Case Study:

Efficacy of EXM Perinatal-Derived ECM Therapy for Chronic Muscle Injuries 3 Participant Series with 12-Week Follow-Up

Author: Dr. Kade Hadley, DPM, DO

Affiliations: In collaboration with Utah Valley University – College of Health Science

Introduction

Background:

Chronic shoulder pain is frequently associated with degenerative changes, rotator cuff pathology, and glenohumeral joint inflammation. It significantly affects function and quality of life, while standard treatments such as corticosteroid injections or physical therapy often provide only temporary relief. Perinatal-derived biologics such as EXO-MOVE and EXM represent an emerging therapeutic approach, combining extracellular matrix scaffolding, viable cells, growth factors, and exosomal signaling to promote a reparative joint environment.

By delivering both structural and signaling components, EXO-MOVE and EXM may support cellular attachment, angiogenesis, tissue remodeling, and modulation of inflammation. These mechanisms provide a biologically rational option for shoulder pain where regenerative capacity is otherwise limited.

Objective

To evaluate the safety, tolerability, and early efficacy of a single ultrasound-guided intra-articular and periarticular injection of EXO-MOVE (1 mL) combined with EXM (1 mL) in three participants with chronic shoulder pain, with follow-up extending to 8 weeks.

Methods

Participant Selection

Inclusion criteria: Adults aged 35–70 with chronic shoulder pain (>6 months), imaging-confirmed degenerative or inflammatory changes, and failure of conservative therapy. Exclusion criteria: Active infection, prior shoulder arthroplasty, systemic corticosteroid use within 1 month, pregnancy, or breastfeeding.

Pre-Treatment Preparation

Written informed consent obtained. Injection site prepared with chlorhexidine. Optional local anesthetic administered. Ultrasound guidance used to confirm intra-articular and periarticular placement. Treatment Protocol EXO-MOVE (1 mL) + EXM (1 mL) injected intra-articularly and periarticularly under sterile technique.

Post-Procedure Care

Patients observed for 15 minutes for immediate adverse events. Written aftercare advised mild soreness (24–72 h), avoidance of NSAIDs/alcohol (72 h), and restricted overhead lifting for 2–3 days.

Outcome Measures

Primary: Safety/tolerability and change in VAS pain. Secondary: Functional improvement (range of motion, daily activity tolerance) and satisfaction at 8 weeks.

Results

Participants:

Participant 1 (Age 50, baseline VAS 7): At 8 weeks, no adverse events. VAS improved to 2. Reported improved mobility and reduced nighttime pain. Rated 'very satisfied.'

Participant 2 (Age 44, baseline VAS 6): At 8 weeks, no adverse events. VAS improved to 3. Noted improved overhead activity tolerance and decreased stiffness. Rated 'very satisfied.'

Participant 3 (Age 61, baseline VAS 8): At 8 weeks, no adverse events. VAS improved to 2. Reported improved daily function, with some residual pain on exertion. Rated 'satisfied.'

Discussion

This case series demonstrates that combined EXO-MOVE and EXM injections were safe and well-tolerated in patients with chronic shoulder pain. Clinically meaningful reductions in pain and improvements in functional outcomes were noted at 8 weeks. These findings align with the proposed regenerative and anti-inflammatory mechanisms of perinatal-derived

ECM biologics.

Limitation

Limitations include the small sample size (n=3), lack of a control group, reliance on patient-reported outcomes, and relatively short follow-up duration. Future controlled trials with objective measures of shoulder function and longer observation periods are needed to confirm efficacy.

Conclusion

A single ultrasound-guided intra-articular and periarticular injection of EXO-MOVE combined with EXM (2 mL) was safe, well-tolerated, and associated with meaningful reductions in pain and improvements in function through 8 weeks in patients with chronic shoulder pain. These preliminary findings support the need for larger, controlled studies to further explore the therapeutic role of perinatal-derived ECM biologics in shoulder pathology.

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