Stemcelldoc's Weblog

March 12, 2014

Supercharged Platelet Rich Plasma

The Centeno-Schultz Clinic utilizes a special advanced platelet rich plasma (PRP).

The injection of platelet rich plasma is a successful treatment option for joint, tendon, ligament, muscle and joint injuries.  The concentrated blood platelets contains critical growth factors that increase the body’s ability to repair itself.

In most clinics and hospitals and clinics, PRP is created by a bedside centrifuge that separates the plasma and concentrates the platelets.  Bedside centrifuges typically create a PRP with platelet counts of 3-5 times the normal.  Unfortunately they also contain white and red  blood cells which can cause inflammation.

bedside

Are there differences in PRP treatments?

YES!

Regenexx has a superior PRP  called Regenexx SCP (Super Concentrated Platelets).  It is created by cell biologists in a state of the art laboratory and results in a 10-20 fold concentration of platelets.  Higher concentration of platelets has been shown to have a positive effect on the stem cells responsible for repairing damaged tissue.

White and red blood cells within platelet rich plasma can result in excessive inflammation, pain, restriction in range of motion and inhibition of  repair cells.

Bedside centrifuges are not adept at removing white and red blood cells whereas cell biologists at Regenexx are very capable of separating these cells. The image below demonstrates the cardinal difference.  The PRP on the left is red in color due to the red blood cells whereas the Regenexx SCP on the right is amber in color due to the successful removal of most red and white blood cells.

scp_vs_prp

PRP is an effective treatment of many ligament, tendon, joint and muscle injuries.  There are differences in platelet rich plasma concentrates.  Regenexx SCP which is produced in a state of the art lab by a cell biologists affords a much higher level of platelets with reduced red and white blood cell contaminates which ultimately results in  best possible outcomes.

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August 16, 2013

Epidural Platelet Injections: A safe alternative to steroids

At the Centeno-Schultz Clinic safety is paramount.

Platelet therapies are a safe and effective alternative to steroid epidural injections.

Platelet lysate (PL) and concentrated stem cell plasma (cSCP) are the two platelet treatments.

The efficacy of PL epidural injections compared to tradition steroid injections have been previously discussed.

We are concerned about the contamination of compounded steroid products and its sequelae.

Earlier this year the New England Compounding Pharmacy recalled compounded steroids due to fungal contamination. .   As of March 10, 2013, 48 people had died and 720 were being treated for persistent fungal infections.

 

NASS spine safety alert

This week another safety alert was issued by North American Spine Society and the FDA over concerns of bacterial infections.

Bacterial and fungal infection are serious issues with potentially serious and longterm complications.

If you suffer from ongoing neck or lower back pain consider platelet epidural injections at the Centeno-Schultz Clinic as a safe alternative to steroids.

August 10, 2013

Rotator Cuff Tears and Onset of Symptoms

At the Centeno-Schultz Clinic we acknowledge the pain, limitation and frustration associated with a rotator cuff tear.

shoulder-pain

A recent study from Norway examined the natural progression of rotator cuff tears in asymptomatic patients.

Was the progression of the rotator cuff tears correlated with the onset of symptoms?

Study:  50 patients with asymptomatic FT rotator cuff tears were followed using ultrasound and MRI imaging.

Changes of tear size, muscle atrophy, fatty degeneration, and condition of the long head of the biceps tendon were evaluated over 3 years.

Key Points

Eighteen of fifty tears developed symptoms over the three years.(36%)

Significantly larger increase in the rotator tear size (3X) in the newly symptomatic group when compared with the still-asymptomatic group.

The rate of progressing to advanced muscle atrophy was higher in the newly symptomatic group.

The rate of pathology of the long head of the biceps tendon was significantly higher in the newly symptomatic group.

Bottom Line

Over a three year period 36% of asymptomatic rotator cuff tears became symptomatic.  Increase in tear size and decrease of muscle quality were correlated to the development of symptoms.

If you have a rotator cuff tear be mindful and know the natural progression of tears.  Treat early on when symptoms occur.  Treatments at Centeno-Schultz Clinic include MSK US guided cSCP, PL and autologous bone marrow stem cells.

June 6, 2013

Successful Treatment of Sciatica: Disc Herniation Location and Clinical Success

At the Centeno-Schultz Clinic knowing which patients will benefit from which procedure is key.

Sciatica due to a lumbar disc herniation can respond favorably to epidural steroid injections. The location of the disc herniation can dictate success.  Previous blogs have discussed the  successful treatment of sciatica with platelet epidural injections (Regenexx PL-M).  Pre and post MRI studies have demonstrated reduction in disc herniation which corresponded with clinical symptoms.

At recent study confirmed what we have known clinically for years.  Lee et al demonstrated that patients with herniated lumbar discs in the foraminal or extra-foraminal zone had excellent clinical response to transforaminal epidural injections.

