Stemcelldoc's Weblog

July 10, 2011

Stem Cells Decrease Pain

At the Centeno-Schultz Clinic we have observed a reduction in pain in some patients after  stem cell treatments that can not be explained by tissue regeneration.  Specifically some patients report a reduction in pain weeks to days after treatment with Regenexx SD, Regenexx C and Regenexx PL.  Regeneration of cartilage, bone, and tendon can take weeks to months but many patients reported significant pain reduction in pain  in the first several weeks.   We searched for alternative explanations.

A recent publication has shed some light as it demonstrated a role between pain control and stem cells.

Researchers at  Boston University  currently reported that bone marrow derived mesnechymal stem cells can relieve pain.  The study utilized rats and examined two types of pain:  myofascial and neuropathic.  Cells were injected into  IV or  directly into the injured tissues.  Pain was relieved in rats who received stem cell injections whereas the untreated group suffered pain.

Pain clinics and narcotics in particularly have been demonstrated to poorly control pain.  At the Centeno-Schultz Clinic we utilize  stem cells derived from bone marrow, adipose and blood in the treatment of common orthopedic conditions and disorders of the lumbar, cervical and thoracic spine.

A new chapter in medicine, orthopedics and pain management has started.

March 26, 2011

Piriformis Syndrome: Ultrasound Therapy is Superior

The piriformis is a small but important muscle in the gluteal (buttock) area.

It originates from sacrum(base of lumbar spine), exits the pelvis through the sciatic foramen and inserts on the greater trochanter of the femur(hip bone).

The piriformis muscle functions to  laterally rotate the hip.

Piriformis syndrome is a condition in which the piriformis muscle irritates the traversing sciatic nerve causing pain, tingling and numbness in the buttock and leg.


Common causes of pirifromis syndrome include weak abductors combined with tight adductors, SI joint dysfunction and overpronation of the foot.  Runners, bicyclist and other athletes engaged in forward moving activities are particularly susceptible.

Comon referral pain pattern is:

Treatment involves  stretching exercises and massage, and avoidance of contributory activities,

When conservative treatments fail,  injection of local anesthetics and low dose steroids are a viable option.

Are all injections the same?  NO

At the Centeno-Schultz Clinic we have both x-ray and ultrasound within our clinic.  Our practice is to use ultrasound as it has been demonstrated to be superior to x-ray in placing the medication directly into the piriformis muscle.  Finnoff found that most of the fluoroscopically attempted piriformis injections were placed superficially within the gluteus maximus and therefore did not reach the targeted piriformis.

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.

January 11, 2011

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.

January 9, 2011

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.

January 5, 2011

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.

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.

December 22, 2010

Sciatica and Stem Cell Therapy

Sciatica is a debilitating searing pain in the lower extremity commonly as a result of nerve root irritation. 

 Disc herniation, disc protrusion, overgrowth of the facet joint and thickening of the ligaments can result in nerve root compression or irritation.  Non-surgical treatments to date have included x-ray guided epidural injections of local anesthetics and steroids.  As discussed in previous blog, steroids injections can be associated with many complications including cell death.

At the Centeno-Schultz  Clinic Regenexx PL is used as an alternative to conventional epidural steroid injections.  A  patient’s own platelet derived growth factors are injected into the epidural space with the aim of increasing blood flow thereby stopping and potentially reversing the degenerative process.  Enhanced blood flow to a given area increases the amount of nutrients and optimizes healthy environment.  Regenexx PL has led to many clinical successes.

TA is an athletic patient with a 6 month history of severe right leg pain which was progressive in nature, originating in her right lower back with radiations into her big toe.  She described it as a “sharp knife” in her foot.  Oral narcotics and muscle relaxants did not relieve her pain.  Having had extensive neck surgeries which were complicated and required revisions, she was committed to non-surgical therapy.  Her MRI demonstrated a large  right-sided disc protrusion @ L5/S1 with compression of the adjacent nerve root.

She underwent three  x-ray guided injections of Regenexx PL and reports  90% relief.  The “knife like” leg pain is gone and she has returned to her passion. She was last seen headed up to Steamboat.

December 21, 2010

Rotator Cuff Tears: Non-Surgical Treatment Options

The rotator cuff is compromised of 4 major muscles and tendons that act collectively to stabilize the shoulder joint.

The four muscles include the supraspinatus, infraspinatus, subscapularis and teres minor.  Tendons are the fibrous portion of the muscle that anchors the muscle to bone.  This fibrous anchor can be inflamed resulting in a tendinitis or can be  chronically degenerative resulting in tendinosis.  The one of  4 muscles can have a partial or full thickness tear.

At the Centeno-Schultz Clinic ultrasound is utilized to determine the source of pain.  The pain may arise from a tear in one or more of the four rotator cuff muscles or inflammation or degenerative changes in the fibrous tendon anchor. Other explanations exist which will be discussed in another blog.

Rotator cuff tears can be treated with Regenexx SD whereby a patient uses their own mesencymal stem cells.  Tendinosis  can be treated with Regenexx SCP.

The Regenexx family of procedures represent the highest quality stem cell therapy with the largest number of stem cell treatment options in one clinic and which are ICMS certified.

December 17, 2010

Microfracture knee surgery

Microfracture knee surgery is designed to repair articular cartilage.  The surgery is performed via a small camera that is placed into the knee (arthroscopy).  Thereafter an awl is used to create small fractures in the bone whereby blood and bone marrow seeps out of the fracture creating a blood clot.

  The bone marrow is rich in stem cells which gives rise to the new cartilage.  Microfracture unfortunately forms fibrocartilage rather than hyaline cartilage.  Fibrocartilage is weaker and at higher risk for break down. Recovery can be slow given the extensive period on non-weight bearing.

Microfracutre 2.o involves placing stem cells directly into areas of cartilage damage without the trauma of making multiple small holes into the cartilage and bone.  Regenexx procedure enables patients to use their autologous mesenchymal stem cells which are placed either through direct x-ray visualization or ultrasound guidance.  The Regenexx procedure family has no significant post-injection rehabilitation or downtime and allows the patient to return to passions.

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