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Hip Labral tears

Hip labral tears
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Hip Labral tears
-What does the hip labrum do?
-What does it mean if it’s been torn?
-What are the symptoms to suggest a torn hip labrum?
-Why it matters whether you have a degenerative or acute traumatic Labral tear.
-When should you consider hip labrum surgery.
-When should you consider regenerative medicine treatment options.


Hip Labral tears

Hello, this is Siddharth Tambar, from Chicago arthritis and regenerative medicine. Welcome to our weekly live educational broadcast. It’s September 14th, 2020. Welcome everyone. I hope everyone is healthy and doing well. So on this weekly broadcast, I’d like to discuss common questions that either patients or my own staff has regarding things that we evaluate, treat and assist with here in the clinic. So in this office, we are focused on nonsurgical evaluation and management of arthritis, tendonitis, injuries, and back pain.

So a occasional question that I get is regarding hip labral tears. So I had a patient last week who specifically was asking regarding her hip pain, whether her MRI finding could account for her pain and whether she should consider surgery or not. So what is a hip labrum? So the hip labrum is a thickened connective tissue layer that extends from the cartilage of the hip joint. It surrounds a rim of the acetabulum. It extends a hip joint socket itself. It increases the surface area of the hip joint socket, which then in turn helps to strengthen the hip joint socket. So it’s a really important structure in the hip joint in that it offers stability and adds to the overall strength and function of the hip joint.

So in someone that has an injury to the labrum, what they will experience is pain in the front of the hip, classically in the groin area pain with range of motion and even a possible catching sensation. And certainly pain as a physician is moving your hip around sort of internally and externally rotating the hip.

So what do you do if you have a hip labral tear. There’s really two ways you want to think about this. Number one is, do you have a degenerative tear versus you have a traumatic acute tear? So MRI can tell the difference, certainly your history and description of your pain when it occurred, how it occurred, can help out as well. So if you have a degenerative tear, degenerative tear means an MRI, you can tell that there’s been some blunting or some degeneration of the labrum itself. It’s not an acute tear. It may not even be what’s causing your pain. It’s a finding that you can see in many people that have chronic degeneration of the labrum of the hip in particular hip arthritis, it’s part of the overall wear and tear and stress that you can see in hip arthritis. You don’t want to overreact to that finding on MRI, if it’s a degenerative tear. And the reason why is because as a part of the overall degenerative process, if you overreact to it and you think that’s what’s causing your pain, it may lead you down the wrong avenue in terms of treatment. There’s no evidence that surgically correcting or treating a degenerative hip labrum will help more than physical therapy alone. In addition, there’s no evidence that it will actually help prevent progression of hip arthritis.

So in a degenerative tear, the way you want to think about that, is it’s evidence that there’s chronic stress on the hip. So you want to ask yourself, why do you have stress on the hip? Is it because you have a prior injury, and there’s a little bit of instability from ligaments in the hip. Is it because you have some weakness around the muscles of the hip that’s causing more strain on the hip joint? Is it because you have some instability in the SI joint, which is in the back of the hip, in the buttock area. Or is it because you have a mild pinched nerve in the lower back that’s then causing some weakness in the muscles around the hip, which is then causing more stress in the hip joint and the hip labrum. All of those things can be treated. either through strengthening, such as physical therapy or regenerative medicine treatment, such as utilizing your own platelets or bone marrow stem cells to inject some of the ligaments to actually strengthen the ligaments. If there’s actually pain in the hip joint itself in the groin area, then actually injecting cells into the hip joint makes sense as well. If you have a mild pinched nerve in the lower back, then actually injecting platelets around that pinch nerve can make a difference as well. Those are all effective and appropriate ways to treat a degenerative labral injury.

Actually getting surgery to it does not make sense, and it’s not the right way to do it. The problem with surgery in this case, is if you cut out, soft tissue and tissue, that’s actually helping to protect the joint. You’ve now left that joint to be exposed to more or three changes longterm. So in a degenerative tear, absolutely avoid surgery, absolutely maximize physical therapy and absolutely consider a regenerative medicine treatment.