Basic Definitions

Foramen:  Opening

Neural Foramen:  Boney doorway through which of the spinal nerve root, dorsal root ganglion, the spinal artery pass.

neural  foramen

Foraminal zone:  The zone between planes passing through the medial and lateral edges of the pedicles.

The spinal canal can be divided into three zones:  central, foraminal and extra-foraminal.

Spinal Canal Zones

Spinal Canal Zones

There are two principle types of epidural injections:  transforaminal and interlaminar.  The former is directed towards the neural foramen and exiting nerve root whereas the latter is injected into the posterior epidural space.  Successful treatment is knowing the location of the disc hernation and providing the appropriate epidural injection.  This is the standard of care at the Centeno-Schultz Clinic.

January 12, 2013

Platelet Rich Plasma vs Hyaluronic Acid Comparison for Knee Osteoarthritis

knee pain

At the Centeno-Schultz Clinic we acknowledge that knee pain can be debilitating and severely impact an active life style.

Stem cell treatment is an alternative to traditional knee surgery.

Hyaluronic acid (HA) is a thick liquid that helps lubricate the joints and is used routinely in the treatment of knee osteoarthritis.  Different brands of hyaluronan are available and include Euflexxa, Hyalgan and Orthovisc.

Platelet rich plasma is a concentration of a patient’s own platelets which can be used in treat degenerative knee disorders.  Many professional athletics have undergone PRP injections including, Hinds Ward and TigerWoods.

Is PRP better than HA for knee osteoarthritis?

 Cerza et al recently published such a study.   120 patients with knee osteoarthritis were divided into two equal groups and underwent weekly intra-artricular knee injections for 4 weeks.  One group received hyaluronic acid injections whereas the other group received platelet rich plasma.

Platelet rich plasma showed signficantly better clinical outcome compared to treatment with HA.  PRP was associated with a faster onset of relief that continued up to 24 weeks.  Unlike HA which had poor results with patients with advanced OA (LC 3) PRP showed no statistically signficant difference with varying severity of osteoarhtritis.

In 2013 when you doctor recommends a hyaluronic acid injection for your knee pain ask about the superior PRP alternative.

December 31, 2012

Lumbar Disc Surgery Update: Disappointing

spine surgery

At the Centeno-Schultz Clinic we acknowledge that ow back and leg pain secondary to lumbar disc disease can be disabling. Stem cell therapy is an alternative to traditional back surgery.

Regenexx PL-Disc utilizes platelet growth factors to enhance blood flow and reduce inflammation at affected disc level and adjacent nerve roots. 

PL stands for ‘Platelet Lysate”.  We take our novel Super Concentrated Platelet (SCP) mix and break open all of the platelets to get the growth factors out.  Why?  Just like an immediate release pill, it is sometimes better to have more growth factors available to help stimulate cells towards repair.  So while SCP is like a time released pill which releases growth factors slowly, PL is like an immediate release pill.  Our experience dating back to 2005 has demonstrated that PL works best around nerves.

Poor blood supply is at the heart of why many patients with chronically pinched low back nerves fail to heal.  Regenexx PL-Disc is an out-patient “walk-in/walk-out” injection procedure where patients can immediately return to activity as tolerated.  Blood is drawn from your arm, processed in our lab and the separated platelets are concentrated and injected into the lumbar spine. Unlike conventional PRP injections (platelet rich plasma) PL quickly accelerates stem cell growth. This is because all of the growth factors in the platelets become immediately available to the local stem cells.

Success to date:

http://www.regenexx.com/2011/02/regenexx-pl-disc-works-in-this-patient-when-steroid-epidurals-fail/

http://www.regenexx.com/2012/12/epidural-steroid-injection-reviews-heres-a-patient-who-has-tried-both-steroids-and-using-his-own-growth-factors/

Lumbar surgery has been utilized for the treatment of low back pain and sciatica.

Results?

http://www.regenexx.com/2012/12/epidural-steroid-injection-reviews-heres-a-patient-who-has-tried-both-steroids-and-using-his-own-growth-factors/

Jacobs et al conducted a systematic literature review on the effect of surgical techniques for sciatica due to disc herniation to update the Cochrane review of 2007. Sixteen studies were included: seven from the original review and nine additional studies.

No conclusions can be drawn with regard to the comparative efficacy of open, microscopic, and tubular discectomy surgical techniques to treat sciatica due to a herniated disc.   There was no clinically relevant superiority of either technique.

2013:  Patients beware.  Explore treatment recommendations and ensure that none limit future options.

November 7, 2012

Posterior Knee Pain: Popliteus Tendonitis

At the Centeno–Schultz Clinic we acknowledge that knee pain can be disabling. Knee pain can arise as result of loss of cartilage, ligament instability, meniscus degeneration or tears, bursa inflammation and tendon irritation. Stem cell therapy is a non surgical treatment option for many types of knee pain. At the Centeno –Schultz Clinic other treatment options include IMS, prolotherapy, Regenexx SCP and RegenexxPL.

