MACI – A New Regenerative Technique for Knee Problems

MACI for Knee ProblemsCartilage regeneration has been a long debated issue for orthopedic surgeons. In the case of runner’s knee, this problem can cause a lot of irritation where the kneecap rests on the thighbone.

Together the kneecap and the thighbone form a third joint known as the patellofemoral joint. It is at this junction that cartilage denegation or damage happens resulting in a sharp and sudden pain or one that is dull and chronic. The pain may affect one or both knees with symptoms including the following:

• Tenderness behind or around the kneecap.
• Pain located at the back of knee.
• Sense of cracking that the knee is giving out.
• More discomfort when treading on uneven terrain or climbing stairs.

In addition to cartilage getting damaged in this area from sports injuries, the same can also happen due to auto accidents as well as arthritis.

New Re-Generating Techniques

As the regenerative technology constantly evolves, it makes available a range of orthopedic surgery treatments for the prevention of bone, joint and muscle ailments.

A latest advancement is in the surgical methods is Matrix-Induced Autologous Chondrocyte Implantation. This invention was approved for use by FDA in 2017. It is a new cartilage regeneration procedure which allows the growth of chondrocyte cells on a biologic scaffold.
The new technology uses cells from the patient’s own cartilage to generate the scaffold and as opposed to earlier treatments, can be affixed to the cartilage.

The treatment has only recently surfaced in the US but has been operational in Europe for at least a decade with very promising results.
Basics of MACI include the following:
• In the first step of the MACI procedure, healthy chondrocytes are harvested on a sponge-like area of the bone.
• These cells are sent to the laboratory for 4-6 weeks to be cultivated over a sterile collagen membrane.
• The enriched scaffold is comparatively easier to implant and requires a minimal incision.
• The procedure is less painful with fast recovery.
• More than 6 weeks are required for the growth of the new cartilage cells.
• After the surgery, the cells grow to cover the defected area of the knee.
• The recovery period, as is true with most knee surgery procedures, is long and demands minimum movement to prevent damage to the new cartilages.
MACI appears to be an effective alternative for cartilage regeneration, compared to microfracture. If the quality of the cartilage used is good, MACI may be able to give surgeons a new technique at hand to prevent osteoarthritis.

Conclusion:

Cartilage damage can severely paralyze knee movement. The holes caused as a result of damaged cartilages can lead up to osteoarthritis. Compared to the old surgical techniques, new innovations in technology like MACI may prove effective as a procedure that requires a minimum invasion.
MACI, with the use of high-quality cartilages and minimal incision, places an implant on the knee to enable growth of new cells. FDA approval makes the effectiveness of this treatment promising for many suffering from runner’s knee and other knee issues.

Is Spinal Stenosis a Serious Condition?

Is Spinal Stenosis a Serious ConditionSpinal stenosis is a condition where the bony vertebral canal that the spinal cord runs through narrows leading to compression of this structure. The result is pain and neurological issues such as numbness reduced reflexes and decreased muscle power at the level of spinal cord compression. Paralysis may occur if the stenosis is severe enough which makes this a very serious condition that needs to be managed adequately and appropriately. Spinal stenosis causes include the following pathologies and scenarios:

Congenital defects

  • The spinal canal develops a narrow structure.
  • There may be deformities of the vertebrae leading to canal stenosis.

Aging

  • The spinal ligaments can become thicker.
  • Intervertebral discs may bulge or herniate into the canal.
  • Bone spurs may form taking up space in the spinal canal.
  • Breakdown of facet joints leading to spinal column collapse.
  • Degenerative disc disease resulting in narrowing of the spaces in the spinal column.
  • Cyst formations on the facet joints resulting in compression of the thecal sac which is the spinal sac of nerves.
  • Osteoporosis (brittle bones) complicating into compression fractures of the vertebral bones.

Trauma

  • Patients with spinal stenosis caused by cervical spine myelopathy are at a higher risk of acute cord injury if they are involved in any accidents.
  • Injuries and accidents may result in dislocation of the spine or spinal canal or lead to burst fractures where fragments of bone may end up in the canal.

