Disclosures: Gabriel M. Kim, MD, MSE: Nothing to disclose

Case Description: A 36-year-old female patient presented to outpatient PM&R clinic with complaints of right shoulder pain for 5 months. She stated she injured her shoulder while performing the Clean maneuvers, which involved moving weights from floor to a rack position. She described her shoulder pain as intermittent, sharp/stabbing, and achy, radiating to the biceps but not past the elbow. Pain worsened with heavy lifting, pulling, push-ups, laying on the shoulder, and overhead activity with worst level of pain at 6/10. NSAIDs and acetaminophen did not provide any pain relief. She endorsed shoulder weakness due to pain but denied numbness and tingling in her upper extremity. Musculoskeletal exam of right shoulder revealed full range of motion, pain with external rotation of the shoulder. MRI of the right shoulder showed full-thickness near complete supraspinatus tendon tear and partial thickness tear of infraspinatus tendon. DASH score was 12.5. Patient refused orthopedic surgery, opting for a stem cell injection instead.

Setting: PM&R Pain Clinic

Patient: 36-year-old female active duty service member with rotator cuff injury.

Assessment/Results: After performing fluoroscopic guided bone marrow aspiration, bone marrow aspirate stem cell concentrate (BMAC) was injected intra-tendinously to supraspinatus and infraspinatus tendons under ultrasound guidance. When patient followed up at the clinic 6 weeks after the procedure, she had 70% relief and functional improvement. DASH score was 5, an improvement from her previous score 6 weeks ago. However, repeat MRI of the right shoulder acquired 8 weeks after the procedure showed a similar finding in a previous MRI.

Discussion: Newer treatment techniques using mesenchymal stem cells demonstrate early promising results, particularly for rotator cuff repair.

Conclusion: Although there wasn’t an apparent reconstruction of the rotator cuff tendon, patient did have significant pain relief and functional improvement. There is a need for continued investigation into the efficacy of stem cells-based therapies.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/crossfit-shoulder-injury-treated-with-bone-marrow-derived-mesenchymal-stem-cell-therapy/