Joint Preservation Blog

January 20, 2009

Rotator Cuff Pain Relief Therapy

 

rotator cuff pain relief therapy

rotator cuff pain relief therapy

So you’ve torn your rotator cuff, is there such a thing as rotator cuff pain relief therapy without surgery?  Yes.  First the simple stuff.  If you can’t lift your arm, then you’re likely too injured for this particular blog post (more to come).  However, if you just have pain on lifting, then this blog’s for you.  If you’re in this later category, the good news is that you likely have a partial rotator cuff tear, where the muscle is torn, but not through and through.  We frequently use treatment such as IMS to get rid of the muscle knots and help the pain.  This is where a tiny acupuncture needle is used to eliminate painful portions of the muscle (this is very different than traditional Chineese acupuncture where the muscles aren’t treated). In addition, massage therapy of the supraspinatus, infraspinatus, subscapularis, teres, or upper trapezius may help.  Finally, before you consider surgery, look at one of the newer injection based options to heal the tear with less down time.  For example, the patient’s own stem cells can now be injected into the rotator cuff tear under x-ray guidance, so that no surgery is required.  This gets rid of that big blue pillow immobilizer and the long recovery commonly associated with rotator cuff surgery.  You should give your rotator cuff tear a 4-6 weeks to heal and if it’s staying the same, time to get something done.  The big issue you want to avoid is muscle atrophy, so all of this should be performed with rotator cuff exercises.

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.

December 13, 2008

Ligament Injuries in Elbow

There are several ligaments that help support the elbow and a host of tendons that also help support the joint.  The collateral ligaments are the main structural support and act like duct tape that holds the elbow together.  Ligament injuries in elbow are very similar to other areas such as the ankle.  They can be caused by repetitive use or trauma.   While many heal, some do not.  Surgery for this condition can be difficult, as sewing damaged ligaments may or may not result in a good physiologic reapir.  The problem is that many times, the repair will either be tighter or looser than the original.  If the repair is not at the right physiologic tension, then the joint can be beat uo by the extra force and degeneration in the joint can increase.  I have several patients that are young and in this category.  They had a ligament repair that regrettably ended up too tight and now in their 20’s and 30’s the joints are wearing out. 

Is there a better way to treat a partial elblow ligament tear?  Yes, injecting the patient’s own stem cells into the ligament tear can help that ligament heal.  This way, the body sets the right level of tension in the ligament, more like a natural ligament repair.  For more information on this new procedure, see the link above.

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.

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