Stemcelldoc's Weblog

April 6, 2014

Treatment of Knee Arthritis Pain: Curcumin vs NSAID

At the Centeno-Schultz Clinic we understand the limitations, physical and emotional drain associated with pain.

Curcumin is an active ingredient in the Regenexx Advanced Stem Cell Support Formula.

It is an innovative formula of nutritional supplements that helps maintain and support normal joint health and functioning.  In Regenexx laboratory studies, the supplements within the formula helped to maintain the health of the cell environment and provide support for the joint’s natural cartilage growth (chondrogenesis) process.

What is Curcumin?

tumeric_0706

Curcumin an extract from the Indian spice tumeric.  Research has shown curcumin to modulate inflammation.

Is Curcumin as effective a Ibuprofen?

Yes!

Kuptniratsaikul et al recently compared the efficacy and safety of Curcumin with Ibuprofen in patients with knee osteoarthritis.  In a multicenter study, 367 patients with knee osteoarthritis were randomized to receive 1,200 mg/day of ibuprofen or Curcuman extracts 1500mg/day for 4 weeks.  Curcumin was as effective as Ibuprofen in improving pain and function in patients with knee osteoarthritis.  While the number of adverse events was not different between the groups, there was a higher number of abdominal pain/discomfort in the ibuprofen group.

Are there other differences?

Absolutely!!

The chart below outlines the key differences.

NSAID have significant side effects which include reduced bone healing, increases in systematic inflammatory markers, increases in oxidative stress and increases in deadly heart attack risk by 200-300%.

Know the risks and natural alternatives for management and treatment of knee arthritis pain.

knee-arthritis-supplement

 

April 5, 2014

Saphenous Nerve Entrapment as a source of knee pain

At the Centeno-Schultz Clinic we acknowledge that there can be many causes of knee pain.

In our online book, Ortho 2.0 a systematic approach is discussed: SANS.

N references neurologic dysfunction.

Irritation or dysfunction of the saphenous nerve can be cause of knee pain.

The saphenous nerve is a pure sensory nerve compromised of fibers from L3 and L4.  The saphenous nerve is the longest branch of the femoral nerve.

 

femoral nerve division

Branches

Above the knee joint the infrapatellar branch arises whereas below the knee the medial crural cutaneous branch provide sensation to the front and medial aspect of the knee.

Dermatomes of Saphenous Nerve

A common site of entrapment is adductor (Hunter’s) canal which is an aponeurotic tunnel in the middle third of the thigh.  Adductor canal contains femoral artery, femoral vein and branches of the femoral nerve which include the saphenous nerve.

The Adductor canal has the following boundaries:

  • Anteriorly – Sartorius
  • Postermedially – adductor longus and adductor magnus
  • Laterally -vastus medialis
adductor canal

adductor canal

 

Ultrasound image of saphenous nerve in Adductor canal

saphenous nerve ultrasound image adductor canal

A systematic approach with diagnostic tools that include MSK ultrasound ensure maximal patient outcomes.  Treatment options of saphenous nerve irritation/entrapment include MSK ultrasound guided hydrodissection with platelet growth factors.

March 26, 2014

Common Causes of Chronic Knee Pain: A systematic Approach

At the Centen0-Schultz Clinic we utilize a comprehensive approach to patient care.    Our online ORTHO 2.0 discussess a systematic approach to common orthopedic conditions.

Don’t assume that loss of cartilage is the source of all knee pain.

Below is an infographic which outlines the common causes of knee pain.

Tendons:  patellar, distal quadriceps and pes anserine.

Spine:  Lumbar disc disease with compression of L5 and or S1 nerve root.

Peripheral nerves:  compression and or irritation of saphenous and tibial nerves.

Muscles:  Dysfunctional muscles resulting in weakness or imbalance.

Ligaments:  key stabilizers of the knee joint include the ACL, MCL and LCL.

Knee Joint:   medial and lateral meniscus

Bottom Line:  prior to undergoing any treatment ensure that the principal pain generator has been identified to maximize clinical results.

 

 

 

Common-causes-of-Chronic-knee-pain-Infographic

March 25, 2014

ACL Tear Stem Cell Study: Free Care for Those Who Meet Criteria and can Travel

tree with clouds

The Centeno-Schultz Clinic is a research based medical practice that acknowledges the importance of research.

Our publications to date are multiple and easily identified in the U.S. Library of Medicine.

