Wheelchair User Finds Complete Shoulder Pain Relief After One Year
Chris Cherian, Gerard A. Malanga, Nathan Hogaboom, Michael A. Pollack, Trevor A. Dyson-Hudson · Spinal Cord Series and Cases · 2019
Shoulder Pain Affects Up to 70% of Wheelchair Users
People with spinal cord injuries face a unique challenge. They rely heavily on their arms and shoulders for daily activities. This constant use often leads to shoulder pain, particularly in the rotator cuff muscles. Studies show that up to seven out of ten wheelchair users experience shoulder pain. This pain can seriously limit independence and quality of life.
Traditional treatments include physical therapy, pain medications, and steroid injections. When these fail, surgery may be recommended. However, surgery outcomes for people with spinal cord injuries are mixed. Post-surgical recovery also creates major challenges. It may require switching to a power wheelchair and needing help with daily activities during healing.
Active 54-Year-Old Faced Worsening Pain Despite Multiple Treatments
This case involves a 54-year-old man with a complete spinal cord injury at the T10 level. He had been injured ten years earlier. He used a manual wheelchair and was an active weight-lifter. Three years before treatment, he developed right shoulder pain without any specific injury.
His pain gradually worsened from occasional flare-ups to constant discomfort. He rated his pain as seven out of ten. Imaging showed a partial tear in his rotator cuff tendon and joint degeneration. Over time, he tried:
Reduced workout intensity
Anti-inflammatory medications
Steroid injections two to three times per year
Each steroid injection provided only temporary relief. Eventually, even this benefit diminished.
Patient Received Ultrasound-Guided Injection of His Own Fat Tissue
The patient enrolled in an approved research study. He received an injection of micro-fragmented adipose tissue (MFAT). This is specially processed fat tissue taken from his own body. The procedure used the Lipogems® system to prepare the tissue.
Doctors first collected fat from his lower flanks using local anesthesia. The fat was washed and broken down into smaller pieces. This process preserves the natural healing cells within the tissue. Doctors then used ultrasound imaging to guide precise injections into three areas:
The torn supraspinatus tendon (2.5 milliliters)
The subacromial bursa, a fluid-filled sac near the shoulder (2 milliliters)
The acromioclavicular joint (1 milliliter)
Complete Pain Relief Maintained at One-Year Follow-Up
The results were remarkable. The patient achieved complete relief from his shoulder pain. This improvement was maintained at the one-year follow-up appointment. Follow-up MRI imaging also showed improvement in the partial tendon tear compared to before treatment.
This outcome is especially meaningful for wheelchair users. Unlike surgery, this minimally invasive procedure did not require prolonged immobilization. The patient could maintain his mobility and independence during recovery.
First Reported Case Offers Hope for Spinal Cord Injury Patients
This is the first reported case of using MFAT to treat chronic shoulder pain in a person with spinal cord injury. The researchers note that this treatment shows promise for people who depend on their upper limbs for mobility.
Previous research in able-bodied individuals has shown similar benefits. One study of 18 people with rotator cuff problems found sustained pain improvement lasting 12 months after MFAT treatment.
What This Means for Your Treatment Decision
This case report suggests that MFAT injection may offer a promising option for wheelchair users with chronic shoulder pain. The treatment appears to provide lasting relief without the challenges of surgery.
However, this is a single case report. More research with larger groups of patients is needed. If you are considering this treatment, discuss it with your healthcare provider. They can help determine if you might be a good candidate based on your specific situation.
The key advantages demonstrated in this case include:
Using your own tissue (no risk of rejection)
Minimally invasive procedure
No prolonged immobilization required
Sustained pain relief at one year
Imaging evidence of tissue improvement
Source: Cherian et al., Spinal Cord Series and Cases, 2019.
Original Publication
Autologous, micro-fragmented adipose tissue as a treatment for chronic shoulder pain in a wheelchair using individual with spinal cord injury: a case report
Chris Cherian, Gerard A. Malanga, Nathan Hogaboom, Michael A. Pollack, Trevor A. Dyson-Hudson · Spinal Cord Series and Cases · 2019
Shoulder pain is common in persons with chronic spinal cord injury (SCI), with a prevalence reported as high as 70%. Current treatment of shoulder pain includes conservative measures such as physical therapy, pain medications, patient education, injections, and assistive devices. When conservative treatments fail, shoulder surgery is often the next option. Unfortunately, outcomes after shoulder surgery in persons with SCI are limited and conflicting. This case report describes a 54-year-old right-handed male with T10 complete SCI (duration of injury = 10 years) who had a complaint of right-sided shoulder pain for 3 years. The individual used a manual wheelchair as his primary means of mobility and was an avid weight-lifter. Physical examination and MRI demonstrated a rotator cuff tear and degenerative changes of the acromioclavicular joint. He was previously managed conservatively with physical therapy and intermittent corticosteroid injections but failed to improve. He was enrolled in an IRB approved study and underwent an ultrasound-guided injection with autologous, micro-fragmented adipose tissue (MFAT) and ultimately received improvements in pain and function that were maintained a year after treatment. To our knowledge, this is the first reported case of treatment of chronic refractory shoulder pain in a person with SCI using MFAT. Complete relief from pain was maintained at the 1-year follow-up. Injection of MFAT under ultrasound guidance is an effective and promising treatment for chronic refractory shoulder pain in upper limb-dependent persons with SCI and warrants further research.