Joint Preservation Blog

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:

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January 10, 2009

Replacing the Achilles Tendon with a Cadaver Tendon?

 

As a doctor, replacing the Achilles tendon with a cadaver tendonwould be the absolute last resort for patients with complete and retracted tears of the Achilles tendon.  This means that the two pieces of the tendon aren’t connected.  For patients with partial tears of the Achilles tendon where the tendon is still intact and not completely torn and retracted, this should not be considered.  This is due to the significant complications that can accompany this type of very big surgery.  Newer methods of tissue bioengineering look to replace this Achilles tendon replacement surgery.  This involves injecting the patient’s own mesnechymal stem cells into the Achilles tendon tears.  We have some experience with injecting adult mesenchymal stem cells into torn tendons with very good results.  This procedure is much less invasive and involves much less recovery and downtime for the patient. 

January 2, 2009

achilles tendon repair

As a doctor, if I have a partial tear of my Achilles tendon, I’m not anyone near me with a knife! Why, surgery means big downtime and lots of trauma. Achilles tendon repair of a small tear shouldn’t require sutures, but instead the injection of the patients own adult stem cells into the tear. This state of the art technique repairs the tear with much less downtime. Click here to see how Achilles tendon repair is done in the 21st century.

Mesenchymal stem cells are present in everyone and have the ability to differentiate (turn into) tendon tissue and orchestrate a natural repair effort.

MRI Showing Tear Achilles tendon

MRI Showing Tear Achilles Tendon. MRI’s are pictures that show soft tissue as well as bones. The Achilles tendon is made of up dense collogen and often appears black on MRI sequences used to look for ligament or tendon tears (usually T1 or proton density sequences). A white or light colored area in the tendon on these sequences usually means a tear in the tendon. A partial tear is when the lighter colored area diesn’t extend all the way through the tendon and the two parts on either side of the tendon are still attached to one another. On the other end of the spectrum is a full or complete tear where the two ends are retracted and pulled apart. If the tear is partial, then the patient is usually immobilized in a walking cast or boot for several weeks. This aggressive immobilization can be a two edged sword, as the lack of activity can also weaken the area. If this doesn’t work, then surgery to sew the tear may be recommended, but this requires large amounts of downtime to allow the sutures to mend the area. Newer stem cell based treatments for partial Achilles tendon tears are injection based and allow for more activity.

Torn Tendon in Foot

Torn Tendon in Foot. Tendons are the cords that attach muscles to bone. In the foot, there are many tendons broken down into a couple of categories based on how they move the foot. These are tendons that plantar flex (foot pointed down), dorsiflex (toes and foot moving up), pronate and/or invert (bottom of foot points to other foot), and supinate and/or evert (bottom of foot points to the outside). A tear in a foot tendon is usually due to either an injury or overuse. For example, a tear in the tibialis anterior tendon can be due to too much force on the tendon as it tries to keep the foot from slapping on the ground. This type of tear is also usually caused by weakness in the tibialis anterior muscle (front of the shin) from a chronic low back pinched nerve. This muscle helps us control the foot as we walk. As the muscle gets weaker, the tendon gets beaten up trying to keep the foot from slapping while walking. In addition, the extensor hallicus longus (EHL) can get worn out trying to help the weak tibialis anterior muscle. Fixing a torn tendon in the foot can sometimes involve surgery, but newer non-surgical methods are much more promising. The newer treatments for torn tendons involve injecting the patient’s own stem cells into the tendon so that they can repair the damage. This is a full activity or a minimal downtime procedure, unlike surgery.

December 15, 2008

supplements that help prevent torn tendons

Supplements that help prevent torn tendons usually involve various components of tendons such as collagen.  Collagen is a natural substance that acts as the mortar for the brick building blocks (cells) that make up much of the body.  Taking more of this collagen “mortar” may help provide better masonry building blocks in areas like tendons.  In addition, another major component of tendons and ligament repair is Vitamin C or ascorbic acid.  Vitamin C is a catalyst for this repair and building up of collagen.  Think of it as the food for the brick mason so he can lay more cellular bricks to make more tendon and ligament using the collagen mortar.  Another major tendon and joint component are GAG’s (glycoaminosglycan’s).  These are the chemicals that help to hold onto water and help provide elasticity to tendons, ligaments, and joints.  GAG’s include glucosamine and hyaluronic acid.  Another major strategy for preventing torn tendons is activity.  Activity helps to build up tendons and ligaments and make them stronger.  In this case, walking the mall may not be enough activity, but walking to the mall is more like the kind of activity levels needed.  Once a tendon tears, avoiding surgery should be the goal.  Sewing a partial tendon tear may make the tendon too tight and cause other problems.  Non-surgical methods to heal the tendon can include prolotherapy or adult stem cell injections.  Prolotherapy involves injecting substances to cause a brief inflammatory healing reaction to try and get the torn tendon to heal.  Injecting stem cells into the tendon provides more building blocks or bricks in our mason example above.

achilles tendon tear bursitis

The Achilles tendon is the cord that connects the calf muscle (gastrocnemius) to the heel bone (calcaneus).  This transmitts force to the foot for “toe off” in normal walking.  An Achilles tendon tear bursitis is when the tendon gets a partial tear (not through and through, but strecthed or torn a bit) and the bursa (lubricating sac between the tendon and the calcaneus bone) gets inflammed.  This bursitis can cause pain and is usualy from too much force on the tendon.  The cause of this problem is usually altered bio mechanics.  This means that things like excessive tightness in the claf muscle, too much weight on that side of the body, or even issues with range of motion of the hip or knee joints are overloading the achilles tendon.

The most traditional way to treat this is with a steroid injection into the busa.  While this can reduce the swelling in the bursa and some of the pain, it can also destroy the body’s ability to heal the tendon tear.  Steroids will reduce the activity of the body’s own stem cells it uses for repair.  Smarter ways to fix this problem would start with changing the biomechanics to reduce over load in this region.  Orthotics may help, as well as loosening the muscles in the calf and around the knee or hip joints.  Once that’s accomplished, newer non-surgical methods to treat this problem are now available.  These include prolotherapy injections into the tendon area.  These injections are used to cause a brief inflammatory healing reaction in the tendon.  While these may help, they can only rarely help strengthen the tendon in our experience.  The issue is that the Achilles tendon is such a big and dense tendon, getting the prolotherapy medicine into the tendon can be difficult.  In addition, accessing the exact area of the bursitis without x-ray guidance is almost impossible.  A newer alternative is the injection of the patient’s own stem cells into the bursa area under x-ray guiance.  This allows the stem cells to turn into new tendon material and strengthen the tendon and reduce the bursitis.  For information on this technique, see the link at the front of the first paragraph above.  This newer stem cell tecnique avoids surgery and allows for high activity levels after the procedure, unlike surgery which usually requires at least a walking boot for immobilization.

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.

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.

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