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.


January 19, 2009

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 10, 2009

Surgery for a Torn Labrum in Hip?

surgery for hip labrum

surgery for hip labrum

As a doctor who sees patients with labral tears, there’s allot of confusion among patients about what’s injured when they hear the word “labrum”. Think about the labrum as the lip around the socket where the ball of the femur bone (hip bone) inserts. I’ve seen a number of patients get surgery for a torn labrum in the hip, some with good results, some not so good. Why? One of the issues appears to be the very large amounts of traction that need to be pulled on the hip to get the arthroscope into the hip. This can cause the major nerve of the leg to loose the ability to transmit signals as well as extreme stretching of critical hip ligaments. The second reason likely has more to do with the same reason meniscus surgeries have recently come under fire, removing parts and pieces of a joint as part of what we medical types call “debridement” may sometimes cause more problems than it solves. For example, this removeal of important structural tissue from the hip may cause a retear of the hip labrum. How can a torn hip labrum cause problems in the first place? Realize that the labrum is one of the things that helps the hip bone (femur) stay in it’s socket. So a tear may cause small amounts of extrra motion, especially with movement out to the side (as in figure skaters, horse back riding, and gymnastics). So if the repair of the torn labrum in the hip can actually help the lip of the hip socket (labrum) mend without adding additional trauma, then the surgery will be sucessful. However, if it’s just a “cut out the bad part” type surgery, then it may make the problem worse. Is there a better way without surgery and pulling 80-100 pounds of traction? Yes, we’ve had good success with injecting the patient’s own stem cells into the tear in the labrum, which helps provide new tissue and heal the tear. This procedure can be done through an injection, without the need for surgery and as a result, with much quicker recovery and less down time.

Ankle support in london?

As a physician, you might say that I have an American MD specializing in Regenerative Medicine and a “doctorate of hard knocks” in ankle braces.  When I came across people searching for “Ankle support in london” I had to throw in my two cents.  I don’t live in London, far from it, I’m in beautiful Boulder, Colorado.  If you’re looking for an ankle support brace, I can tell you first hand that I’ve tried them all.  The winner?  The Malleoloc.  However, my quest for the perfect ankle support didn’t end there, I then tried prolotherapy which allowed me to get rid of the ankle support brace.  This technique involves injecting substances into the ankle ligaments to kick off an inflammatory healing response.  This worked pretty well, even allowed me to take a run every once in a blue moon.  What would I do today instead of the ankle support?  I’d try this cutting edge procedure where they inject your won stem cells into the ankle ligaments to heal and repair the damage.  The video below shows a patient where this was done in the U.S.:

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:

January 6, 2009

Orthopedic Knee Surgery?

Orthopedic knee surgery no better than placebo surgery?  Two recent research articles have questioned whether orthopedic knee surgery is effective.  In fact, one study performed in 2002 showed orthopedic knee surgery was no better than sham surgery and the second published in 2008 showed orthopedic knee surgery no better than physical therapy and SynVisc shots.  Why?  The concept of arthroscopic surgery for the knee makes some sense.  Remove the offending parts and the knee will move more smoothly.  However, that seems to be the problem with orthopedic knee surgery, as removing parts of the meniscus or cartilage only make the knee get arthritis much more quickly.  In addition, another study has also questioned if meniscus tears are in fact a normal part of aging, showing that 60% of people with no knee pain had meniscus tears on MRI.  The video below explains some of this:

So wouldn’t it make more sense to put the cartilage back in or repair the meniscus by healing it? That’s the goal of new stem cell therapies for the knee:

To learn more about how to avoid orthopedic knee surgery…

January 4, 2009

Ligament Tear Symptoms

Ligament Tear Symptoms

Ligament Tear Symptoms

What are ligament tear symptoms? Think of ligaments as the duct tape that holds your bones and joints together. What happens when the duct tape gets stretched or gets torn? In this case, the duct tape (your ligaments) don’t hold the joint together, allowing for too much movement. While the area of the ligament tear can hurt and swell, once that initial several weeks of healing is over, if the duct tape hasn’t mended completely, the joint can be left unstable (read moving around too much). This instability can cause popping, clicking, and/or further swelling and pain in the joint. Over a few months to years, this can cause arthritis to develop much more quickly. How do you fix this ligament issue? Surgery is a possibility, but a bit more traumatic than the repair needs to be in most instances. A newer method is injecting your own stem cells into the ligament to get it to heal. The ligament grades above show that grade 1 and 2 are when the ligament is stretched or partially torn, grade 3 is completely torn. This stem cell treatment works best in grades 1 and 2. If you have a grade 3 tear, then surgery may be the only answer at this point.

Torn Ankle Ligament

Filed under: ankle — Tags: , , , , , , , — D @ 4:49 pm
torn ankle ligament

torn ankle ligament

The outside (lateral) ankle ligaments are the ones that are usually injured. These are the anterior and posterior (front and back) talo-fibular ligaments (the duct tape that holds the talus bone to the heel bone) and the calcaneo-fibular (the duct tape that holds the outside small leg bone (fibula) to the heel bone (calcaneus)). As a physician with a torn ankle ligament, there are three ways to fix a torn ankle ligament that hasn’t healed on it’s own:

1. Tendon graft surgery. The surgeon will take a tendon from the foot and sew it into place to substitute for a torn ankle ligament. The surgeon may also sew up any partial tears in any of the ankle ligaments. There are tow big downsides. The first is that this is a tight space and getting an arthroscope into the ankle can by itself cause some tissue damage. The second is that the tendon graft may end up either causing biomechanical issues (you need all of your tendons, so borrowing one from another spot may cause problems) or it can be placed too tightly and cause further ankle arthritis.
2. Prolotherapy. This is the injection of substances to cause a brief inflammatory healing reaction in the ligaments. For more information on prolotherapy.
3. Percuteneous stem cell assisted repair. This is where the doctor takes the patients own stem cells, grows them in a lab over a few weeks to bigger numbers, and then injects them back into the torn ligaments to repair the tears. This is the future of dealing with this problem and has just become available in the US. For a vido on the subject, see below:

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.

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