Arthritis

  • Osteoarthritis and less commonly rheumatoid arthritis results in narrowing of the canal due to persistent inflammation in or around the bony structure resulting in the formation of space-occupying canal lesions.

Management

Spinal stenosis treatment protocols involve conservative (non-surgical) and surgical therapies.

Conservative treatments may include:

  • Oral medications such as acetaminophen, non-steroidal anti-inflammatories, and narcotics.
  • Aerobic exercising to help to achieve or maintain overall satisfactory health.
  • Physical therapy to help perform and learn stretching and to strengthen exercises to build-up muscle mass to help support the back.
  • Weight loss in order to reduce pressure on the back and slow down the progression of the spinal stenosis.
  • Epidural steroid and/or anesthetic injections to help with pain relief.

Surgical interventions may include:

  • Lumbar decompressive laminectomy where the roof of bone overlying the narrowed spinal canal and surrounding thickened ligaments are removed to allow more space for the nerves and spinal cord to displace in. Around 70 to 90 percent of patients have good results after this procedure reporting decreased pain and neurological deficits.1
  • An interlaminar implant is placed in the area where the decompression was done to offer stability to the spine and to allow the nerves to freely run through the device without any compression of the tissue.
  • Patients with cervical myelopathy may have a discectomy and fusion performed where the intervertebral disc where spinal cord compression is located is removed from the cervical spine. The procedure can be done via access to the front or back of the neck.

What Causes Human Growth Hormone Deficiency?

Human Growth Hormone DeficiencyHuman growth hormone is an essential protein that facilitates normal physical development in humans as well as being responsible for the maturation and proper functioning of secondary sexual characteristics in males and females. Growth hormone deficiency in adults is a condition caused by issues that affect the pituitary gland in the brain that is responsible for the production of this hormone. In turn, a deficiency of this hormone in humans causes certain problems depending on the age of the affected individual. Growth hormone deficiency symptoms and signs may include the following:

Childhood 

  • Micropenis in males.
  • Jaundice (yellow discoloration of the skin and/or eyes) and/or hypoglycemia (low glucose levels) in the first few days of life.
  • Short stature with poor growth velocity.
  • Delayed bone maturation.
  • Delayed onset of puberty.
  • Slower muscular development.
  • Delayed gross motor milestones such as jumping, walking and standing.
  • The composition of fat, muscle, and bone may be disproportionate resulting in a mild to moderate chubby appearance.
  • Prominent forehead.
  • Sparse hair growth with the frontal recession.

Adulthood

Adult-onset growth hormone deficiency occurs in 1 in every 100,000 people and is caused by tumors of the pituitary gland. Signs and symptoms include:

  • Baldness in men.
  • Decreased muscle mass and strength.
  • Reduced energy.
  • Decreased bone mass resulting in osteoporosis.
  • Increased body fat especially around the waistline.
  • Increased LDL cholesterol levels.
  • Cardiac dysfunction due to a thickened inner lining of the blood vessels.
  • Memory loss and impaired concentration.
  • Infertility due to absent or decreased production of sperm and ova in males and females, respectively.

Management

Growth hormone deficiency treatment includes injecting synthetically produced growth hormone under the skin (subcutaneously) or into the muscle (intramuscularly).

The following points are made regarding treatment of childhood growth hormone deficiency:

  • Administration of growth hormone in these patients is performed on a daily basis.
  • Growth monitoring and dose adjustments are done every three to six months together with information gained from X-rays and blood tests.
  • Treatment with the synthetic medication is provided as long as the child is growing and they may need to receive the hormone for the rest of their lives if the deficiency is severe.
  • Injections sites include the stomach, biceps, buttocks, and thighs and the sites need to be rotated on a daily basis to avoid shrinking and hardening of these areas.
  • Relatively pain-free devices are used to help with compliance.

