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The new advances in stem cells

stemThis photograph was initially published by the Center for Life in Newcastle, England, It depicts the begining of life as eight cells cluster that will form embryo. The picture was taken 3 days after the initial nuclear transfer. The British scientists are among the first group of frontiers in the field.

Sep 21, 2011

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Olympic Silver Medalist

olympic_davidpayneOlympic Silver Medalist David Payne has joined elite athletes Tiger Woods, Hines Ward and Takaishi Saito in using Cell Therapy. According to A.J. Farshchian, MD, an Orthopedic Regenerative practitioner at The Center for Regenerative Medicine, “Sport injuries need an adequate blood supply and cellular migration. Platelet-derived growth factors are c…

Jun 27, 2011

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Gout

gout72 year old male from Texas with history of Gout for 2 years in his right knee presents with complaint of pain and swelling. Patient states prior to onset of gout he was fine without any discomfort. Past medical history is unremarkable. Patient takes no medications and has no allergies. He has tried conventional treatments with some relief. He is…

Apr 29, 2011

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Shoulder Pain

shoPatient is an affable 47 year old male from Michigan. Patient reports to clinic with a history of exostosis in the right glenohumeral joint now hoping to prevent shoulder replacement till later in his life time, looking for alternative treatment . Patient complains of pain in the right shoulder during activities requiring over-head motions. Patient…

Mar 29, 2011

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Tear of UCL in a Baseball Pitcher

pitcher21 years old male Baseball pitcher for local university came in to be treated today. Patient says “last summer I was able to throw the ball at 95 miles per hour , now for the past 4 months I have dropped to 85 miles per hour and it is painful when I throw.” His past medical history is unremarkable and he is otherwise a very athletic male and very h…

Mar 27, 2011

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Osgood-Schlatter

fbKB is a 50 year old white male with history of knee pain since a teenager, came in today for a consultation with me regarding his right knee. Patient past medical history is significant for the history of Osgood-Schlatter disease, followed by a Football injury at the age of 20 , followed by 2 arthroscopy surgeries which both helped the patient sign…

Jan 31, 2011

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Edema

edema45 years old male from Scotland flew in today for treatment. Patient is complaining of pain and swelling in the right knee. Edema (medical lingo: swelling) gets worse when patient goes dancing or playing Golf. His past medical history is significant for compound fracture of right knee in 1978 requiring surgical repair at the level of Tibia and Fibu…

Dec 26, 2010

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Hip Pain

hip_pain_2Hip pain – How to identify severe hip damage

Nov 26, 2010

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Degenerative Joint Disease in the knees


70 year old male from Ohio is presenting with advanced osteoarthritis of both knees. Patient’s pain is more pronounced mostly upon walking.  Stairs are very difficult, going down is a more of a big task. He has no pain sitting he says: “but I can not sit all the time”. His past medical history is positive for Hypertension, he takes Diltiazam and Vitamins. He has been advised for   total knee replacement.

The picture depicts sever bow legged also known as genum Varus. of the knees.

It is very important for the knee to be be aligned properly. Patients who develop bow legged-knees is usually because of  ore pressure on the medial (inner aspect of the) knees. This condition is also known as “Genu Varus.” This abnormal distribution of weight causes wearing of the cartilage and joint to accelerate and makes arthritis worse leading to surgeries and possible  total knee replacement. In this condition legs are bowed outwards in the standing position (see the picture). This unusual misalignment usually occurs at the level of the knees, and then when the patient is standing with his or her feet together, the  knees can not touch each other.

Oct 20, 2010

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Degenerative Joint Disease in the knees

stan70 year old male from Ohio is presenting with advanced osteoarthritis of both knees. Patient’s pain is more pronounced mostly upon walking. Stairs are very difficult, going down is a more of a big task. He has no pain sitting he says: “but I can not sit all the time”. His past medical history is positive for Hypertension, he takes Diltiazam and Vit…

Oct 20, 2010

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Medial epicondylitis






hb47 year old golfer flew in from Japan for evaluation of his right elbow today. Patient has been diagnosed with medial epicondylitis. Patient has tried anti-inflammatory, Chinese and Korean acupuncture, His orthopedic surgeon felt his case is more of a non-surgical case and advocated physical therapy. Patient describes pain as “a shooting sensation …

Sep 20, 2010

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Osteo-Arthritis knows nothing of your age

CRM_011_smA 27 year old male comes to the center for consultation and evaluation of his left knee.

Aug 18, 2010

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The Knee Diaries: Ligament Injuries

Mar 11, 2008

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The Knee Diaries : Centenarians

Feb 14, 2008

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The Knee Diaries : Patellar Tendonitis

Dec 17, 2007

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The Knee Diaries: Running on empty

“Thewear pattern on your running shoes suggests that you watch too much TV.”
A 50- year-old male who has experienced intermittent pain in the right knee for the past three years presents with chief complaint of constant and severe pain “Off and on for the past two months,” An interference with his accustomed lifestyle, the pain is described as “continuous but worse when walking or putting weight on the knee.” The pain lessens but remains uncomfortable upon sitting, he adds.

