Stemcelldoc's Weblog

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.

November 15, 2010

Elbow Pain: Finding the Missing Pieces to the Puzzle

At the Centeno-Schultz Clinic we are commited to identifying the source of a patient’s pain. 

Lateral epidondyitlits is a common source of elbow pain which often can be  treated successsfully with IMS and ultrasound guided PRP therapy.

When therapies fail to provide signficant and sustained relief, alternative explanations are sought.

BS is an athletic professional with severe bilateral elbow pain which had been unresponsive to conservative therapy.   PT, trial of NSAID, splints and injection with corticosteroids failed to provide significant relief.  She was referred for ultrasound guided PRP injections which provided modest improvement. Upon followup,  we performed a comprehensive evaluation and noted numbness in her fingers, neck pain and recreation of elbow pain with rotation of her neck.

BS”s MRI of the cervical spine was significant for disc bulges at several levels which narrows the central canal and compressed nerves.  She underwent x-ray guided cervical epidural injection completely relieved her elbow symptoms clearly identifying her neck as a major source of her debilitaing elbow pain.

BS’s MRI and a normal MRI are shown below.  They are side views (Sagital).  On the right is a normal MRI with the cervical discs outlined by red circles.  The spinal cord is the thick, dark structure that runs from the top of the image to the bottom and is bathed by white cerebral spinal fluid.(CSF).  BS’s MRI on the right is significant for several disc protrusion which narrows the cervical canal and irritates the exiting nerve roots.

 

September 30, 2010

Headaches Originating from Muscle Dysfunction

Headaches can be debilitating.  At the Centeno-Schultz Clinic we experts at evaluating and treating head and neck pain.  Muscle dysfunction can be a major source of head pain and requires evaluation.  Tight, dysfunctional muscles in the shoulders and cervical spine often give rise to head pain.  In a previous blog I discussed referred pain.  Referred pain is a term used to describe the phenomenon of pain perceived at a site adjacent to or at a site away from the site of injury’s origin.

 Tight, poorly functional muscles give rise to a pain in common referral patterns.  The trapezius and splenius capitus muscle are responsible for referred pain into the head as  illustrated below:

Treatment for muscle dysfunction is aimed at restoring  normal function through IMS and strengthening through MCU.

September 28, 2010

Cervical Facet Syndrome: A Pain in the Neck

Injury or inflammation of the cervical facet can led to neck, shoulder and headache pain.

The cervical facet is a  joint in the posterior aspect of the cervical spine. It functions to provide stability and guide motion.

Cervical facet pain is common in patients who have sustained a whiplash injury, trauma to the neck or undergone cervical fusion. Physical examination is typically significant for restriction in range of motion along with pain.  Each joint has a distinct referral pattern illustrated below.

 

The Centeno-Schultz Clinic are experts at diagnosing and treating cervical facet dysfunction.  Injury to the joint is not commonly detected by conventional radiographic studies.  A thoough understanding of the mechanism of injury is essential.

Successful treatments include intra-articular facet injections, prolotherapy and burning of the nerves which give sensation to the affected cervical facet (radiofrequency ablation).

August 22, 2010

The True Risks Associated With Spine Surgery

Filed under: Cervical Spine, International Cellular Medicine Society, Lumbar Spine — stemcelldoc @ 3:00 pm

While attending a medical conference, I came across this poster which tells the true risks associated with spine surgery. 

May 31, 2010

Essential Differences in PRP Therapies

Platelet rich plasma (PRP) therapy is the use of a patient’s own platelets to accelerate healing.  It is termed rich because the platelets are concentrated, typically 5-10x above the concentration that is circulating in your blood.

PRP therapy has been used for a number of different indications  including wound healing in surgery,tendinitis, cardiac care and dental health.

Platelet-rich plasma (PRP) therapy made headlines following the Super Bowl, when it was revealed that Pittsburgh Steelers Hines Ward and Troy Polamalu had undergone PRP injections in the days leading up to the game.

Are all PRP therapies the same?

NO.

There are distinct differences in platelet rich plasma .

Most PRP is created by a bedside machine that creates a platelet concentrate by spinning (centrifuge) the blood thereby separating the platelets from the other blood products.

A cell biologist in a laboratory, however,  is able to separate the platelet from other blood products and so much more.

A cell biologist can create PRP that is pure and free of any red or white blood cells.  A machine cannot.

A cell biologist can create PRP in a specific concentration for specific indications.  A machine cannot.

A cell biologist can make PRP that has a very high levels of specific, naturally occurring growth factors such as VGEF, vascular  growth endothelial factor.  A machine cannot.

At the  Centeno-Schultz Clinic we are not reliant on a machine.  Rather through the use of a state of the art lab with full-time cell biologists we are able to provide our patients with customized PRP therapies that are specifically designed for them.  This is the critical difference which translates to improved outcome.

March 17, 2010

Debilitating Headache Unresponsive To Therapy

Filed under: Case Reports, Cervical Spine, International Cellular Medicine Society — stemcelldoc @ 8:11 am

BT is a 36y/o nurse s/p MVA with a five-year history of right upper neck and headache pain which was constant in duration, 6/10 in severity, exclusively right-sided localized principally at the base of her skull with radiations into the back of ther head and forehead.  Pain was sharp, stabbing and aching in character and aggravated by extension and stress.  BT was a restrained driver of a mini-van when a 18 wheeler truck struck the driver’s side of her vehicle.  Treatment to date had included physical therapy, massage, cervical traction, trigger point injects,  TENS unit, Botox injections complicated by cervical weakness and radiofrequency ablation of the right C2-4 joints without significant relief.  BT was no longer able to work due to her unrelenting pain.