Regarding the treatment of growth hormone deficiency in adults:

  • A minimally invasive procedure known as transsphenoidal surgery is performed to remove the pituitary tumor. This involves removing the tumor through the sphenoid sinus, which is a hollow space in the skull behind the nasal passages and below the brain and is performed under general anesthesia. An image guiding system is placed on the head of the patient to help guide the surgeon. The overall success rate of the procedure when removing small tumors (microadenomas) is 90 percent and removing larger tumors (macroadenomas) is 60 percent.1
  • The majority view amongst specialists is that most adults with growth hormone deficiency do not show an adequate response to the medication and therefore do not warrant treatment with the synthetic hormone.
  • Treatment may be warranted in cases where there is a severe growth hormone deficiency, there’s major impairment of the patient’s quality of life, and if the affected individual is being treated for other pituitary hormone disorders.
  • The duration of the treatment will depend on the indication for its use.

Health Options for Temporomandibular Joint Pain

Temporomandibular Joint Pain DiagnosisTemporomandibular joint pain occurs where there is a problem with the jaw, the facial muscles surrounding it or, the actual hinge joint which connects the lower mandible to the temporal bone. This impacts the movement of the jaw and limits chewing motion. Although the actual cause of temporomandibular joint pain is not entirely clear, it can certainly impact life on a day to day basis. The exact cause may be unknown but, whiplash injuries or, general injury to the muscles of the head, neck or jaw may be responsible for joint pain. Grinding teeth can put a lot of pressure on the jaw if there is osteoarthritis or rheumatoid arthritis in the jaw, or the individual is highly stressed, this may cause the tightening of the muscles in the jaw. It is important to also consider whether there is dislocation of the disc between the ball and socket.

 

Symptoms can be painful. Headaches are likely to be experienced and there will be a pain in the temple area. There may be limited movement around the temporomandibular joint and the ears may pop, develop a ringing sound or dizziness may be experienced. There may also be stiffness in the back, shoulder or neck. Symptoms will be related to the amount of mental and physical stress that occurs on a day to day basis. Stress impacts everyone in life, it’s impossible to avoid it completely so learning how to manage it and to compensate is important. Even those under pressure from stressful situations in the short term need to learn how to manage stress levels. The healing powers of each person will vary too. This is also interconnected to the individual’s adaptability. Constant pain can lower immune function and affect mood, and this is why it is important to seek medical assistance when temporomandibular joint pain occurs. Self-diagnosis is not advisable. Symptoms are likely to continue if treatment does not take place and the condition can even become chronic if left unchecked. Where there is early intervention, there is usually a much quicker relief. The Orthopedic Center Arizona specializes in chiropractic treatment for these types of conditions and the success rate for this type of condition is high. Chiropractic treatment works well generally.

 

It takes a holistic and whole-body approach to wellness and the chiropractor will need to understand the condition and how it affects the individual so to create an accurate recovery plan. There may be x-rays to assess the body structure and spine. The individual’s medical history will be reviewed, and a physical examination will also occur. Subsequently, some spinal adjustments are likely.

 

In addition, massage therapy, rehabilitation exercises, electrical nerve stimulation and lifestyle changes are likely. There may be adaptations to posture, nutrition and a discussion about weight-loss. Spinal mobilization and manipulation have been found to be beneficial for those with temporomandibular joint pain offering much relief. Treatment is based on an accurate diagnosis of the cause of pain considering any traumatic or surgical history and typically, it is a treatment that offers much relief for back and neck pain generally.  Find out more about how to improve this condition by seeking advice from OSPLarizona

 

Options for Shoulder Impingement Treatment

Shoulder impingement syndrome is known by many names including painful arc syndrome, swimmer’s shoulder, and subacromial impingement and this condition occur when the tendons of the rotator cuff muscles become inflamed as they move through subacromial space. As a result, there is reduced the flexibility of the shoulder, and weakness and pain will usually be experienced too. Pain usually intensifies if the shoulder is moved to an overhead position or, at night, when the individual lays upon that shoulder. Restricted movement increases the sense of frustration experienced. Pain may manifest as a dull ache, gradually occurring, or, it may suddenly manifest and be acute. There may be a grinding motion or a popping sensation. Elevation of the arm is likely to be painful but will also occur when applying downward force too although this will ease. Seeking medical assistance for shoulder impingement treatment is paramount.