A traumatic tear is kind of an interesting and other kind of story. So let’s say you’re a 20 year old athletic individual. You injure your hip during a athletic activity, and now you have pain in the hip joint. And let’s say, you’re now told you have an acute traumatic tear of the labrum. Should you go for surgery? It’s kind of a controversial question. So the typical thing that’s done currently is hip labral surgery would be recommended. In some cases they can actually stitch that up back together, but frequently it’s actually shaving down where the tear is. Shaving down where the tear is then does put you at more risk for hip arthritis longterm. You need to be careful about that. It’s a risk and benefit kind of issue that you need to really think carefully about. If you’re a professional athlete that has a acute labral tear and your living at a very substantial level is based on being able to play for another few months to a year or a couple of years. You know, thinking about that kind of risk benefit in terms of dollars might make sense. If you’re a amateur athlete and your goal is to maintain a level of physical activity for more than a decade, I would say rethink whether surgery makes sense. Can you get by with not only physical therapy, but a regenerative medicine treatment to treat this in a nonsurgical fashion so that you don’t remove tissue, that’s really meant to help to protect that joint. If you can do that, you at least in theory, put yourself at a greater likelihood of protecting the hip joint from progressive arthritis by cutting out tissue. A lot of this is more theory and principle based because really we don’t have longterm results when it comes to what happens to a hip labral patient 10 years down the line, if they’ve had surgery versus if they’ve had a regenerative medicine treatment. But at least from a regenerative medicine principle standpoint, avoid surgery, if you can.
Another aspect to this is something that’s talked about a lot by hip surgeons nowadays is femoral acetabular impingement. It’s a concept that if you have a slight bony outgrowth on the femur part of the hip, that or bony outgrowth on the acetabular part of the hip, that can you be more prone to hip labral injuries because there’s a little anatomical defect. And so surgically they will come in the, like you shave down that bump. Does that make sense? In some cases it might, if you have catching. If you have the right kind of clinical scenario, a young person that’s presenting with this kind of issue. In a lot of people though, it gets diagnosed when they’re older and I’ve seen patients who are 35 plus 40 plus, who’ve been told that they may have femoroacetabular impingement. That doesn’t make quite as much sense. You need to be careful. That’s someone who’s likely had that anatomic defect on x-ray going on for decades. That’s not the cause of his hip pain. It’s more degenerative process in the hip. So in some people it may make sense to consider that surgery. Again, I would always caution if you’re thinking about surgery, ask if there’s nonsurgical methods, including regenerating medicine treatments that maybe significantly effective in keeping you active, that does not have the higher, longer term risk of surgically removing something. It’s important to understand that while surgery may be able to get you to x-ray picture that you’re looking for, it may not necessarily get you the pain relief and functional improvement that you desire longer-term. Those are different things. And the musculoskeletal system is not always just, how does it look on an X Ray? It really is very much how are you doing pain and function wise? So try to maintain your own anatomy if possible.

In my patient’s case, 35 year old woman, one pregnancy in the past, who’s had some SI joint instability symptoms, some pelvic pain in the past related to that as well while she does have some groin pain, on her MRI what’s being described is a degenerative tear of the meniscus, excuse me, of the labrum, which I believe is due to chronic stress on that part of her hip due to chronic instability in her SI joint. In addition, my recommendation for her was to avoid surgery. Note that she did not have significant pain while actually moving her hip on examination. And I think she’s someone who would do well with the regenerate medicine treatment. She does not have significant damage to her hip joint yet. And if we can avoid surgery in her case, she’ll be better off longterm.

Great. Well thank you for your time. I hope everyone stays well. As a reminder, we’re doing this live stream twice per week, Mondays and Wednesdays, open and interested in hearing your questions. In addition, I’m doing a webinar this Wednesday 5:00 PM central standard time. I’ll put a link down below on any social sites that this gets posted on, where I’ll be talking about the truth behind regenerate medicine. What are realistic expectations, what can be treated, what can not be treated? How do you know if you’re getting a good quality treatment and being treated by an appropriate physician and clinic and how to avoid people who don’t know what they’re doing. Until next time, have a good day and live well. Bye bye.