Stem cell therapy is a successful alternative to traditional surgery in the treatment of ACL tears.

Successful cases of ACL repairs have been discussed in prior blogs with comparisons of pre and post MRI’s illustrating the healing afforded by autologous stem cell treatment.

Regenexx currently has an ACL stem cell study which is available for patients that qualify and can travel to our Broomfield clinic.

Full Inclusion criteria is listed on web site and includes:

  1. Physical examination consistent with lax ACL ligament (Anterior Drawer Test)
  2. Abnormal Telos Arthrometer measurement
  3.  Positive diagnostic MR imaging of the affected knee with at least 1/3 of the ACL ligament at any area along its length having high signal on MRI PDFS/Fat Sat images.

Exclusion criteria is also listed and includes:

  1.  A massive ACL tear or one that includes more than 2/3’rds of the ligament that’s retracted.
  2.  Previous surgery to the affected ACL
  3. Concomitant meniscus tear or cartilage injury that occurred at the same time as the as the ACL tear and which is considered a pain generator.

If you or family or friends are interested please contact us at 303 963-9528 or complete the Regenexx candidacy form.

 

 

 

 

March 17, 2014

Regenexx ACL Procedure Featured in Outside Magazine

outside magazine logo

Regenexx ACL procedure is dynamic new technology that enables a patient to use their own stem cells to heal ACL tears.  This procedure was featured in Outside Magazine.

Extreme skier and founder of DPS Ski, Stephan Drake, tore his ACL while skiing a steep face in Alaska.  He rejected surgical repair and opted for Regenexx ACL at the Centeno-Schultz Clinic in Colorado.

Regenexx ACL is a alternative to traditional knee surgery.  Bone marrow derived stem cells are injected under direct visualization into the ACL.  Patients are fitted with knee brace and undergo 4 weeks of physical therapy.

Complications of ACL surgeries have been discussed previously and include graft failure, infection and acceleration of arthritis.

Successful clinical cases with detailed pre and post treatment MRI’s outlining improvement have been presented in previous blogs.

It is a new day in orthopedic medicine with new opportunities.  Not long ago open heart surgery with bypass and coronary grafting was the standard of practice.  Then interventional cardiology with a new skill set including balloon angioplasty became the new standard of care making coronary bypass surgery a less prevalent and less attractive procedure.

March 2, 2014

Successful Repair of Anterior Cruciate Ligament Tear with Stem Cells

At the Centeno-Schultz Clinic we recognize that tears of the Anterior Cruciate Ligament (ACL) can be game changers.  Surgical repair is associated with significant complications which include infection, graft failure and alteration of biomechanics.  Many patients who undergo surgical repair do not return to high level competition.

Stem cell therapy is a viable alternative to traditional surgical repair.   The Regenecxx  SD procedure enables a patient to forgo surgery, the lengthy rehabilitation and utilize their own stem cells to heal tears in the ACL.

HK is a case in point.  He is a 44 y/o athletic weekend warrior who sustained a hyper-extension injury with near complete tear of the ACL.  He declined surgical repair and underwent Regenexx SD.  6 months post injection of his stem cells he had complete return to normal activities and sports.  His professional and scholastic endeavors delayed follow-up MRI which accounts for the gap in pre and post imaging.

Pre and post stem cell treatments are posted below.  The pre-injection images are on the left and the post injection images are on the right.  The first images are taken from the side (sagittal) whereas the second set are frontal (coronal).

The thigh bone is on top (femur) and the tibia is below.  The ACL stretches across the knee-joint and prevents excessive forward motion.  The ACL is outlined in dashed yellow lines.  On the pre-injection images note the disorganized quality of the ACL fibers and the disruption of the ACL towards the top.  On the post injection images the ACL fibers are well-organized, tight and uniform extending from the tibia to the femur.  The formal MRI report post stem cell injection notes no tear in the ACL which is consistent with HK’s clinical results.

Keel Successful ACL Stem Sag

Keel Successful ACL COR

In 2014 stem cell treatment is an alternative to traditional surgery for tears of the ACL.

January 29, 2014

Pitfalls of ACL surgical reconstruction: Consider Stem Cell Therapy

ACL tear illustration

At the Centeno-Schultz Clinic we understand that injury to the anterior cruciate ligament (ACL) can be a game changer.

Repair of anterior cruciate ligament (ACL) tears with stem cells  is an alternative to traditional surgery.

