Joint Preservation Blog

January 10, 2009

ankle sprain with bone bruise that has taken 5 months

ankle brace

ankle brace

I recently saw the call for help, “ankle sprain with bone bruise that has taken 5 months appear on the Internet. It reminded me of my own problems some 15 years a go as a young doctor just out of residency. I was running and slipped off the concrete path and severely twisted my ankle. It was so bad that I had to limp home at 1/4 walking pace. I placed myself in an immobilizer and waited for it to heal, no healing after 1-2 months. I then began an Odyssey of ankle braces. The air cast was popular at the time, it was a joke, a great way to cut off my circulation without helping any stability. Then 2 months, then 3 months… I was onto seeing specialists. The people who worked with ankle sprains in my community at the time were all podiatrists. I went one who told me he had nothing to offer. Then 3 months became 4 months. I was still limping around the house when I did anything active. I then tried more braces. I bought the old fashioned lace up type, some stability, but getting the beast on and off was a nightmare. I was in a physical free fall of sorts, going from a very active young man to a couch potato. My weight ballooned. 4 months became 5 months. I then finally found my first savior, the Malleoloc brace. While this helped, 5 months became 6 months, 7 months, 8 months, 9 months, a year. Finally I tried prolotherapy, which wasn’t perfect, but got me to the point where I could function and even go out running every once in a great while. If I had injured this today, I would have certainly chosen injecting my own adult stem cells to fix my ankle ligaments. We’ve had great success with this new cutting edge injection treatment using the patent’s own stem cells. The video below tells more:

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December 23, 2008

How to save a knee…

Filed under: knee — Tags: , , , , , , , — D @ 2:14 pm

This is a case of a 72 yo male who makes fangs.  Yep, he is a professional dental prothesis maker for everyone from Hollywood actors to Goth kids who just want to add a little Dracula look to their black attire.  His knee is for all intents and purposes trashed (what we would call grade 4 Kellgren osteoarthritis).  How did we make his knee functional again, what were the steps?

First, he had significant problems with myofascial trigger points in his muscles and loose collateral ligaments (the duct tape that holds a joint together).   Before we could do anything else, we needed to solve these issues.  IMS therapy helped get rid of these muscle knots and prolotherapy injections helped tighten his knee ligaments.  The big difference here was that he felt like his knee was more stable and not “moving around” all the time while he made his fangs.  However, he still had significant pain especially with standing for a long-time.  So the next step was to look at his cartilage on an MRI.  His knee was a mess, with severe cartilage loss and meniscus loss.  While there is no way to “grow” him a new knee, we could use his own adult stem cells to help rebuild some cartilage and improve the health of what is still left.  As a result, we collected his stem cells, sent them to the lab for culture expansion (to grow to bigger numbers) and then injected those into the knee.  His pain with standing went from about a 7/10 to a 4/10.  While this was significant, his MRI provided a clue to another issue.  Because he was unable to fully extend the knee (due to his severe arthritis related bone destruction through the years), he was standing by stressing his quadiceps and patellar tendon (the tendon that holds the knee cap and attaches below the front of the knee).  This happens in some patients who have this lack of knee extension (can’t get their knee stright) because straightening the knee allows us to use no energy when we stand.  When you can’t “take the weight off” by fully extending the knee you hand on the quadiceps muscle and it’s patellar tendon.  As a result, his patellar tendon was constantly getting overstressed.  To help this we injected this area to attract stem cells to help beef up the tendon.  This finally helped the rest of his pain and allowed him to stand longer while making his fangs.

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.

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.

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