Content- Weekly Education
Live Weekly educational meeting for the team at Chicago Arthritis and Regenerative Medicine where we discuss the basics of what we do for arthritis, tendinitis, injuries, and back pain.
Watch live on FB/IG/Youtube every monday.
https://www.Instagram.com/ChicagoArth…
https://www.Facebook.com/ChicagoArthr…
https://www.youtube.com/c/chicagoarth…

***For more educational content:
Sign up for our email newsletter:
https://www.chicagoarthritis.com/news…

See our blog:
https://www.chicagoarthritis.com/blog/

Listen to the Regenerative Medicine Report podcast:
https://www.chicagoarthritis.com/rege…

***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
Determine if you are a Regenerative Medicine treatment candidate:
https://www.chicagoarthritis.com/rege…

Contact us for more information or to schedule an appointment:
https://www.chicagoarthritis.com/cont…

MEDICAL ADVICE DISCLAIMER: All content in this message/video/audio broadcast and description including: infor­ma­tion, opinions, con­tent, ref­er­ences and links is for infor­ma­tional pur­poses only. The Author does not pro­vide any med­ical advice on the Site. Access­ing, viewing, read­ing or oth­er­wise using this content does NOT cre­ate a physician-patient rela­tion­ship between you and it’s author. Pro­vid­ing per­sonal or med­ical infor­ma­tion to the Principal author does not cre­ate a physician-patient rela­tion­ship between you and the Principal author or authors. Noth­ing con­tained in this video or it’s description is intended to estab­lish a physician-patient rela­tion­ship, to replace the ser­vices of a trained physi­cian or health care pro­fes­sional, or oth­er­wise to be a sub­sti­tute for pro­fes­sional med­ical advice, diag­no­sis, or treatment. You should con­sult a licensed physi­cian or appropriately-credentialed health care worker in your com­munity in all mat­ters relat­ing to your health.

***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses treatment for hip labral tears.

 

Uncertainty in Life and Medicine

dealing with uncertainty
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Weekly Live broadcast replay 20200805

Uncertainty in life and medicine.

Strategies and examples
-Focus on what you can control.
-Accepting uncertainty.
-Focus on your big principles.
-Trusted sources

Also covered a new study showing treatment with canakinumab a il1 blocking medication can possibly help prevent progression of osteoarthritis.
Discussion on how IRAP, PRP, and Bone marrow derived cells can do so as well without medication risks.

Chicago Arthritis and Regenerative Medicine Weekly Live broadcast.
Check us out live on Instagram, Facebook, or Youtube every Wednesday at 12:15pm cst.
Discussing relevant issues regarding state of the care for arthritis, tendinitis, injuries, and back pain.
https://www.Instagram.com/ChicagoArthritis
https://www.Facebook.com/ChicagoArthritis
https://www.Youtube.com/c/chicagoarthritis