Although other options are likely to be considered first, a subacromial decompression may be required which helps to prevent the bones and tendons rubbing together. Subacromial simply means under the acromion which is a part of the shoulder blade helping to form the shoulder joint. This is usually done through keyhole surgery and a general anesthetic would be required. When there is subacromial impingement, this means that the actual space between the rotator cuff tendons and the shoulder blade is reduced, typically through swelling and irritation or, the development of bony spurs. Where the latter occurs, it’s often as a result of osteoarthritis. Treatment enables this space to be extended and any inflamed bursa or bony spurs can be removed.

Any surgery can be worrying and so, it’s important for good communication to be in place and to speak to specialists in the field such as the Orthopedic Center, Arizona who can explain the process reducing any fears about the procedure. Any surgical operation will be carried out by an orthopedic surgeon who will guide each person through the process as is relative to their case. As a general anesthetic is likely, fasting will be necessary prior to the operation. Any individual who smokes will be asked to stop as smoking increases the risk of infection. The procedure takes approximately one hour although this will vary on an individual basis and a local anesthetic may also be injected into the shoulder nerves to reduce any discomfort experienced following surgery. Pain management is important and there will be options to ease discomfort. The surgeon may also decide to repair any damaged tendons at the same time.

Shoulder impingement treatment does not always require surgery. There are various causes and symptoms which may not mean invasive treatment at all. Certainly, resting the shoulder joint and avoiding extensive movements can help and doctors may suggest non-steroidal anti-inflammatory medicines along with physiotherapy initially. Where necessary, steroid joint injections may be given. Note that subacromial decompression will only be recommended usually if other treatments have not helped. It can take up to four months for full recovery following surgery and most people will make a complete recovery.  Following up with physiotherapy is often beneficial to aid flexibility and to increase movement. It will also be important to build strength up in the shoulder joint too. Find out more by visiting OSPLarizona.com

Natural Healing with Regenerative Medicine Treatments

Regenerative Medicine involves repairing and regenerating the damage in the body. These new treatments utilize the body’s natural healing powers to relieve a wide range of physical problems related to tendon, ligament, muscle, and bone damage.

Leading orthopedic and sports medicine practices, such as OSPI in Arizona, offer various regenerative medicine treatments –

  • Bone Marrow Derived Stem Cell Therapy (Your Own Bone Marrow)
  • Amniotic Fluid Stem Cell Therapy
  • Platelet Rich Plasma Therapy (PRP Therapy)

Stem cell and PRP therapy have been utilized in treating various areas of the body, including knees, hips, backs, and shoulders, that people have injured or that are affected by degenerative conditions such as rheumatoid arthritis.

OSPI has teamed up with R3 Stem Cell, the nation’s leading regenerative medicine company offering cutting edge technologies and research, to provide OSPI patients with state of the art options.

Stem Cell Therapy

Stem cell therapy involves harvesting stem cells from a human source, either the amniotic fluid or the person’s own bone marrow. Amniotic stem cells are either extracted from a willing donor’s amniotic fluid.

Once either of these fluids is harvested, the stem cells are isolated and injected into the affected area. This encourages the creation and strengthening of the affected tissue and also helps to reduce inflammation and pain.

PRP Therapy

PRP therapy involves deriving platelet rich plasma (PRP) from the person’s own blood. The PRP contains several growth and healing factors that aid healing in the damaged tissues.

Many orthopedic doctors are now utilizing stem cell and PRP therapy instead of highly invasive and risky joint replacement surgeries. Regenerative medicine treatments are relatively non-invasive, pose fewer risks and are less expensive, quick and efficient.

If you are looking for the best regenerative and sports medicine doctor in Gilbert, AZ, call OSPI (Orthopedic and Sports Performance Institute) at 480-899-4333.

