such inadequate explanations like that. Thank you for posting this. Its good to know that just maybe some real progress is being made in understanding the biology of these conditions.

    1. Regenexx Team Post author

      Mike,
      Yes. Please see: http://www.regenexx.com/blog/is-being-prone-to-injury-a-genetic-thing/ However, there are many different explanations and diagnoses for what you describe. A physician who is willing to spend an hour with you to investigate what’s going on is needed. If you’d like one of our docs to take a look, please fill out the Candidate form.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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