Stemcelldoc's Weblog

January 26, 2014

Effect of Amide Local Anesthetics on Stem Cell Viability: Patient BEWARE !

At the Centeno-Schultz Clinic ongoing research and publication is a cornerstone of the practice.

Multiple articles have been published in peer-reviewed journals.

A new article just published examined the effect of amide type local anesthetics on human mesenchymal stem cell viability and adhesion.


cell death

Local anesthetic are commonly utilized in joint and injections.  Local anesthetics combined with high dose steroids are commonly injected into the joint.  The local anesthetic provides numbing which gives the patient several hours of pain relief.

Do the injected local anesthetics affect stem cells?

Four amide local anesthetics were examined in varying concentrations:  ropivacaine, lidocaine, bupivacaine and mepivacine.

Each anesthetic in different concentrations was incubated with human mesenchymal stem cells for 40 minutes, 120 minutes and 360 minutes and 24 hours.  Cell viability was assessed at each time point.


Extended treatment with local anesthetics for 24 hours or more had signficant impact on both stem cell viability and adhesion.

Stem cells treated with lidocaine, bupivacaine and mepivacine resulted in cell death via apopotosis after brief exposures.

Amide local anesthetics induce stem cells apoptosis(cell death) in a time and dose dependent manner.

Bottom Line

Patient beware!  Know that injected local anesthetics can negatively impact your repair cells.  If you medical provider wants to inject your joint ask why and with what acknowledging that your repair cells and cartilage are at risk of damage.

June 15, 2013

Understanding Peroneal Nerve Entrapment: Lateral Knee Pain and Weakness

At the Centeno-Schultz Clinic identifying the source of your knee pain and weakness is critical. There are many causes of lateral knee and leg pain. Entrapment of the peroneal nerve as it crosses the fibular head is discussed below.

The sciatic nerve, largest nerve in the body divides into the tibial and common peroneal nerve just above the level of the knee-joint (popliteal fossa).


The common peroneal nerve travels laterally and courses around the fibular neck and passes through an opening in the  peroneus longus muscle. This opening can be quite tough and can result in the nerve angulating through it at an acute angle.



Peroneal nerve injuries are the most common peripheral nerve injuries of the lower limb to result from multiple traumatic injuries.  While the nerve can be injured at any site along its path, most peroneal nerve injuries occur at the region of the fibular head.


Habitual leg crossing


Prolonged squatting (strawberry picker’s palsy)

Knee dislocation

Total knee and hip replacement and arthroscopies


ALTERED GAIT secondary to weakness or paralyzed muscles that control ankle extension (ankle dorsiflexors).  This can result in foot drop foot where dorsiflexion of the foot is compromised and the foot drags during walking.


LOSS OF SENSATION over the lateral knee and leg.

Peroneal Nerve Sensory Distribution

Peroneal Nerve Sensory Distribution

At the Centeno-Schultz Clinic MSK Ultrasound is an essential part of the diagnostic evaluation and allows for direct visualization of platelets and stem cells therapies.

Below is an ultrasound image of the common peroneal nerve at the level of the fibular head.  The nerve is seen on cross-section and identified by the white arrow.  fh=fibular head and lhg is lateral head of gastrocnemius, a major muscle in the calf.

common peroneal nerve ultrasound

May 30, 2012

Plantar Fasciitis: New Treatment Options

At the Centeno-Schultz Clinic we acknowledge that heel pain can be disabling.

Plantar fasciitis is the most common cause of heel pain and is caused by the  inflammation  of the plantar fascia at its insertion on the medial process of the calcaneus ( heel bone).  The plantar fascia is the thick connective tissue which supports the arch on the bottom of the foot.  It runs from heel bone (calcaneus) forward to the heads of the metatarsal bones.  Repetitive microtrauma of the plantar fascia due to alterations in foot bio mechanics is thought to be major pathology.

Intense sharp heel pain with the first couple of steps in the morning is a common presentation.  Other diagnostic considerations include:

  • Achilles tendon injuries

Lumbar radiculopathy

  • Calcaneal stress fracture
  • Calcaneal Bursitis
  • Contusions
  • Tarsal Tunnel Syndrome

In-0ffice MSK ultrasound at the Centeno-Schultz Clinic allows for radiation free method of visualizing the plantar fascia and diagnosing plantar fasciitis.

Treatment options for those who have not responded to rest and conservative therapy include IMS, ultrasound guided prolotherapy, PRP and percutaneous needle tenotomy. The latter is a non surgical procedure where under ultrasound guidance a small needle is placed into the fascia and small holes are created. A recent study by Vohra demonstrated greater than 80% improvement in 41 patients with chronic plantar fasciitis who underwent percutaneous needle tenotomy.  The ultrasound image below shows a needle directed into the plantar fascia in a patient with severe plantar fasciitis.

March 3, 2011

Steroids and Cell Death: Apoptosis


Apoptosis is the process of programmed cell death.  The process is controlled by a variety of factors both within and outside of  cells.  High dose steroids have been demonstrated to create cell death in muscles, bones, cartilage and ligaments.  High dose steroids are commonly used to treat a variety of painful conditions which include rotator cuff tears, lateral epicondylitis, patellar and Achilles tendonitis, pes anersine bursitis,  lumbar facet dysfunction and sciatica.

At the Centeno-Schultz Clinic we acknowledge the negative effect of  high dose steroids.  Our aim is to identify the source of a patient’s pain and provide a therapy which will attempt to repair the damaged tissue.  Our treatments are not aimed at advancing the degenerative process or triggering apoptosis.  Accordingly we use only very small doses of steroids when necesary and have a large number of regenerative therapies which promote healing: prolotherapy, platelet rich plasma (PRP), Regenexx SCP, Regenexx AD and Regenexx SD.

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 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 27, 2011

Bone Marrow Derived Stem Cells are Best for Cartilage Regeneration

Mesenchymal stem cells are available from different tissues sources which include blood, adipose, synovial fluid, muscle and bone marrow.  Superior clinical outcomes are associated with selecting stem cells from the most appropriate source, isolating them in a state of art laboratory and placing them into the area of tissue damage with direct visualization using either ultrasound or intermittent x-ray guidance.  This  is the Regenexx difference.


Blood and adipose derived stem cells are less expense to obtain and process than those arising from bone marrow.  In a recent article bone marrow derived mesenchymal cells were shown to have a higher potential to differentiate into cartilage cells than  stem cells arising from synovium, adipose and muscle. That is why when treating cartilage defects in either the hip, knee or ankle, Regenexx SD is the treatment of choice.

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