Bone Marrow Derived Stem Cells are Best for Cartilage Regeneration

Mesenchymal stem cells are available from different tissues sources which include blood, adipose, synovial fluid, muscle and bone marrow.  Superior clinical outcomes are associated with selecting stem cells from the most appropriate source, isolating them in a state of art laboratory and placing them into the area of tissue damage with direct visualization using either ultrasound or intermittent x-ray guidance.  This  is the Regenexx difference.

 

Blood and adipose derived stem cells are less expense to obtain and process than those arising from bone marrow.  In a recent article bone marrow derived mesenchymal cells were shown to have a higher potential to differentiate into cartilage cells than  stem cells arising from synovium, adipose and muscle. That is why when treating cartilage defects in either the hip, knee or ankle, Regenexx SD is the treatment of choice.

Meniscus Tears on MRI: Non surgical treatment options

The menisci are C-shaped fibrocartilages that act as a shock absorber between the thigh bone(femur) and shin bone (tibia).  Horizontal tears are the most common meniscal tear pattern and separate the meniscus into upper and lower parts.  Surgery on the meniscus is referred to as a menisectomy as have been associated with increasing unwanted muscle activity and accelerating the degenerative process.

Non surgical treatments options for meniscus tears at the Centeno-Schultz Clinic focus on repairing the damages tissue utilizing  autologous stem cells.  The stem cells are available through a bone marrow derived therapy, Regenexx SD, an adipose derived therapy, Regenexx AD and a blood derived therapy, Regenexx SCP alone or in combination.  All regenerative therapies are accurately placed through MSK ultrasound or x-ray guidance.

A horizontal tear in a knee meniscus is shown below:

Tarsal Tunnel

Carpal tunnel syndrome is compression of the median nerve at the level of the wrist with resultant hand and wrist pain.

Tarsal tunnel syndrome (TTS) is the equivalent in the ankle.  There is compression of the tibial nerve as it passes through tarsal tunnel at the ankle.  The tarsal tunnel is located behind the medial mallelous, the  bump on the inside of the ankle.

Patients typically complain of numbness and burning pain in the big toe and first two to three toes.

Inflammation and swelling within the tarsal tunnel with compression on the tibial nerve can arise from many different causes.

At the Centen0-Schultz Clinic the first step is a complete history and thorough examination.  Some patients may have a Tinel’s sign.  Ultrasound examination provides a dynamic picture of the structures within the tarsal tunnel including scar tissue and tendon irritation.  Hydrodissection is a non-surgical treatment option for tarsal tunnel in patients who have failed conservative therapy.

Arthrogram and Regenerative Therapies

An arthrogram is an x-ray procedure whereby contrast is injected through a needle into  a joint.

Why is this important?

Contrast in the joint confirms that the needle is in the correct place.  If the needle is not appropriately placed, the injected contrast with NOT fill the joint space but rather will fill the adjacent tissue (muscle, ligament and tendon).  Rather than outlining the joint, the injected contrast will look like a blob.

Accurate placement is essential for both diagnostic and therapeutic injections.  If a given joint is suspected to be the source of pain, it is essential that the needle be in the joint and the local anesthetic injected go into the joint and not the adjacent tissue.  The only way to achieve this is with an arthrogram. 

PRP, prolotherapy, adult bone marrow derived stem cells, adipose derived stem cells  have significant healing and regenerative properties.  Accurate placement of the injected therapy is critical for maximal clinical success.  That this why at Centeno-Schultz Clinic injections are guided by either x-ray or ultrasound.

Below is an illustration of an arthorgram of the SI joint.  Filling of the joint with contrast is essential prior to injecting any medication or regenerative therapy.

Knee menisectomy and changes on MRI

The knee meniscus is a fibrocartilage structure that serves as shock absorbers between the thigh bone( femur) and shin bone(tibia).  Injuries to the meniscus can cause knee pain and often are treated with surgery.  Non surgical treatment options of knee meniscus injuries at the Centeno-Schultz Clinic  include Regenexx SD, Regenexx AD, Regenexx SCP and Regenexx PL. 

Knee meniscectomy is an arthroscopic procedure in which a portion of the injured meniscus is cut out.  It is similar to a nip and tuck as performed by a plastic surgeon. There are many studies that question the efficacy regarding this very common procedure.   Other studies have demonstrated that knee meniscectomy  surgery accelerates the degenerative changes in the knee.

How?

The meniscus is changed in size after a meniscectomy.  That means that there is more force on a smaller surface area.  The force arises from daily activities such as walking and running.  This increased force in combination with changes in architecture following the surgery led to degeneration.  Often times the mensicus is also displaced from the joint space.  In the end you have a shock abosber that is smaller in size, prone to weakness and degeneration and partially pushed out of the joint space.  The result is a nonfunctional shock absorber which exposes the cartilage surfaces to increased force.  Over time the increased force leads to bone swelling (edema) which has as patchy white appearance on T2 MRI images.