Other wise healthy, he only takes an anti-inflammatory medicine for discomfort, stating he has never incurred a sports injury in the past. He works out by running on a treadmill “to stay in shape,” despite the knee pain.  After a review of the patient symptoms and further examination a diagnosis of Osteoarthritis was confirmed.

Discussion

“Will running cause arthritis?” is a question many patients ask.

Despite a debate of many years, it is near-certain that the continued pounding experienced on weight-bearing joints
by running can certainly result in damage to them. To those asking if exercising an arthritic and degenerating joint can increase stress, common sense would logically answer “yes.”

However, according to Dr. Lyle Micheli of Harvard Medical School Dept. of Orthopedics in Boston, the answer is “no.” Dr. Micheli compared the frequency of degenerative arthritis in 504 former collegiate long distance runners with that
of 287 former collegiate swimmers. His study found the frequency of degenerative arthritis 2.0% lower in long-distance runners than in swimmers (2.5 %), even though swimming requires little stress on the body’s weight-bearing joints.

As an indication of arthritic severity, Dr. Micheli also recorded the number within each group with an arthritic problem severe enough to require surgery. Comparing the two groups, the need for related surgery was found to be three times greater among the swimmers than among the runners.

Dec 22, 2006

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The Knee Diaries: Degenerative Joint Disease

A 65 year old male with chief complaint of knee pain, presenting with bone on bone osteoarthritis of left knee was referred to us by his physician for prevention of total knee replacement. Patient past history is positive for a Basketball injury in 1980, which was followed by a knee surgery.

He is otherwise healthy, does not smoke and drinks only on social bases. There is no family history of osteoarthritis.

His symptoms are specific to pain, stairs specially bother him. He experiences stiffness after sitting more than 10 minutes. On the exam the knee is extremely bowlegged.

Discussion:
Bowlegged ness produces a disturbance in the biomechanics of the knee and misalignment between the involved muscular skeleton system . This contributes to Degenerative Joint Disease. A recent Northwestern University study concluded that people with arthritis or DJD (Degenerative Joint Disease) whose knees are misalignment with their ankles and feet have up to five times the risk of their getting worse.

It is very important for the knee to be be aligned properly. Patients who become bowlegged is usually because of more pressure on the medial (inner aspect of the) knees. This condition is also known as “Genu Varus.” This abnormal distribution of weight causes wearing of the cartilage and joint to accelerate and makes arthritis worse. In this condition legs are bowed outwards in the standing position.

Sep 25, 2006

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The Knee Diaries: rejection of Osteochondral Allograft

Left: X-ray of the patient’s right knee shows the transplanted tissue attached to the Tibia by means of 3 screws.
A 59-year-old Massachusetts female was presented with concern for right knee rejection of a bone/cartilage transplant, recurring dislocation, and instability of the knee for several years. Patient had been plagued with a knee problem since a skiing accident 10 years ago. A year after initial injury, a metal plate was attached to strengthen the knee joint, followed by an Osteochondral Allograft surgical procedure which transplants a cartilage section and attached bone from a cadaver donor to the damaged region of the joint surface. She required crutches to aid walking for nearly one year and subsequently developed Osteoporosis in the knee’s right lower extremity while her body began rejection of the transplant. Despite the unsuccessful procedures (to avoid knee replacement), a second Osteochondral Allograft was undertaken, followed by more non-weight-bearing ambulation which continued and heightened the osteoporosis condition.
Patient upon entering The Center for Regenerative Medicine sought assistance to prevent possible rejection and potential future knee replacement. Otherwise healthy, patient uses Fosomax for Osteoporosis relief and anti-inflammatory medications. Well-educated (Ph.D in Physical Therapy), her family history is non-contributory.
Discussion:

Department of Orthopedic Surgery and Rehabilitation, University of California, San Diego: The following are the results of a study of 58 patients with recent Osteochondral allograft knee transplants: Most patients in this study mostly had severe, Osteochondritis Dissecans, a traumatic defect or osteonecrosis of the femoral condyle, a painful, healed depressed fracture or traumatic defect of the tibial plateau, and unicompartmental traumatic Osteoarthritis of the knee. All patients reported disabling pain after failure of attempts to correct problems surgically. Of 39 patients available for follow-up study after allograft transplants, nine (22.5 per cent) failed and of those patients with unicompartmental traumatic arthritis, the rate of success was only 30 per cent.

Jul 7, 2006

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The Knee Diaries: Sports injuries in young athletes

23-year-old Utah male was presented to the Center complaining of deep left knee pain: “Not there all the time” but worse when walking downstairs, “almost no pain” when walking upstairs.

