# What to ask about a joint procedure *Straight Answers About blood-or-tissue care | cellular therapy Surprise* > Get plain answers about cellular therapy Surprise, meaning blood-or-tissue joint care, including the shots, costs, and questions. Some mornings, your joint loosens after a few steps. On other days, the ache stays. You may hear several names for joint shots. Ask what each shot contains and how it's made. These answers give you the plain words. ## Sources 1. In 96 patients, concentrated bone marrow aspirate contained a mean of 26.3 million nucleated cells per mL but only about 1,422 colony-forming units of connective tissue progenitors, and the nucleated cell count had negligible predictive value for how many progenitor cells were actually present (r-squared 0.28). Muench LN, et al. — [Nucleated Cell Count Has Negligible Predictive Value for the Number of Colony-Forming Units for Connective Tissue Progenitor Cells (Stem Cells) in Bone Marrow Aspirate Harvested From the Proximal Humerus During Arthroscopic Rotator Cuff Repair](https://pubmed.ncbi.nlm.nih.gov/33581306/). *Arthroscopy*, 2021. DOI: 10.1016/j.arthro.2021.01.064. 2. Mesenchymal stromal cells make up only about 0.001 to 0.01 percent of the nucleated cells in bone marrow, so the harvesting and processing technique - aspiration site, syringe size, centrifuge speed and time - materially determines what ends up in the syringe, and no consensus protocol exists. Jeyaraman M, et al. — [Impact of the Process Variables on the Yield of Mesenchymal Stromal Cells from Bone Marrow Aspirate Concentrate](https://pubmed.ncbi.nlm.nih.gov/35200410/). *Bioengineering (Basel)*, 2022. DOI: 10.3390/bioengineering9020057. 3. The International Society for Cell & Gene Therapy position statement holds that the acronym MSC should mean mesenchymal STROMAL cells and should only be called stem cells where rigorous in vitro and in vivo evidence of stemness exists for that specific preparation. Viswanathan S, et al. — [Mesenchymal stem versus stromal cells: International Society for Cell & Gene Therapy (ISCT®) Mesenchymal Stromal Cell committee position statement on nomenclature](https://pubmed.ncbi.nlm.nih.gov/31526643/). *Cytotherapy*, 2019. DOI: 10.1016/j.jcyt.2019.08.002. 4. The 2005 International Society for Cellular Therapy statement that first flagged the problem concluded that plastic-adherent marrow cells do not meet generally accepted criteria for stem cell activity, making the name 'mesenchymal stem cell' scientifically inaccurate and potentially misleading to the lay public. Horwitz EM, et al. — [Clarification of the nomenclature for MSC: The International Society for Cellular Therapy position statement](https://pubmed.ncbi.nlm.nih.gov/16236628/). *Cytotherapy*, 2005. DOI: 10.1080/14653240500319234. 5. A laboratory study of three commercially available amniotic fluid products marketed for orthopedic use found no viable mesenchymal stem cells in any of them when compared against unprocessed amniotic fluid and bone marrow-derived MSC samples - products sold as 'amniotic stem cell therapy' contained no living stem cells. Panero AJ, et al. — [Are Amniotic Fluid Products Stem Cell Therapies? A Study of Amniotic Fluid Preparations for Mesenchymal Stem Cells With Bone Marrow Comparison](https://pubmed.ncbi.nlm.nih.gov/30844295/). *Am J Sports Med*, 2019. DOI: 10.1177/0363546519829034. 6. 21 CFR 1271.10(a) sets the four criteria a human cell or tissue product must meet to be regulated SOLELY under section 361 of the Public Health Service Act: it must be minimally manipulated; intended for homologous use only, as reflected by labeling and advertising; not combined with another article beyond water, crystalloids or a preserving agent; and either have no systemic effect and not depend on the metabolic activity of living cells, or else be for autologous use, use in a close blood relative, or reproductive use. US Code of Federal Regulations, Title 21 — [21 CFR 1271.10 - Are my HCT/P's regulated solely under section 361 of the PHS Act](https://www.ecfr.gov/current/title-21/chapter-I/subchapter-L/part-1271/subpart-A/section-1271.10). *null*, 2004. 