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The treatment of choice for advanced glenohumeral arthritis is a total shoulder replacement. While these measures provide improved symptomatic control and functionality, they fail to stop the progressive degeneration of articular cartilage and many patients may go on to require surgery due to worsening symptoms or osteophyte formation causing complications such as impingement(6). Intra-articular corticosteroid injections may be used to reduce joint inflammation. Non-surgical treatment of osteoarthritis will usually start with analgesics and anti-inflammatories, in conjunction with a therapeutic exercise program and activity modification. This paper aims to evaluate the current existing evidence of autologous stem cells, with a focus on it’s use in the shoulder. This increase in research is well known and has been capitalised on by various companies who have opened clinics promising to cure various diseases, from osteoarthritis to motor-neuron disease, through the administration of autologous adipose-derived stem cells. As such it is unclear as to where we are in relation to incorporating stem cells into the treatment of everyday shoulder pathologies. However, stem cell research is still in its early stages with the much of the research relating to in vitro and animal studies. The regenerative potential of these cells may be utilised to regenerate functional articular cartilage and tendon fibres, as well as providing a strong immunomodulatory function that may work to reduce inflammatory damage in acute injury(1). There has recently been a a large amount of research on to the potential of mesenchymal stem cells as a therapeutic target for the treatment of a huge range of diseases. Many older patients may not be suitable candidates for surgery due to the anaesthetic risk(4). Shoulder replacement surgery is the mainstay of treatment for the advanced stages of these conditions however treatment can be challenging when applied to the younger population as long-term revision may be required. Osteoarthritis (OA) of the shoulder is another condition which can present in nearly any demographic of patient and, along with the former, can be highly problematic to treat.Ĭonservative treatment including analgesia, physiotherapy and intra-articular injections are commonly used in both conditions, however in the case of OA this does not work to slow progression of disease(3). This affects 30-50% of patients over the age of 50 at some point in their life however is common across ages and activity levels. The most common pathology of the shoulder involves dysfunction of the rotator cuff, including inflammation and physical tearing leading to pain, weakness and instability of the shoulder joint. Shoulder pain affects up to a quarter of the adult population at any given time(1), and injury is rife amongst the young, healthy athletes, with shoulder pathology accounting for up to 20% of athletic injuries(2). The shoulder is a highly complex joint and is thus predisposed to a wide range of pathologies. The treatment is expensive and one has to question whether the current evidence justifies the cost. More trials need to be done to assess its efficacy for injection both at the point of surgical repair and in non-surgical patients. Evidence to support use of MSCs for rotator cuff tendon pathology is very early and limited, but promising. There is a reasonable body of evidence to support its use for the early stages of OA and as such phase III trials should be implicated. Rotator cuff tear studies yielded 8 animal studies and 3 human studies. We identified 22 animal studies and 17 human studies for Osteoarthritis (OA), with a cumulation of 399 patients assessed. In this article we aim to review the evidence for mesenchymal stem cell therapy so far, focussing on it’s use for the shoulder. High profile cases, media and internet prominence of stem cell therapies have led to a patient demand for the treatment for numerous traumatic and degenerative musculoskeletal conditions. This has led to commercial products and early adoption of the technology. In recent years there has been a boom in the advancements and research in mesenchymal stem cells (MSCs) injections for tissue regeneration.
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Mesenchymal Stem Cells for Shoulder Tendon and Arthritis
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