Stem Cell Crier
Posted by Mitchell B. Sheinkop, M.D. in Regenerative Pain Center, Stem Cells on January 30, 2012
Musculoskeletal Care of the Mature Patient
I’m back from a short Blog sabbatical, refreshed and with much to discuss. During the time away, I spent a week skiing in Colorado with my wife, read a book, The Immortal Life of Henrietta Lacks, a must read for anyone interested in or considering regenerative medical care, and kept up on issues that I believe would be of interest to readers. While I was gone, my staff continued to work and both finalized and submitted the request to The Institutional Review Board that will enable us to begin The Bone marrow Aspirate Concentrate Stem Cell (BMAC) management of osteoarthritis. I will share with you what I read, watched and observed.
From the American Medical Association Morning Rounds of Tuesday, January 24, Leading the News “Stem cell treatment may help patients with macular degeneration”
On NBC’s The Doctors-Jan 25, a Regenexx stem cell procedure is featured for a patient with a failed microfracture in a woman with an arthritic knee seeking return to an active life style.
The Immortal Life of Henrietta Lacks , written by Rebecca Skloot is the fascinating biography of a woman whose cells were harvested without her knowledge in 1956 at Johns Hopkins; and ultimately became responsible for the world of regenerative medicine today. Along with the factual history of how the first cell cultures of human cells has evolved into the practice of medicine as we know it today, one learns about the evolution of medical ethics, government mandated patient protection and informed consent processes that govern contemporary medicine. You will better understand my approach to regenerative medicine when you finish this book named by more than 60 critics as one of the best books of 2010.
We arrived in Vail on Saturday afternoon, January 21, just as a snowstorm was starting. By time we ventured out on Sunday morning, there was 12 inches of fresh powder at the top of Rivas Ridge. It snowed again two more times during the week with another 14 inches of fresh powder by time we headed down Shangri-La in China Bowl. During the week, a friend came over from Breckenridge with his snow- board. By the end of our Wednesday skiing, I needed regenerative care for my entire body; almost no one was on the slopes besides us.
Over the next two weeks, I am scheduled to do site visits to observe and compare notes with centers involved in BMAC. If you want to move forward with learning whether you might be a candidate for regenerative medical care of your arthritis before scheduling that joint replacement, make an appointment or make a call. While no authority can promise success, there is an accumulating body of global information suggesting autogenous, autologous, adult bone marrow derived mesenchymal cells my be an effective, long term, anti-inflammatory and perhaps alter the natural history of degenerative arthritis.
Mitchell B. Sheinkop
1565 N. LaSalle Street
Chicago, Illinois 60610
847-390-7666
FDA Warning on Stem Cells
Posted by Mitchell B. Sheinkop, M.D. in Osteoarthritis, Regenerative Pain Center, Stem Cells on January 12, 2012
Because of the 60 Minute Television program exposing fraud in the marketing of Stem Cells last Sunday, I feel it necessary to preempt the previously announced blog for this week with a word or more of caution. Sometimes called the body’s “master cells,” stem cells are the precursor cells that develop into blood, brain, bones and all of your organs. When used as a medical treatment, there is the potential to repair, restore, replace and regenerate cells and thereby treat many medical conditions and diseases including arthritis.
But the Food and Drug Administration (FDA) is concerned that the hope, which patients have for cures not yet available, may leave them vulnerable to unscrupulous providers of stem cell treatments that are illegal and potentially harmful. Witness the Sunday night episode of 60 Minutes.
FDA cautions consumers to make sure that any stem cell treatment they are considering has been approved by FDA or is being studied under a clinical investigation that has been submitted to and allowed to proceed by FDA.
Regulation of Stem Cells
FDA regulates stem cells in the U.S. to ensure that they are safe and effective for their intended use.
Stem Cells that come from bone marrow or blood are routinely used in transplant procedures to treat patients with cancer and other disorders of the blood and immune system.