7. FDA's final guidance for industry, issued July 2020 by CBER and CDRH under docket FDA-2017-D-6146, sets out how the agency applies the minimal manipulation and homologous use criteria that determine whether a cell or tissue product is a 361 HCT/P or an unapproved 351 biological product requiring a license. US Food and Drug Administration, CBER and CDRH — [Regulatory Considerations for Human Cells, Tissues, and Cellular and Tissue-Based Products: Minimal Manipulation and Homologous Use - Guidance for Industry and Food and Drug Administration Staff](https://www.fda.gov/regulatory-information/search-fda-guidance-documents/regulatory-considerations-human-cells-tissues-and-cellular-and-tissue-based-products-minimal). *null*, 2020. 8. In a 480-patient, four-arm, multicenter randomized phase 2/3 trial, none of three orthobiologic cell injections - autologous bone marrow aspirate concentrate, autologous adipose stromal vascular fraction, or allogeneic umbilical cord tissue-derived mesenchymal stromal cells - was superior to any other, or to a corticosteroid injection control, on pain at 12 months. Mautner K, et al. — [Cell-based versus corticosteroid injections for knee pain in osteoarthritis: a randomized phase 3 trial](https://pubmed.ncbi.nlm.nih.gov/37919438/). *Nat Med*, 2023. DOI: 10.1038/s41591-023-02632-w. 9. FDA states in its consumer alert that the only FDA-approved stem cell products in the United States are blood-forming stem cells derived from umbilical cord blood, approved for disorders of the blood-forming system, and that NONE of these products - stem cells, stromal vascular fraction, umbilical cord blood, Wharton's jelly or amniotic fluid - has been approved for the treatment of any orthopedic condition, including osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain or shoulder pain. US Food and Drug Administration, Center for Biologics Evaluation and Research — [Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes](https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/consumer-alert-regenerative-medicine-products-including-stem-cells-and-exosomes). *null*, 2020. ## What shots may be offered for a sore joint? One may use your blood. The letters PRP mean platelet-rich plasma, a shot made by spinning your own blood and keeping a platelet-heavy part. Other procedures start with pelvic marrow or fat taken from you. Ask which material you're getting. ## How does the clinic prepare a joint shot? Clinics may draw blood or marrow, then spin it. Fat may be washed and cut into small pieces. These steps don't make the same material. Ask what the clinic starts with, what it does next, and whether anything gets added. ## What is marrow drawn and spun, called bone marrow aspirate concentrate? The clinician takes marrow near the back of your pelvis. A fast-spinning machine keeps a smaller amount for the procedure. It contains blood cells, platelets, fluid, and proteins. It isn't a pure kind of cell. Ask what was measured. ## What is the cell mix from fat called stromal vascular fraction? The hard name means several kinds of cells separated from fat. Some clinics cut and wash the fat. Others use enzymes, substances that break tissue apart. The methods don't make the same mix. Ask which method the clinic uses. ## What are mesenchymal stem cells, meaning cells that passed set lab tests? That name belongs to cells shown to act in certain ways. A same-day marrow mix hasn't automatically passed those tests. Ask the clinic to use plain words for the material. Then ask what the lab actually checked. ## What should I ask before paying? Ask what's included in the price. Find out whether follow-up visits cost more. Ask what happens if you don't improve. Tell the clinic about your medicines and health problems. Don't pay until you understand the material, risks, and next step. ## What to take to a joint visit Bring notes about painful movement and swelling. Add the home care and clinic care you've tried. The clinician can check how your joint moves. You'll hear which care may fit and when another doctor is needed. The Peoria office is at 13128 N. 94th Dr., Suite 205. From central Surprise, Bell Road takes you east. Call (602) 837-PAIN to reach the clinic team. Book a free consultation: --- Ease the soreness. Know when to get help. Plain help for soreness, home care, warning signs, and nearby joint procedures made from your blood or tissue. Plain help for soreness, simple relief, urgent changes, and visits near Surprise. This site is operated by the owners of the QC Kinetix Phoenix-area clinics, including the Peoria office recommended here, and the business may benefit when a reader books. Copyright 2026 The Surprise Syringe Notes. General health education, not medical advice for an individual diagnosis or treatment decision.