– Hello, everyone. This is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. This is our weekly live, live broadcast. Welcome, it is August 5th, 2020. On this broadcast, essentially I’m discussing topics and professional aspects that are relevant and interesting to me. Here at Chicago Arthritis and Regenerative Medicine, we are focused on evaluation and treatment of arthritis, tendonitis, injuries, and back pain with a real focus on utilizing nonsurgical treatments and the most up-to-date and interesting treatments that are currently available to treat not only pain and improve function, but to really treat the root cause of what’s driving these conditions. So there’s two topics I’m talking about today. The bigger one is uncertainty because I think that is just huge right now. But before that, I wanted to briefly go over a recent article that was published in the articles, on the Annals of Internal Medicine yesterday. It’s sort of a hot-off-the-press sort of topic that I think is interesting that I want to give a very brief but relevant commentary on. So essentially the title of the article is Effects of Interleukin-1B Inhibition on Incident Hip and Knee Replacement. It’s a ridiculous name, but it’s being sort of presented as, hey, finally, a medication that will prevent the progression of osteoarthritis and relevant because we have other treatments for things like rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, where medication will actually prevent the progression of those conditions. And we don’t really have a medication for osteoarthritis that can do the same thing. So in this study, they looked at a medication called canakinumab, which specifically blocks a molecule called interleukin-1B, and it’s currently approved for rheumatoid arthritis. Canakinumab is approved for systemic juvenile rheumatoid arthritis or juvenile idiopathic arthritis. And it’s also approved for a very small subset of some other inflammatory conditions called caps CAPS, C-A-P-S. And in this study, they actually looked at patients that in a bigger study, they looked at the patients who have had a history of heart disease and have mildly elevated inflammation levels. And they wanted to know if utilizing this medication would prevent other heart disease. So this followup sort of subset of this study was to look at 1,000 of those patients. And they wanted to see if the patients who are on this medication would actually, it would actually do anything else from a osteoarthritis standpoint. And they found that for patients who are on this medication, as compared to patients who were just taking placebo, they had a much lower rate of progressing to knee replacement surgery or total hip replacement surgery. And so it’s presented as, wow, look at this, finally a medication that is disease-modifying for osteoarthritis. And it’s interesting. It’s very early. There still needs to be much larger studies and more dedicated studies from the osteoarthritis standpoint. And the whole point is that it’s blocking this molecule called interleukin-1. And that’s interesting because here is possibly a biologic way to actually prevent the progression of osteoarthritis. Super interesting. And it’s curious that the medication can do it, but it’s worthwhile understanding that this sort of medication has potential risks, and there may be other treatment options, and I’ll discuss that, that can do the same thing. So the potential risks of this kind of medication are, the main one is infection risk, that it increased the risk of infection. And that’s significant because you need to balance the risk of infection with the possible benefit of what this treatment is trying to do. And you’d have to be careful about suddenly utilizing this in a wide spectrum and like millions of people who’ve had osteoarthritis, especially if there’s some other treatment options that are lower risk. So the options that are lower risk are to utilize your own blood platelets and bone marrow graft stem cells to actually treat osteoarthritis. And the reason why is because those same treatments from your own blood and body and bone marrow do actually block interleukin-1 receptor antagonist protein. So it does the same effect, but because you’re utilizing your own cells, you don’t have that same risk of infection, that same risk of allergic reaction. And anytime you’re measuring risks and benefits, you need to say, what are the potential risks? And can I get the same benefit in a lower-risk fashion? And in this case, you possibly can. Now there’s no head-to-head trials of saying, utilizing your own cells versus this medication. That’s still very early. But it’s worthwhile understanding that while there may be some benefit here to this medication, you can get a similar, if not same effect, in a much lower-risk fashion utilizing your own cells right now. And so my sort of hot-take or initial take is very interesting that there there’s maybe some progress on looking for disease-modifying medications for osteoarthritis. It’s always good to have additional options, but understand that there’s existing options that already work in that same kind of mechanism where we know it’s definitely safer. Okay, so the bigger topic for the day I wanted to discuss is the concept of uncertainty, obviously with a focus on the medical side and a focus on musculoskeletal health and stuff like that. But uncertainty is the topic of the day. It’s just too big of a topic to ignore. I mean, I can’t just talk about joint and tendon issues and not sort of address what are the things everyone’s thinking about, uncertainty, meaning uncertainty with COVID, uncertainty with what are people doing if they want to go back to the gym, uncertainty when it comes to sending your own kid back to school. Obviously, my wife and I are thinking about that a lot in terms of what’s right for our own family and our own child in terms of going back to school, knowing that most schools really don’t, don’t know how to address this. I mean, this is a once-in-every-couple-100-years kind of event. And obviously the modern school system is not exactly made for that once-in-a-several-lifetime event. And there are a number of things that I think about when it comes to uncertainty and obviously seeing patients, and they’re all going through those same issues and thinking about those same concerns. Here’s kind of how I think about it. There’s sort of four different things that I’m going to give examples of of how to address kind of each one of these. But, you need to focus on what you can actually do something about. You need to be able to accept uncertainty, focusing on big principles, and you need to know what are trusted sources. And the examples I’m going to discuss are going to involve COVID-19, in addition, uncertainty in everyday decision-making, as a physician how I look at some of the uncertainty associated with musculoskeletal conditions, whether it’s things like inflammatory arthritis or even routine things like lower-back or knee issues, and how you think about imaging findings as well. Because uncertainty is present in all of these things. So first and foremost, I think