Stemcelldoc's Weblog

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.

January 10, 2011

Shoulder Pain and Ultrasound Guided Injections

Platelet rich plasma, prolotherapy and autologous stem cells are non-surgical treatments for shoulder pain.  Clinical success is dependent upon selecting the appropriate treatment option and placing the solution into the targeted site.

Ultrasound has become the standard of care at the Centeno-Schultz Clinic.  Ultrasound does not involve exposure to x-rays and provides a rich image of the bone, muscles, tendons and ligaments. It also allows for a dynamic evaluation whereby the patient is able to go through the activities that cause them pain.  This is not the case with MRI’s given that they require a patient to remain completely still.  MRI’s provide a static image of the shoulder which may not be helpful in some cases of impingement.

This last weekend Ron Hanson M.D. was an instructor at a highly respected shoulder ultrasound course.

We are very pleased to have Ron’s gifted clinical and ultrasound skills here in Denver/Boulder area at the Centeno-Schultz Clinic.

December 26, 2010

Wrist Pain: Alternatives to Steroid Injections

De Quervain snydrome is a common cause of wrist pain.

It is inflammation of the sheath that surrounds two critical tendons which are responsible for thumb moment.  Just a like the outer plastic lining on any electrical cord holds all the small wires together, the tendon sheath holds the extensor pollicis brevis and abductor pollicis longus tendons in a protective sleeve.

Inflammation and or chronic degeneration of the sheath or tendons can result in pain, swelling over the radial side of  the wrist accompanied with difficulty in gripping.  The Finkelstein test is a common diagnostic test.

Treatment options include rest, splinting, injection of steroids and surgery.

At the Centeno-Schultz Clinic we understand the risks involved with steroids and offer alternatives in the form of prolotherapy, PRP and Regenexx PL.  Clinical success comes from accurately delivering the prescribed  solution to the targeted area.  To that extent we use ultrasound to that ensure growth factors or stem cells are placed within the damaged tissue.  Below is  an ultrasound image from clinic of the two tendons and the enveloping sheath.

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.

October 15, 2010

Another Success: Treatment of Supraspinatus Tear with Stem Cells

In a previous blog I discussed the clinical success of rotator cuff repair using expanded stem cell therapy.

Today we had the opportunity to review MRI images of an elderly patient who also underwent the Regenexx procedure 2 years ago for a supraspinatus tear.  AB  is an 80 y/o patient with neck, headache and shouder pain.  Her shoulder pain was severe and  she was unable to lift her shoulder.  She declined surgery and elected to proceed with mesenchymal stem cell therapy.  Her own stem cells were injected into the rotator cuff tear under x-ray guidance. 

To understand the differences in pre and post  MRI’s, some basic MRI concepts and anatomy is essential. 

The image above is the patient’s pre-injection coronal MRI.  The rotator cuff tendon is the area of interest.  The rotator cuff is compromised of 4 principle muscles.  Muscles have two parts:  the muscle belly and the attachment of the muscle to bone(tendon).  Tears in the rotator cuff commonly involve the tendon.

Above are AB’s pre and post MRI’s .  On the left the rotator cuff tendon(red arrows) are bright in color and mottled in appearance.  This means that it’s a full thickness tear with severe degeneration.  On the right is AB’s MRI 2 year post stem cell injection.  The rotator cuff tendon identified by the yellow arrows is better organized and darker in color consistent with significant healing.    This is consistent with her clinical improvement.  She reports 100% improvement in pain and  full range of motion.

October 13, 2010

Repair of Rotator Cuff Tear with Stem Cells

The rotator cuff is compromised of 4 principles muscles and their tendons:  supraspinatus, infraspinatus, subscapularis and teres minor.  Collectively they stabilize the joint and allow for movement .  Tendons at the end of the rotator cuff muscles can become torn resulting in pain and restriction in motion.  The majority of tears occur in the supraspinatus tendon. Typical presentation includes pain with impaired motion. Surgical treatment often involves arthorscopic repair, subacromial decompression or use of an anchor to secure the tendon to the bone.  Surgical complications included fatty atrophy, re-tears of the rotator cuff,  infection and failure.

 JG is a 32y/o patient at the Centeno-Schultz Clinic who suffered shoulder injury after a motor vehicle accident.   Despite surgery in the form of subacromial decompression  JG continued to have shoulder pain.  Repeat MRI demonstrated near complete rotator cuff tear involving the supraspinatus.  He declined surgery and opted to undergo the Regenexx procedure whereby he could use his own mesenchymal stem cells

2 years after stem cell therapy JG reports greater than 90 % reduction in pain and full range of motion. Post stem cell injection MRI is posted below.  The supraspinatus tendon is outlined with red circle.  On the left there is a significant tear whereas on the right the tear is significantly improved.  This corresponds with JG’s clinical improvement.  Other patients have also undergone successful stem cell therapy for rotator tendon tears.

September 17, 2010

Thumb Pain: CMC Joint Arthritis

Filed under: International Cellular Medicine Society, Thumb, Uncategorized — stemcelldoc @ 10:44 am

Thumb pain can be disabling.  A general understanding of the anatomy of the wrist and hand helps one understand possible sources of thumb pain.

