Stemcelldoc's Weblog

December 30, 2010

Hip Labral Tears and Other Sources of Hip Pain

At the Centeno-Schultz Clinic we acknowledge that there are many potential sources of hip pain which include dysfunctional muscles, stretched or partially torn ligaments, tears in fibrocartilage structures and damage to articular cartilage.  It is critical that all the potential sources of pain be evaluated.

MRI’s do not indicate the source of a given patient’s pain. MRI’s do not have flashing arrows indicating where the pain is originating.  Rather radiographic studies  are only one piece of the puzzle.  They are used in conjunction with the history and physical finding to accurately identify the pain generator.

GB is a 14y/o elite ballerina who presented to the Centeno-Schultz Clinic with a one month history of groin pain after her ballet instructor had forcefully externally rotated her hip.  Her pain was sharp in character and prevented her from performing.  An MRI of the hip demonstrated a very small tear in the hip labrum which is a fibrocartilage structure that provides support in the hip socket.  A highly regarded orthopedic surgery recommended arthroscopic surgery.  The surgery involves placing traction on the patients leg so that the hip is partially pulled out of the socket whereby a small camera can be inserted and the damaged labrum removed.

GB declined surgery and underwent myofascial deactivation and fluoroscopic guided prolotherapy of the hip capsule.  After 4 weeks GB reports 90% reduction in pain,m full range of motion and has returned to dancing.  An appreciation of the structures responsible for hip pain and simple regenerative therapies has enabled GB to return to her passion.

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December 27, 2010

Radiofrequency Ablation for Facet Pain

Radiofrequency ablation is a treatment for neck, thoracic and back pain that is arising from the facet joint.  The facet joint is a small cartilage lined joint in the spine that is susceptable to injury and can cause significant pain and restriction in  range of motion.

Small nerves within the facet joint transmit a pain signal from the joint to the brain.  Radiofrequency ablation works by interrupting the transmission of the pain signal.

Alternative treatments for facet pain include prolotherapy, Regenexx SCP and Regenexx PL.

At the Centeno-Schultz Clinic radiofrequency ablation has been used extensively in the treatment of debilitating  pain.  Injuries to the facet joint are typically not detected by traditional radiographic studies.  Clinical experience, an understanding of the mechanism of injury and excellent physical examination skills are critical.  This is the standard of care at the Centeno-Schultz Clinic.

Diagnosis of a facet injury is confirmed if  a patient reports a  significant reduction in pain following injection of a small amount of local anesthetic into the facetjoint under x-ray.  This procedure is referred to as a intra-articular facet injection.  The first step is to identify where the pain is originating from.  Only then can an appropriate treatment plan can be formulated.

December 26, 2010

Wrist Pain: Alternatives to Steroid Injections

De Quervain snydrome is a common cause of wrist pain.

It is inflammation of the sheath that surrounds two critical tendons which are responsible for thumb moment.  Just a like the outer plastic lining on any electrical cord holds all the small wires together, the tendon sheath holds the extensor pollicis brevis and abductor pollicis longus tendons in a protective sleeve.

Inflammation and or chronic degeneration of the sheath or tendons can result in pain, swelling over the radial side of  the wrist accompanied with difficulty in gripping.  The Finkelstein test is a common diagnostic test.

Treatment options include rest, splinting, injection of steroids and surgery.

At the Centeno-Schultz Clinic we understand the risks involved with steroids and offer alternatives in the form of prolotherapy, PRP and Regenexx PL.  Clinical success comes from accurately delivering the prescribed  solution to the targeted area.  To that extent we use ultrasound to that ensure growth factors or stem cells are placed within the damaged tissue.  Below is  an ultrasound image from clinic of the two tendons and the enveloping sheath.

December 22, 2010

Sciatica and Stem Cell Therapy

Sciatica is a debilitating searing pain in the lower extremity commonly as a result of nerve root irritation. 

 Disc herniation, disc protrusion, overgrowth of the facet joint and thickening of the ligaments can result in nerve root compression or irritation.  Non-surgical treatments to date have included x-ray guided epidural injections of local anesthetics and steroids.  As discussed in previous blog, steroids injections can be associated with many complications including cell death.

At the Centeno-Schultz  Clinic Regenexx PL is used as an alternative to conventional epidural steroid injections.  A  patient’s own platelet derived growth factors are injected into the epidural space with the aim of increasing blood flow thereby stopping and potentially reversing the degenerative process.  Enhanced blood flow to a given area increases the amount of nutrients and optimizes healthy environment.  Regenexx PL has led to many clinical successes.

TA is an athletic patient with a 6 month history of severe right leg pain which was progressive in nature, originating in her right lower back with radiations into her big toe.  She described it as a “sharp knife” in her foot.  Oral narcotics and muscle relaxants did not relieve her pain.  Having had extensive neck surgeries which were complicated and required revisions, she was committed to non-surgical therapy.  Her MRI demonstrated a large  right-sided disc protrusion @ L5/S1 with compression of the adjacent nerve root.

She underwent three  x-ray guided injections of Regenexx PL and reports  90% relief.  The “knife like” leg pain is gone and she has returned to her passion. She was last seen headed up to Steamboat.

December 21, 2010

Rotator Cuff Tears: Non-Surgical Treatment Options

The rotator cuff is compromised of 4 major muscles and tendons that act collectively to stabilize the shoulder joint.