Regenexx SD utilizes a patient’s own stem cells to repair ACL injuries.  Case reports have demonstrated the successful repair of ACL injuries without surgery utilizing a patient’s own stem cells.

The anterior cruciate ligament is the most commonly injured ligament in the United States with a prevalence of 100, 000-200,000 case per year.  There are in excess of 150,000 ACL reconstructions performed per year.

A surgically repaired ACL is not like the original ACL.

What are the risks associated with surgical repair of ACL tears?

-Infection

Graft failure ranges from 3-27%.

Development of osteoarthritis ranges from 51-78%

-Failure to restore movement back to pre-injury baseline.

Increased cartilage load and higher risk of re-injury

-Significant postoperative physical therapy

Bottom Line:  Know that there are non operative options utilizing your own stem cells to repair ACL injuries.

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.

Why?

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.

Conclusions

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.

November 30, 2013

Another ACL Tear Successfully Treated With Stem Cells

The Centeno-Schultz Clinic has previously reported on the successful treatment of ACL tears with stem cell therapy.

Stem cell treatments are an alternative to traditional knee surgery.

S.D. is 38 y/o world-class extreme skier who sustained a complete tear of his ACL and declined surgery.  He underwent 5 prolotherapies in Mexico with minor improvement.

drake stephan

On 7.31.2013 S.D. underwent the Regenexx SD procedure where bone marrow derived cells were injected into the torn ACL.  Due to abnormal neurologic examination and history of intermittent lower back pain also underwent Regenexx PL-Disc where concentrated platelet growth factors were injected around the exiting spinal nerve roots and lumbar discs.

On 9.13.2013 S.D. underwent a booster injection with Regenexx cSCP  injected into the ACL under direct x-ray guidance.

A new MRI was recently performed approximately 4 months post stem cell therapy.

The pre and post treatment images are posted below.  The ACL is outlined in yellow.  Note that the ACL fibers are disorganized and loose in the pre treatment images whereas post treatment the ACL fibers are uniform and tightly organized.  This is consistent with his clinical progress as he reports a reduction in pain and increase in stability.  Muscle weakness remains an issue but is improving with MAT techniques.

Drake. ACL pre and post 2013.sagittal

Drake. ACL pre and post 2013.Coronal

Congratulations to SD who declined surgical repair and opted to utilize his own bone marrow stem cells to repair his torn ACL.  Updates to follow as snow continues to fall and the depth of the powder increases.

October 16, 2013

Regenexx Patient Completes 2013 Kona Ironman

Image your day consisting of a 2.4-mile (3.86 km) swim, a 112-mile (180.25 km) bicycle ride and a marathon 26.2-mile (42.2 km) run.  This is without breaks and all events must be completed in 17 hours.

To participate you must have completed prior Ironman competitions under certain and strict guidelines.

kona ironman

Welcome to the Kona Ironman, which is the world championship of all Ironman.

TG is a patient who presented to Centeno-Schultz Clinic with the aim of successfully completing Kona despite ongoing knee pain.

TG is 54 y/o avid athlete and professional with a 15 month history of right knee pain localized on the medial aspect without radiations and  associated with  limp and intermittent swelling.  Treatment to date included unloader brace, steroid injection, PT, massage, trial of NSAID and two knee arthroscopies with partial resection of the medial meniscus.  MRI was significant for mild scarring of the ACL, tear of the medial meniscus, partially extruded medial meniscus , edema in bone on medial femoral condyle and thinning of cartilage in medial and patella femoral compartment and laxity of MCL.

Physical examination was significant for asymmetric calf girth, quadriceps weakness, decreased sensation in right big toes, laxity of the ACL and MCL( medial collateral ligament) and right knee swelling.

Lumbar spine x-ray demonstrated disc space narrowing and 3 mm anterolisthesis.(slippage)

What! Why the back? Refer to SANS in free Ortho 2.0 text

Treatment included:

x-ray guided prolotherapy of ACL and MCL.

Regenexx cSCP into the lumbar epidural space at L4/5 and L5/S1.  Regenexx PL-Disc

Prolotherapy of the supraspinous,  intraspinous, and iliolumbar ligaments.

Regenexx cSCP injected into ACL, MCL.

One of TG’s largest concerns prior to the competition was his knee and he reports that he ‘had no problems”.

We acknowledge all the time, hard work, commitment and dedication it took to qualify and complete in the Kona 2013 Ironman.  Thank you for allowing Regenexx to assist you in achieving your goal.

CONGRATULATIONS !!

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