Stemcelldoc's Weblog

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.

November 10, 2013

Suprascapular Nerve: A Key Player in Shoulder Function and Pain

At the Centeno-Schultz Clinic we understand shoulder pain.

Stem cell treatment is an alternative to traditional shoulder and rotator cuff surgery.

The suprascapular nerve is a key player in shoulder function and pain.

The suprascapular nerve is derived from upper trunk of brachial plexus typically C5 and C6.  It contains both motor and sensory components.  The sensory branches innervate the GH and AC joint whereas the motor branches innervates the supraspinatus and infraspinatus muscles

The suprascapular nerve runs lateral and beneath the trapezius and enters the supraspinous fossa through the suprascapular notch.  The suprascapular notch or referred to as the scapular notch is a notch in the superior border of the scapula through which the suprascapular nerve descends.  The supraspinous fossa is a concavity above the spine on the dorsal surface of the scapula that gives origin to the supraspinatus muscle.

supraspinus fossa

suprascapular nerve

MSK ultrasound is utilized to identify the nerve and any possible entrapment which can lead to pain and or weakness.

Suprascapular Nerve US. jpg

Sites of entrapment and clinical presentation will be discussed in future posts.

Ablation of the nerve utilizing radiofrequency has been described by Liliang as an effective treatment in the management of chronic shoulder pain.

Upshot:  the suprascapular nerve and its visualization is critical to the successful management of shoulder pain.

November 3, 2013

Iliolumbar Ligament: A Key Stabilizer of the lumbar spine

At the Centeno-Schultz Clinic stability is a central theme acknowledging that instability can lead to additional wear and tear, degeneration and injury.  To understand the importance of stability refer to  our e-book, Orthopedics 2.0

Stability is dependent upon 2 principal factors:  muscle strength and ligament integrity.

The iliolumbar ligament (ILL)I s an important stabilizer of the lumbar spine.  Ligaments are fibrous tissue that connect one or more bones together.  Think of them as duct tape.   The ILL originates from the lateral aspect of the transverse process of L4 and L5 and attaches to the anterior surface of the ilium (waist bone).  The ligament literally prevents the L5 vertebra from slipping forward.

iliolumbar ligament

Pool-Goudzwaard also demonstrated that it ILL was an important stabilizer of the SI joint.

The iliolumbar ligament can be injected under x-ray guidance or MSK ultrasound which is the standard of care at the Centeno-Schultz Clinic.  Below is an x-ray image from clinic with the ILL outlined.

The Regenexx-DDD procedure deals with both the lax ligaments and the irritated nerves without using harmful steroids.  The procedure involves platelet growth factors that are injected into the epidural space as well as into the lax ligaments.  Previous blogs have discussed clinical cases where patients have utilized their own platelet growth factors and avoided lumbar surgery.

iliolumbar ligament x-ray

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 !!

October 13, 2013

Low Back Pain: Fusion vs Non operative Treatment

lumbar fusion

At the Centeno-Schultz Clinic we acknowledge and know first hand the pain, restriction in range of motion and erosion of well-being associated with low back pain.

Previous blogs have discussed the clinical success of Regenexx PL in patients with lumbar disc disease and pain.

Regenexx C when injected directly into the disc has been demonstrated to reduce pain, increase level of activity and has been associated with changes on MRI.

Surgery in the form of lumbar fusion is the often held out by many as the answer.

Is it an effective therapy for low back pain?

No not according to Smith et al who examined this question.  In a retrospective analysis they reviewed consecutive patients with back pain and concordant lumbar discogram who were offered fusion.   96 patients were examined: 53 who underwent fusion  and 43  opted for non surgical  treatment.  Conclusion:  no improvement in pain, health status, satisfaction, or disability was noted in patients who underwent lumbar fusion in comparison to those who had conservative care.

Take away is that lumbar fusion is not the holy grail for low back pain.  Exhaust all treatments and make sure that all possible pain generators are considered.  These include myofascial,  facet, SI joint, ligamental instability, nerve entrapment and intervertebral disc.

October 12, 2013

Thumb Arthritis Treated Successfully With Stem Cells

thumb pain

At the Centeno-Schultz Clinic we acknowledge the pain and restriction in range of motion associated with thumb arthritis.

Is there medical evidence that surgery for thumb arthritis is better than no surgery?  NO!

The latest large review of medical studies by Wajon contained little information that compared thumb surgery to non operative treatments.  Of note was the fact that participants who underwent trapeziectomy with ligament reconstruction and tendon interposition, 22% had adverse effects.  Adverse effects included  scar tenderness, tendon adhesion or rupture, sensory change, or Complex Regional Pain Syndrome.

