Stemcelldoc's Weblog

January 28, 2010

Abnormal Head Position with Neck and Shoulder Pain

Dystonia:  Abnormal muscle tone characterized by prolonged muscle contractions.

RV is 53 y/o patient with a 1.5 year history of left neck and shoulder pain which is constant in duration, 5/10 in severity, nonprogressive in nature localized exclusively on the left. Pain is throbbing in character, aggravated by extension and rotation to the right.  Patient has no significant past medical or surgical history and denies any trauma.  Patient had involuntary muscle contractions which pulled her head to the left making walking straight, operating a car and sleeping difficult.

 Treatment to date included chiropractic care, neurologic, orthopedic and physical medicine consultations.  The orthopedic surgeon diagnosed a tear in shoulder and recommended surgery.  The neurologist injected Botox repeatedly on both sides of her neck which resulted in head and neck weakness precipitating nausea.   Facet injections provided no significant relief.  MRI of the brain, cervical and thoracic spine were all normal except  mild degenerative changes at C5/6.

Physical examination was significant:   left rotation of head, downward  gaze , left shoulder and neck was tender to the touch with multiple muscle nodules.  Most striking was her right sternocleidomastoid muscle (SCM) which was contracted, thick and very painful.

Cervical Dystonia is a movement disorder in which sustained muscle contractions cause abnormal postures.

Insertion of several small needles (IMS) into the right SCM provided the patient with complete resolution of her left sided neck and shoulder pain along with a significant reduction in her involuntary head rotation. 

  Understanding the complexity of the musculoskeltal system is essential.  It was contraction of her RIGHT SCM which led to the left head rotation and stretch of left shoulder and neck muscles.  Injection of the left side, the side where the pain was would only have increased her head rotation and pain. 

The Centeno-Schultz Clinic is committed to the highest level of  diagnostic and regenerative medicine.

January 27, 2010

Achilles Tendon Pain Unresponsive to Therapy

EC is a 80 y/o patient referred for platlelet rich plasma (PRP) injections of his inflamed left Achilles tendon.  Patient was active with no significant past medical history.  He denied any traumatic injury but had a 6 month history of severe left Achilles pain which was constant in duration, 6/10 in severity and progressive.  Treatment to date included physical therapy, trial of non-steroidal anti-inflammatory mediations and massage.   PRP therapy was considedered due to patient’s failure to improve.

PRP therapy is the injection of a patients own platelets into the damaged/irritated tissue.  RPR therapy is aimed at accelerating the healing process. 

Physical examination was significant for the following:  reduced  flexion/extension of lumbar spine secondary to pain,   decreased sensation along the left big toe and outside aspect of foot, decreased strength of left big toe and significant muscle banding in both the back and leg.

 After the initial evaluation, an x-ray of the lumbar spine was obtained which was significant for instability of the several vertebral bodies(anterolisthesis) along with marked reduction in the disc height at L5/S1.

EC’s Achilles tendon problem was not responding to conventional therapy since no have bothered to look beyond the tendon itself.  He had irritation of the left L5 and S1 nerve root which required treatment in addition addressing the Achilles tendon inflammation.

Looking at the bigger picture is essential for maximal clinical outcomes.  This is the essential paradigm required as we move from joint replacement to joint restoration. Ortho 2.0 presents  four principal elements previously discussed.

This is the standard at Regenerative Sciences and  The Centeno-Schultz Clinic.

Ed underwent PRP therapy in addition to injection of platelet derived growth factors at the L5/S1 and S1 levels.  He had  reduction of his debilitating Achilles pain  and headed off to florida for the back nine. I will report back upon his return.

January 26, 2010

New Perspective: Ortho 2.0

Everyone told Christopher Columbus that the world was flat.   

 Friends told the Wright brothers that birds were the only creatures capable of flight.  


A paradigm shift was required.  This also applies to medicine. The time has come to focus not on joint replacement but on joint restoration and repair.     Dr. Centeno has termed this Ortho 2.o.   Ortho 2.0 has a bigger focus beyond just fixing one part of the musculoskeletal system (bone, joints, muscles, tendon, and ligaments).   When the focus shifts to repair, the amount one needs to know about the joint increases exponentially.  There are four principal elements which are addressed when evaluating a gvien joint: (S.A.N.A.)   

ORTHO 2.0 : S.A.N.A.

