Stemcelldoc's Weblog

September 25, 2008

Narrowing the knee joint space

Filed under: Uncategorized — stemcelldoc @ 10:35 pm

Have you been told that your knee x-ray shows narrowing of the joint space and therefore your should have arthroscopic knee surgery?  Before you schedule for knee arthroscopic surgery or arthritis knee surgery consider the following facts.

A study in the New England Journal of Medicine recently demonstrated that knee arthroscopy in patients with osteoarthritis of the knee is no better than physical and medical management.

The meniscus is a cushion that sits between your thigh and calf bone (femur and tibia). 

 

  It acts like a shock absorber. The meniscus is kept in place by a number of structures which include the medial and collateral ligaments.  Conceptually the collateral ligaments can be viewed as the sidewall of a tire.  If the sidewall is torn, stretched or damaged it is less effective in containing the meniscus.  If there is less cushion between the two bones, then the joint space is reduced.  Knee arthroscopy surgery or arthritis knee surgery is not the answer. 

A recent article in Arthritis and Rheumatology concluded that the change in meniscal position accounts for a substantial proportion of change in joint space narrowing.

 Treatment should therefore be directed at tighening the collateral ligament so as to contain the meniscus and thereby maintain joint space.  At the Centeno-Schultz Clinic we utilize prolotherapy to tighten ligaments.

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September 24, 2008

Meniscus knee surgery

Filed under: Uncategorized — stemcelldoc @ 7:39 pm

As a pain physician I am committed to identifying the source in a given patient so that the appropriate treatment can be provided.  We have learned that degenerative discs identified on  MRI of the lumbar spine are NOT  by default the origin of a patient’s back pain .  Degenerative lumbar discs are part of the aging process and are seen in many patients who have no pain. 

Knee arthroscopic surgery is a very common orthopedic procedure.  When a patient has knee pain it is not uncommon for the patient to have an MRI.  Like the lumbar disc, the knee meniscus was thought to be a major source of pain and therefore  the patient not uncommonly would undergo meniscus knee surgery.  During mensicus knee surgery the “damaged” meniscus is trimmed or removed with the thought being that the meniscus  was the source of pain.

The New England journal of Medicine recently published a study which casts serious doubt on this concept that the meniscus is a source of pain.  The study demonstrated that the prevalence of a meniscal tears on MRI varied from 19% to 56%.  In patients  with osteoarthritis  and knee pain the prevelance  of meniscus tears on MRI was 63%.  What is interesting is that  60% patients with OA but NO  knee pain also had meniscal tears on MRI. Overall 61% of the subjects who had mensicus tear on MRI had no pain, aching or stiffness.  The conclusion was that meniscal tears on MRI are common and increase with age. 

So the next time your surgeon informs you that your MRI shows a tear in the meniscus,  a meniscus knee surgery is not solution.  Ask questions and realize that the MRI finding does not identify the source of your pain.  At the Centeno-Schultz Clinic we are committed to identifying the source of your pain.

September 23, 2008

Knee pain and knee arthroscopic surgery

Filed under: Uncategorized — stemcelldoc @ 4:33 pm

Pain the in knee can arise from many sources:  osteoarthritis, torn ligaments, excessive wear of the cartilage and improper tracking of the knee cap due to muscle imbalance.  All too often an x-ray is taken which demonstrates osteoarthritis and the patient is scheduled fro knee arthroscopic surgery.

There are other causes of knee pain which need to be evaluated which include the bursa.

September 20, 2008

Osteoarthtritis of the knee

Filed under: Uncategorized — stemcelldoc @ 10:31 pm

Osteoarthritis is a common disorder affecting nearly 27 million Americans. 

 

It is is a clinical syndrome in which low-grade inflammation results in pain in the joints, caused by abnormal wearing of the cartilage that covers and acts as a cushion inside joints and destruction or decrease of synovial fluid that lubricates those joints. As the bone surfaces become less well protected by cartilage, the patient experiences pain upon weight bearing, including walking and standing.

Arthroscopic knee surgery is a common therapy used by orthopedic doctors to treat osteoarthritis of the knee.  A small camera is inserted into the knee joint through a small incision which provides a direct look into the knee and surrounding structures.  In knee arthroscopic surgery if damage to the knee ligaments is detected, knee ligament surgery will be performed where they trim or cut our the damaged ligaments.  If damage of the meniscus is visualized, meniscus knee surgery will be performed.

Unfortunately knee arthroscopy for osteoarthritis of the knee is no more effective than physical and medical therapy as reported by The New England Jounral of Medicine.  The study concluded: arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy. 