Why my Pilot Study and then Clinical Trial? As part of these studies, I must show how the product will be harvested and prepared so that FDA can make certain appropriate steps are being taken to help assure the product’s safety, purity and potency.
Consumers need to be aware that at present—other than cord blood for certain specified indications—there are no approved stem cell products.
Advice for Consumers
- If you are considering stem cell treatment in the U.S., ask your physician if the necessary FDA approval has been obtained or if you will be part of an FDA-regulated clinical study. This also applies if the stem cells are your own. Even if the cells are yours, there are safety risks, including risks introduced when the cells are manipulated after removal.“There is a potential safety risk when you put cells in an area where they are not performing the same biological function as they were when in their original location in the body. Cells in a different environment may multiply, form tumors, or may leave the site you put them in and migrate somewhere else.
- If you are considering having stem cell treatment in another country, learn all you can about regulations covering the products in that country. Exercise caution before undergoing treatment with a stem cell-based product in a country that—unlike the U.S.—may not require clinical studies designed to demonstrate that the product is safe and effective. FDA does not regulate stem cell treatments used solely in countries other than the United States and typically has little information about foreign establishments or their stem cell products. China has recently announced a governmental mandated regulation of a prior free for all in the stem cell market.
- To reemphasize my approach to realizing the promise of stem cell management of arthritis; treatment at the Regenerative Pain Center will only be offered via Pilot Study or Clinical Trial under FDA governance and IRB regulation. Your cells will be harvested from your own bone marrow, concentrated, and administered to your arthritic joint.
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle Street
Chicago, Illinois 60610
847-390-7666
On Proteins, PRP, Bone Marrow Concentrate, Stem Cells and Orthokine
Posted by Mitchell B. Sheinkop, M.D. in Platelet Rich Plasma, Regenerative Pain Center, Stem Cells on January 4, 2012
The difference between platelet-rich plasma therapy, also known as PRP, and the Orthokine treatment that Alex Rodriguez, Kobe Bryant and other athletes have received in recent months in Germany is fairly straight forward. I personally treat athletic injuries and arthritis with PRP; but, do not use the Orthokine procedure because it is not approved in the United States or Canada.
With PRP, I withdraw 20 cc blood, spin it in a special kit and inject plasma that is rich in platelets and lymphocytes into joints, thereby introducing growth factor and hopefully helping the body to heal itself. In the Orthokine procedure, 20 ccs of a patient’s blood are mixed in a tube with ‘factors,’ incubated for a time , the blood is spun down, and the substance is injected much in the same way as PRP.
The theory of Orthokine, which has also been used by Alex Rodriguez, Kobe Bryant and golfers Vijay Singh and Fred Couples, among other athletes, is that Orthokine addresses one of the possible triggers of joint disease; thought to be the protein interleukin. The theory is an attack on one of the culprits behind arthritis. The protein is an important part of the body’s immune system and has the ability to alter the function of other cells. IL-1 can be positive when it allows the body’s ‘repair troops’ to move in quickly to fight infection or other kinds of damage; but it can also trigger inflammatory processes that lead to degeneration and breakdown of cartilage. These negative effects are primarily responsible for the pain and stiffness of osteoarthritis.
The Germans say that another protein that counteracts the effects of IL-1 is a ‘good protein’ in the body called anti-IL(1) produced by blood cells that protects cartilage by keeping the pro-inflammatory proteins in check. It is the body’s own natural anti-inflammatory and that is what gets mixed in prior to incubation.
In none of these treatments, PRP, stem-cell therapy Yankee pitcher Bartolo Colon had performed in the Dominican Republic. Is there good published research readily available that confirms they are effective, although it could turn out to be so. Individual anecdotes suggest they work. The procedures are not banned by the World Anti-Doping Agency or by Major League Baseball. However, Rodriguez was given the go-ahead by MLB and the Yankees to have it done in Germany. While PRP is available throughout the United States, the Regenerative Pain Clinic Bone Marrow Concentrate Stem Cell Pilot is now open for enrollment. Bone Marrow Concentrate has all the right proteins but does it work? Why am I advocating Bone Marrow Concentrate?