MRI changes following knee meniscectomy are illustrated below.  The image on the left is a normal knee MRI.  Normal meniscus are triangular in shape and black in color.  They are outlined in yellow circles.  The MRI on the right is after meniscectomy and significant for a change in the size and shape of the mensicus which is identified by blue circle.  A smaller mensicus in this case failed to cushion the thin bone from the shin bone resulting in bone swelling.

Shoulder Pain and Ultrasound Guided Injections

Platelet rich plasma, prolotherapy and autologous stem cells are non-surgical treatments for shoulder pain.  Clinical success is dependent upon selecting the appropriate treatment option and placing the solution into the targeted site.

Ultrasound has become the standard of care at the Centeno-Schultz Clinic.  Ultrasound does not involve exposure to x-rays and provides a rich image of the bone, muscles, tendons and ligaments. It also allows for a dynamic evaluation whereby the patient is able to go through the activities that cause them pain.  This is not the case with MRI’s given that they require a patient to remain completely still.  MRI’s provide a static image of the shoulder which may not be helpful in some cases of impingement.

This last weekend Ron Hanson M.D. was an instructor at a highly respected shoulder ultrasound course.

We are very pleased to have Ron’s gifted clinical and ultrasound skills here in Denver/Boulder area at the Centeno-Schultz Clinic.

Baker’s Cyst, Knee Pain and New Treatment Options

A Baker’s cyst can cause knee pain. A Baker cyst is swelling caused by fluid from the knee-joint protruding to the back of the knee.

A Baker’s cyst is NOT a  true cyst since the it has communication with the synovial sac.

They are typically arise from degenerative changes or injury to the articular cartilage (arthritis) or meniscus.  At the Centeno-Schultz Clinic we believe that baker’s Cysts are simply a barometer of the health of the knee-joint.  In a healthy knee there are absent whereas with injury and degenerative changes they are common.

Baker’s cysts arise between the tendons of the medial head of the gastrocnemiusand the  semimembranosus muscle.

Treatment options include rest, drainage, cortisone injection, ice packs and surgery.

Treatment of a Baker’s cyst at the Centeno- Schultz Clinic with prolotherapy has been published.

The recent introduction of ultrasound guided prolotherapy will optimize clinically results in the non-surgical treatment of Baker’s cysts.

Hip Pain Arising From Hip Capsule

At the Centeno-Schultz Clinic we acknowledge that the hip is a complex joint and that pain may arise from many different sources which include dysfunctional  muscles, stretched or partially torn ligaments, damaged or degenerative fibrocartilage and cartilage  structures. 

The hip-joint is enveloped in ligaments which collectively compromise a capsule.    Prolotherapy is an effective therapy for hip ligament injuries.

The hip capsule is comprised fo three principal ligaments. The ligaments are named from where they attach onto the bone. 

The  pubofemoral ligament attaches proxmially on the pubic bone and distally on the femoral neck.  This is oftne referred to as the anterior hip capsule.

The  iliofemoral liagment attaches proximally on the ilium and distally on the femoral neck. This is referred to as the lateral hip capsule.

The  ischiofemoral ligament attaches proximally on the ischium and distally to the femoral neck.  Yep you guessed it, this is often called the posterior capsule.

Pain referral patterns are as follows:

Anterior hip capsule pain typically involves the inguinal area and refers to the knee.

Posterior hip capsule pain typically involves the buttock and radiates down the back of the leg.

Knee Meniscus: Understanding Your Knee MRI

The Centeno-Schultz Clinic offers a large number of non surgical therapies for the knee.  IMS treats dysfunctional muscles. Prolotherapy is used to strengthen loose or sprained ligaments.  Regenexx SD, Regenexx AD and Regenexx SCP can be used to treat damage in meniscus and cartilage.

Understanding your knee MRI is helpful for many patients.  The key structures are identified below.  The image on the left is a frontal view whereas the image on the right is a side view of the left knee.  The principal bones are identified in red:  femur, tibia and fibula.  The meniscus is the dark triangle outlined with dashed circles.  On the left, the yellow circle identifies the medial meniscus whereas the blue circle identifies the lateral meniscus.  The meniscus has an anterior horn and posterior horn which are identified on the image on the right. 

Chataronga and Shoulder Pain

Chataronga  or  yoga up dog pose requires significant upper body strength and excellent form.  Weakness or poor form can lead to injuries in the rotator cuff muscles and or strain on the supporting shoulder ligaments.  While there are four muscles that comprise the rotator cuff, the supraspinatus muscle/tendon is the injured most frequently resulting in anterior shoulder pain.

The Centeno-Schultz Clinic offers the largest number of  non surgical regenerative therapies for shoulder, knee, hip, ankle and spine pain.  Therapies are patient specific and may include prolotherpy, plasma rich plasma (PRP), bone marrow derived stem cells (Regenexx SD), adipose derived stem cells (Regenexx AD), plasma derived stem cells(Regenexx SCP) or a combination thereof.  Selection of appropriate therapy is critical as is the delivery.  Accordingly therapies at the Centeno-Schultz Clinic utilize x-ray or ultrasound guidance to ensure that the regenerative therapy is applied to the targeted areas.  The large number of regenerative therapies and direct visualization result in superior clinical outcomes.

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