So if knee  pain and function are not improved in patients with osteoarthritis of the knee, what alternatives exist.  At Regenexx, utilizing a patients own stem cells,  knee cartilage has been increased which resulted in a reduction in pain and increase in function.  The procedure is a simple, needle in, needle out procedure conducted in the clinic under x-ray.

September 18, 2008

Knee Arthroscopic Surgery

Filed under: Uncategorized — stemcelldoc @ 7:09 pm

Knee arthroscopic surgery in a very common procedure performed by orthopedic surgeons in an attempt to treat knee pain. Knee arthroscopic surgeryis  typically performed in an outpatient surgical facility where a small camera is inserted into the knee joint.  The camera affords the surgeon an inside view of ones knee.

 

Utilizing arthroscopic surgery the surgeon can trim any “damaged” ligaments which is called knee ligament surgery.  Alternatively, if ‘damaged” meniscus is detected then it also be trimmed and or removed which is called meniscus knee surgery.

The New England Journal of Medicine recently demonstrated that knee arthroscope surgery in many cases is no better than physical therapy.  The implication is far reaching.  Patients are being exposed to many needless risks during knee arthroscopic surgery including anesthesia complications, infection, failure, blood clot not the mention the cost incurred.

Regnexxoffers an alternative in the treatment of knee pain.  If there is evidence on MRI of loss of cartilage, we can inject a patent’s own stem cells via a small needle under x-ray.  It is a simple needle in, needle out procedure without the inherent risks associated with surgery and anesthesia.  Furthermore it is regenerative in nature.  Our aim is to regenerate your own tissue with your own stem cells. A recent study demonstrated MRI evidence of cartilage in the knee following stem cell therapy.

September 17, 2008

Let’s Break it Again

Filed under: Uncategorized — stemcelldoc @ 11:52 pm

Fracturesof the long bones occur commonly and include the humerus, radius, ulna, femur,  tibia and fibula.  Often times they require surgery with insertion of rods or plates.  Unfortunately despite patients and surgeons best efforts, often times these fractures fail to heal.  The all to common result is a patient that has limited mobility and function and continues to have pain.

Treatment options are limited and may include application of a bone stimulator in the hopes that it will stimulate the generation of bone growth and hence healing of the fracture.

Regret ably another option  is for the surgeon  is to simply remove the hardware and re break the bones.  Yes.  Re Break the bones and place another set of plates and or rods into the bone.  This exposes the patient to anesthesia, the risks inherent in surgery  not to mention the pain and suffering associated with the surgery and rehabilitation.

Now there is an easy, non-surgical therapy for long bone fracctures which have not healed.  At Regenexxwe place you own expanded stem cells inthe the fracture site with a needle.  It is a needle in, needle out procedure with profound results which we be published shortly.  Please see two case examples below:

 

 

Now you hve an alternative.  a simple, quick restorative procedures using your own stem cells vs going through an additional sugery with its associatied risks

September 16, 2008

Rotater Cuff Tear Surgery

Filed under: Uncategorized — stemcelldoc @ 5:07 pm

 The rotator cuff is compromised for four principal muscles which stabilize the shoulder.

Muscle Origin on scapula Attachment on humerus Function Innervation
Supraspinatus muscle supraspinous fossa greater tubercle abducts the arm Suprascapular nerve (C5)
Infraspinatus muscle infraspinous fossa greater tubercle laterally rotates the arm Suprascapular nerve (C5-C6)
Teres minor muscle lateral border greater tubercle laterally rotates the arm Axillary nerve (C5)
Subscapularis muscle subscapular fossa lesser tubercle medially rotates the humerus Subscapular nerve (C5-C6)

Pain in the shoulder joint can arise for many sources which include, muscle inhibition, muscle tear, shoulder impingement, inflammation of the bursa and tears or degeneration in the labrum.

Rotator cuff tear sugery is a common technique which is used.  It has risks including but not limited to the risk of anesthesia, nerve damage and extensive rehabitilation.  Have you ever seen someone at the store with their arm in a restrictive brace?  They have probably had arthoscopic shoulder surgery or rotator cuff tear surgery.  Please view the procedure.

Alternatively one can now use their own stem cells to regenerate a torn muscle or ligament.  AtRegenexx we have successfully healed a torn supraspinatous with a patient’s own stem cells who  had failed rotator cuff tear surgery.  

 

  In contrast to surgery, this is a needle in, needle out procedure with minimal down time and no need for restrictive braces. In addition at the Centeno-Schultz Cinic we focus on the biomechanics of the shoulder to ensure maximal outcome.  This may include myofascial deactivation of one of the four muscles listed above or prolotherapy to tighten lax ligaments.

The supraspinatous abducts the arm.

The infraspinatous laterally rotates the arm.

