Joint Preservation Blog

January 14, 2009

Thumb Surgery

As a doctor, I see a lot of hand arthritis. With all of the Blackberry thumb and painful, and often disabling thumb joints out there, why don’t we see more thumb surgery? The reason is likely that the artificial joints in the hand seem to involve a long and often painful recovery with a lot of occupational therapy. Unlike a knee replacement, where you can still work with your hands, type, text, etc… a thumb joint replacement in your dominant hand means you’re totally out of commission in today’s modern hand-centered work force. As a result, we do see the occasional patients getting thumb surgery with a tendon (see Thumb Surgery Alternative post), but still the same issues above apply. Is there a way to avoid thumb surgery? Yes, we’ve had good experience with injecting the patent’s own adult stem cells into the joint. I’ve posted a patient testimonial below:

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January 11, 2009

Prolite Thumb Support

Filed under: thumb — Tags: , , , , , , , — D @ 3:14 pm
prolite thumb support

prolite thumb support

 

As a doctor, thumb braces such as the “Prolite Thumb Support” can help provide an additional sense of stability.  However, have you ever wondered if your thumb arthritis could be fixed without surgery by repairing the painful joint?  Is this possible?  New advances in using the patient’s own stem cells mean that a simple injection might help the thumb without the need for invasive surgeries.  Since a video is worth a few thousand words, here are some for more information.  The link above has more information as well.

January 8, 2009

Bone Stimulators

As a doctor, patients with a fracture that won’t heal can be in quite a pickle. There are many bone stimulators on the market including the Exogen, the Symphony bone growth stimulator, and the mbi bone growth stimulator. How does a bone stimulator work ? There are two main types, ultrasound based and an electrical bone stimulator. The ultrasound type works by emitting a pulsed low intensity ultrasound signal (PLIUS). This has been shown to stimulate mesenchymal stem cells which turn into osteoblasts which are cells that make new bone. An electrical bone growth stimulator works in much the same way. It’s usually worth using one of these units for 6-12 weeks. What if using a bone stimulator doesn’t work? Bone grafting is one option, but a big surgery. Is there another way? Yes, newer stem cell based injection methods can avoid the surgery and use your own stem cells to heal the fracture. I’ve posted two videos below on the subject:

electrical stimulation for fracture healing

As a doctor, one of the most difficult problems a patient can face is is a bone that won’t  heal.  One of the most miserable patients I can rememeber was a little old lady with a sacral fracture who at three months after her fracture couldn’t even go to physical therapy because the fracture wasn’t healing.  She had tried electrical stimulation for fracture healing, but this failed.  Other patients who come to mind are a thirty something smoker with an non-healing humerus fracture and a 60 something geologist with a leg fracture (tib-fib non-union).  They all had one thing in common, they could barely do anything.  What other options are there for these patients?  One option is as we’ve discussed, electrical stimulation for fracture healing.  There are also other types of fracture healing assist devices, including PLIUS or Pulsed Low Intensity Ultrasound.  These units can help, but what to do when they fail?  The issue is often a poor blood supply to the fracture.  As a result, surgeons traditionally try a bone graft with it’s own blood supply.  However, this is a very big surgery.  Is there another way to heal these fractures that won’t heal on their own?  Yes, recent research into adult stem cells have shown them capable of fracture repair.  How did we heal up the three fractures described above?  By injecting the patient’s own adult stem cells into the fracture lines (without bone graft surgery).  The little old lady?  Independent in 6 weeks with a healed scaral compression fracture.  The smoker?  Healed in 6 weeks and had full function of her arm.  The 60 some year old geologist with the tib-fib non-union?  Same.  All without surgery.  Below is a video that explains more:

September 1, 2008

Thumb Surgery Complications

Our oposable thumb is our most important appendage, it’s what separates us from most other animals.  As a result, pursuing an operation can be scary as thumb surgery complications can have disastrous results.  This blog entry will focus on a few thumb surgery complications.

The most popular thumb surgery is for basal joint arthritis.  A tendon transplant is common, where one of the hand bones is removed and a tendon is coiled up and sewn in it’s place.  In this type of surgery, the biggest complication is infection.  If this operative site were to get infected, than IV antibiotics would be needed for many weeks.  Another thumb surgery complication is chronic pain.  This is a small joint with very fine movements, any movement of the tendon graft out of place can have disasterous results.  How do you get around these complications?  Just don’t go there!  For an alternative to possible thumb surgery complications, consider an injection of stem cells into the basal joint.

Thumb Surgery Alternative

As a physician with friends who have the dreaded “blackberry thumb”, a recent web search for thumb surgery alternatives turned up this illustration. This demonstrates a traditional tendon graft surgery where one of the bones at the base of the thumb is removed and a tendon is coiled up to add a cushion. No wonder my freinds are asking me about thumb surgery alternatives. I must say that this tendon transfer surgery is “nuts”. I remember a discussion with a plastic hand surgeon about blackberry thumb and what he had to offer. “Not much” was his reply, as he admited that traditional thumb surgery was pretty poor. We discussed stem cell alternatives to thumb surgery and he was excited, as he often talked patients out of thumb surgery for basal joint arthritis because of the poor results.

The CMC joint or “basal” joint of the thumb doesn’t have good prosthetic replacement options. In addition, since it’s nearly impossible to do much without a functional thumb, pain in this joint is much more disabling than other joints. If there ever was an easy joint to treat with adult stem cells, this would be it, as it’s small and doesn’t have to bear weight while healing. While an injection of stem cells into this joint may seem like science fiction, it’s already here (thumb surgery alternative). So don’t let anyone pull out an important bone in your hand if this thumb surgery alternative might work.

August 21, 2008

What is joint preservation?

Joint preservation is both an unknown and new medical science.  It literally means what it sounds like, preserving a joint via a number of tools rather than replacing all or part of that joint.  So instead of a total knee replacement, fixing as many issues as possible to make sure the joint still functions.  Why do this?  Joint replacement is big surgery with big risks, so many of us would like to avoid these risks.  In addition, from a psychological perspective, one knows they are truly “old” when a surgeon cuts out what used to a perfectly good joint and replaces that with metal and plastic.  So this blog is dedicated to my clinical experience and the tools I use to save joints, hence joint preservation.

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