At the Centeno-Schultz Clinic we acknowledge that forearm pain can be disabling.
Intersection syndrome is a painful condition on the radial (thumb) side of the forearm when inflammation occurs at the intersection of the first and second extensor tendons.
The first compartment is compromised of EPB (extensor pollicis brevis) and APL (abductor pollicis longus) whereas the second compartment includes ECRB and ECRL (extensor carpi radialis brevis and longus).
Presentation: pain approximately 4 cm above the back of the wrist joint where the first and second compartment tendons cross.
Tendons are surrounded by a slippery sac called a tenosynovium which allows the tendons to glide. Inflammation of the tenosynovium (tenosynovitis) impairs the tendons ability to glide and results in pain.
Etiology can be traumatic or due to repetitive wrist flexion and extension commonly seen in weightlifters ad rowers.
Other causes of radial forearm pain include de Quervain tenosynovitis, thumb CMC arthritis, radial sensory nerve irritation and extensor pollicis longus (EPL) tendinitis.
In cases unresponsive to conservative therapy a guided injection under ultrasound is indicated. At the Centeno-Schultz Clinic MSK US is utilized in joint, ligament and tendon injections. Accuracy and visualization is critical for successful clinical results. Below is an ultrasound image of the first and second compartment tendons crossing. The white arrows identify the tendons of compartment 1 superficially crossing those of compartment 2. This is the site of inflammation in intersection syndrome that results in radial side forearm pain.
This last week in Grand Cayman we have performed a number of Regenexx C procedures where culture expanded bone marrow derived stem cells are injected for the treatment of knee meniscus injuries and loss of cartilage in the knee, hip and ankle. This is different from the Regenexx SD procedure that does not utilize culture expansion. At the Centeno-Schutz Clinic in Colorado, Regenexx SD, AD and platelet therapies are provided as non surgical treatment options for common orthopedic conditions.
Caymanians and tourist alike engage in a number of water activities. Deep water running and walking is quite popular. Deep water exercises have signficant cardiovascular benefits which have been summarized. This form of exercise also reduces the force exerted on a given joint.
Exercise along with diet is key in optimizing stem cell health. Here are 10 steps to improve your stem cell health.
At the Centeno-Schultz Clinic we understand that hip pain can be debilitating. Hip pain can arise from osteoarthritis, avascular necrosis of the femoral head(AVN), labral tears and fractures. Stem cell treatments are an alternative to traditional hip surgery.
Trochanterteric bursitis is an inflammation of the bursa on the outside aspect of the hip bone (greater trochanter). The bursa, a fluid filled sac lies between the insertion of the gluteus medius and gluteus minimus muscles into the greater trochanter.
Other causes of lateral hip pain include inflammation(tendinitis) and degeneration(tendonosis) of the tendons. MSK ultrasound is an office based evaulation at the Centeno-Schultz Clinic that allows for accurate diagnosis and treatment. Trochanteric bursitis can be distinguied by diagnostic ultrasound so that appropriate therapy can be understaken. Therapies include prolotherapy, PRP and Regenexx platelet derived therapies.
Below is a illustration of the 4 surfaces on the greater trochanter and the insertions of the gluteus medius and mimimus tendons.
Average NFL career is 3.5 years. An injury can end or significantly shorten a player’s career. Surgery can also dramatically limit a player’s career. Surgery all too often paints a patient into a corner form which they can not successfully rebound given the significant rehabilitation, down time, alternation of simple mechanics of the joint.
Jarvis Green, 2 time Super Bowl defense lineman knew first hand the limitations of surgery and its impact on his game. After failed knee surgery and return of pain and restriction in range of motion he rejected surgery and opted for stem cell therapy utilizing the Regenexx C and SD procedure.
St Louis Cardinal’s Mark McCormick knows the limitations of surgery and acknowledges stem cells as an alternative to shoulder surgery.
Washington Redskins safety LaRon Landry suffered an Achilles tendon injury and has taken a similar path. After undergoing team recommended PRP and shock wave therapy Landry failed to fully recover. The team instructed him that” the best thing for me was to get open up and fully cut my Achilles and that’s a tough surgery as it takes a year and a half to heal”. He rejected the extensive surgery and Redskins elected not to resign the defensive safety. Ortho 2.0 discusses the importance of looking a stability, alignment and neurological function in treating an injury.
The list of professional athletes electing non-surgical stem cell treatments includes Tiger Woods, Hines Ward, Bartolo Colon and continues to grow.
Stem cell therapy is a alternative to traditional orthopedic knee surgery. Mesenchymal stem cells (MSC) can differentiate into cartilage, bone, tendon, ligament and disc. Studies have demonstrated that the use of cultured expanded mesenchymal stem cells are both safe and effective in the treatment of knee osteoarthritis.
Does it matter how the stem cells are delivered to a targeted area?
In the case of soft tissue this is not a concern since the surrounding tissue will confine the spread of the stem cells to the targeted area.
In the case of a joint such as the knee the delivery of cells is of critical significance. The key is that stem cell function through local attachment to the damaged site. Animal studies have demonstrated that cells injected into a large joint often times have difficulty finding their way to the damaged area.
The key is delivering stem cells directly into the damaged site. Koga demonstrated this by comparing the results of blindly injecting stem cells into a joint vs dripping the cells directly into the damaged area. The illustration below tells the story. A defect in the cartilage was created and different methods of delivery were examined. On the left there was minimal cartilage growth after the injection of saline. In the middle there was minimal cartilage growth after blindly injecting stem cells into the joint. On the right where cells were injected directly into the area of damaged there was robust cartilage growth. The new cartilage is purple in color.
Bottom Line: The exact placement of stem cells within a joint is of critical importance.
At the Centeno-Schultz Clinic we utitlize x-ray and MSK ultrasound to guide bone marrow and platetlet derived stem cells into the area of damaged tissue to maximize clinical outcomes.