The teres minor laterally rotates the arm,

The subscapularis medially rotates the humerus

September 4, 2008

X-Rays: Only Part of the Picture

Filed under: Uncategorized — stemcelldoc @ 11:26 pm

As an interventional pain physician, I have the opportunity to evaluate patients who are seeking alternatives to arthroscopic hip, hip resurfacing surgery and total hip replacement surgery.  Most patients want to avoid having the top of the femur sawed off and replaced with a metal prosthesis.

Most patients come with x-rays and a history of pain. Unfortunatley  X-rays  only visualize  bone structures and as such can demonstrate fractures, tumors , degenerative changes in the bone and reduction in joint spaces between bone.

 The hip is a complex structure with multiple sources of pain generators which include but are not limited to ligaments, bursa, cartilage and capsule.  None of these structures can be identified on x-ray and therefore x-rays tells only part of the picture.

Anatomy of hip

Anatomy of hip

At the Centeno-Schultz Clinic, I reviewed the hip x-rays of a patient who had been advised that her only option  to reduce her hip pain and impaired function was total hip replacement.  She opted for a second opinion.  Her x-ray was significant for degenerative changes in the hip socket as well as the ball of the femur.  What was curious was the presence of cysts within the bone.  This abnormality along with her history prompted me to order an MRI.

It demonstrated areas of decay in the bone.  The disease is called avascular necrosis(AVN). 

 The diagnosis was not advanced osteoarhritis of the hip.  Digging deeper revealed a much more serious condition called AVN.  The good news is that Regenexxutilizing autologous stem cells can stop the progression of this diease if caught early.

September 3, 2008

The Importance of Posture

Filed under: Uncategorized — stemcelldoc @ 3:30 am
Is the a correlation between posture and knee surgery or hip surgery?
Have you ever seen someone that leans disproportionately to the right or the left?  Someone who walks with one of their legs twisted outward?  Or someone whose stride is affected because they are bowlegged?
Posture is key to proper maintenance of one’s joints.  It is similar to tire alignment.  After you hit that pothole, the alignment of your tires is typically affected.  The inside or the outside of the tire begins to bear a dispropiate amount of the vehicle’s load.  The  end result is a tire that is bald on either the inside or the outside.  The same holds true for our joints.
If a patient has back pain they may lean to one side in an effort to decrease the amount of pressure applied to the painful side.  While this may decrease the patient’s back pain, it regretably places an increase amount of pressure on the patients hip and knees.  If this posture is maintained over time, the individual typically develops pain in the affected joints.  The individual may then go to their doctor and x-rays demonstrate excessive wear of the joint (osteoarthritis).  They are often then referred for arthroscopic hip surgery or arthroscopic knee surgery.  In cases where there has been significant wear on the joint, they may be hip resurfacing surgery or total hip replacement surgery.  Just like the tire on your car there has been excessive wear as a result of misalignment.  The key is to keep everything aligned. 
At the Centeno-Schultz Clinic we evaluate patients who have been advised that they are in need of meniscus knee surgery, knee ligament surgeryminimally invasive hip surgery and joint replacement surgery.  We look beyond the affected joint to determine the possible cause of joint overload and then direct therapy to correct this misalignment.  Failing to evaluate the patient as a whole and determine the cause of the joint overload is like replacing bald tire without correcting the alignment. 

September 2, 2008

Arthritis knee surgery

Filed under: Uncategorized — stemcelldoc @ 3:34 am

Osteoarthritis is  derived from the Greek word “osteo“, meaning “of the bone”, “arthro“, meaning “joint”, and “itis“, meaning inflammation.

It is a clinical syndrome in which low-grade inflammation results in pain in the joints, caused by abnormal wearing of the cartilage that covers and acts as a cushion inside joints and destruction or decrease of synovial fluid that lubricates those joints

As the cartilage wears down there is progressive damage to the bone, meniscus and ligaments.  The end result is pain with standing and walking. Osteoarthritis is the he leading cause of chronic disability in the United States(1).

Surgery in the form of meniscus knee surgery, knee ligament surgery,  and arthroscopic knee surgery and total knee surgery is often recommended.  Unfortunately there are potential complications with each of the procedures including bleeding, infection, nerve damage, pulmonary embolism and reactions to anesthesia.  These complications have been well documented(2).

Stem cell therapy is now available and can be used as an alternative to surgery.  At Regenexx a given patent’s stem cells are expanded and then injected directly to the area of damage. A published study has demonstrated an increase in cartilage after the injection stem cells.  This office based procedure involves the injection of cells through a small needle guided by x-ray.  Unlike meniscus knee surgery or arthroscopic knee surgery where vital parts of the knee are removed, with Regenexx autologous stem cells are injected to regenerate the damaged tissue.  Please view patient’s testimonals

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