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 11, 2009

Sprained Ankle Discharge Instructions

torn ankle ligament

torn ankle ligament

As a doctor who has treated sprained ankles and had a severe sprained ankle myself, here are my sprained ankle discharge instructions for my patients:

1.  Stay away from anti-inflammatories if you can help it!  These medications, otherwise known as NSAID’s block inflammation which can make things feel better, but inflammation is the basis of all healing, so blocking it is ill advised.  Use Tylenol if need a pain reliever.

2.  To control the swelling you can use ice and elevation.  Elevation means bringing the ankle above your chest/heart.  Icing means that you keep an ice bag on the ankle until the skin goes numb and then you remove it.  Again, the swelling is there is bring healing cells, growth factors, and new blood supply, so control it when it gets uncomfortable, but realize that it is serving a purpose.

3.  Immobilization as tolerated.   This means stay off of it when it hurts, but animal studies of ligament and joint healing usually show that staying completely off the area for extended periods will reduce the quality of the repair your body is able to muster.

4.  A sprained ankle takes only 4-12 weeks to completely heal.  if you still have pain, swelling, popping, clicking or other signs of an injury that is too big for your body to heal, consider getting an MRI or other type of imaging.  If the ligaments are completely torn in half, you will likely need surgery.  If they are stretched or partially torn, consider an injection based procedure to enhance healing.  In my clinical experience, prolotherapy can usually help.  Other options include surgery (I wouldn’t recommend this for a partial tear), or having the doctor inject your own stem cells into the ankle ligaments to heal the tear.  Below are videos on the newer stem cell procedures:

January 2, 2009

Achilles Tendon Support Socks

The Achilles tendon can be weakened by injury or being overloaded.  Support socks for the Achilles tendon will add compression around the tendon which may allow it to feel like it has greater support.   In essence, this pressure gives the tendon more structure.  Look for support socks that place pressure on the tendon (the heel cord) without causing pain.  The need for support in the Achilles tendon is usually from a partialtear or chronically frayed tissue in the tendon.  Another way to treat this without surgery or bracing is to use the patients own stem cells to repair the tendon.  These are cells taken from the patient, grown in the lab, and then injected into the tendon so that they can orchestrate a healing response.  With this type of Achilles tendon repair therapy, the need for Achilles tendon support socks can be eliminated.  This type of Achilles tendon treatment is new to the US and holds great promise for making the tendon stronger.

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

Rotator Cuff Surgery

Thinking about rotator cuff surgery? What’s done and why? How invasive is this? What’s a doctor’s perspective? Rotator cuff surgery usually involves stiching back together the torn ends of the rotator cuff tendon(s) or muscle(s). This means that the surgeon will open an arthroscopic port and place an arthroscope about the size of a ball point pen into the shoulder joint cavity. Under direct visualization, the torn ends will be brought back together and the repair stitched. Sounds simple? Not so fast. The immobilization needed to allow the stitches to mend the tissue also can cause major atrophy of the rotator cuff muscles (read muscle shrinkage). This is why as doctors, we often see patients after these surgeries who have lost function and don’t seem to return to high level activities. Sure they can use the arm again, but it’s never quite the same.

Is there another way? One of the problems with even a small tear is that the blood supply and resources to heal it are often inadequate. What if you could supply building blocks to aide normal healing and increase the blood supply. One candidate for this is mesenchymal stem cells. These are adult stem cells that can turn into (differentiate into) muscle and tendon cells. They also help orchestrate a repair response by bringing in new blood supply to the area. While this may sound like science fiction, it’s already being done. The Center for Regenerative Medicine will harvest these cells, grow them to bigger numbers in culture, and inject them back into the tear. While large, full thickness tears may not be a candidate for this type of injection based treatment, patients with partial tears are good candidates to avoid rotator cuff surgery.

So how do you avoid the pitfalls of rotator cuff surgery? Just skip the surgery part!

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