Joint Preservation Blog

January 6, 2009

recooperation from shoulder surgery

Typical shoulder surgery recovery.

Typical shoulder surgery recovery.

As a doctor, recooperation from shoulder surgery can be tough. The problem is that the severe degree of immobilization that’s needed (that big blue pillow) makes that arm/hand useless. Is there a better way? Well, if you have a rotator cuff tear, newer and much less invasive methods of treatment may be the answer, as with less trauma from the procedure comes quicker recovery times (read no blue pillow). How can this be possible? Trade the scapel for a needle. Rather than trying to sew ligaments back together or sewing a torn rotator cuff tendon, get stem cells to repair the damge. The doctor simply places the cells in the damaged area with an injection. Little trauma, little recovery. Sounds like science fiction? Not really, as this procedure using your own stem cells to repair the damage is now being used reduce recooperation times. No surgery, less recovery. To learn more, click the video below:

January 3, 2009

Knee Replacement Surgery Recovery

Knee replacement surgery recovery is hard. As a doctor, I’ve seen everything from patients who can get back on their feet in weeks, to patients with months of severe pain requiring narcotics and ultimately poor outcomes (the knee area still hurts). Why? How can you tell who will do well and who will have a prolonged Knee replacement surgery recovery? After many years of seeing these patients, I think it comes down to why the knee hurts in the first place. Too often, the knee is diagnosed as the main pain generator, but much of the pain is really coming from somewhere else. For example, recent research has shown that while we see meniscus tears on MRI, they are often not the cause of knee pain. In addition, there is a mean serious complication rate from knee replacement surgery of 20%. This gets worse as the patient gets older, with severe consequences and complications (with protracted recovery) occurring in many more patients when they are over age 80. Even if the knee is the cause of the pain, you might consider trying non-surgical options before you pull the trigger on knee replacement. Many patients can get good results from SynVisc or other artificial joint lubricants. Some of my patients try prolotherapy. Even newer techniques are now available where the patient’s own stem cells are used to heal the problems in the knee. So one way to avoid a long Knee replacement surgery recovery watching re-runs of Oprah is to avoid the knee replacement altogether.

December 14, 2008

Torn Achilles Tendon Physical Therapy

A tear in the Achilles tendon can be either partial or complete.  Torn Achilles tendon physical therapy depends greatly on how the tendon is treated.  Surgical repair usually means significant immobilization.  This is a two edged sword.  On the one hand, immobilization can help the tendon mend, on the other, it also dramatically weakens the strength of the natural repair.  For a complete tear of the tendon (when it’s disconnected), aggressive casting may be the only way to promote even weak repair.  However, when the ligament is partially torn, the rehabilitation and recovery plan can vary widely depending on treatment method.

The rehab plan depends on if surgery is needed or not.  If the tendon is sewn back together, rehab will have to be non-weight bearing (on crutches) so at least 4-8 weeks.  However, there is a better way that can allow for quicker return to activities.  Recent research has shown good results when implanting the patient’s own adult stem cells into the tear.  This treatment technique is available now to patients in the first link above.  This is an injection of stem cells to heal the partial tendon tear.  If the Achilles tendon is repaired by this method, activity can start immediately as it helps stem cells differentiate into fibroblasts to repair the tendon.

For our patients, it’s critical to get rid of myofascial trigger points in the gastrocnemius muscle.  This can be accomplished by IMS.  This allows the muscle to function normally and allows for quicker strengthening of this critical muscle.

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.

August 28, 2008

Rotator Cuff Surgery

Thinking about rotator cuff surgery? What’s done and why? How invasive is this? What’s a doctor’s perspective? Rotator cuff surgery usually involves stiching back together the torn ends of the rotator cuff tendon(s) or muscle(s). This means that the surgeon will open an arthroscopic port and place an arthroscope about the size of a ball point pen into the shoulder joint cavity. Under direct visualization, the torn ends will be brought back together and the repair stitched. Sounds simple? Not so fast. The immobilization needed to allow the stitches to mend the tissue also can cause major atrophy of the rotator cuff muscles (read muscle shrinkage). This is why as doctors, we often see patients after these surgeries who have lost function and don’t seem to return to high level activities. Sure they can use the arm again, but it’s never quite the same.

Is there another way? One of the problems with even a small tear is that the blood supply and resources to heal it are often inadequate. What if you could supply building blocks to aide normal healing and increase the blood supply. One candidate for this is mesenchymal stem cells. These are adult stem cells that can turn into (differentiate into) muscle and tendon cells. They also help orchestrate a repair response by bringing in new blood supply to the area. While this may sound like science fiction, it’s already being done. The Center for Regenerative Medicine will harvest these cells, grow them to bigger numbers in culture, and inject them back into the tear. While large, full thickness tears may not be a candidate for this type of injection based treatment, patients with partial tears are good candidates to avoid rotator cuff surgery.

So how do you avoid the pitfalls of rotator cuff surgery? Just skip the surgery part!

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