There are many bones in the hand but for this discussion we will limit it to two major groups:  the carpals and metacarpals.

The carpals are eight small small bones bound in two rows of four bones each.

The metacarpals are five in number and make up our palm region.  They lie between the carpals and the fingers (phalanges).

The joint space between the carpal bones and the proximal base of the metacarpals make up the CMC (carpometacarpal) joint.

Thumb pain can occur when there is arthritis in the CMC joint.  Other causes of thumb pain include tendonitis, DeQuervan’s tenosynovitis, peripheral neuropathy, peripheral nerve compression, brachial plexus injury, peripheral artery disease.

Treatment options involve splinting, PT, rest and NSAIDs. Surgical options include fusion or prosthetic replacement both of which are major surgeries with moderate to poor outcomes.

At the Centeno-Schultz Clinic other options exist which include prolotherapy, PRP and stem cell therapy.

September 16, 2010

Elbow Pain: Accurate Diagnosis and Treatment

Pain on the outside of the elbow which is referred to as lateral epicondylitis can be disabling.  Typically seen in 30-60 year olds, patients complain of point tenderness over the outside aspect of the  elbow ( lateral epicondyle) aggravated by gripping and activities that extend the wrist.

The pain is thought to arise from degenerative changes in the muscles that attach to lateral epicondyle called the extensor muscles.  These muscles allow the arm to extend(bent backward) .

The diagnosis is made by clinical signs and symptoms.  A common diagnostic test is the Cozen test. Conservative treatment includes PT, NSAIDs, heat, ice and rest.  Injection of cortisone has been demonstrated to be no different than placebo.  Complications from repeated steroid injections include fat atrophy and potential weaking of the tendon.

Not all lateral elbow pain is lateral epicondylitis. 

LF  presented with a 5 month history of lateral elbow pain after tripping over her dog and striking her elbow on her granite countertop.  Conservative therapy had failed and her physician had referred her for PRP injection.  At the Centeno-Schultz Clinic therapeutic injections are performed with either x-ray or ultrasound to confirm accurate placement. LF’s ultrasound exam was significant for tendosis (tendosis) of the extensor muscles which are commonly associated with lateral epicondylitis.  More important was the significant tendosis and partial muscle tear of the triceps muscle (not typically seen with lateral epiconduylitis).  Identifying this second site of injury was cardinal as it represented another source of pain which needed to be treated for maximal clinical outcome.  At the Centeno-Schultz Clinic  an accurate diagnosis and appropriate placement of regenerative therapies whether it be stem cell therapy, prolotherapy, APC or PRP injections  is our standard.

May 31, 2010

Essential Differences in PRP Therapies

Platelet rich plasma (PRP) therapy is the use of a patient’s own platelets to accelerate healing.  It is termed rich because the platelets are concentrated, typically 5-10x above the concentration that is circulating in your blood.

PRP therapy has been used for a number of different indications  including wound healing in surgery,tendinitis, cardiac care and dental health.

Platelet-rich plasma (PRP) therapy made headlines following the Super Bowl, when it was revealed that Pittsburgh Steelers Hines Ward and Troy Polamalu had undergone PRP injections in the days leading up to the game.

Are all PRP therapies the same?

NO.

There are distinct differences in platelet rich plasma .

Most PRP is created by a bedside machine that creates a platelet concentrate by spinning (centrifuge) the blood thereby separating the platelets from the other blood products.

A cell biologist in a laboratory, however,  is able to separate the platelet from other blood products and so much more.

A cell biologist can create PRP that is pure and free of any red or white blood cells.  A machine cannot.

A cell biologist can create PRP in a specific concentration for specific indications.  A machine cannot.

A cell biologist can make PRP that has a very high levels of specific, naturally occurring growth factors such as VGEF, vascular  growth endothelial factor.  A machine cannot.

At the  Centeno-Schultz Clinic we are not reliant on a machine.  Rather through the use of a state of the art lab with full-time cell biologists we are able to provide our patients with customized PRP therapies that are specifically designed for them.  This is the critical difference which translates to improved outcome.

January 25, 2010

Resolution of Thumb Pain with Stem Cell Therapy

LK is 60 y/o patient who presented with a 1 year history of bilateral thumb pain, constant in duration, 4/1o in severity, progressive in nature localized at the base of the thumb.  Pain was sharp and stabbing in character and preventing him from buttoning his shirt.  Prior therapies had included a trial of NSAID and chiropractic care.  MRI of the thumbs was significant for moderate to advanced arthritic changes at the base on the thumb(CMC joint).  LK was told that surgery was his only option:  fusion of one joint and tendon wrap at the other.  Both surgeries are significant with extensive rehabilitation and poor outcomes.

Patient elected to proceed with the Regenexx procedure which allowed him to use his own mesenchymal stem cells.  At six months post injection of his own stem cells,  LK reports a 90% reduction in pain and  increase in range of motion.  Friends and work associates have stopped asking him about his swollen thumbs.  Buttoning a shirt is no longer an issue.

 Through the use of his own stem cells, LK has had significant reduction in his thumb pain, increase his range of motion and avoided a significant surgery. The time has come to embrace joint restoration instead of all therapies directed at joint replacement.

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