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What’s in Bone Marrow Concentrate: Both pro- and anti-inflammatory cytokines and the factors: Fibroblast Growth Factor-b, PDGF-AB, TGF-B, and VEGF. |
Call to see if you might qualify for the clinical pilot trial.
Mitchell B. Sheinkop, M.D.
1565 N LaSalle Street
Chicago, Illinois 60622
847-390-7666
From Anecdote to Clinical Trial
Posted by Mitchell B. Sheinkop, M.D. in Regenerative Pain Center on December 28, 2011
If you watched the Los Angeles Lakers play the Chicago Bulls over the Christmas weekend, you would have heard the story repeated many times during the broadcast of how Kobe Bryant had traveled to Germany for a Platelet Rich Plasma treatment for his arthritic knee and how PRP is not available in the United States. My congratulations to Kobe Bryant and his doctors, it looks like the treatment worked although the Bulls did win. He played well and there was no visible sign of the bone-on-bone arthritic knee affecting him. To correct the announcers though, you should be aware that platelet rich plasma injection, not unlike that used in the case of Kobe Bryant, is widely available in the United States and FDA approved. Since April of this year, I have personally treated 28 patients with Platelet Rich Plasma including the knee, hip and shoulder. Improvement in arthritic symptoms and increased function has been observed in about 70% of those patients so far. That’s a reasonable improvement for arthritic impairment but is there something better? Might a non-surgical stem-cell treatment for people suffering from knee pain due to common injuries or other degenerative problems be a substitute treatment for arthroscopy or total knee replacement?
Original Article
Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons
Martin Englund, M.D., Ph.D., Ali Guermazi, M.D., Daniel Gale, M.D., David J. Hunter, M.B.,B.S., Ph.D., Piran Aliabadi, M.D., Margaret Clancy, M.P.H., and David T. Felson, M.D., M.P.H.
N Engl J Med 2008; 359:1108-1115September 11, 2008
Results
The prevalence of a meniscal tear or of meniscal destruction in the right knee as detected on MRI ranged from 19% among women 50 to 59 years of age to 56% among men 70 to 90 years of age. Among persons with radiographic evidence of osteoarthritis, the prevalence of a meniscal tear was 63% among those with knee pain, aching, or stiffness on most days and 60% among those without these symptoms. The corresponding prevalence among persons without radiographic evidence of osteoarthritis was 32% and 23%. Sixty-one percent of the subjects who had meniscal tears in their knees had not had any pain, aching, or stiffness during the previous month.
Conclusions
Incidental meniscal findings on MRI of the knee are common in the general population and increase with increasing age.
Because of the aforementioned scientific study, I have determined the following Inclusion criteria for the Bone Marrow Concentrate Pilot Study
1. Age over 50. For patients with an osteoarthritic defect on MRI
2. Near normal knee alignment
3. Symptoms referable to the cartilage defect:
Swelling
Pain
Giving way
Locking
Crepitation
4. Early OA with no evidence of inflammatory arthritis
5. >2mm residual joint space on X-ray
6. Unicompartmental osteoarthritis
a. ROM >-10 to 110
b. Mechanical axis <12 degrees varus or valgus
c. Minimal involvement of patella femoral joint
d. No >2-3mm laxity in any plane
To find out if you qualify for the study, call and make an appointment. For those who don’t qualify for inclusion in the Pilot Study, you still may be a candidate for Bone Marrow Concentrate treatment of your arthritic joint.
