Anatomy hub
Shoulder: Options and What the Evidence Actually Shows
Rotator cuff disease and glenohumeral osteoarthritis are the two highest-intent shoulder paths. Both have established surgical and non-surgical ladders.
Anatomy and clinical context
The shoulder trades stability for range of motion. The rotator cuff and labrum are common failure points; glenohumeral cartilage wear produces a different clinical picture.
Physical therapy and activity modification remain first-line for many cuff and OA presentations. Injections and surgery follow based on tear morphology, age, and function goals.
The standard ladder of care
Conservative care first, then injections, then surgery when indicated. Cell therapy belongs inside that conversation — not above it.
- 1
Conservative care
Physical therapy, activity modification, and oral analgesics for many cuff and OA presentations.
- 2
Injections
Corticosteroid, PRP, and orthobiologic injectates in selected partial tears or early arthritis when a physician recommends them.
Autologous cell approaches enter here — dose and donor age are what change the conversation.
- 3
Surgery
Rotator cuff repair, reverse or anatomic arthroplasty, and other procedures for full-thickness tears or advanced arthritis.
Availability
Where this procedure is available
Availability requires both an authorizing state statute and a Forever Labs network physician. Status updates when we publish a provider in Payload — no code change required.
Available now
Florida
Orthopedic authorizationSB 1768 · Ch. 2025-185; Fla. Stat. §§ 458.3245, 459.0127
- Dr. Moises Irizarry-Roman, MD · Miami, Florida
- Dr. Tad DeWald, MD · Miami, Florida
- Dr. Joshua Hackel, MD · Gulf Breeze, Florida
Law open — network coming
Tennessee
HB 2246 · Tenn. Code Ann. Titles 63 & 68 (as amended)
Forever Labs network recruitment in progress — no committed quarter yet
Rulemaking still pending
Wyoming
SF 0048 — Stem Cell Freedom Act · W.S. §§ 35-4-1101 through 35-4-1106
Forever Labs network recruitment in progress — no committed quarter yet
Physician must be listed on the Board of Medicine registry
Pending legislation
Arizona
SB 1214 — Bill still pending; definition would expressly cover culture-expanded cells
Different pathway
These states have regenerative-medicine laws, but not Florida-style orthopedic authorization. Labeled with their actual scope.
Review-board pathway
Montana
SB 535 — Phase 1 safety data + review-board approval required; not condition-specific
Right-to-try
Texas
HB 810 + HB 5147 — Restricted to severe chronic or terminal illness
Right-to-try
Mississippi
Stem cell investigational access — Right-to-try style; not a general orthopedic authorization
Birth tissue only
Utah
SB 199 / SB 275 — Allogeneic birth tissue only — not autologous MSC banking
Not in one of these states?
Banking and shipping are nationwide. Your cells can be shipped to your physician, but the procedure itself has to be arranged with your doctor first.
Browse the full provider networkVerified as of July 31, 2026. Statute claims cite primary sources. Forward-looking network quarters are Forever Labs targets, not legislative promises. Therapies described here are not FDA-approved.
Evidence
Where cell therapy fits
Shoulder orthobiologic studies vary widely in product, dosing, and outcomes. Treat marketing claims skeptically; treat your physician's exam and imaging as the primary decision frame.
- 2
- Randomized trials
- 1
- Expanded-cell approvals
- 440
- Largest trial (participants)
The honest read — Same-day products keep landing at parity. The approved products that show more are the expanded ones — which makes dose, not enthusiasm, the variable worth acting on.
- 01
Partial cuff tears and early OA are the scenarios most often discussed for regenerative injectates — not every tear or every arthritis stage.
- 02
Same-day products remain limited by cell yield and donor age — the same dose story as knee OA.
- 03
Banking preserves younger cells if a future course of care needs expansion beyond a single aspiration.
The sources
Both directions, cited plainly — the trials that found no advantage and the approvals that show what engineered dose looks like.
- Randomized trialn = 440
MILES
Mautner et al. · Nature Medicine (2023)
n=440 knee OA trial: BMAC, umbilical tissue, and SVF vs corticosteroid — none beat steroid at one year; none moved MRI scores.
- Randomized trial
Shapiro 2017
Shapiro et al. · AJSM (2017)
BMAC vs saline in the same patient's other knee — no difference on primary outcomes.
- Regulatory approvalSouth Korea
Cartistem
Approved product (Korea) · Regulatory approval (2012)
Culture-expanded allogeneic MSC product approved in Korea with structural signal in cartilage repair settings.
You are your own best donor
The most powerful medicine you'll ever use is already inside you.
Your stem cells are the body's repair crew — the same cells that build, heal, and renew tissue your whole life. Bank them now, at their most potent, and keep that regenerative power on your side for the years ahead.
Your cells, your biology, zero rejection.
No donor waitlist, no match required. These are your own stem cells — the safest, most natural material medicine has to work with.
Younger cells are stronger cells.
Your stem cells are more vigorous today than they'll ever be again. Bank them now and you lock in that youthful potency — 35-year-old cells stay available to the 55-year-old you.
One bank becomes a lasting supply.
Culture expansion turns a single collection into dose after dose — enough for a full course of treatment, not a one-shot souvenir. Rolling out now as our Florida cGMP lab comes online.
Ready the moment you need it.
When you and your physician decide it's time, your cells are waiting at peak potency — so the treatment works with the best version of you.
