Just as I cringe when a new patient announces that they have “bone on bone”, so too do I squirm when I am told by a patient “I have a torn” at times meniscus or cartilage; others, a torn rotator cuff; and then again, a torn labrum. Attention please, your X-ray or MRI image is not causing pain, the inflammation in or around your joint is the pain generator. 95% of the population over age 45 will have an abnormality interpreted by the radiologist on the report their MRI, be it of the shoulder, hip or knee. Cartilage and meniscal changes at the knee, labral tears at the hip or shoulder, and rotator cuff abnormalities are part of the attritional process; alternatively, these changes are commonly over diagnosed.
Last week, a 70-year-old woman called to schedule an appointment and indicated that she had a torn acetabular(hip) labrum diagnosed on a recent MRI. I responded, “your pain generator is arthritis unless you are a hockey goalie”. I was being a bit facetious but at the same time truthful. My 37-year experience as a reconstructive orthopedic surgeon specializing in hip and knee replacement really prepared me for this life after surgery; namely, a cellular orthopedic interventionalist.
It takes a history and hands on physical examination prior to review of images to determine what is causing a painful musculoskeletal condition. The common denominator is inflammation, not a computer image. In the case of arthritis, unless the cartilage (meniscus), labrum or rotator cuff alteration is generating mechanical problems such as weakness, locking, “clunking” or giving way, we frequently need not address the former with a maximally invasive surgical procedure; a needle will suffice and deliver the platelets, Mesenchymal Stem Cells, Growth Factors and precursor cells required to address pain, improve function, increase motion, stop progression of arthritis and restore, at times regenerate the joint.
Cellular Orthopedics encompasses a full joint Preservation, Restoration and Regenerative scope of options. The notion introduced by a print media ad, that it is “one and done”, won’t help you postpone, perhaps avoid a joint replacement. In my practice, we monitor progress and intervene when necessary at five months or five years if indicated.
To learn more, visit my web site at www.SheinkopMD.com or call and schedule a consultation at (847) 390-7666
Tags: arthritis, bone lesion, Bone Marrow Concentrate, cellular orthopedics, hip pian, joint pain, joint replace, knee pain, meniscus, Osteoarthritis, PRP, Rotator cuff, stem cells, stiffness, torn labrum
PRP and Stem Cells: More advances in the care of the aging athletes
How Might I Need Stem Cells in 2013
PRP / Platelet Rich Plasma for Hamstring Injuries
PRP can be used in proximal hamstring injuries, which are common in athletes and frequently result in prolonged rehabilitation, time missed from play, and a significant risk of re-injury. For example, reports of acute hamstring strains in dancers have suggested recovery times ranging from 30 to 76 weeks. The Physical Examination is compatible with tenderness on palpation localized to the buttocks, and aggravated by resisted knee flexion. The hamstring strength is reduced while sensory and vascular examination is normal. Radiographs are “normal” and the MRI is diagnostic. Treatment consists of placing the patient prone, scrubbing and prepping the area of tenderness, and injecting Platelet Rich Plasma directly into the area of tenderness. A two-week period of relative rest is recommended. At week three, the patient is allowed to gradually resume full activities over eight weeks. The MRI usually demonstrates healing after four months.
Platelet Rich Plasma for Plantar Fasciitis
The customary explanation describes plantar fasciitis as being due to repeated micro-trauma associated with over use. Yet there are a significant number of patients who don’t respond to strengthening/stretching, orthotics, anti- inflammatories and corticosteroid injections. The injection of Platelet Rich Plasma into recalcitrant, symptomatic plantar fasciitis has been shown to cause a reparative effect leading to resolution of symptoms in six weeks or less after months of pain and suffering from the entity.
PRP for Partial rupture of the Achilles Tendon or Posterior Tibial Tendon
The patient will present with either heel pain or pain on the inner aspect of the mid-foot and a loss of the arch. Rest of the part, anti-inflammatories and a heel lift or arch support relieves symptoms in 50% of cases. On physical examination, the concerned tendon is quite tender to palpation. An ultrasound evaluation indicates partial rupture of the tendon. Platelet Rich Plasma matrix has a high probability of complete resolution of symptoms as well as tendon repair when followed by ultrasound
PRP for Symptomatic Rotator Cuff Tendinopathy and Partial Rupture
Ultrasound guided injection of an autologous preparation rich in growth factors within the injured muscle or tendon enhances healing and functional recovery. This relatively simple procedure is recommended to patients considering surgery for partial rotator cuff tears and in patients who are not surgical candidates due to medical co-morbidities
Stem Cells for Patellar Tendinitis and Jumper’s Knee
As in Achilles Tendinitis, the patellar tendon and the tendons above the knee may be rendered asymptomatic with healing enhanced by administration of growth factors via Stem Cells. Might Stem Cells be used to treat a bad patellar tendon problem? A recently published paper out of The Hospital for Special Surgery suggests they can.
“Keep going my friend”
Tags: Achilles Tendon, athletes, hamstring inuries, Interventional Orthopedics, Mature Athlete, Patellar Tendinitis, Plantar Fasciitis, Rotator cuff, stem cells