Surgery vs. Stem Cells+PRP

If you read the post here, you’ll recall that I saw a physiatrist with experience treating Shoulder Injury Related to Vaccine Administration (SIRVA), Dr. Bodor. He was able to accurately pinpoint the location of the needle of my flu shot using ultrasound to identify the changes to tissue (tendonitis of the teres minor, potential bone damage). He proposed a new path forward:

1. A simple lidocaine/saline solution/flush out of the spot. And if that didn’t help in 2 months, ….
2. A stem cell (bone marrow aspirate concentrate – BMAC) plus platelet-rich plasma (PRP) injection to the spot.

I haven’t found any information about #2 being tried on a SIRVA case, or whether it carries a risk. One correspondent from this website (thank you!) has seen a different physiatrist who is also interested in trying it, which gives me relief that it is not completely out in left field. I’ve done a deep-dive into the stem cell/PRP research to try and understand what people think about its effectiveness at treating (normal) injuries of the rotator cuff, as well as its safety.

I took all this information back to my orthopedist at home, who poo-poo’d the idea of stem cells altogether, calling them “untested, unregulated, unknown” and who recommended surgery instead. At 5+ months out, with only minor improvement (I’d say #1 above did not generate a substantial improvement), I’m interested in trying something to help me return to normal, pain-free life and rock climbing.

Why surgery?

Unlike for stem cell treatments, there IS information out there about surgeries for SIRVA. One respondent in our survey (THANK YOU!!) has had surgery, but is too soon to report on its complete effect but indicates it was ‘extremely helpful.’ In this person’s case, a complete rotator cuff tear was observed, along with bursitis and tendonitis. Their shoulder surgery was pretty major, given the damage. (In my case, the surgeon thinks recovery will be quick, as the primary action will be just subacromial decompression and debridement, with no need for a rotator cuff repair. Unfortunately it is not uncommon for surgeons to go in to shoulders based off the MRI and find unexpected rotator cuff tears that don’t show up well on the imaging, which would turn into a more involved recovery.)

In Atanasoff et al. 2010, she describes that one-third (out of 13) SIRVA cases eventually went to surgery, but does not describe the type or outcomes specifically. One case study, Uchida et al. 2012, describes surgery performed “several months” after a SIRVA-causing shot where the patient did not get better with steroids or PT (similar to myself) but recovered fully after surgery. The procedure was “arthroscopic synovectomy and subacromial decompression” with a shaver and radiofrequency probe. Another case study on a flu shot SIRVA victim with extensive bone damage, surgery, and eventual recovery (though not quickly) is described in Messerschmitt et al. 2015. And most compelling is a case study in Hexter et al. 2015 where the author says:

“At present, there is no consensus in the literature on how to manage this vaccine-related injury. … The patient in our case only regained a pain-free and functional shoulder after washout, arthrolysis, synovectomy and decompression of the subacromial space. We recommend invasive treatment, such as that described in our case, in patients with ongoing shoulder symptoms related to vaccination that do not settle with conservative measures.”

In total, my review of the papers about SIRVA indicate that a total of 11/30 cases ended up having surgery (very consistent with the one-third described above). I do not have as detailed information as in the papers about how successful those cases were. The types of actions performed during surgeries include “irrigation”, “distention arthrography” (this is for frozen shoulder), “debridement”, “subacromial decompression,” and “synovectomy”.

I have about 3 weeks to decide what to do before my appointment for stem cell+PRP treatment. Is it too experimental? Too unlikely to work, especially considering the cost, pain, and risk? Better to just let a surgeon go in and “scope it out”, as my orthopedist said? It is a very tough decision. I’m inclined to go with Dr. Bodor’s approach because of his commitment to understanding how to help SIRVA patients and a desire to avoid a full-blown surgery. I am getting one more opinion next week from a second orthopedist, but one who I know to be more stem cell-friendly than my original orthopedist.

If you have advice, let me know!