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September 24, 2009

Treatment of Sacroiliac Joint Pain with Prolotherapy

X-RAY IMAGE OF SI JOINTThe sacrolilac joint is the joint between the sacrum, the base of the spine, and the ilium of the pelvis.

It can be a common source of pain in patients who have had lumbar fusions and traumatic injuries.

Diagnosis is made by injection of a small amount of local anesthetic into the joint.  Insertion of a needle into the SI Joint can be challenging.  Confirmation of accurate placement is achieved through the injection of contrast which  fills the joint.  This is illustrated below with yellow dashed circle. 

Prolotherapy at the Centeno-Schultz Clinic involves injecting into joint as well as the surrounding ligaments.  A very important ligament for the  succesful treatment of the SI joint pain is the iliolumbar ligament.  The ligament is illustrated in blue.  It attaches to the L5 transverse process.

Maximal results from prolotherapy of the SI joint includes accurate placement of the injectate, as confirmed by contrast, as well as treatment of all ligaments.  This is the standard of care at the Centneo-Schultz Clinic.

March 30, 2009

Patrick’s Test: Evaluation of Sacroillac Joint Dysfunction

Filed under: Sacral Spine — Tags: , , — stemcelldoc @ 9:33 am

The Patrick’s Test is a physcial examination test  to determine the presence of sacroiliac joint dysfunction in patients with lower back pain. It is important to evaluate all sources of lower back pain.  Common sources of lower back pain include lumbar facet dysfunction, lumbar ligamental instability, lumbar degenerative disc disease and sacroillac joint dyfunction.

The sacroillac joint is a synovial joint formed by the articular surfaces of the sacrum and ilium.  sacroillac-jointThe stability of the joint is maintained by a series of ligaments which include the anterior and posterior sacroillac ligament.  The joint functions as a shock absober for the pelvis and lumbar spine.

Trauma is the most common cause of SI dyfunction.  Patient often times report falling directly onto their buttucks or being involved in a rear end motor vehicle injury.

Symptoms of SI joint dsyfunction include mild to moderate pain, unilateral in nature, aggrevated by prolonged sitting often times referred into the buttuck and posterior thigh.

The patrick’s TTest is performed by flexing the patients leg and putting the foot of the tested leg on the opposite knee.  Pressue is applied on the superior aspcect of the tested knee joint lowering the leg into further abduction.

Patricks Test

Patrick's Test

The test is positive if there is pain at the hip or sacral joint, or if the leg can not lower to the point of being parallel to the opposite leg.

At the Centeno-Schultz Clinic, sacroillac joint dyfunction is treated with core stabilization, restoration of muscle imbalances and prolotherapy.

February 10, 2009

Valgus and Varus Alignment

Valgus and varus describe the alignment between two anatomical segments.  Valgus  refers to outward angulation of the distal segment of a bone or joint.  Varus is the opposite of valgus and refers to inward angulation of the distal segment of a bone or joint. To better understand these concepts, see the  illustration below.   A line is drawn along the long axis of the proximal segment.  Another line is drawn along the long axis the distal segment.  When comparing the two lines,  focus on the the distal segment’s alignment with respect to the proximal segement. valgus2

 The illustration on the left depicits valgus in which the distal segment of the joint is angulated outward.

The illustration on the right is an example of varus.varus-alignment

What is the significance?    Look at the x-rays below.valgus-x-ray1


Misalignment of one bone in relation to other places disproportionate forces on the joint with resultant excessive wear and tear on the meniscus, ligament and cartilage.  At the Centeno-Schultz Clinic we emphasis correct joint aligment through various therapies including IMS, prolotherapy, physical therapy and the use of unloader braces.  If there has been excessive wear of the cartilage,  there is a novel technique which allows patients to use there own stem cells.




Valgus;  – femur internally rotated, and tibia externally rotated.  Problems:  maliagnilgment as results from asymmetric wear of the posterior aspect of the lateral femoral condyle  patellofemroal tracking problems. patellar maltracking. posterolateral instability

January 19, 2009

Treatments for Shoulder Separation

Shoulder separation injurycommonly involves the acromioclavicular joint ( AC joint).   The AC joint is where the clavicle meets the highest point of the shoulder blade (acromion).  

ac-joint Three ligaments support the acromio-clavicular joint; the cocrocoacromial, corococlavicular (CC) and acromioclavicular ligaments(AC). Ligaments are soft tissue structures that connect bones to bones.


Falls directly on the shoulder can injure the ligaments that stabilize the AC joint.

If the force is severe enough,  the AC ligament and or coracoclavicular (CC) ligaments can tear with resultant separation of the clavicle and acromion.   The result is a bump on the shoulder.

Treatment options include surgery if the pain continues or if the deformity is severe. Often the end of the collarbone is cut out so that it does not rub against the acromion along with reconstruction of the ligaments.

Other successful treatment options include prolotherapy and stem cell therapy to repair damaged ligaments and joints. At the Centeno-Schultz Clinic prolotherapy has been utilized extensively to strengthen loose or torn shoulder ligaments.  At Regenexx a patient’s own stem cells are use to repair torn ligaments and damaged joints.  Both therapies enable the patient to forgo the risks of surgery and the time, expense and pain of shoulder surgery rehabilitation.

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