Joint Preservation Blog

January 2, 2009

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 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.

Patella Tendon Repair and Rehab

The patellar tendon is the duct tape that holds the quadriceps muscle to the knee cap and attaches that bone to the tibia.  Patella tendon repair and rehab is all about how agressively you need to treat the tendon.  A complete tendon rupture needs surgery to reconnect the tendon.  However, a partial tear is a different story.  While this could be treated with surgery, newer treatments allow for more activity.  For example, to treat a partial patella tendon tear, an injection of stem cells (see link above) can allow for much less down time, no immobilization, and less needed rehab.

Rehab for this problem should focus on strengthening the quadriceps and hip girdle musculature.  However, we have seen many patients who have significant trigger points in the quadriceps.  These often prevent effective strengthening of the muscle.  An easy way to clear these trigger points is with IMS

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!

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