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 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.

January 19, 2009

Exercises that Stress the Rotator Cuff

The rotator cuff provides stability to the shoulder.  The most commonly injured muscle of the four muscles that make up the “rotator cuff” (Supraspinatus, Infraspinatus, Teres, Subscapularis) is the supraspinatus.  Exercises that stress the rotator cuff would focus on use of these four muscles more than other surrounding shoulder muscles (like the trapezius).  To stress the supraspinatus, the empty can maneuver is the best way to go.  Place your arm out to the side with the thumb down like you’re pouring out a can of soda.  The arm should be slightly forward.  If you move your arm up and down from the side of your body to just shoulder level, the muscle being stressed is the supraspinatus.  If this is painful and if when you place the thumb up much of the pain goes away, that’s a good indication that your supraspinatus muscle may be torn or injured.  If you can’t do this at all, it may be completely torn and retracted (not connected).  The infraspinatus and teres can be stressed by movements that externally roate the shoulder and arm (if you place your elbow at your side and start with your hand on your stomach and move it out to the side while keeping your elbow tucked in, that’s external rotation).  The subscapularis goes the other way, it brings the hand in with the elbow tucked into the side.  What if exercises won’t heal the problems?  You might consider some of the newer non-surgical methods that use injections of thepatient’s own stem cells to heal the rotator cuff tear.  The recovery times are much shorter and you can avoid the knife!

Torn Shoulder Rotator Cuff

Ruth is like many of our patients with a torn shoulder rotator cuff. She’s a health care professional (nurse) who has had the RIGHT rotator cuff treated twice with traditional roator cuff repair surgery. The several month recovery was difficult, the blue pillow immobilization meant that she couldn’t work as an ER nurse. Because of the muscle atrophy (this means that the sutures from the surgery can hurt local muscle cells, causing them to atrophy and die off) she likely experienced with the first RIGHT sided rotator cuff surgery, she had a retear of the same rotator cuff a few years later. The second time she was again off work for several months and unable to earn her salary. Based on her outcome with her first and second surgeries on the RIGHT, when the LEFT rotator cuff tore (while she was transferring a patient as a nurse), she went searching to see if non-surgical alternatives were available. We treated the LEFT by using her MRI to plan our x-ray guided injections of her own mesenchymal stem cells into the tear. It’s should be noted that this time, she remained working and fully active during the procedures. She has had three injections into her torn shoulder rotator cuff with excellent relief of pain and return of full range of motion. Rather than the doctor continuing to tell what happened, best to let the patient tell her own story:

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:

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).

torn shoulder ligaments cures

There are many ligaments that help to support the shoulder.  The shoulder ligaments are the duct tape that hold the 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 stretches these ligaments can cause instability, meaning that the duct tape can be stretched an lose it’s ability to hold these shoulder bones together as they move and as you use the shoulder.  This can cause many problems, including early arthritis and pain.  Torn shoulder ligament cures 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.  In addition, this surgical approach carries more risk of infection.  Newer treatments are all injection based.  This means that 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. 

As an example, a patient with an AC joint injury often has chronic and painful popping and cracking in this joint between the front of the should blade and the collar bone.  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).

August 28, 2008

Shoulder Surgery Recovery

As a doctor, because we use our upper extremities for everything, shoulder surgery recovery can be very difficult. Have you seen someone walking around in a sling with a big blue pillow between their arm and chest? Shoulder joint replacement surgery is notorious for a long, painful recovery. Rotator cuff surgery is also a very long and tough recovery, mostly because the stitches placed into the tendon must be kept immobile while the tear heals. So why all this suffering? Is there a better way? This post will explore if shoulder surgery recover from a rotator cuff tear can be shortened and if there is an alternative to shoulder joint replacement surgery.

The rotator cuff is simply a group of muscles that help to stabilize the shoulder. Think of them as the muscles that help keep the ball of the shoulder in it’s shallow joint while allowing for maximum alignment and mobility. When one of these muscles and/or their tendons (like the supraspinatus) gets torn, it’s a big problem. Patients often can’t lift their arm and have pain with any movement. This can be diagnosed on an MRI. If the tear is small, then sometimes it’ll heal on it’s own with therapy. However, many partial and complete tears fail to heal. When this happens, the traditional treatment is simply sewing up the tear and immobilizing the area. This is where the recovery problems begin. Immobilizing the shoulder is tough. Hence the crazy blue pillow shown below:

Typical shoulder surgery recovery.

Typical shoulder surgery recovery.

What happens when you immobilize the muscle for this long? Regrettably, it often causes to atrophy. This means the muscle starts to die off and this atrophy is associated with a poor outcome. How can you get around this atrophy? How about skipping the immobilization? Can you do this? Yes, the Regenexx procedure allows patients with partial rotator cuff tears to shorten their shoulder surgery recovery. Why, because it starts by skipping the surgery step. In this breakthrough procedure, your adult stem cells are injected into the rotator cuff tear under fluoroscopy (real time x-ray). Less trauma to fix the tear means less recovery. In addition, unlike simply sewing the tear and hoping for the best, the joint preservation team at The Center for Regenerative Medicine at the Centeno-Schultz Clinic places repair cells in the tear.

Shoulder Surgery Recovery

Shoulder Surgery Recovery

Check out the MRI pics above. Stem cells placed into the tear helped the tear heal without surgery. So if you want to avoid a lengthy recover with a crazy blue pillow, trade the surgery for a needle!

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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