Orthobiologic Treatment of the Shoulder Joint

What Is Orthobiologic Treatment for the Shoulder Joint?

Orthobiologic treatments are methods that use substances usually obtained from the patient’s own body (blood, bone marrow, fat tissue) or other biological sources to support the healing of musculoskeletal tissues (in the shoulder, particularly tendons, cartilage, joint capsule, bursa), reduce inflammation, and relieve pain. The main goal of these approaches, which are a branch of regenerative medicine, is not to replace traditional medications or surgery, but rather to improve function by stimulating or supporting the body’s natural repair mechanisms, and to potentially delay the need for more invasive treatments.

Main Orthobiologic Methods Used in the Shoulder

The main orthobiologic treatment methods mentioned for shoulder joint problems are as follows:

• PRP (Platelet-Rich Plasma): Plasma obtained from the patient’s own blood through centrifugation, enriched in platelet cells and the numerous growth factors these cells contain. When injected into the damaged area (tendon, intra-articular space, bursa), the growth factors are intended to trigger healing signals, suppress inflammation, and reduce pain. Its use in the shoulder is being studied particularly for rotator cuff tendinopathies and partial tears, biceps tendinitis, and early-stage osteoarthritis.
• “Stem Cell” Treatments (Mesenchymal Stem Cells – MSCs): These are cells, usually obtained from bone marrow (BMAC – Bone Marrow Aspirate Concentrate) or fat tissue, that have the potential to differentiate into different cell types and to send healing signals. When injected into the shoulder, their main effects are thought to be reducing inflammation and positively influencing other cells (paracrine effect) through the bioactive molecules they secrete into the environment. Strong scientific evidence that injection alone completely heals cartilage damage or a full-thickness rotator cuff tear in the shoulder joint is still very limited. Research in this area is ongoing, and it is important to keep expectations realistic. Caution should be exercised regarding products marketed under the name “stem cell” that do not contain live cells or whose effectiveness has not been proven.
• Other Biological Treatments: Special serums prepared from the patient’s own blood (such as ACS/Orthokine) or products such as amniotic fluid/membrane can also be used in the shoulder. The effect of these products is also thought to be mainly through the growth factors, hyaluronic-acid-like substances, and anti-inflammatory molecules they contain.

In Which Conditions Can Orthobiologic Treatments Be Used in the Shoulder?

While the effectiveness and applications of orthobiologic treatments in the shoulder are still being researched, the conditions considered to potentially benefit are as follows:

• Rotator Cuff Tendinopathy (Tendinitis/Tendinosis) and Partial Tears: PRP injections can be used, particularly in chronic tendon problems and partial tears that do not require surgery, to reduce pain and support functional recovery. Full-thickness rotator cuff tears should not be expected to heal with injection alone.
• Shoulder Osteoarthritis (Glenohumeral Arthrosis): Particularly in mild to moderate osteoarthritis, intra-articular PRP or sometimes MSC (BMAC, fat-derived) injections may be tried to control pain and improve joint function. These treatments do not “reverse” osteoarthritis, but they may relieve symptoms and help delay replacement surgery.
• Biceps Tendinopathy: PRP injections may be given into or around the tendon sheath in cases of wear or inflammation of the long head of the biceps tendon that causes anterior shoulder pain.
• Subacromial Bursitis: In chronic bursitis resistant to other treatments, PRP may be tried as an alternative to cortisone injections.
• Adhesive Capsulitis (Frozen Shoulder): Particularly in the early painful phase, intra-articular injections (cortisone is more common, but PRP is also being studied) are thought to be able to reduce pain and inflammation, thereby facilitating physical therapy.
• Labral Tears (SLAP, etc.): The role of orthobiologic treatments in the primary treatment of labral tears is unclear, and surgery is generally considered. However, in some cases their use is being studied as an adjunct to surgery or to support healing after surgery.

Important Note: More scientific studies are needed to draw definitive conclusions about which conditions these treatments are more effective for and who they are suitable for. The decision should be made by the physician after a detailed evaluation of the patient.