Pain does not awaken him from sleep but certain movements are troublesome, especially when playing basketball. Predicament with knee began at age 15 after bad fall during game (apparent tearing of ligaments and parts of meniscus). After surgical correction and for the past eight years, patient has undergone four arthroscopic surgeries and was told a total knee replacement is inevitable.

Patient is otherwise healthy; no medications required.

Discussion:
Young athletes experiencing chronic pain are an increasing syndrome at The Center for Regenerative Medicine.

As trauma remains one of the leading causes of Osteoarthritis, we nevertheless continue to challenge our bodies to impossible goals.
Expressions and slogans such as “No pain, no gain”, “Just do it” and, most recently, “The impossible is nothing” are common marketing campaigns passed from generation to generation to answer competitive instincts seeded in human nature . Parents too often encourage children’s participation in extreme sports without weighing the consequences of permanent damage to muscular skeleton systems which are very fragile. Once serious damage occurs, problems can reoccur over lifetime despite corrective surgical procedures.

Before giving consent to sports participation by children or young teens, parents must weigh temporary rewards against the risk of potential long-term damage and disability that would limit essential flexibility and support of muscular structure over an anticipated lifetime.

Jun 27, 2006

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The Knee Diaries: Knee Locking

A 77-year-old male from New Jersey presented the Clinic with a complaint chiefly of right knee pain, stating pain occurs almost continually. Pain described as “dull, worse when walking,” and mostly located medially (inner knee area ). Pain has persisted for 30 years since an incident while patient walked downstairs at home when knee ‘locked’ at 90-degree angle.

Prior to locking episode, patient was an avid sportsman and runner, never experiencing pain in either pursuit. At time that knee lock occurred, a physician ‘unlocked’ knee by injection of anesthetic and application of traction to stretch joint. Following treatment, patient relates knee began to deform and became bowed. Arthroscopic surgery was undertaken at a later time to alleviate constant pain.

Prior to this locking episode, he was avid sportsman and a runner and never experienced pain. His knees were straight. When his knees locked, he saw a local physician who after injecting his knee with anesthetic was able to unlock the knee by traction (medical lingo: the pulling of or tension established in one body part), he says ever since then his knee started to deform and bowing. After wards he had arthroscopy in the right knee which helped him with the pain.

His past medical history of Atrial Fibrillation and takes Digoxin for it. Otherwise he is a good candidate for a total knee replacement. He also takes Celebrex which eases his pain.

Locking of the knee is a common phenomenon, patients typically describe the knee is stuck in a particular position ,and not being able to move the knee. Most common cause of it is usually a meniscus tear. Other common causes are ACL Damage, loose bodies and patellar dislocation. Patients inability to fully extend the knee produces excruciating pain.

Jun 5, 2006

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The Knee Diaries: One Strong Joint

Happy Memorial
An 80 year old WWII Veteran presents with chief complaint of knee pain, patient states he has had pain in the left knee since World War II. He describes while fighting in Germany, he was shot in the knee by the enemy forces.

Subsequently he developed infection and necrosis which required surgery and removal of bone and soft tissue, this was followed by 5 months of hospitalization and IV antibiotics, “If it wasn’t for Penicillin, they would have had to amputate my knee.”

Afterwards the patient returned home, going back to his work as a farmer, which required him years of hard work on the fields. He was getting by with his knee pain and worked till 1990 which at that point due to knee pain he was forced to retire. He had an arthroscopy in 1995 and he was recommended against total knee replacement since the prosthesis will not fit due to the damaged bone.

Patient describes pain to be worse when he walks or bends the knee. Pain is mostly located in the middle part of the knee. This elderly male has no other remarkable medical history and is otherwise healthy.

This rarely-seen case illustrates the strength of the knee joint after sustaining a major deformity; patient was able to retain mobility for many years despite extent of damage (as shown in central tibia, second-longest bone in the human body structure surpassed only by the femur).
His X-Ray showed severe osteoarthritis
with deformity and fragments of metal and bullets left behind.

