Joint Preservation Blog

September 22, 2010

Ehler Danlos Syndrome Treatment

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While we have seen a few patients through the years with Ehler Danlos Syndrome (EDS) variants or simply hypermobile tissue (patients that have very loose joints) without a confirmed diagnosis, I recently was asked by a severe EDS patient to consider prolotherapy for her frequently dislocating joints. EDS is a disease where the collagen (the stuff that holds our joints together) isn’t normal and is made by the body much too stretchy (see above picture). In it’s most severe forms, these patients can barely walk or be active without dislocating a joint. They tend to have arthritis at an early age due to the extra motion in their joints. This patient was in her early 20’s and unable to walk more than 20 steps without her left hip dislocating. She wore special rings on her fingers just to keep her finger joints from poping out of place. She wanted to try prolotherapy on the theory that it would beef up her already loose tissue, laying down thicker tissue or more of the same stretchy stuff, but maybe enough to keep her joints more in place. I was skeptical, but she had no other options. I’m happy to say that after several x-ray guided prolotherapy injections in her left hip and the surrounding tendons she now reports that she can walk through a home depot without the need for her scooter and has had a record low number of hip dislocations this past month. The theory here seems to be correct, that in severe EDS patients injecting substances that have been shown to “beef-up” tissue may give them anough added stability to function better.

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:

January 10, 2009

Surgery for a Torn Labrum in Hip?

surgery for hip labrum

surgery for hip labrum

As a doctor who sees patients with labral tears, there’s allot of confusion among patients about what’s injured when they hear the word “labrum”. Think about the labrum as the lip around the socket where the ball of the femur bone (hip bone) inserts. I’ve seen a number of patients get surgery for a torn labrum in the hip, some with good results, some not so good. Why? One of the issues appears to be the very large amounts of traction that need to be pulled on the hip to get the arthroscope into the hip. This can cause the major nerve of the leg to loose the ability to transmit signals as well as extreme stretching of critical hip ligaments. The second reason likely has more to do with the same reason meniscus surgeries have recently come under fire, removing parts and pieces of a joint as part of what we medical types call “debridement” may sometimes cause more problems than it solves. For example, this removeal of important structural tissue from the hip may cause a retear of the hip labrum. How can a torn hip labrum cause problems in the first place? Realize that the labrum is one of the things that helps the hip bone (femur) stay in it’s socket. So a tear may cause small amounts of extrra motion, especially with movement out to the side (as in figure skaters, horse back riding, and gymnastics). So if the repair of the torn labrum in the hip can actually help the lip of the hip socket (labrum) mend without adding additional trauma, then the surgery will be sucessful. However, if it’s just a “cut out the bad part” type surgery, then it may make the problem worse. Is there a better way without surgery and pulling 80-100 pounds of traction? Yes, we’ve had good success with injecting the patient’s own stem cells into the tear in the labrum, which helps provide new tissue and heal the tear. This procedure can be done through an injection, without the need for surgery and as a result, with much quicker recovery and less down time.

September 1, 2008

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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