What Happens in an Ulnar Collateral Ligament Injury?

Ulnar collateral ligament injuryAn ulnar collateral ligament injury is an injury to the elbow ligament. It happens due to overuse of one of the ligaments on the inner side of the elbow and can result in tearing the ligament.
The injury is very common in contact sports where athletes have to repetitively stretch their arms or where elbow dislocation occurs. The injury is caused by a force that exceeds the strength of the ligament with activities like throwing or overhead sports being very likely triggers.

Possible complications and treatment

Injuries of this type hold the potential to damage other structures of the elbow and cause elbow stiffness.
In most cases, where the injury is not too serious, ice and pain medications can be used to treat the swelling and discomfort. Ice helps target swelling while medications stop the pain temporarily. Where pain persists, the individual may also get a brace or cast to seek relief.

What is Tommy John surgery?

The surgical treatment for correcting an ulnar collateral ligament injury is called the Tommy John surgery. The procedure derives its name from a surgery performed on the MLB pitcher and LA Dodgers Tommy John for a tendon transplant.
The procedure works by replacing the torn ligament with a graft tendon taken from the hamstring, forearm, knee or foot of the individual. However, the surgery is only recommended for those patients who do not find relief from non-surgical methods.
Athletes who need to engage in grueling overhead throwing activities and whose careers depend on performance are ideal candidates for this procedure.
The surgery involves implanting the graft to the injury site by drilling tunnels in both the forearm and upper arm bones once the elbow is opened up.
Flexor muscles in the area are also opened up where the graft is woven and the reconstruction is performed. Any remaining portion of the original ligament is then attached to the reconstructed ligament.
While it might seem like a lot of work, the surgical procedure takes between an hour and an hour and a half to perform. Most patients are required to stay overnight in the hospital and are discharged the next day.

Post-operative care

Post-operative care after this procedure involves keeping the incision dry and clean and not showering for 3 days. The patient also needs to give the elbow a rest for a week with no driving for a minimum of six weeks. Other remedial steps include resting the elbow on a pillow when seated and keep it elevated to minimize swelling.
Most patients will recover from surgery in 6 to 8 weeks with motion achieved in this time without pain.

Rehabilitation

Rehabilitation consists of gentle exercises such as squeezing a softball while avoiding moving the elbow. With improvement, the patient can advance to an active motion from passive motion.
Once comfortable, the patient can move to engaging the elbow more by working with a fuller range of motion. Care needs to be taken not to cause direct stress to the elbow during recovery.
It usually takes 12 months for returning to normal sports.

What is Osgood Schlatter Treatment?

Osgood Schlatter is a common cause of knee pain resulting from an inflammation just below the knee. The condition occurs primarily through periods of growth spurts when structures like bones, muscle, and tendons change rapidly. Depending on the severity of the condition, Osgood Schlatter treatment involves taking a few different measures.

Good osgood schlatter treatmentOsgood Schlatter symptoms

The symptoms of Osgood Schlatter typically involve pain at the tibial tuberosity or bony pit at the top of the shin.  When this part becomes inflamed or swollen, the affected area becomes more prominent than usual.

Other symptoms include experiencing tenderness and pain which is worsened during and after exercise. Some children may even experience limping after physical activity.

The severity of the symptoms can easily vary from one person to the next. Some children may only experience mild pain during specific activates while others may suffer from a constant throbbing pain. The duration of the discomfort can also vary, lasting from a few weeks to a couple of years.

Adequate rest, however, can improve these symptoms and symptoms typically disappear once the growth spurt is over.

