A clinical research scientist with Proaxis Therapy uses an ultrasound probe at Greenville Health System's Patewood Medical Campus to measure the extent of the damage from a rotator cuff injury. (photo credit: Patrick Collard/Greenville News)
By Liv Osby, Greenville News
There's no shortage of reasons for rotator cuff injuries.
Nearly 2 million people seek medical attention for these painful and limiting shoulder injuries every year, according to the American Academy of Orthopedic Surgeons.
Surgery and physical therapy can help. But experts say it's not always easy to tell which patients will benefit the most from which treatment.
Now Clemson University researchers are developing a device they believe will be able to help doctors make the call.
The rotator cuff is a group of muscles and tendons that stabilize the shoulder and enable it to move in various directions, according to the academy. Aging, trauma and overuse can cause it to degenerate, and sometimes tear.
These injuries are most common in people over 40, and those who repeatedly perform overhead actions with their arms, such as carpenters and painters, and baseball and tennis players, according to the Mayo Clinic.
Former baseball great Dwight Gooden and tennis star Maria Sharapova both suffered rotator cuff injuries.
But which patients will do well with physical therapy and which need surgery?
A special non-invasive pressure-sensing ultrasound probe designed by the Clemson researchers can measure the extent of the damage and enable doctors to map disease progression and determine treatment, said Dr. David M. Kwartowitz, assistant professor of bioengineering at Clemson.
"With this technology, we can see things in real time ... the dynamic movement of muscle and tissue and say exactly what's going on there," he told The Greenville News.
And better diagnosis can spare patients more costly treatment and improve outcomes, said Chuck Thigpen, a clinical research scientist with Proaxis Therapy who is working with Kwartowitz on the project.
While emerging science suggests that physical therapy alone may be enough for some patients, postponing surgery, which requires four to six months of limited activity, may impact shoulder function, he said. The probe improves the ability to get the information that helps make the determination, he said.
Orthopedic surgeon Dr. Richard Hawkins, co-founder of the Steadman Hawkins Clinic, said the probe should be helpful in determining whether an injury can be repaired.
"This device allows us to analyze the tissue characteristics of the rotator cuff," he said. "And if it has a lot of degeneration, it might not be as reparable as if it had stronger tissue characteristics."
Physicians use conventional ultrasound now to see rotator cuff injuries, but the probe in development should provide more accuracy, said Hawkins, who is also collaborating on the project along with Dr. Mike Kissenberth, vice chair of orthopedics at Greenville Health System.
And while costly MRI imaging is also used now to visualize rotator cuff injuries, he said, the probe, while offering similar images, is another tool that would be much less expensive and could be done in the office setting.
The researchers say the device could cut costs by as much as 70 percent.
Rotator cuff injuries are a growing problem, and second only to back injuries in lost work and medical costs, Kwartowitz said. And with the incidence highest among people over 60, it will get even worse as the nation ages, he said.
"Most people think about this in terms of athletes," he said, "but athletes are only part of the problem."
While the researchers are currently targeting the shoulder, the probe could eventually be used on other joints, Thigpen said.
The idea was hatched about three years ago, he said, and was brought to fruition with Kwartowitz and the help of some of his students at Clemson in the Creative Inquiry program.
Support has also come from the South Carolina Medical Translational Technology Program, the Hawkins Foundation and other funding sources, he said.
And much of the work has been conducted at the Clemson University Biomedical Engineering Campus (CUBEInC) at GHS's Patewood Medical Campus, which was designed to help develop the Upstate's medical-technology industry.
Though it will still be a few years before it hits the market, Kwartowitz said the device, which has been tested on youth and professional baseball players, has been patented and will be refined as more patient data is collected.
Thigpen said the probe should give patients accurate, timely and cost-effective care.
"It's good for patients to understand what the best treatment path is," he said, "hopefully to get a clear path for diagnosis, and also for prognosis - what can I expect my level of function and outcome to be."