BMI and Road Wear

BMI not BMW.

BMI is statistical measurement which compares a person’s weight and height.  It can be a useful tool to estimate a healthy body weight.

A recent study examined the knees of 336 overweight patients over 30 months.  20.2 % of the patients showed a slow loss of knee cartilage and 5.8% had rapid cartilage loss.  The Boston University researchers concluded that for every one-unit increase in body mass index, the chances of rapid knee cartilage loss increased 11%. Bottom line: stay lean.

If you have knee pain knee as a result of cartilage loss, there are non-surgical options.  Mesenchymal stem cell therapy involves the use of a patients own stem cells, avoids all of the risks associated with srugery and anesthesia and does not require extensive rehabilitation commonly associated with surgical procedures.

Ultrasound And Stem Cell Differentiation

Mesenchymal stem cells have the potential to change into bone, cartilage, ligament or fat.  In a previous blog, I discussed the importance of exercise in providing clues to the mesenchymal stem cells to change into cartilage.

Are there other factors which provide clues to mesenchymal stem cells?

Schumann et. al., demonstrated that low intensity pulsed ultrasound (LIPUS)  made a significant difference in prompting mesenchymal stem cells to morph into cartilage.  At Regenexx, where patients are afforded the opportunity to utilize their own mesenchymal stem cells,  now utilizes LIPUS   in all patients with cartilage damage.  It is critical that the correct stem cells are placed in the correct location and provided every opportunity to prosper as well as to change into the desired tissue.  That is our commitment at Regenexx.

Exercise Directs Path of Mesenchymal Stem Cells

Mesenchymal stem cells(MSC) can morph into ligament, cartilage, bone or fat.   How and why they differentiate is critical.    Sen et. al., recently demonstrated that mechanical stress (the laboratory equivalent of exercise) lead mesenchymal stem cells to differentiate into bone instead of fat, even if they are given chemical signals to become fat.  What does this mean?  MSC can become fat cells simply by lack of exercise.  There are other factors which give MSC’s clues to turn into fat vs cartilage, bone or ligament.

If you are a patient with worn knee cartilage and are restricted as a result of pain, one surgical option would be micro-fracture. 

This is a surgical procedure where multiple small punctures are made into the femur(thigh) bone in an effort to stimulate cartilage regeneration.  A fragile thin clot is formed at the site which mandates a period on 6-8 weeks of non-weight bearing.  No running, golfing, cycling.  No fun! 

Multiple Puncture Sites From Micro-Fracture

Regenexx offers patients the opportunity to use their own MSC’s to generate cartilage via a needle-in, needle-out procedure.  No surgery is required.  Most importantly, the physical restriction are minimal.  In contrast to micro-fracture technique, the Regenexx patient is encouraged to exercise.  The mechanical loading associated with exercise gives the stem cells signals to change into cartilage.

Please review knee MRI of a patient who underwent stem cell therapy at Regenexx with radiographic evidence of increased cartilage as well as complete resolution of her severe  knee pain.

Pain radiating down my arm after shoulder surgery

Pain radiating down the arm after shoulder surgery can and does occur.  The cause of radiating arm pain can arise from the one of many sources:  inappropriate or prolonged positioning, cervical injury or aggravation  and hematoma.  First and foremost the arm is often positioned such that it is hanging and as such may be exposed to a inappropriate or prolonged traction and tension  placed on the shoulder joint.

This can cause an injury to the shoulder joint and or the brachial plexus, a bundle of nerves that cross the first rib and provide sensation and motor function to the arm and hand.

A second cause of pain radiating down the arm is a cervical disc injury or aggravation caused at time of surgery due to positioning.  The patient is put to sleep while resting on their back but are repositioned after they are asleep to optimize the working conditions for the surgery.  The neck, shoulder and arm are all moved.  If particular attention is not directed to the patient during the positioning, a cervical disc may be injured or aggravated.  The result is a pain radiating down the arm (cervical radiculopathy).

Another cause of pain radiating down the arm is a expanding blood clot otherwise known as a hematoma.  If left untreated the hematoma can compress critical blood vessels and nerves with resultant arm pain.

The morale of the story is that surgery and anesthesia are not without significant risks.  Fortunately patients with shoulder dysfunction now have the opportunity to use stem cell therapy to regenerate damaged ligaments, tendons and worn cartilage in the joint without surgery or anesthesia.   Regenexx is a simple needle-in, needle-out procedure which allows patients to use their own stem cells to regenerate damaged joints, lumbar discs and non healing long bone fractures.

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Post rotator cuff surgery physical therapy

Rotator cuff surgery involves repairing one of the four principal muscles of the rotator cuff. Typically this is accomplished through arthroscopy in which the surgeon visualizes and repairs the defect through a small camera.

Sometimes the damaged muscles and ligaments are too extensive and the shoulder has to be cut open.

Rehabiliation post rotater cuff surgery is extensive. The intital phase is one of immobilization during this time muscles begin to loose their tone and strength (atrophy). The joint can also stiffen due to lack of use.