Osgood Schlatter disease causes

While the condition does occur through an overuse of the tibial tuberosity, there are specific factors that may increase the susceptibility of sustaining this disease. These can include the following causes:

  • Age can be a notable factor in the diagnosis of Osgood Schlatter disease. In many instances, the pain experienced by boys between 13 to 15 years of age and girls between 10 -12 years old is put down as growing pains. However, it may actually be Osgood Schlatter especially if young adolescents are engaged in high impact sports or other such activities.
  • Gender seems to play a part in the occurrence of the disease. That is to say that the condition is diagnosed more in boys than girls. But with more girls getting involved in sporting activities, the gap is becoming narrower between the two.
  • Activity levels can also be a contributing factor. As the bones of young athletes grow, it may take some time for their muscles and tendons to catch up. Regular sports activity can pull on localized tendons which in turn pull on the tibial tubercle. The result of this repetitive traction can lead to inflammation in the area and cause distressing discomfort.

Osgood Schlatter treatment options

Treatment for this disease aims at reducing the associated pain and swelling. Such treatment may also demand to limit exercise and activity until the person starts to feel better.

  • Medications are usually the first line of treatment for this condition. Over the counter pain relievers like acetaminophen, ibuprofen and naproxen are all helpful. They reduce swelling and help subside the associated pain.
  • Physical therapy can be used to stretch the quadriceps which assist in reducing tension in the inflamed area.
  • Surgery may be considered as a last resort in very rare cases. Typically the condition resolves without formal treatment as symptoms usually disappear after the growth spurt is over.

However, in cases where the pain persists and does not subside even after the growth spurt, the doctor may decide to administer surgery. The surgical procedure will likely be done to remove the bony overgrowth in the area.

How to Treat Sharp Pain In Front Right Shoulder?

Having sharp pain in front right shoulderPain experienced at the front of the shoulder may be acute or chronic. Also known as bicep tendonitis, this condition can occur from injury, strain, tear or an inflammatory response. Here is what to do when experiencing sharp pain in front right shoulder:

Reduce inflammation

The first line of treatment is to address the inflammation in the affected area. This can be done by taking adequate rest along with anti-inflammatory medication to start the healing process.

Improve range of motion

When pain starts to subside, individuals can start working on getting their range of motion back. In most cases, the overreach is affected and suffering individuals need to reclaim their overhead full flexion.

One consideration while doing so is that any tightness felt in the back of the shoulder may cause increased stress at the front of the shoulder and trigger more pain.

Build strength

As part of early recovery, individuals can try to strengthen affected muscles in the shoulder along with others in the back which support the shoulders.

When doing so, try strengthening the rotator cuff muscles as this muscle group and their tendons provide strength and stability during movement of the shoulder.

Go for functional training

Once the healing process starts and inflammation subsides, the individual can then start functional training. This step focuses on enhancing movement in a coordinated manner.

Functional training promotes proper mobility of shoulder, trunk, and scapula to allow synchronized movement.

There are a number of flexibility exercises that can help with bicep tendonitis treatment and may even help prevent the condition in the first place.

These can include the following:

  • Pec stretch
  • Rhomboid stretch
  • Inverted Rows
  • Side lying external rotation
  • External arm rotation
  • Push up to side plank

Other Bicep Tendonitis Treatment Options

Where exercise alone does not suffice, it may be paired up with other treatment options like the following:

  • Medications such as NSAIDs are typically the first option to treat the discomfort associated with the condition. The drugs can be helpful in alleviating the pain in the initial stages.
  • Icing is an elementary injury management technique and a drug-free method of relieving pain. An application of an icepack to the skin can soothe symptoms from strains, sprains, bruises as well as tendonitis.
  • Stretching on a regular basis may also help prevent tendonitis from occurring in the first place. Gentle stretches before and after workouts are highly recommended.
  • Massage is another effective way to loosen tissue and keep it from clogging muscle fibers. This therapy not only sustains the range of motion but also keeps muscles more supple to minimize the chance of further injury.

Among the different type of massages, deep tissue massage helps reduce inflammation and relieve muscle tightness. Sports massages, on the other hand, target muscle-tendon junctions to improve endurance and flexibility.

  • Surgical intervention is typically considered a last resort for people who do not benefit from other types of treatments.
  • Non-operative management involves the administration of injections to the inflamed area to manage inflammation and pain.

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