Stemcelldoc's Weblog

February 21, 2011

Anterior Knee Pain: Pes Anserine Bursitis

Knee pain can be disabling.  At the Centeno-Schultz Clinic we acknowledge that it is essential to determine the cause of pain.

Pes anserine bursitis and tendinosis is a common cause of anterior knee pain.

The pes anserinus is the insertion of the conjoined tendons of three muscles of the hamstring onto the front inside (anteromedial) surface of the shin bone (tibia). 

 The three muscles are the sartorius, gracilis and semitendinosus.

A bursa is s fluid filled sac that lies between the bone and the tendons.  It serves as cushion and helps reduce friction and provides a gliding surface. 

Pes bursitis is a condition in which the bursa gets inflamed resulting in pain and potential restriction in range of motion.

Patients often complain of pain  directly over the pes anserine area which is located about two to four inches below the joint line on the inside of the knee.  Pain, swelling and tenderness are common.

Overuse of the hamstrings is a common cause of pes anersine bursitis.  Runners are affected most often.  Direct trauma and osteoarthritis are other causes.

Treatment typically involves rest, ice, PT and hamstring stretches.

At the Centeno-Schultz Clinic IMS (intra-muscular stimulation) is used to treat dysfunctional hamstring muscles along with ultrasound guided injections into the inflamed tendons or bursa.  Prolotherapy is an effective therapy to pes anersine bursitis and tendonosis.

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February 11, 2011

Knee Pain, Micromotion and Prolotherapy

Ligaments are fibrous tissue that connect bone to bone.

In the knee there are 4 principal ligaments;  ACL(anterior cruciate ligament), PCL(posterior cruciate ligament),MCL(medial collateral ligament) and LCL(lateral collateral ligament).

Ligaments in the knee  provide structural stability for the joint.  If a ligament is injured, partially torn or stretched it affects the stability of the joint.  Instability often results in very small movements, mircomotion, within the joint that is outside the range of normal.   Micro-motion places additional forces and stress on the joint which translates to abnormal wear and tear on the joint.  Patients typically complain of instability, pain and swelling.

PR is a 40 y/o minor league baseball player who presented to the Centeno-Schultz Clinic with 10 plus year history of right knee pain who underwent multiple therapies including PT, massage, chiropractic care, Synvisc injections.  Two arthroscopic surgeries failed to provide a reduction in pain.   On physical examination his anterior cruciate ligament was noted be loose.  Not loose enough to require surgery but loose enough to create excessive wear and tear on the knee with resultant pain and swelling.

At the Centeno-Schultz Clinic, PR underwent two x-ray guided injections of prolotherapy directly into the ACL.  After the needle is placed into the ACL a small amount of contrast is injected which outlines the ligament.  This is shown below.  After two proloterapy sessions PR has had near complete resolution of his chronic knee swelling and 75% reduction in pain.  Structure stability is essential in evaluating all joints and is the standard of care at the Centeno-Schultz Clinic.

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February 5, 2011

Musculoskeletal Ultrasound: Getting the Bigger Picture

X-rays, MRI s and CT studies are often obtained as part of a sports injury evaluation.  In most cases these studies are static in nature and not dynamic.  Patients are positioned and instructed “NOT TO MOVE”.  Unfortunately for many patients their pain only occurs with movement.

At the Centeno-Schultz Clinic we acknowledge ultrasound as a powerful clinical tool since it emits no radiation, can be performed in our clinic and provides a dynamic evaluation of a painful joint or extremity.

Dynamic evaluation of a joint examines all the important structures at rest but also with movement.  For example during an ultrasound examination of the shoulder, the shoulder in put through various movements and stress.  In doing so it mimics the stress of daily activities.

A video illustrates how movement of the shoulder joint is incorporated into the  ultrasound examination.

In addition to its diagnostic value, ultrasound also ensures accurate placement of injected medication, prolotherapy and autologous stem cell therapies such as Regenexx SD, Regenexx AD and Regenexx SCP.    A video shows an ultrasound guided injection into the knee.  Accurate placement of treatment therapies ensures the best clinical outcomes.  This is the standard of care at the Centeno-Schultz Clinic.

February 3, 2011

Headaches Arising from Atlanto Occipital Joint

At the Centeno-Schultz Clinic we acknowledge that headaches can arise from many different sources including dysfunctional muscles, tears in the ligaments, misalignment of the vertebral bodies, injury to cervical facets and degenerative discs. 

The C0-C1 joint can cause significant headache and upper neck pain and should always be considered in the evaluation of the headaches not responsive to traditional therapy.  I have previouly discussed  the successful treatment of C0-C1 headache pain.

The C1-C0 joint, also referred to as the Atlanto-Occipital Joint(OA) is the first joint in the neck.  The base of the skull is the occiput.  The first bone in the neck is the atlas.  The joint bewtteen the two structures is susceptible to traumatic injury and degeneration.

The pain arising from the OA joint typically refers to the base of the skull as decpited.

Treatment options include prolotherapy, low doses of steroids and autologous mesenchymal stem therapy utilizing Regenexx SD.

Diagnosis is made by injecting a small amount of local anestheti into the joint under x-ray.  The neck is rich in nervies, veins and arteries which make injection into this area difficult and a potential source of complications.  Injection of dye (contrast) is essential to confirm accurate placement of the needle.  An image of contrast in the  C0-C1 joint is posted below.

February 1, 2011

PRP Therapy: One Size Fits All

At the Centeno-Schultz Clinic we acknowledge the important of taking a history, performing a physical examination and reviewing radiographic studies.  We appreciate that MRI’s or x-rays alone rarely identify the source of pain.  Many painful conditions such as facet dysfunction are not reliably detected on conventional radiographic studies.

Some health care facilities have recently advertised PRP treatments through radiology departments without the need for an initial evaluation.  A prospective patient calls, provides a brief history and secures an appointment.  No initial examination is required nor is a complete history  taken.  The platelet rich plasma is injected via guidance and the patient is subsequently discharged with no followup.

We find this treatment lacking on many counts.  In medicine one size does not fit all.  Not all conditions require the same PRP therapy.  In contrast an automated, bedside machine which can only produce a one PRP product, a state of the art lab practice such as the Centeno-Schultz Clinic can customize platelet rich therapy.  Important factors in a patients history are taken into consideration at the Centeno-Schultz Cinic. We have blogged previously on how medications such as statins can complicate certain conditions such tendonitis.  Patients see their physician immediately after the injections to evaluate the immediate results and followup in clinic weeks thereafter to ensure clinical progress.  It is this attention to detail that differentiates the Centeno-Schultz Clinic from others.

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