Have stem cells been used successfully?  Yes!

Stem cell therapy is an alternative to traditional thumb surgery.

We just had a paper accepted for publication which examined the benefits of culture expanded Regenexx in the treatment of thumb arthritis.  This is a prospective, case series  with Six OA patients and four controls.  The mean reported pain relief was significantly higher +60%.

If you have thumb pain consider your options carefully.

October 6, 2013

Centeno-Schultz Clinic Reviews: Continued Success in Football Player with Torn ACL Treated with Stem Cells

Filed under: Knee, Regenerative — Tags: , — stemcelldoc @ 6:57 am

At the Centeno-Schultz Clinic we acknowledge the significance of an ACL tear as it can lead to knee instability, cartilage and meniscus damage, ligament irritation and alternation in gait.  In short, it can be a game changer.

Stem cell treatment is an alternative to traditional ACL surgical repair.

Previous success stories have been posted on patients who declined surgery and underwent stem cell treatment with Regenexx SD.

BT is 19y/o college football player who tore his ACL and rejected surgery.  In November 2012 he underwent Regenexx SD where bone marrow derived cells were placed into the ACL.  He had three post stem cell injections and a booster injection which contained SCP and PL.  At follow up he had no pain, instability or restrictions.

This week BT scored his first collegiate touchdown!!!!  Congratulations B!

Tow 1st college touchdown

September 15, 2013

Anterior Crucuiate Ligament Stability: Tests

At the Centeno-Schultz Clinic stability of a joint is critical.  It is one of the four cornerstone’s in our evaluation.

SANS

SANS-Infographic

Stability

Articulation

Neurologic

Symmetry

Laxity of the ACL of the knee is commonly associated with complaints of instability while walking on uneven surfaces and descending hills.

On physical examination there are two principal tests to determine ACL laxity.

lachman test

Lachman Test:  with the knee flexed at 30 degreees the examiner pulls on the tibia to assess the amount of anterior motion of the tibia in comparison to the femur.

Anterior drawer sign:

MRI, CT and x-rays of the knee do not identify laxity as this is a finding on dynamic testing of the joint.

Instability of the ACL predisposes to meniscus, cartilage and ligament injury , damage and pain.

There is an association between ACL integrity and osteoarthritis.

Keegan that looked at MRI’s on about 300 patient with known knee arthritis and found that 1 in 6 had ACL ligament abnormalities.

Stein in another study demonstrated that about 14% of knee OA patients had ACL abnormalities on MRI.

Treatment options include prolotherapy, platelet lysate and bone marrow derived stem cells.

The problems associated with surgical repairs have been previously discussed.

ACL tears have been successfully treated without surgery utilizing Regenexx SD, a bone marrow derived same day stem cell treatment.

If you have had an injury and your knee feels unstable understand that non surgical treatment options and evaluation is available to at Centeno-Schultz Clinic.

Specialized doctor discusses tests to determine ACL laxity and non surgical treatment options.

September 6, 2013

Successful Stem Cell Treatment for ACL Tear

At the Centeno-Schultz Clinic we acknowledge that injury to Anterior Cruciate Ligament (ACL) can lead to knee instability, pain, meniscal injury, cartilage damage and restriction in range of motion. Surgical repair is often recommended.

Surgery is not the only option and the problems associated with ACL grafts have been previously discussed.

JP is an active physician who injured his ACL while skiing. MRI of knee was signficant for mid substance disruption of the ACL with signficant swelling and irregularity of the ACL fibers. He had signficant knee pain with restriction in range of motion and used crutches in clinic intermittently.

JP rejected the recommended ACL surgery and opted for stem cell therapy in June 2013. Three months post Regenexx therapy he reports 90% improvement with no restriction in range in motion. MRI post stem cell injection is significant for intact fibers in both the originating and inserting margins with marked improvement in mid substance swelling.

Below are the pre and post MRI’s. The images were taken at the same imaging center. The images on the left are frontal whereas on the right are from the side. The dashed yellow lines outline the ACL. Pre-stem cell injection the ACL fibers are irregular and poorly defined whereas post stem cell injection the ACL fibers are well-organized, tight and well-defined.

ACL Anatomy

Peragine pre and post ACL 1

Peragine pre and post ACL 2

Through stem cell therapy JP is was able to avoid surgery and the lengthy rehabilitation. Yesterday he purchased his season ski pass.
Congratulations!!

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.

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