All knee treatments utilize guidance in the form of MSK US and or x-ray to insure accurate needle placement.

Popliteus tendonitis can be a cause of posterior lateral knee pain.

The popliteus muscle originates from the lateral femoral condyle and the posterior horn of the lateral meniscus. The popliteus tendon runs deep to the LCL and passes through the hiatus to attach to the posterior surface of the tibia.

The popliteus muscle unlocks the knee in the standing or walking position whereby it rotates the tibia inward, pulls the lateral meniscus backwards and flexes the leg upon the thigh.

Popliteus tendonitis is common among runners and typically presents as pain in the posterior aspect of the knee.

Below are images of the popliteus tendon.

October 6, 2012

Sacroiliac Joint Ligaments: Importance of Stability

In a previous blog, the sacroiliac joint has been discussed as a source of lower back, buttock and posterior leg pain.

The importance of stability has been discussed in Ortho 2.0.  There are 4 central components:  Stability, Articulation (joint), Neuromuscular, and Symmetry (SANS).

Treatment options of sacroiliac joint dysfunction at the Centeno-Schultz Clinic include prolotherapy, PRP, IMS and autologous stem cell therapy.

The stability of the SI joint is dependent upon the integrity of the supporting ligaments.

These ligament include:

Dorsal  sacroiliac ligament:  joins the sacrum and the ilium and is composed of the long and short posterior SI ligaments.

iliolumbar ligament:    stretches from the transverse process of  L5 to iliac crest.

sacrospinous ligament:   triangular in shape attached by its apex to the ischial spine and medially, by its broad base, to the lateral margins of the  sacrum and coccyx.

sacrococcygeal ligaments:  stretches from the sacrum to the coccyx and thus dorsally across the sacrococcygeal symphysis.

Sacrotuberous ligament:  stretches from sacrum to the tuberosity of the ischium.

October 4, 2012

Medial Foot Pain: Posterior Tibialis Tendon Dysfunction

At the Centeno-Schultz Clinic we acknowledge that foot pain can be disabling and affect your game.

Posterior tibialis tendon dysfunction is a common source of medial foot pain and instability. 

Stability is critical and is one of the four central components as discussed in Ortho 2.0.

Tendons connect muscle to bone.  The posterior tibial muscle originates in the lateral part of posterior surface of tibia and medial aspect of the fibula.  It runs down and behind the inside bump of the ankle (medial malleous) and attaches to the bottom of the foot.  The bulk of the tendon inserts on a prominence on the medial aspect of the navicular.  This prominence is called the navicular tubercle.

The posterior tibialis tendon is held in place by a thick fibrouse tissue, the flexor retinaculum.  The flexor retinaculum is the roof of the tarsal tunnel

The posterior tibialis muscles act to plantarflex the ankle and invert the foot. It is also medial ankle stabilizer.

Presentation:  primarily occurrs in women who are middle-aged or elderly.  Patients commonly complain of pain in the inside of the foot and ankle with  radiation into the arch of the foot.

On physical exam there is pain along the course of the tendon and often patients are unable to stand on their toes on the affected side.

Visualization is critical for effective clinical outcomes.  At the Centeno-Schultz Clinic MSK ultrasound is used both diagnostically as well as with tendon injections to ensure accurate placement of regenerative agents.  Prolotherapy, PRP and autologous stem cells are treatment options when conservative therapy has failed.

Below is an ultrasound image of the posterior tibialis tendon at the level of the medial malleous.

FDL:  Flexor digitorum longus

PT:  Posterior tibialis

September 22, 2012

Sacroiliac Joint Dysfunction: A Cause of Back, buttock and Leg Pain

At the Centeno-Schultz Clinic we acknowledge that sacroiliac joint can be a cause of lower back and buttock pain.

The sacroiliac joint (SIJ) is the joint between the sacrum and the ilium of the pelvis.  It is a  synovial joint characterized by a capsule surrounding the articulating surfaces and synovial fluid.  The stability of the SI joint is maintained through an extensive number of ligaments.  Stability is critical as discussed in Ortho 2.0.

The function of the SIJ is to dissipate loads of the torso through the pelvis to the lower extremities.

Clinical presentation varies but commonly involves unilateral back and buttock pain  originating at the PSIS which can be dull ,sharp, stabbing, or knife-like

Slipman demonstrated pain in various areas including lower back (72%), buttock (94%) and lower leg (50%).

Causes of SI joint dysfunction include mechanical dysfunction, inflammation, lumbar fusion, trauma, degeneration and pregnancy.

 A comprehensive study at Hopkins demonstrated the incidence of sacroiliac joint pain is between 15% to 25% in patients with axial low back pain.

Diagnosis can be made by provocative physical examination manuevers which include Gaenslen and FABER test.

The gold standard is injecting SIJ under intermittent x-ray with local anesthetic and steroid with the patient reporting signficant reduction in pain.

Treatment options include physical therapy, IMS, prolotherapy, PRP and autologous stem cells.

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