Physical examination was significant for sensitivity to light, balance disturbance preventing her from walking heel to toe, extreme tenderness over the right C0/C1 and C1/2 joint with marked restriction in extension and rotation secondary to pain.

Upper cervical joints are common sources of pain following motor vehicle accidents.  The atlanto-occipital joint ( C0/C1) is compromised of the atlas of the vertebral column and the occipital bone (base of skull).  The atlas is the topmost (first) cervical vertebra and forms the joint that connect the skull to the spine.

Injection of the right atlanto occipital joint provided 90% reduction in pain.  The C0/C1 joint should always be considered as a possible pain generator when evaluating patients with headache pain following motor vehicle accidents.  Dreyfuss has mapped the referral patterns. Ogoke was detailed the anatomy, clinical presentation and various treatment modalities.

February 10, 2010

Theraupatic Lumbar Discogram?

Lumbar discography is procedure in which a needle is placed into the disc at two or more levels to determine whether of not a specific disc is the  source of pain.  Is the pain coming from the L4/5 disc or the L5/S1 disc?  The procedure is performed with intermittent x-ray.  Once the needles are in the center of each disc,  contrast is injected into the disc.   A patient’s response is graded as follows:

P0:  no pain:  a common response in a healthy disc

P1:  painful, but not identical in quality or location to the patient’s daily pain.

P2:  painful, identical in character, quality and location.

Discograms are strictly a pre-surigcal procedure which tells the surgeon which level to operate.  They have no therapeutic benefit.  I have had two discograms and they HURT!

A recent study demonstrated that lumbar discograms accelerate disc degneration.

Patients are often  misinformed about discograms.

AJ was a 23y/o with 6 month history of low back pain following a rear-end motor vehicle injury.  Pain was constant in duration, 6/10 in severity, progressive in nature and  localized in her lower back, right =left with radiations into her buttocks.  MRI was significant for mild degeneration of the L5/S1 disc. Physical examination was significant for tenderness in the lower lumbar spine with extension and rotation.  She had no treatment to date:  no physical therapy, chiropractic care, trial of good quality fish oil, massage or evaluation by a pain specialist.  Her PCP referred her to a surgeon for evaluation of her back pain.  She was scheduled for a discogram which she thought was going to help here back pain.

 Evaluation of all possible sources of pain is essential.  For lumbar back pain common causes include:

myofascial: dysfunctional muscles 

facet dysfunction:

ligamental dysfunction: treated with proloterhapy

SI joint dysfunction:

Disc dysfunction.

The Centeno-Schultz Clinic is committed to identifying the cause of a patient’s pain and designing an proper treatment plan utilizing state of the art therapies.

January 28, 2010

Abnormal Head Position with Neck and Shoulder Pain

Dystonia:  Abnormal muscle tone characterized by prolonged muscle contractions.

RV is 53 y/o patient with a 1.5 year history of left neck and shoulder pain which is constant in duration, 5/10 in severity, nonprogressive in nature localized exclusively on the left. Pain is throbbing in character, aggravated by extension and rotation to the right.  Patient has no significant past medical or surgical history and denies any trauma.  Patient had involuntary muscle contractions which pulled her head to the left making walking straight, operating a car and sleeping difficult.

 Treatment to date included chiropractic care, neurologic, orthopedic and physical medicine consultations.  The orthopedic surgeon diagnosed a tear in shoulder and recommended surgery.  The neurologist injected Botox repeatedly on both sides of her neck which resulted in head and neck weakness precipitating nausea.   Facet injections provided no significant relief.  MRI of the brain, cervical and thoracic spine were all normal except  mild degenerative changes at C5/6.

Physical examination was significant:   left rotation of head, downward  gaze , left shoulder and neck was tender to the touch with multiple muscle nodules.  Most striking was her right sternocleidomastoid muscle (SCM) which was contracted, thick and very painful.

Cervical Dystonia is a movement disorder in which sustained muscle contractions cause abnormal postures.

Insertion of several small needles (IMS) into the right SCM provided the patient with complete resolution of her left sided neck and shoulder pain along with a significant reduction in her involuntary head rotation. 

  Understanding the complexity of the musculoskeltal system is essential.  It was contraction of her RIGHT SCM which led to the left head rotation and stretch of left shoulder and neck muscles.  Injection of the left side, the side where the pain was would only have increased her head rotation and pain. 

The Centeno-Schultz Clinic is committed to the highest level of  diagnostic and regenerative medicine.

January 26, 2010

New Perspective: Ortho 2.0

Everyone told Christopher Columbus that the world was flat.   

 Friends told the Wright brothers that birds were the only creatures capable of flight.  

    

A paradigm shift was required.  This also applies to medicine. The time has come to focus not on joint replacement but on joint restoration and repair.     Dr. Centeno has termed this Ortho 2.o.   Ortho 2.0 has a bigger focus beyond just fixing one part of the musculoskeletal system (bone, joints, muscles, tendon, and ligaments).   When the focus shifts to repair, the amount one needs to know about the joint increases exponentially.  There are four principal elements which are addressed when evaluating a gvien joint: (S.A.N.A.)   

ORTHO 2.0 : S.A.N.A.

  S: stabilization   

A: articulation   

 N: neurologic   

 A: alignment   

 Injection of magic stem cells alone is not sufficient for joint restoration.  Multiple studies have shown that just injecting stem cells into a joint blindly is not that effective.  For the best clinical outcomes, each of the factors listed above must be evaluated and treated. At Regenerative Sciences and The Centeno-Schultz Clinic this is the standard.  Case examples utilizing the S.A.N.A. paradigm will be in future blogs.   

It is truly a new day:)    

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