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle Street
Chicago, Illinois 60610
847-390-7666
Stem Cell and Adjunctive Therapies
Posted by Mitchell B. Sheinkop, M.D. in Stem Cells on December 20, 2011
Between May of 2001 and November of 2009, I was an invited visiting professor teaching joint replacement surgery in 76 cities around the world at hospitals, in operating rooms, and at orthopedic conferences in 37 countries including Japan, China, Singapore, Russia, Turkey, Israel, Jordan, Lebanon, Qatar, The United Arab Emirates, Saudi Arabia, Bahrain, North Africa, and the emerging newly independent countries of Central and Eastern Europe. My introduction of American joint replacement methodology extended through most of Asia, Central and Eastern Europe, North Africa and the Middle East. During that span, I hosted in Chicago, several hundred visiting orthopedic surgeons from around the globe to teach them my joint replacement techniques as well introduce basic arthroplasty technique, minimally invasive surgery and new prosthetic made in America designs. I still maintain active scientific exchange serving on the editorial board of orthopedic journals both in Serbia and Poland. All these initiatives have provided me with the unusual opportunity not only to stay abreast of and participate in orthopedic developments in the United States but to stay on top of the orthopedic developments around the world. It is time I believe to adopt an Active Ageing approach to orthopedics in this country and that’s why my Blog has been so directed over the past 36 months.
It has taken us almost three years of study and global observation to allow for announcement of a Pilot Study for the treatment of arthritic joints with Bone Marrow Concentrate; now is the time. Last week, I used my Blog to announce the opening of The Regenerative Pain Center with the sole purpose being an attempt at pain control through Regenerative Medicine in contrast to operative intervention. This week, I am announcing the start up of the first Pilot Study made possible because of the Regenerative Pain Center. A Pilot Study is the standard scientific tool for “soft” research, allowing me to conduct a preliminary analysis before committing to a full-blown clinical trial. I will investigate the validity of Bone Marrow Concentrate in treating arthritis of the hip or the knee in compliance with the FDA governance as described in CFR21 Part 1271 falling under the same day surgical exemption discussed in 1271.15(b).
To date, it has been patient testimonials and anecdote supporting regenerative medical care in the musculoskeletal system. That’s all changing, yesterday I received a new course announcement from the American Academy of Orthopedic Surgeons in Phoenix, April 20 to 22, titled Advances in Care of the Aging Athlete. Among the hot topics will be stem cell updates.The course will cover a broad array of topics, including degenerative, arthritic, and traumatic conditions that result from injuries, and take an expanded approach to the treatment of aging female athletes. I will use this course to help me better counsel active patients on managing their participation in sports as they age. Christopher J. Centeno, MD has gone further than anyone in this country, to the best of my knowledge, in advancing the regenerative field with his publication of Orthopedics 2.0. How Regenerative Medicine will Create the Next Generation of Less Invasive Orthopedics.
My intent is to advance the scientific process with the introduction of a pilot study using Bone Marrow Concentrate in the hip and the knee. Next week I will focus on the several pilot studies and who qualifies.
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle Street
Chicago, Illinois 60610
847-390-7666
The Regenerative Pain Center
Posted by Mitchell B. Sheinkop, M.D. in Regenerative Pain Center on December 13, 2011
The Regenerative Pain Center
There is a very unique challenge concerning how to manage the effects of aging and the resulting impact on musculoskeletal well-being and continued participation in sports-from the weekend to the master athlete. Better understanding of the basic science of aging allows for better management of the physiological and biological issues and challenges facing the athletic baby boomer patient. The major problem as we age is weight gain despite a high level of activity and the same nutritional patterns as when we were younger. One must be aware that the body’s Resting Metabolic Rate (RMR) comprises 60-75% of daily energy expenditure and that RMR decreases 20% from childhood to retirement. The second major contribution to athletic decline is degenerative arthritis
The Basic Science of Aging :Implications for the Male and Female Master Athletes
We all must recognize the normal physiologic effects of aging and how our activities of daily living, work related undertakings, recreational enjoyment, and participation in sports are impacted. Are there appropriate non-operative treatment plans for patients with traumatic, degenerative, and arthritic conditions, particularly related to the knee, hip, shoulder and spine that might allow you to postpone or even avoid a joint replacement?