The four muscles include the supraspinatus, infraspinatus, subscapularis and teres minor.  Tendons are the fibrous portion of the muscle that anchors the muscle to bone.  This fibrous anchor can be inflamed resulting in a tendinitis or can be  chronically degenerative resulting in tendinosis.  The one of  4 muscles can have a partial or full thickness tear.

At the Centeno-Schultz Clinic ultrasound is utilized to determine the source of pain.  The pain may arise from a tear in one or more of the four rotator cuff muscles or inflammation or degenerative changes in the fibrous tendon anchor. Other explanations exist which will be discussed in another blog.

Rotator cuff tears can be treated with Regenexx SD whereby a patient uses their own mesencymal stem cells.  Tendinosis  can be treated with Regenexx SCP.

The Regenexx family of procedures represent the highest quality stem cell therapy with the largest number of stem cell treatment options in one clinic and which are ICMS certified.

December 17, 2010

Microfracture knee surgery

Microfracture knee surgery is designed to repair articular cartilage.  The surgery is performed via a small camera that is placed into the knee (arthroscopy).  Thereafter an awl is used to create small fractures in the bone whereby blood and bone marrow seeps out of the fracture creating a blood clot.

  The bone marrow is rich in stem cells which gives rise to the new cartilage.  Microfracture unfortunately forms fibrocartilage rather than hyaline cartilage.  Fibrocartilage is weaker and at higher risk for break down. Recovery can be slow given the extensive period on non-weight bearing.

Microfracutre 2.o involves placing stem cells directly into areas of cartilage damage without the trauma of making multiple small holes into the cartilage and bone.  Regenexx procedure enables patients to use their autologous mesenchymal stem cells which are placed either through direct x-ray visualization or ultrasound guidance.  The Regenexx procedure family has no significant post-injection rehabilitation or downtime and allows the patient to return to passions.

December 15, 2010

Stem Cell Therapy Enables Jarvis Green to Sign Contract

                                                                  Today after completing a full NFL practice and physical examination by team physicians, Jarvis Green signed with the Houston Texans.

Jarvis is a two-time Superbowl defensvie lineme champion who played for the patriots from 2002-2009.  Plagued with knee pain after failed lateral meniscus knee surgery, he elected to use the Regenexx procedure which allowed him to use his own mesenchymal stem cells.  Jarvis underwent  Regenexx-C therapy in July 2010 immediately prior to Bronco training camp.  Unfortunately, he was cut at the end of training camp.

Jarvis recently underwent additional therapy at the Centeno-Schultz Clinic which dramatically improved in knee pain.  He underwent Regenexx SD, and Regenexx PL which made the critical difference. His performance today was without any limiations.

We are tremendously proud of Jarvis and his return to his passion. 

What a wonderful holiday gift and blessing!

December 12, 2010

Bone Marrow Stem Cells: Regular or Premium?

Adult stem cells are available from  three principal sources:  bone marrow, adipose and blood.

Bone marrow is obtained by placing a needle into a large, readily accessible bone and aspirating (withdrawing) marrow.  Hence the term bone marrow aspirate.

The use of x-ray during bone marrow aspirate ensures correct placement of the needle, minimizes time required, maximizes patient comfort and avoids complications such as puncture of blood vessels and organs.  X-ray guidance during bone marrow aspirate is the standard of care at the Centeno-Schultz Clinic.  We have had no complications and the procedure is performed in 20 minutes or less.

After the bone marrow is obtained the stem cell rich cells ( the nucleated cells)  need to be separated and concentrated.  Hence the term bone marrow aspirate concentrate:  BMAC.

Most clinics use a bed side centrifuge whereas Regenexx has a state of the art lab.

Does it make a difference?

Yes.

When compared to bedside centrifuges, the Regenexx lab  produced a concentrate that had a 3 times the number nucleated cells. This is illustrated in the graph below.  The greater the number of nucleated cells the better since studies have demonstrated that placement and number of cells injected can translate to better clinical outcome.

December 7, 2010

Adipose Derived Stem Cell Therapy: Regenexx AD

Regenexx has recently added another tool to their regenerative medicine tool box: Adipose derived stem cells.  As discussed in a prior blog, bone marrow derived stem cells are ideal for orthopedic application such as osteochondral defects and areas of degeneration in the knee, hip, ankle and thumb.  Patients have the ability to use their own mesenchymal stem cells through the Regenexx procedure.  Regenexx therapy has been demonstrated to be safe.

Adipose derived stem cells offer structural support to areas of instability.  A case in point is when a patient’s meniscus is reduced in size either through degenerative processes or through a surgical procedure (menisectomy).  The reduction in meniscus size results in laxity of the collateral ligament and a change in the knee alignment. This is depicted in the illustration below.

 The loose collateral ligament and the reduced meniscus size often result in the meniscus being displaced outwardly(being spit out) In this non-anatomical position the meniscus cannot perform its function as a shock absorber thereby exposing the cartilage to excessive forces and potential degeneration.

Prolotherapy is used to treat loose ligaments.  Bone marrow derived cells are placed in areas of cartilage defects or excessive wear. When the meniscus is small and extruded outwardly, adipose derived stem cells are used in a structural capacity.  They are injected through ultrasound or x-ray guidance in such a fashion as to push the meniscus inwardly returning it closer to its true anatomical position.

The Centeno-Schultz Clinic offer patients a number of regenerative therapies including prolotherapy, platelet concentrates, bone marrow and adipose derived stem cells injected under ultrasound or x-ray guidance.

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