Shoulder Orthobiologic Treatment Procedure

The procedure is usually performed in an office or outpatient clinic setting:

1. Preparation: For autologous methods such as PRP or BMAC, a blood or bone marrow sample is taken from the patient; for fat-derived cells, a mini-liposuction is performed.
2. Processing: The sample taken is processed under sterile conditions by centrifugation or special filtration methods to prepare it for injection.
3. Injection: The prepared biological material is carefully injected, usually under ultrasound guidance in the shoulder, into the targeted area (intra-articular space, subacromial bursa, around the tendon, tear site, etc.). Ultrasound guidance increases the effectiveness of the treatment by ensuring the injection is delivered to the correct location.
4. Afterward: A short period of rest is recommended after the injection. Pain, swelling, or tenderness may occur at the injection site for the first few days. Ice application and simple pain relievers may be used. Shoulder movements and activity level are gradually increased according to your doctor’s recommendations. A physical therapy program is usually recommended after the injection.

Shoulder Orthobiologic Treatments: Evidence Level, Expectations, Limitations, and Risks

Being realistic is very important when considering orthobiologic treatments for shoulder problems:

• Level of Scientific Evidence (Specific to the Shoulder):
  
  • The evidence for the shoulder is not as strong and extensive as for the knee, and is still evolving.
  • There is promising but not yet conclusive data that PRP may have positive effects on pain and function in rotator cuff tendinopathy, partial tears, and mild-to-moderate shoulder osteoarthritis. Results vary from study to study.
  • The effectiveness of “stem cell” (MSC) treatments in the shoulder (particularly in terms of cartilage or tendon regeneration) is even more uncertain and is still largely at the research stage.
  • There is not yet a consensus on application protocols (dose, injection frequency, preparation method, etc.).
• Potential Benefits:
  
  • Reduction in pain and inflammation.
  • Improvement in function.
  • Helping achieve a better response to physical therapy.
  • Serving as an alternative or complement to cortisone injections.
  • Potentially delaying the need for surgery.
  • Using the patient’s own biological material (a safety advantage).
• Limitations and Realistic Expectations:
  
  • These treatments are not a “miracle cure” for shoulder problems.
  • In particular, they do not heal full-thickness rotator cuff tears or advanced osteoarthritis.
  • Effectiveness varies greatly from person to person. It does not produce the same result in everyone.
  • The benefits obtained may be temporary.
  • Cost: Usually not covered by insurance and requires private payment.
  • More data is needed on long-term outcomes and effects.
• Risks:
  
  • These are generally low-risk procedures.
  • The most common side effects are temporary pain, swelling, tenderness, or bruising at the injection site.
  • Infection risk is low, as with any injection (<1%).
  • Rarely, nerve or vascular injury or allergic reactions may occur.
  • There are small risks associated with taking a bone marrow or fat tissue sample.
  • One of the most important risks is that the treatment may be ineffective.

Orthobiologic Treatments for the Shoulder in Ankara and Prof. Dr. Murat Bozkurt’s Approach

Interest in regenerative and biological treatment methods for shoulder problems is growing in Ankara. Prof. Dr. Murat Bozkurt keeps scientific evidence and patient safety at the forefront when evaluating these modern approaches:

• Evidence-Based Presentation of Options: When informing his patients about orthobiologic treatments, he clearly explains the available scientific data, the potential benefits of the treatment, and especially its limitations. He avoids creating unrealistic expectations.
• Priority: Proven Treatments: In treating shoulder problems, he primarily applies or recommends methods with proven effectiveness (physical therapy, medications, surgery when necessary).
• Proper Patient Selection: He may consider orthobiologic treatments as an option only after a very careful evaluation, in selected patients and in appropriate circumstances (e.g., patients with tendinopathy resistant to other treatments, or patients with early-stage osteoarthritis who do not want or are not suitable for surgery).
• Adjunctive Treatment Approach: He generally views these treatments as a supportive or complementary approach to other conservative methods such as physical therapy, rather than as a stand-alone solution.
• Reliable Application: If the decision is made to proceed, he performs the procedure using standard and reliable methods, usually under ultrasound guidance, ensuring a targeted and safe injection.

Prof. Dr. Bozkurt notes that orthobiologic treatments may have a potential role in shoulder problems, but that answers to many questions are still being researched, and he encourages his patients to remain cautious in this regard.

Orthobiologic treatments for the shoulder joint are one of the exciting developments in regenerative medicine, but they are not yet a cure-all. When considering these treatments, the best approach is to consult an experienced orthopedic specialist who is knowledgeable about the scientific evidence, potential benefits, and especially the limitations. You can get an expert opinion from Prof. Dr. Murat Bozkurt for your shoulder problems in Ankara.

For detailed information and appointments, you can contact Prof. Dr. Murat Bozkurt by phone at 0312 502 70 74.