To address these issues, the Regenerative Pain Center (RPC) will open its Chicago doors next week with offices in Lincoln Park and Des Plaines; the sole purpose being an attempt at pain control through regenerative medicine. Is the timing right; is it premature? Last week, Dr. Jon Lapook on CBS NEWS Healthwatch reported on the experimental treatment Platelet Rich Plasma therapy, the procedure that appears to help heal a muscle, tendon or joint injury without surgery. Assessing the value of PRP therapy may be viewed at
http://www.cbsnews.com/video/watch/?id=7390747n&tag=mncol;lst;1
On page 3 of The Chicago Tribune/Business/Section 2/Friday, December 9, 2011 FOCUS STEM CELL THERAPY featured “Investors poised to pounce on a commercial breakout”. ”Early clinical trial successes of dozens of treatments bring hopes some will hit the market in 5 years.” To paraphrase, the promise of stem cells lies in their ability to repair tissue and reduce inflammation. While the Food and Drug Administration has not yet approved unfounded claims of success with regenerative menu of offerings, the FDA does not interfere in the clinical practice of medicine as long as there are no unsubstantiated claims made. Next week, I will announce a Pilot Study using autologous bone marrow concentrate for the treatment of patients impacted by arthritis made possible because of the Regenerative Pain Center.
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle Street
Chicago, Illinois 60610
847-390-7666
Does hip arthroscopy work?
Posted by Mitchell B. Sheinkop, M.D. in Hip Arthroscopy on November 29, 2011
The overriding principal of medicine is First No Harm. When I was in residency training, I rotated for a year through the University of Utah. Incidentally, that was the year I turned 30 and bought myself a Schwinn bicycle 10 speed (orange $110); I started riding 10 miles each way to the Shriners Hospital instead of driving. My mentor used to teach by principles, not preferences. He taught me something that I have followed my entire professional career; never operate inside an adult’s hip joint unless you are going to replace it. The notion of bumpectomy is not new and was a failure in the 30s through the 80s. It was reintroduced via sports medicine and the arthroscopic surgeon. While there is an occasional anecdote of success, where the hip is concerned, I believe the population is being victimized. We are in an era when celebrity and marketing determine too much of the practice of orthopedics, the following article appeared in the New York Times. Space allows for only excerpts.
New York Times Health THE Athlete’s Pain
Hip Procedure Grows Popular Dispite Doubt
By GINA KOLATA
Published: November 15, 2011
It is one of the most popular operations in sports medicine. It comes in various forms, all with the same name: Hip impingement or bone shaving surgery. World-renowned athletes have had the operation — the Yankees’ third baseman Alex Rodriguez had it about two years ago and the sprinter Tyson Gay had it last summer.
But some sports medicine researchers are asking: where is the evidence that shaving bone helps? Might the bumps or irregular shapes they call impingement be just normal variations? Does the shaved bone grow back?
And it is not just professional athletes who are having the operation. Now some surgeons are even operating on teenage athletes with hip pain.
The idea is that bone that has rough edges or an irregular shape in the hip is rubbing against soft tissue in the joint, causing tendons to fray or muscles to tear. The hope is that by shaving and smoothing the bone, surgeons can protect patients from further injury and also protect them from developing arthritis. The amount of bone removed varies but can be significant — sometimes, as much as a third of the femoral head and neck.
One difficulty in assessing the operation’s effects is that it is combined with other procedures to repair torn tissue. When patients say they feel better, is that because their impingement was fixed or because their torn tissue was repaired, or both? Another is that it takes years for arthritis to develop so it will take years for studies to determine if it has been prevented.
The combination surgery also complicates efforts to estimate the cost of the operations because it is billed under a variety of codes. The cost is also hard to evaluate because medical centers say that their charges are proprietary information. But at one academic medical center, the orthopedist’s charge for hip impingement surgery is about $4,400. The doctor’s charge to repair torn cartilage is an additional $4,400. Hospital charges are extra, as are charges for the months-long rehabilitation.