May 5, 2006

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Knee Diaries: Pellegrini-Stieda disease

A 43-year old male presents a chief complaint of knee pain, stating pain in left knee only occurs when walking or knee is overextended. Pain is occasionally nagging, located primarily in upper mid-knee area. Pain has existed only for the past six months, having started immediately after a sudden twist of knee as patient descended a ladder. Patient relates he never experienced knee pain (or even twinge) in knee since skiing accident nearly 20 years previously when he recalls a “nice jump gone bad” — apparent outward push of left foot in wrong direction, forcing left knee to twist.

knee_diary_1
This happened to him on the slopes and he had to be taken to the local Orthopedic Surgeon by means of a stretcher, who made the diagnoses of partial medial collateral ligament tear and recommended RICE (Rest, Ice, Compression , and Elevation). At that point it took about 6 weeks for him to heal spontaneously. He is otherwise healthy and in good shape. His pain responds somewhat to Celebrex. In the past he was a heavy smoker till he quitted 10 years ago, his parents are healthy but he recalls his grandmother to have arthritis of the knees, requiring her to have a total knee replacement.
On exam there was minimal edema or swelling with tenderness to touch to the medial aspect (inner side of the knee). His X-Ray showed Calcification or thickening of superior part (medical lingo: upper part ) of the Medial collateral Ligament, as if it was recalling it’s unwanted memories.
This condition is also known as Pellegrini-Stieda disease.
X-Ray please note the the thickening and calcification of medial collateral ligament, due to a 20 year old ski accident.

Apr 28, 2006

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Progress of science is inevitable – Part II

Sep 13, 2005

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Progress of science is inevitable


Great news for advancement of science; California Gov. Arnold Schwarzenegger encourages passage of legislation to promote stem cell research, he is being supported by U.S. Sen. Dianne Feinstein.

The event took place at UCLA Neuroscience Research center on the campus in Los Angeles Tuesday, Aug. 23, 2005. Politicians and scientists gathered to recommend the passage of legislation.

The legislation would allow human stem cell research to proceed but would ban the cloning of humans.

Photo © Reuters/ R.Galbraith

Discussion:

In USA one of the most controversial subjects in science
is research on stem cells at the same time this seems to
be one of most promising areas in the field of arthritis
and cartilage repair.

Theoretically Stem cells are cells that their future,
faith and function can be chosen by the scientist who
uses them and develop in to functional tissue and cells
in the body for regenerative purposes and it may be
possible, for example, to use them to regenerate cells
for cartilage, meniscus, a disc or tendon or a ligament.

As oppose to the American laws , European countries
specially Italy and England are much more liberal .

The Center for Regenerative Medicine applauds the
efforts of the Californian Governor Schwarzenegger and
the U.S. Senator Feinstein.

Sep 6, 2005

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Subacromion Bursitis

Professional Basketball player veteran presented to the office complaining of bilateral (medical lingo: both sides) shoulder pain, developing mostly after the last season. Pain and weakness is mostly when he lifts up shoulders sideways to pass the ball.

His past medical history is positive for some degenerative joint disease of the knee that the patient received treatment at our center. He is otherwise healthy and takes Glucosamine and dietary supplements.

As a player patient recalls falling several times on the shoulders. On exam patient has point tenderness on the inside front of the upper arm.
Discussion:
There are several muscles and tendons involved in the multidimensional movements of shoulders. The supraspinatus muscle is one of the major muscles contributing to shoulder movements. This muscle is used to lift the arm up sideways and is also important in throwing sports and holds the arm in the shoulder when things such as a basketball is thrown.

Over the tendon (medical lingo: attachment of muscle to the bone is called tendon) is a bursa (small sack of fluid used to help lubricate the moving tendon). This bursa (known as subacromion bursa) can become inflamed in the shoulder causing pain. A heavy fall onto the shoulder typically seen in professional players can result in injuring this bursa.

Aug 18, 2005

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Tuberculosis of The Hip

RK is 54 year old white female from Fiji who was was initially diagnosed with hip pain at the age 7. At the time, she recalls “living at a rural area in a farm with her pain persisting despite various treatments”. Subsequently after several visits to different physicians fluid was aspirated from the hip and sent to a lab, a culture was positive for tuberculosis; Patient received daily injections of Streptomycin for 6 months. By the time treatment started some damage was already occurred. She did OK and got by until 3 years ago when her right hip was replaced using a Birmingham implant, at this point she is looking for an option to salvage her left hip.

Her past medical history is otherwise remarkable for Hypertension, which is under control. She does not smoke and she rarely drinks alcohol. Patient’s chief complaint was that she can not walk too much. She felt weakness in the left hip, she tried to cope with the pain and at times she got some relief from Ibuprofen . Patient used a cane at times. Patient takes different multi-vitamins, Glucosamine as well as Omega3.

Discussion:

After the spine, the hip joint is the most common site of involvement for tuberculosis. Osteoarticular tuberculosis has become very rare in western countries, but it is still a common problem in under developing countries. Since it is so rare, the diagnosis is usually delayed or it is not included in the differential diagnosis of juvenile arthritis.

delay in the diagnosis is an important cause of outcome because of the nature of the hip joint in a growing child. Although the definite diagnosis is provided by identification of the bacillus in the specimens, this is not always possible in childhood. Tuberculosis of the hip must be in the differential diagnosis of a limping child. A detailed family and environmental history for pulmonary tuberculosis, history of tuberculosis vaccination, and a tuberculin skin test should be performed.

Apr 1, 2005

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