Case Report | Published:

Autologous, micro-fragmented adipose tissue as a treatment for chronic shoulder pain in a wheelchair using individual with spinal cord injury: a case report



Shoulder pain is common in persons with chronic spinal cord injury (SCI), with a prevalence reported as high as 70%. Current treatment of shoulder pain includes conservative measures such as physical therapy, pain medications, patient education, injections, and assistive devices. When conservative treatments fail, shoulder surgery is often the next option. Unfortunately, outcomes after shoulder surgery in persons with SCI are limited and conflicting.

Case presentation

This is a case of a 54-year-old right-handed male with T10 complete SCI (duration of injury = 10 years) who had a complaint of right-sided shoulder pain for 3 years. The individual used a manual wheelchair as his primary means of mobility and was an avid weight-lifter. Physical examination and MRI demonstrated a rotator cuff tear and degenerative changes of the acromioclavicular joint. He was previously managed conservatively with physical therapy and intermittent corticosteroid injections but failed to improve. He was enrolled in an IRB approved study and underwent an ultrasound-guided injection with autologous, micro-fragmented adipose tissue (MFAT) and ultimately received improvements in pain and function that were maintained a year after treatment.


To our knowledge, this is the first reported case of treatment of chronic refractory shoulder pain in a person with SCI using MFAT. Complete relief from pain was maintained at the 1-year follow-up. Injection of MFAT under ultrasound guidance is an effective and promising treatment for chronic refractory shoulder pain in upper limb-dependent persons with SCI and warrants further research.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    Nichols PJ, Norman PA, Ennis JR. Wheelchair user’s shoulder? Shoulder pain in patients with spinal cord lesions. Scand J Rehabil Med. 1979;11:29–32.

  2. 2.

    Dalyan M, Cardenas DD, Gerard B. Upper extremity pain after spinal cord injury. Spinal Cord. 1999;37:191–5.

  3. 3.

    Bayley JC, Cochran TP, Sledge CB. The weight-bearing shoulder. The impingement syndrome in paraplegics. J bone Jt Surg Am Vol. 1987;69:676–8.

  4. 4.

    Curtis KA, Roach KE, Applegate EB, Amar T, Benbow CS, Genecco TD, et al. Development of the Wheelchair User’s Shoulder Pain Index (WUSPI). Paraplegia. 1995;33:290–3.

  5. 5.

    Gerhart KA, Bergstrom E, Charlifue SW, Menter RR, Whiteneck GG. Long-term spinal cord injury: functional changes over time. Arch Phys Med Rehabil. 1993;74:1030–4.

  6. 6.

    Tytherleigh-Strong G, Hirahara A, Miniaci A. Rotator cuff disease. Curr Opin Rheumatol. 2001;13:135–45.

  7. 7.

    Van Straaten MG, Cloud BA, Zhao KD, Fortune E, Morrow MMB. Maintaining shoulder health after spinal cord injury: a guide to understanding treatments for shoulder pain. Arch Phys Med Rehabil. 2017;98:1061–3.

  8. 8.

    Goldstein B, Young J, Escobedo EM. Rotator cuff repairs in individuals with paraplegia. Am J Phys Med Rehabil. 1997;76:316–22.

  9. 9.

    Jung HJ, Sim GB, Jeon IH, Kekatpure AL, Sun JH, Chun JM. Reconstruction of rotator cuff tears in wheelchair-bound paraplegic patients. J Shoulder Elb Surg. 2015;24:601–5.

  10. 10.

    Kerr J, Borbas P, Meyer DC, Gerber C, Buitrago Tellez C, Wieser K. Arthroscopic rotator cuff repair in the weight-bearing shoulder. J Shoulder Elb Surg. 2015;24:1894–9.

  11. 11.

    Striano RD, Malanga GA, Bilbool N, Azatullah K. Refractory shoulder pain with osteoarthritis, and rotator cuff tear, treated with micro fragmented adipose tissue. Orthop Spine Sports Med. 2018;2:014.

  12. 12.

    Bianchi F, Maioli M, Leonardi E, Olivi E, Pasquinelli G, Valente S, et al. A new nonenzymatic method and device to obtain a fat tissue derivative highly enriched in pericyte-like elements by mild mechanical forces from human lipoaspirates. Cell Transpl. 2013;22:2063–77.

  13. 13.

    Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113:9–19.

  14. 14.

    Curtis KA, Roach KE, Applegate EB, Amar T, Benbow CS, Genecco TD, et al. Reliability and validity of the Wheelchair User’s Shoulder Pain Index (WUSPI). Paraplegia. 1995;33:595–601.

  15. 15.

    Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med. 1994;23:129–38.

  16. 16.

    Farrar JT, Young JP Jr., LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149–58.

  17. 17.

    Pentland WE, Twomey LT. Upper limb function in persons with long term paraplegia and implications for independence: Part I. Paraplegia. 1994;32:211–8.

  18. 18.

    Pentland WE, Twomey LT. The weight-bearing upper extremity in women with long term paraplegia. Paraplegia. 1991;29:521–30.

  19. 19.

    Halpern B, Chaudhury S, Rodeo SA, Hayter C, Bogner E, Potter HG, et al. Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis. Clin J Sport Med. 2013;23:238–9.

  20. 20.

    Shin YS, Yoon JR, Kim HS, Lee SH. Intra-articular injection of bone marrow-derived mesenchymal stem cells leading to better clinical outcomes without difference in MRI outcomes from baseline in patients with knee osteoarthritis. Knee Surg Relat Res. 2018;30:206–14.

  21. 21.

    Spasovski D, Spasovski V, Bascarevic Z, Stojiljkovic M, Vreca M, Andelkovic M. et al. Intra-articular injection of autologous adipose-derived mesenchymal stem cells in the treatment of knee osteoarthritis. J Gene Med. 2018;20:748–755.

  22. 22.

    Gill TK, Shanahan EM, Allison D, Alcorn D, Hill CL. Prevalence of abnormalities on shoulder MRI in symptomatic and asymptomatic older adults. Int J Rheum Dis. 2014;17:863–71.

  23. 23.

    Gonzalez-Rey E, Gonzalez MA, Varela N, O’Valle F, Hernandez-Cortes P, Rico L, et al. Human adipose-derived mesenchymal stem cells reduce inflammatory and T cell responses and induce regulatory T cells in vitro in rheumatoid arthritis. Ann Rheum Dis. 2010;69:241–8.

  24. 24.

    Rha DW, Park GY, Kim YK, Kim MT, Lee SC. Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial. Clin Rehabil. 2013;27:113–22.

  25. 25.

    Mulroy SJ, Thompson L, Kemp B, Hatchett PP, Newsam CJ, Lupold DG, et al. Strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial. Phys Ther. 2011;91:305–24.

Download references


This case report is a part of a larger, IRB-approved pilot study, with funding provided for by the Derfner Foundation.

Author information

Correspondence to Chris Cherian.

Ethics declarations

Conflict of interest

Gerard A. Malanga is a consultant for Lipogems®. The remaining authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark
Fig. 1
Fig. 2
Fig. 3