Stemcelldoc's Weblog

August 22, 2013

Common antibiotic associated with possible permanent nerve damage: Beware

Antibiotics are used frequently for a wide variety of medical conditions.

Ciproflaxin is a common antibiotic that has been associated with signficant complications: tendon rupture.

Salt has recently been added to this wound.

ligting

The FDA has recently added an additional warning to this class of antibiotics referred to as fluoroquinolones.

They are associated potentially permanent nerve damage.

Statin medications are another example of a commonly used medications that has signficant complications and also negatively impacts your stem cells. This has been previously discussed.

Here are 10 things to do to improve stem cell function.

August 18, 2013

Lateral Hip Pain: Think Gluteus Minimus Tendon Dyfunction

At the Centeno-Schultz Clinic we understand how frustrating and debilitating lateral thigh can be.

There are many causes of lateral thigh pain so an accurate diagnosis is essential.

Irritation or inflammation of the  gluteal muscles, tendons and trochanteric bursa can create pain.

Treatment options include MSK ultrasound guided injections of prolotherapy, platelet lysate and concentrated stem cell plasma.

There are three major tendons that attach onto the greater trochanter (the large boney prominence on the lateral aspect of the thigh): gluteus maximus, medius and minimus.

greater-trochanter

The gluteus minimus tendon can be a cause of lateral thigh pain.

The gluteus minimus muscle originates from outer surface of the ilium and attache onto the anterior facet of the greater trochanter .

Gluteus Minimus Tendon

The greater trochanter has four principal facets onto which the  various tendons attach.  The gluteus minimus attaches to the anterior facet.

Trochanteric Facets

The gluteus minimus muscle and tendon are visible on MRI.

Gluteus Minimus MRI

The gluteus minimus muscle and tendon are also visible on MSK Ultrasound.

Gluteus minimus ultrasound

Accurate diagnosis is essential for maximal clinical results.  At the Centeno-Schultz Clinic MSK ultrasound is used to diagnosis and accurately guide treatment of lateral thigh pain.

August 16, 2013

Epidural Platelet Injections: A safe alternative to steroids

At the Centeno-Schultz Clinic safety is paramount.

Platelet therapies are a safe and effective alternative to steroid epidural injections.

Platelet lysate (PL) and concentrated stem cell plasma (cSCP) are the two platelet treatments.

The efficacy of PL epidural injections compared to tradition steroid injections have been previously discussed.

We are concerned about the contamination of compounded steroid products and its sequelae.

Earlier this year the New England Compounding Pharmacy recalled compounded steroids due to fungal contamination. .   As of March 10, 2013, 48 people had died and 720 were being treated for persistent fungal infections.

 

NASS spine safety alert

This week another safety alert was issued by North American Spine Society and the FDA over concerns of bacterial infections.

Bacterial and fungal infection are serious issues with potentially serious and longterm complications.

If you suffer from ongoing neck or lower back pain consider platelet epidural injections at the Centeno-Schultz Clinic as a safe alternative to steroids.

August 13, 2013

Cervial Epidural Injections: Insist Upon X-ray guidance

At the Centeno-Schultz Clinic patient safety is paramount.

Cervical epidural injections are utilized to diagnose and treat neck and arm pain arising from the cervical spine.

Not all cervical epidural injections are performed in the similar fashion.

Some use x-ray guidance (fluoroscopy with injection of contrast) and others perform the injection without x-ray (blind).

Is there a difference?

Yes

c-arm_fluoroscopy

X-ray is used to guide and confirm the accurate placement of the needle into the epidural space.

Complications associated with not using x-ray:

Spinal nerve injury

Spinal hematoma

Injection into the spinal fluid with onset of hypotension and respiratory arrest.

Spinal cord injury.

Postdural headaches.

Vasovagal reaction.

X-ray also enables the injection of contrast (dye) to demonstrate the location and flow of medication injected.  If flow is limited to the right and the patient has pain only on the left the injection most likely will fail.  X-ray guidance documents the flow of contrast to maximize clinical results.  All cervical injections at the Centeno-Schultz Clinic utilize x-ray guidance.

Cervical-Interlaminar-Epidural-Steroid-Injection-post-contrast

Cervical epiduralw are useful in the treatment of neck and arm pain but require the use of intermittent x-ray (fluoroscopy) to minimize the significant potential complications and maximize clinical outcome.  This is the standard of care at the Centeno-Schultz Clinic.

August 10, 2013

Rotator Cuff Tears and Onset of Symptoms

At the Centeno-Schultz Clinic we acknowledge the pain, limitation and frustration associated with a rotator cuff tear.

shoulder-pain

A recent study from Norway examined the natural progression of rotator cuff tears in asymptomatic patients.

Was the progression of the rotator cuff tears correlated with the onset of symptoms?

Study:  50 patients with asymptomatic FT rotator cuff tears were followed using ultrasound and MRI imaging.

Changes of tear size, muscle atrophy, fatty degeneration, and condition of the long head of the biceps tendon were evaluated over 3 years.

Key Points

Eighteen of fifty tears developed symptoms over the three years.(36%)

Significantly larger increase in the rotator tear size (3X) in the newly symptomatic group when compared with the still-asymptomatic group.

The rate of progressing to advanced muscle atrophy was higher in the newly symptomatic group.

The rate of pathology of the long head of the biceps tendon was significantly higher in the newly symptomatic group.

Bottom Line

Over a three year period 36% of asymptomatic rotator cuff tears became symptomatic.  Increase in tear size and decrease of muscle quality were correlated to the development of symptoms.

If you have a rotator cuff tear be mindful and know the natural progression of tears.  Treat early on when symptoms occur.  Treatments at Centeno-Schultz Clinic include MSK US guided cSCP, PL and autologous bone marrow stem cells.

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