  S: stabilization   

A: articulation   

 N: neurologic   

 A: alignment   

 Injection of magic stem cells alone is not sufficient for joint restoration.  Multiple studies have shown that just injecting stem cells into a joint blindly is not that effective.  For the best clinical outcomes, each of the factors listed above must be evaluated and treated. At Regenerative Sciences and The Centeno-Schultz Clinic this is the standard.  Case examples utilizing the S.A.N.A. paradigm will be in future blogs.   

It is truly a new day:)    

January 25, 2010

Resolution of Thumb Pain with Stem Cell Therapy

LK is 60 y/o patient who presented with a 1 year history of bilateral thumb pain, constant in duration, 4/1o in severity, progressive in nature localized at the base of the thumb.  Pain was sharp and stabbing in character and preventing him from buttoning his shirt.  Prior therapies had included a trial of NSAID and chiropractic care.  MRI of the thumbs was significant for moderate to advanced arthritic changes at the base on the thumb(CMC joint).  LK was told that surgery was his only option:  fusion of one joint and tendon wrap at the other.  Both surgeries are significant with extensive rehabilitation and poor outcomes.

Patient elected to proceed with the Regenexx procedure which allowed him to use his own mesenchymal stem cells.  At six months post injection of his own stem cells,  LK reports a 90% reduction in pain and  increase in range of motion.  Friends and work associates have stopped asking him about his swollen thumbs.  Buttoning a shirt is no longer an issue.

 Through the use of his own stem cells, LK has had significant reduction in his thumb pain, increase his range of motion and avoided a significant surgery. The time has come to embrace joint restoration instead of all therapies directed at joint replacement.

January 24, 2010

Non-Surgical Options to Shoulder Osteoarthritis

JM is 47 y/o athletic patient who had a 1.5 year history of severe shoulder pain and restriction in movement.  He was unable to shave or lift objects from the kitchen cabinet with the affected arm.  MRI was significant for advanced osteoarthritis, degeneration of the labrum and tears in the rotator cuff.  Total joint replacement was the only option presented.  This is a major surgery with extensive rehabilitation and relatively poor outcomes.

Patient elected to undergo a non- surgical stem cell therapy:  the Regenexx procedure. The patient’s own stem cells (autologous) were injected into joint, labrum and rotator cuff tears.  Mesenchymal stem cells have significant repair and regeneration properties. JS made significant improvement after multiple sessions.    13 months after starting the Regenexx procedure, an MRI was obtained for comparison. The most striking changes are below.  The top picture show multiple tears in the supraspinatus tendon identified by the red arrows. The extensive light-colored areas in the tendon represent swelling and tears.  The bottom picture is significant.  It shows significant reduction in rotator cuff tendon swelling  as evidenced by the much improved dark-colored signal in the tendon which is identified by the yellow arrows.  The corresponds with JS’s clinical improvement.  JS was able to avoid a major surgery through the use of his own stem cells.

January 22, 2010

Surgical Complications: A Tale that is Seldom Told

Surgeries have risks.  Some are minor while others are major.  While we acknowledge that there are risks most believe it is not going to happen to them.

JM is a 55 y/o patient with long-standing left knee pain who underwent knee arthroscopy and micro-fracture 14 months ago.  She had no significant past medical and surgical history, did not take any medications and did not smoke or drink.  Despite her knee pain she exercised 2-3 time a week.

Micro-fracture: Surgically created holes into bone

The  knee surgery went well without any complications.   Seven days after the procedure JM had abrupt onset of shortness of breath with crushing chest pain.  She spent the next 10 days in the hospital where it was determined that multiple  clots had gone to her lungs (pulmonary embolism). The clots most likely originated from a leg vein but may have also have been from  fat dislodged from the bone during the micro fracture.   Long-term coumadin therapy was started which thins JM’s blood to prevent future pulmonary embolism.

Coumadin therapy places patients at an increased risk for bleeding.  Many medications increase coumadin levels which include NSAIDs, antidepressants(particularly the SSRI’s) and medications that induce the liver enzymes.  This further increases the risk of bleeding.  Coumadin therapy is a known factor associated with death and brain injury after falling.

Non-surgical options of many knee, hip and shoulder conditions include the use of stem cell therapy.

The Regenexx procedure allows patients the opportunity to use their own mesenchymal stem cells for common orthopedic conditions thereby eliminating the risks inherent with surgery and anesthesia.

January 17, 2010

Is Knee Arthroscopy Effective ?