Yet despite the popularity of hip impingement surgery, said Dr. Harry E. Rubash of Harvard Medical School, “no one has really proven that it is uniformly helpful to the patient.”
Dr. Freddie H. Fu, chairman of orthopedic surgery at the University of Pittsburgh School of Medicine, said he had sought more evidence. “I challenge these people all the time,” he said. “I’m all for progress in medicine, but I want to do it right.”
But researchers say many questions remain. Among the most pressing is whether the procedure prevents arthritis.
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle
Chicago, Illinois 60610
847-390-7666 or 312-475-1893
Bad Medicine: Very rich and the very poor
Posted by Mitchell B. Sheinkop, M.D. in Uncategorized on November 22, 2011
by Cory Franklin
Chicago Tribune Opinions of the People
November 12, 2011
“The people who receive the worst care in America,” I said, “are the very poor and the very rich that the very poor received substandard medical care notion that the very rich received poor medical care.
The rich are used to telling everyone what they want and how they want it, and they think nothing of bending a doctor’s will to their own. The doctor abandons his medical judgment.
Last week, the point was driven home following the trial of Dr. Conrad Murray, found guilty of manslaughter by giving the intravenous anesthetic drug Propofol to pop star Michael Jackson to help him sleep Safe to say, no middle-class American has ever suffered Michael Jackson’s fate as the result of a doctor’s house call.
Lest there be any lingering doubt about medical care for the very rich, the new biography by Walter Isaacson of Apple co-founder Steven Jobs provides another graphic example. Isaacson discusses Jobs’ medical care in detail. He outlines the force of Jobs’ personality in dealing with his medical team and how the patient delayed an operation for nearly a year for a malignancy that might have been cured with immediate surgery.
Though Jobs received much of his medical care at Stanford University Medical Center, one of the world’s top medical institutions, Isaacson states that no one there fully took charge of all aspects of Jobs’ condition. Physician, heal thyself. The cases of Michael Jackson, Elvis Presley and Steve Jobs provide cautionary tales and proof that in today’s America, the rich and powerful sometimes receive no better medical care than the poor and disadvantaged. Space constraint requires excerpting; yet this we aren’t at the end of the saga.
From The American Academy of Orthopedic Surgery’s Headline news
11/21.2011
Today’s Top Story
“Super-Committee fails to reach deal”
Politico reports that the Joint Select Committee on Deficit Reduction has announced its failure to come to an agreement for reducing the federal deficit by $1.2 trillion over the next ten years. Under terms of legislation that created the committee; the committee’s failure means the automatic spending cuts including reductions to Medicare and Medicaid; are now scheduled to take effect in 2013. In addition though, a 27% decrease in Medicare reimbursement to physicians is scheduled to take effect on January 1, 2012. It seems that Congress is aiming to include everyone in the Bad Medicine scenario.
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle Street
Chicago, Illinois 60610
847-390-7666
Current Trends in Platelet-Rich Plasma Injections
Posted by Mitchell B. Sheinkop, M.D. in Platelet Rich Plasma on November 15, 2011
Musculoskeletal Care of the Mature Patient
The application of growth-factor is a treatment to improve tissue repair using a patient’s own platelets and plasma. While initially, PRP was used in heart surgery, it has since been applied to non-healing skin ulcers, orthopedics, podiatry, otolaryngology, neurosurgery, dentistry, wound healing and in preventing post operative blood loss. Blood is composed of red blood cells, white blood cells, plasma and platelets. Platelets are made in the bone marrow and have a circulating life of 7-10 days. They are known to participate in clotting and initiate normal tissue healing. Within the clot, platelets become activated and serve anti-inflammatory, proliferation and remodeling functions. They release many factors responsible for wound healing. With the use of a centrifuge, PRP is concentrated and growth-factor-rich platelets are separated from whole blood and may be re-injected to augment natural tissue healing.
