My patient, a professional baseball player named Bob, could not lift his right arm to shake hands … never mind batting, catching or performing other athletic moves. He had trouble lifting his suitcase, using his arm and hand to open the door, couldn’t carry the groceries. His rotator cuff was torn, and ironically, he had not injured it on the playing field, but while roughhousing on the living room floor with his nine-year-old son. His shoulder hurt badly and over-the-counter pain-killers didn’t help. Surgery was an option. But not only did it cost between $10,000 and $15,000, but there were no guarantees that after the painful operation and three months of intensive physical therapy that his original and range of motion would return.
Together, Bob and I decided on a course of treatment–a melding of ancient techniques (a yoga-like position) and a cutting-edge method (an injection of Platelet Rich Plasma [PRP]) that converge to provide a quicker fix than surgery or a long and possibly fruitless course of physical therapy.
First, I taught him the Triangular Forearm Support (TFS), based on the yoga headstand. My modifications made it possible to perform the maneuver in a traditional headstand, using a chair or against a wall.
First, we tried the TFS on a chair, but Bob could not manage to pull his shoulder blades back and engage his subscapularis. We experimented together against a wall to achieve the position that worked. When he was able to hold the correct pose for the half-minute necessary, I asked him to lift his arms above his head. He did it and was amazed and delighted. He had successfully substituted his subscapularis for his torn supraspinatus, and once he did, there was no turning back. So, as far as I know, he never had pain in that shoulder again.
While Bob achieved great results, my research has shown the supraspinatus rarely heals with this maneuver. The only side-effect I have discovered is that since the subscapularis moves the shoulder joint slightly differently, years later, some arthritis can develop in the joint.
Bob and I waited about two weeks before going on to the second step in the process. I wanted the TFS to “take,” and stabilize, and for Bob to be able to go about his activities of daily living painlessly before working on that shoulder again. When both Bob and I felt secure, we went on to the PRP injection.
Platelet Rich Plasma (PRP)
I used a syringe to remove a small amount of blood from a vein in Bob’s arm, then swirled that blood in a centrifuge to concentrate the platelets. These tiny particles emit growth factor and other proteins and peptides that stimulate the tissue to heal. When the PRP was ready, I injected it into the torn fibres of Bob’s supraspinatus.
This method is still somewhat controversial. Some say it works the same way as stem cell therapy, but it is simpler, and since the PRP comes from the patient, it is biologically identical. Anecdotally, I have seen the concentrated platelets stimulate the injured fibres to knit together and heal about 80 percent of the time.
For Bob and many of my other patients, the old and the new worked synergistically to produce an overall cure. These patients are surprised, grateful and relieved when it happens. For me as a physician, this melding of ancient and cutting-edge techniques was also amazing and satisfying.
Dr. Loren Fishman
Dr. Loren Fishman is medical director of Manhattan Physical Medicine and Rehabilitation. In over two decades of practice, he has gained an international reputation as a back-pain specialist, a diagnostician and a pioneer in the treatment of many disorders, including piriformis syndrome and rotator cuff tears. He has authored more than 70 academic journal articles and six books. He is the past president of the New York Society of Physical Medicine and Rehabilitation, and currently the assistant clinical professor at Columbia Medical School.