Knee arthroscopy is a common orthopedic procedure.  It is estimated that 1 million arthroscopic knee surgeries are performed annually in this country.

Knee arthroscopy involves making a small incision into the knee-joint through which a small camera and surgical tools are inserted.

Various parts of the knee are visualized which include the meniscus, the cartilage and supporting ligaments.  When damage is noted the area can be debrided:  rough surfaces are made smooth.

This is a significant advancement from the open surgeries performed in the 1980’s.

Is knee arthroscopy effective?

A recent article in the New England Journal of Medicine demonstrated that knee arthroscopy for osteoarthritis  provided no additional benefit to optimized physical and medical therapy.

A non surgical alternative to treat common orthopedic conditions is the use of your own mesenchymal  stem cells. The  Regenexx procedure allows patients to use their own mesenchymal stem cells to treat many knee, hip and shoulder conditions.

January 16, 2010

Avascular Necrosis of Femoral Head

Avascular necrosis (also know as osteonecrosis)  is a disease in which bone death occurs.

While the exact cause is unknown there are known risk factors which include alcoholism, excessive steroid use, trauma and vascular compression.

Avascular  necrosis (AVN) primary affects shoulders, knees and hips with death of the bone.  In addition there is often degeneration of the joint articular surfaces which result in pain and restriction in range of motion.

The Regenexx procedure, which allows patients to use their stem cells has been used in the treatment of AVN of the hip. Instead of surgery patients had their own expanded mesenchymal stem cells into the area of necrosis in the bone via x-ray guidance.  The Regenexx procedure with much less downtime than even a surgical CORE decompression and certainly less invasive than a hip replacement surgery.

Preliminary review of the data was significant.  Of the 27 patients treated to date, 4 were lost to follow-up (couldn’t get outcome information), and 3 went on to hip replacements so their data was removed as any results might be due to the hip replacement.  All patients were between 3 months and more than a year out from their stem cell injection.  Of the 20 remaining patients, approximate mean reported improvement was 50%.  This data requires more work.   We will be examining outcomes with regard to the disease severity( ARCO grade I, II, III, IV).  More to follow.

January 14, 2010

Elbow Pain Now Addicted to Narcotics

55 year old patient presented with a 2 year history of left elbow pain which was constant in duration, 8/10 in severity, progressive in nature, localized on the lateral (outside) aspect of elbow without any radiations.  Patient drives a city bus and sustained a slip and fall injury in which he struck his left elbow. He denied any neck or arm pain.  Treatment to date had included massage, x-rays, cortisone injections into the joint and oral narcotics.  Narcotics were started “since other therapies had failed”.  Patient had a known addictive personality and was a recovering alcoholic. He was using up to 8 Vicodin /day as prescribed.

On physical examination he had extreme tenderness over the outside aspect of the elbow (lateral epicondyle) and multiple tender points along the extensor muscles in his forearm. His neurologic exam was normal.

Lateral epicondylitis  is theorized to be an injury of repetitive microtrauma/overuse.

It is commonly caused by  commonly associated with playing tennis  and other racquet sports.

It can also be caused by sustained contraction of the extensor muscles in the forearm which result in excessive force on the tendon where it is attached on the bone.  Treatment is two-fold: relax the dysfunctional muscle and promote healing.  This is possible by IMS and prolotherapy.

Following regenerative therapy at the Centeno-Schultz Clinic, patient had reduction in his pain, increase in range of motion and elimination of all narcotics.

January 13, 2010

Effectiveness of Platelet Rich Plasma Injections

Regenerative medicine therapies include prolotherapy, platelet rich plasma injections and stem cells.

Platelet rich plasma (PRP) involves the use of platelet derived growth factors in the healing of tendon and muscle injuries.  The process includes collection of a patient’s blood with isolation and concentration of the platelets.  The concentrated platelets are then injected into the damaged tissue accelerating the healing process.

PRP therapy has made the headlines and utilized by many professional athletic teams.

Does it work?

According to Robert J. de Vos, M.D., in his recent publication in the Journal of American Medial Association, PRP injections did not significantly improve pain or activity level in patients with long-standing history of Achilles tendon irritation.  What this article did not discuss was the therapeutic effect of simply irritating the tendon (percutaneous tenotomy) which has been demonstrated to be effective.

Regenerative medicine has an increasing number of tools.  At the Centeno-Schultz Clinic it is our goal to utilize the appropriate regenerative therapy for the best possible clinical outcome.

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