Joint Preservation Blog

January 22, 2009

Does ibuprofen inhibit ligament repair?

As a doctor, I get asked allot, “Does ibruprofen inhibit ligament repair?“. In short, likely. We know from the medical research that Ibuprofen belongs to a drug class (NSAID’s) that inhibits the cyclo-oxengenase pathway of inflammation (COX) and that this can inhibit bone healing. We also know from animal models that injecting NSAID’s into a joint can cause arthritis. We also know that NSAID’s can negatively impact adult mesenchymal stem cells that are key in the ligament healing process. The upshot, Ibuprofen and NSAID drugs like Alleve, Motrin, Celebrex, and others likely impair healing of bones, ligaments, tendons, and other musculoskeletal tissues by impairing adult stem cells in their normal role of tissue repair. The upshot, based on the circumstantial evidence, taking NSAID’s after a ligament injury is likely a bad idea.

January 19, 2009

Nutrition to Heal Rotator Cuff Injury

Nutrition to heal a rotator cuff injury is all about the building blocks for repair and their helpers.  What are the building blocks?  Collagen and GAG’s (hyaluronic acid for instance) are good places to strat.  Foods that are rich in collogen include Jello.  Vitamins that help support collogen include vitamin C.  Other building blocks include glucosamine and chondrotin sulfate, although these are a bit more joint focused.  One of the big problems with rotator cuff repair is often there is limited blood supply to this area, so getting any nutrients to it can be tough.  Activity can help in this process.  Gentle rotator cuff exercises can help.  How do you know if it’s healed?  Take your arm and place it out to your side with the eblow extended and point your thumb to the ground.  This stresses the rotator cuff.  if you can’t do this or it hurts, then it’s not healed.  Is there a way to get it to heal without sugery, yes newer non-surgical procedures are available (click link).

January 11, 2009

Sprained Ankle Discharge Instructions

torn ankle ligament

torn ankle ligament

As a doctor who has treated sprained ankles and had a severe sprained ankle myself, here are my sprained ankle discharge instructions for my patients:

1.  Stay away from anti-inflammatories if you can help it!  These medications, otherwise known as NSAID’s block inflammation which can make things feel better, but inflammation is the basis of all healing, so blocking it is ill advised.  Use Tylenol if need a pain reliever.

2.  To control the swelling you can use ice and elevation.  Elevation means bringing the ankle above your chest/heart.  Icing means that you keep an ice bag on the ankle until the skin goes numb and then you remove it.  Again, the swelling is there is bring healing cells, growth factors, and new blood supply, so control it when it gets uncomfortable, but realize that it is serving a purpose.

3.  Immobilization as tolerated.   This means stay off of it when it hurts, but animal studies of ligament and joint healing usually show that staying completely off the area for extended periods will reduce the quality of the repair your body is able to muster.

4.  A sprained ankle takes only 4-12 weeks to completely heal.  if you still have pain, swelling, popping, clicking or other signs of an injury that is too big for your body to heal, consider getting an MRI or other type of imaging.  If the ligaments are completely torn in half, you will likely need surgery.  If they are stretched or partially torn, consider an injection based procedure to enhance healing.  In my clinical experience, prolotherapy can usually help.  Other options include surgery (I wouldn’t recommend this for a partial tear), or having the doctor inject your own stem cells into the ankle ligaments to heal the tear.  Below are videos on the newer stem cell procedures:

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:

December 15, 2008

How to Heal a Torn Ligaments Shoulder

How to heal a torn ligaments in the shoulder.  There are many ligaments that help to support the shoulder.  Ligaments are the duct tape that hold the shoulder bones together.  These include the coraco-acromial ligaments (the duct tape that holds the collar bone to the front of the shoulder blade).  Other ligaments include the joint capsule of the AC joint (duct tape that holds the AC joint together) and the shoulder joint capsule (the duct tape that holds the shoulder ball in the socket).  An injury that injures these ligaments can cause instability, meaning that the ligaments can be stretched an lose their ability to hold the shoulder bones together as you use the shoulder.  This can cause many issues, including early arthritis and pain.  Treatment options have traditionally been surgical.  However, newer non-surgical torn shoulder ligament cures are now available. 

Surgery for this area usually means sewing the torn ligament together or back to it’s attachment to the bone.  While for a complete tear of one of these ligaments this may the only way to get the two ends back together, for partial tears, this is an older method of repair that may have more problems than benefits.  For example, sewing a partially torn ligament often over tightens the ligament.  Newer treatments are injection based.  This means that adult stem cells can be injected into the ligament to help it mend, rather than needing surgery.  The newer stem cell based treatments (links above) also mean much less down-time and immobilization for the patient.   No more blue pillow immobilizer!

As an example, a patient with an AC joint injury often has chronic and painful popping and cracking in this joint.  The shoulder muscles underneath can become sore.  The surgical option is to sew a cadaver ligament or synthetic material around the injured ligaments to try and stabilize the joint.  However, there is huge down-time, with the patient being unable to use the area for months.  In addition, over tightening is common, and this leads to more arthritis.  The newer technique of injecting stem cells into the ligament requires no or little down-time and likely results in a more physiologic repair (without the over tightening) because the goal with this procedure is to get the ligament to heal back to it’s pre-injured state (or as close to it as possible).

December 14, 2008

Healing Tendon Tears

A tendon is the connection between a muscle and a bone.  It transmits force from the muscle, through a joint to allow movement.  Tendons, like any structure, can be torn or damaged.  Most tears heal, but some need help.  Surgery is an option, but should only be considered when the tendon is completely torn in half and retracted (the two ends don’t come together).  If the tear is not complete, but a partial tear, then surgery may not be needed.  Modern advances in regenerative medicine allow us to undertake healing tendon tears instead of sewing them.  This new 21st century way of healing or repairing a tear in the tendon tear has significant advantages over the older, 20th century surgical methods. 

First, if the tendon is only partially torn, the newer stem cell injection procedure often requires very minimal down time, unlike surgical approaches where the tendon is sewn.  This is because the newer stem cell procedure involves injecting those healing cells directly into the tendon under x-ray guidance.  Without a surgical incision, the area heals more quickly.  Also, the stem cells allow the tendon tear to mend fully.  For more information, see the link above. 

For scientific information on healing tendon tears with adult stem cells, see this link to the National Library of Medicine. 

Older, but still interesting ways of healing tendon tears without surgery include prolotherapy.  Another prolotherapy link here and here.  Prolotherapy is injecting the tendon with a substance to cause a brief, inflammatory healing reaction in the tedon.  This is oftern repeated several times, once every 3-6 weeks.  This works well with smaller tendon tears, in younger patients, who can remain very active.

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