One week post rotator cuff surgery, physical therapy begins with the goal to regain flexibility and strength . For the first twelve weeks emphasis is placed on optimizing the flexibility and range of motion of the shoulder through gentle stretching exercises. Driving is not recommended for the first month after rotator cuff surgery. After three months strengthening exercises are added.

Repairing partially torn tendons or ligaments in the shoulder is now an option using stem cell therapy. Regeneration of worn or damaged cartilage in the shoulder joint is also an option using stem cell therapy. Regenexx enables patients to use their own stem cells to repair damaged tendons, ligaments and cartilage in the shoulder thereby avoiding surgery, anesthesia and the extensive time, energy and expensive of physical therapy.

Please review the testimonial of a patient who had tears in both rotator cuffs who underwent surgery and extensive rehabilitation for the first shoulder but elected stem cell therapy for the other side.

Patellofemoral Dysfunction

The patellofemoral compartment is commonly known as the knee cap joint.  The knee cap (patella)  sits on tops of the thigh bone (femur). 

With activity there is movement or tracking of the knee cap along the femoral groove.  If there is misalignment of the knee cap within the femoral groove, the patient experiences pain.

Lateral release is a common surgical treatment for patellofemoral dysfunction  which involves cutting the lateral retinaculum,  the fibrous tissue that supports the kneecap.  

The goal is to release abnormal lateral tension on the knee cap thereby allowing  normal tracking to occur.  Rehabilitation following surgery is extensive  usually requiring 3-5 months of physical therapy.  Unfortunately the body only requires  adjustments in very small increments such as millimeters.  Regrettably surgeons typically make adjustments in centimeters.  The difference is a 10 fold and the result can be an over adjustment with resultant  pain and deterioration of the cartilage.

Once there is loss of cartilage in the patellofemoral joint another surgery is recommended aimed at repairing the cartilage. 

Fortunately regeneration of cartilage in the knee is now available without surgery.  Regenexx enables patients the opportunity to regenerate cartilage by using their own stem cells.  Centeno et. al., have demonstrated cartilage regeneration using stem cell therapy.  Regenexx is a simple needle-in, needle out procedure that avoids surgery and anesthesia.

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Open Knee Surgery Blogs

Open knee surgery blogs are common.

Open knee surgery blogs detail many issues including the reason for the surgery, the postoperative pain, the rehabilitation and the results.

Some blogs highlight the ” success” of surgical procedures on well known athletes such as Jordan Farmar and Tiger Woods.

While open knee surgery blogs are often times insightful they lack evidence based information. Rarely are peer reviewed articles are cited. The information can be incomplete or biased leaving readers with little or no meaningful information. Two cases in point. No knee surgery blog I read today mentioned that knee arthroscope was found to be no better than physical therapy in patients with osteoarthritis. Nor did I see any mention that meniscal tears are not by default painful and are seen with increasing age on MRI. Both articles were published in the New England Journal of Medicine.

Open knee surgery blogs often fail to mention alternatives. Cutting ones knee open, cutting ligaments and meniscus and sometimes placing artificial grafts or screws into the bone is a serious undertaking with inherent risks and pain.

Regenexx offers patients an alternative. Utilizing your own stem cells, knee cartilage can be regenerated. Centeno published these results in a peer review journal. Stem cells can also be utilized to repair torn or damaged ligaments including the collateral ligaments and the cruciate. The procedure is does not require anesthesia or surgery. Rather it is a simple needle in, needle out procedure.Click here to see a video from a patient that underwent the Regenexx stem cell therapy.

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Knee Surgery Rehabilitation

 

Knee surgery rehabilitation varies on the type of surgery performed.

Knee surgery rehabilitation is often minimal in patients who undergone knee arthroscopy.

Knee surgery rehabilitation is extensive for patients who undergo microfracture or total knee replacement. Knee surgery rehabilitation is often painful and requires large amounts of time at a physical therapy office.

Repair of damaged knee cartilage or meniscus does not always require surgery. The benefit of arthroscopy, a surgical procedure in which the surgeon places a small camera into the knee joint through small incisions has recently been questioned. Kirkley et al in the New England Journal of Medicine published a study that demonstrated knee arthroscopy in patients with osteoarthritis had no better outcomes that those that were treated with physical therapy and medicine.

Englund et al also questioned the utility of surgery on the meniscus when most meniscal tears are not associated with pain and only increase in prevalence with age.

Regenexx affords patients with knee pain and damaged cartilage and meniscus a non-surgical option. Regenexx utilizes a patients own stem cells to grow knee cartilage. Centeno et al demonstrated on MRI an increase in knee cartilage in patients who had undergone the Regenexx procedure. Patients are not exposed to the inherent risks of general anesthesia or surgery. The Regenexx procedure is a simple needle in, needle out procedure where a patients own stem cells are injected under x-ray guidance to the area of damage. Please review our patient testimonials.

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