Distal Quadricep Tendinitis: A complication from blind knee Injection

The risks and possible complications associated with blind injections include failure, increased pain and injury and have been previously discussed.

At the Centeno-Schultz Clinic knee injections are performed under x-ray or MSK ultrasound guidance to ensure accurate placement of the PRP, Regenexx SCP or other platelet derived or bone marrow derived therapies.

Unfortunately when guidance is not used complications can occur.  SG is a case in point.

SG is an athletic 45y/o patient who sustained a meniscus injury and declined traditional surgery where a portion of the tear would be cut out.  Removal of a injured meniscus places increased force on the remaining knee structure and is associated with acceleration of the degeneration process.(blog).

SG acknowledged stem cell therapy as an alternative to knee surgery and opted to proceed with Regenexx SD.    He had undergone multiple therapies which included physical therapy, chiropractic adjustments and injection of  Synvisc, a medically approved DW40.  MSK ultrasound was not used.  SG reported that not only was the injection painful since the provider stuck him three times but after the injection the top portion of his knee cap was red, painful to the touch and movement of the knee was difficult.  It remained painful for weeks thereafter.

Diagnostic knee ultrasound at the Centeno-Schultz Clinic demonstrated inflammation and partial tear of the distal quadriceps tendon.  The previous knee injection most likely injured the tendon.  Complications such as these can be avoided with the use of MSK ultrasound guidance.

Low Back Pain: Cluneal Nerve Entrapment

At the Centeno-Schultz Clinic we acknowledge that low back pain can arise from the lumbar facets, intervertebral disc and the sacroiliac joint.

An overlooked cause of low back pain is entrapment of the superior cluneal nerve.

The cluneal nerve is compromised of the posterior rami of L1, L2 and L3 and provides sensation to the upper buttocks.

Three distributions of the cutaneous branches of the nerve exist.   Lu et al described the anatomical relationship of the superior cluneal nerve to the posterior iliac crest.  The medial branch of the superior cluneal nerve is confined within a tunnel consisting of fascia and the superior rim of the iliac crest.    The location is 7-8 cm lateral to the spinous process on the iliac crest.  It is lateral and superior to the posterior superior iliac spine.

The nerve can be entrapped between the fascia and the iliac crest causing pain and restriction in motion.  This is similar to carpal tunnel syndrome where the fascia constricts the median nerve.

Case reports  have documented the entrapment of the superior cluneal nerve as a cause of unilateral back and buttock pain.  Patients who have undergone iliac crest bone grafts for lumbar fusions are at risk for entrapment.  Stem cell therapy is an alternative to spinal surgery and fusions.

The Centeno-Schultz Clinic is committed to establishing an accurate diagnosis so effective treatment can be started and you can return to your passions.

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Low Back Pain: Think Lumbar Facet

At the Centeno-Schultz Clinic we are committed to identifying the source of a given patient’s pain.  Back pain can arise from many sources which include dysfunctional muscles, structural instability, facet joint, sacroiliac joint and  disc degeneration.  Ortho 2.0 details the importance of function and stability.

The lumbar facet joint is a small joint in the posterior portion of the spine that is composed of the superior articular process of one vertebrae and the inferior articular process of vertebrae directly below it.  Similar to the knee-joint,  the facet joint is lined with cartilage which allows for  smooth and  painless motion.  It functions to limit the movement of each spinal  motion segment.  Trauma, instability and degeneration can cause damage to the cartilage lined joint resulting in pain.  Conventional radio-graphic studies often times fail to demonstrate facet injury.  Diagnosis is made by injection of local anesthetic into the joint (intra-articular facet injections) or medial branch blocks.

AB is 36 y/o patient with 10year history of low back pain, constant in duration, progressive in nature over the last 11 months, localized in lumbar region right>left with radiations into hips.  Pain was sharp and throbbing.  Aggravating factors included prolonged walking, sitting and running.

Alleviating factors:  percoset, ice and rest.

Treatment to date included PT, chiropractic care, oral narcotics and muscles relaxants.  Patient had undergone two  lumber epidural steroid injections without significant benefit.

MRI of lumbar spine was significant for mild disc degeneration at L4/5, L5/S1 and facet degeneration at L4/5 and L5/S1.

Patient presented to Centeno-Schultz Clinic frustrated with the treatment to date and lack of  improvement.  She underwent x-ray guided injection into the lumbar facet joints which has provided her significant and sustained benefit.

Rather than relying exclusively on the MRI which demonstrated degeneration of the lumbar discs we took history and performed a thorough physical examination which was significant for lumbar facet dysfunction.

Comprehensive care is our commitment at the Centeno-Schultz Clinic.  In order to save a joint not only do you need to know how to help that joint, but you also need to know how it got that way in the first place.

Orthopedic Stem Cells Sources: Autologous vs Donor

At the Centeno-Schultz Clinic we acknowledge the regenerative potential of stem cell therapy for common orthopedic conditions.  Stem cell treatment utilizing Regenexx C and Regenexx SD has been used successfully as an alternative to

shoulder surgery

knee surgery and joint replacement

Peer reviewed studies have demonstrated its safety.

Regenexx utilizes a patient’s own stem cells which are referred to as autologous.

Stem cells can also come from donors and are referred to as allogeneic.

Is there a difference?

Yes as discussed in Dr. Centeno’s recent chapter on Stem Cell Therapy.

Autologous stem cell cells do not have the same communicable disease transmission risk as donor cells since they are the patient’s own cells.

Donor stem cells have the following concerns.

Gene transmission:  Stem cells transplanted from the bone marrow of mice bred to have osteoporosis were able to induce osteoporosis in healthy mice.

Immunosuppressive potential is reduced in mismatched settings.

Orthopedic Stem Cells: How they work

At Centeno-Schultz Clinic we acknowledge the regenerative potential of stems cells in treating common orthopedic injuries.   Dr. Centeno authored a chapter on stem cell use in orthopedic injury.
Regenexx C & Regenexx SD are alternatives to knee surgeries.

How do stem cells work?

Three principal ways:  differentiation, paracrine affect and regulation of inflammation.

Mesenchymal stem cells are multipotent and can differentiate into cartilage, tendon, bone and ligament.

Paracrine means that mesenchymal stem cells release certain growth factors to assist in tissue repair.  Mesenchymal stem cells  can be viewed as construction managers as they recruit other cells to the local area and coordinate the repair of damaged tissue.  The growth factors include TGF-beta, VEGF and FGF.

Finally MSC’s have been demonstrated to regulate inflammation.  Inflammation is not all bad and is the first step in healing.