PRP use in joints
In the laboratory, PRP has been shown to increase cartilage growth. When compared clinically with hyaluronic acid injections, PRP far outperforms the former.
Spinal application
The basic science research has focused on how PRP treatment of intervertebral disc injury may result in healing when none otherwise takes place. PRP has recently been shown to be potentially beneficial in treating the pain of facet joint arthritis when intraarticular local anesthetic and corticosteroids fail.
Ligament and Tendon application
PRP has been shown to be effective in the treatment of chronic elbow and ligament dysfunction
Research and clinical use of PRP
I currently am involved in a clinical study using Platelet Rich Plasma for the arthritic knee. The preliminary observations of the registry are very encouraging with approximately 70% clinical improvement in all stages of knee arthritis at six months from the first injection. What have not been tested are closely defined unique regenerative rehabilitation programs. Mary Langhenry, PT, OCS just returned from the First Annual Symposium on Regenerative Rehabilitation held under the auspices of the University of Pittsburgh Medical Center Rehabiliation Institute, November 3-4, 2011. She will be revisiting the physical therapy protocols we have in place and updating them with contemporary modalities to best serve the notion of regeneration along with rehabilitation.
Did you happen to see the 11/14 AMA headline , ABC World news, NBC Nightly News, and CBS Evening News headline “Patients’ Own Stem Cells May Be Used To Reverse Heart Damage”? It is a major step forward in bringing the stem cell promise to clinical practice.
Mitchell B. Sheinkop, M.D.
847-390-7666
1565 N. LaSalle Street
Chicago, Illinois 60610
False Findings/ Misleading Evidence
Posted by Mitchell B. Sheinkop, M.D. in Uncategorized on November 8, 2011
There is increasing evidence confirming that many things seen on MRI and blamed as the cause of the patient’s pain leading to invasive surgery are really normal findings. This has shown to be the case with knee MRIs. For years orthopedic surgeons have operated on almost all meniscus tears while modern studies have shown that an awful lot of patients without symptoms have meniscus tears on their MRI. A recent NY Times piece highlighted a study by an orthopedic surgeon that showed the same thing for shoulder MRI. The study involved scanning the shoulders of 31 perfectly healthy baseball players without pain. Despite imaging normal players, the shoulder MRIs found abnormal cartilage in 90 percent and abnormal rotator cuff tendons in a whopping 87% .A patient went skiing and developed knee pain. An MRI seemed to show a tear in his ACL so two surgeons wanted to perform surgery. The third consultant told him his ACL was normal on exam and found an occult fracture that was the real cause of his pain when a bone scan was completed. The story highlights a huge problem. Many physicians have abrogated their exam to the MRI scanner. Too many patients come to us transfixed on their MRI.
Starting in middle age, asymptomatic meniscus tears are common; meniscus tears are part of normal aging. There are two distinctly different meniscus tear types: the normal degenerative tear and traumatic tear that’s really causing pain. A physical examination helps determine the difference, so beware of relying solely on an MRI to make a diagnosis without a thorough exam to confirm that finding.
As of late, there has been an explosion in the diagnosis and treatment of hip labral tears and femoral-acetebular impingement. There are many causes of hip pain other than FAI or hip arthritis. When the radiologist diagnoses FAI on an MRI, how certain is it that the actual cause of pain has been identified? One recent study of 21 professional and 18 college hockey players without any symptoms of hip pain indicated 77% had abnormalities on hip MRI. Another study looked at 200 mostly younger patients without hip pain and showed that FAI was present in 14% of patients. 1 in 4 of the men (24.7%) without any hip problems in this study were qualified as having FAI. I encourage all patients to get an accurate diagnosis before considering FAI or hip labrum repair surgeries. The most common cause of “hip” pain with a “negative” hip x-ray, positive MRI and an equivocal physical examination is referred pain from lumbar disc disease.
Mitchell B. Sheinkop, M.D.
1565 North LaSalle Street
Chicago, Illinois 60610
847-390-7666