it’s so essential to focus on what you can actually control. As an example, so we’re starting to realize that post COVID infection, there’s likely some chronic inflammatory issues that may be present a few months later, and obviously a lot of people are still symptomatic. We’re starting to see some of those patients. And there was a small study that came out of Germany a couple of weeks ago where they found that even two to three months after the initial infection, that a significant number of people in this small study still had evidence of inflammation around the heart, objective inflammation, either lab tests, MRI evidence. And that was regardless of how severe their COVID infection was, whether it was mild, moderate, or severe. So relevant because that same inflammation can be present in other parts of the body as well. And so I’ve had certainly one patient in particular recently who came in with all sorts of pain symptoms and fatigue symptoms after she’d had a COVID infection diagnosed a couple months ago. And it’s challenging because you’re looking for objective evidence of active inflammation that needs to be treated. And in her case, while she has slightly elevated labs, her imaging and exam don’t really show that. And so you’re in that sort of gray zone about, you want to treat this appropriately because this is likely related to her prior COVID infection, meaning the immune system is still revved up. She’s not any longer infected, but her immune system is still revved up and still causing inflammation. And yet how aggressively do you treat this is not clear. In addition, we’re not even sure what the full scope of post-COVID will be, how long does that last, and what’s the right way to handle that. There’s a lot of uncertainty to that. And for that individual that’s dealing with that, that’s super difficult and obviously very challenging when you’re being told that, listen, you have likely something, but we need to be realistic with how we’re going to treat this. And we need to be realistic to understand that there’s a lot of uncertainty here and that there isn’t really definitive guidance as to how to treat this. So let’s focus on what you can control, meaning here’s someone who’s had to pull back in a lot of exercise activity because of symptoms. Well, that will not only perpetuate her pain. It’s obviously affecting her sort of overall emotional and mental wellness as well if she went from doing significant physical activity five days out of the week and now doing none. Well, let’s get back into some physical therapy. Let’s let them start to kind of promote some of that kind of muscle firing, load bearing, get you back into doing some low-impact exercise. They can use some modalities like electrical stimulation, massage, maybe dry needling, just to help with pain as well. Let’s get back into something like that. There’s something that you can do something about. Let’s make sure you’re doing the right stuff from a nutrition standpoint, from a supplement standpoint. Optimize what you can control. It may not be 100% in terms of controlling your symptoms, but let’s at least maximize what we can control on your own without having to resort to medication, stronger treatment options as well. Focus on what you can control. Number two is focusing on big principles. So every single day, right, when I see patients, there’s uncertainty in terms of diagnosis, in terms of treatment options, in terms of what’s the next right step. And a lot of times, you just have to rely on what are your big principle understanding for the overall condition, the way the body works, in order to help make some decisions. So, as an example, inflammatory arthritis, early rheumatoid arthritis, is it really meet the criteria, does it not meet the criteria? You sometimes don’t get exact definitive diagnoses in medicine. And a lot of times, you need to use your best clinical judgment based on what you understand and have seen in the past, based on subtle findings that you might see on exam. For me, utilizing musculoskeletal ultrasound to find some subtle findings to help really push somebody into the right diagnostic criteria, it goes a long way. But a lot of times it is, in times of uncertainty, you still need to find and utilize those big principles, that if somebody has inflammation, their ultrasound findings will tend to look like this as opposed to degenerative arthritis and may look like that. That’s a big principle that helps to guide me in terms of my decision making. And that goes a long way to helping to make a right decision. Another example would be, I mean, knee and lower back degenerative arthritis is endemic. Like 70% of the population will have one of those issues or, if not higher, in their lifetime. And a lot of times people come in with pain symptoms, and their imaging may show a lot of findings. Their X-ray may show advanced arthritis in their knee, or their MRI may show tons of different things. And clinically you realize that not all of that correlates with their pain or their symptoms. And you have to utilize good principles of exam, understanding of the pathology, to really help guide people. As an example, the example I love to give for hips where it can be a little bit confusing is for my own mother. She’d had chronic hip pain for decades, and she’s had some imaging of the hip that actually showed some degree of wear-and-tear arthritis. But after a proper examination and figuring it out, it turned out her pain was really coming more from her SI joint, and her SI joint doesn’t have a ton of imaging findings. But clinically, based on my clinical experience, exam, and even treatment, we figured out that her pain was really coming from the SI joint. And focusing treatment on that has got a humongous way to treating her hip pain. And so even though her imaging may have said one thing, clinical understanding of how pathology works and how a condition presents, those big principles, helped to guide me in terms of making the right kind of medical decision and treatment decision in her case and in other cases as well. I think that same kind of concept applies to big principles in life as well. So, as an example, deciding, you know, what sort of activities do you put your kid back into, you don’t need to make reactive, scared decisions. You do need to make sensible, commonsense ones, things that are based on your own prior experience and principles that you live by. Apply those to the challenges and uncertainty of the day. It’s not going to be 100%, but it’ll at least help guide you to make the right kind of decisions that are going to respect your own beliefs and do the best that you can for your own family. Focus on big principles I think is a huge one in times of uncertainty because that’s how you stay on the right path. The third one is really accepting that uncertainty is, that is what life is. And it’s hard because right now, we went from a world that we were used to. And now there’s a humongous amount of uncertainty about what is happening in the fall for kids’ schooling, uncertainty in terms of what can you do for the normal kind of events in your life, going to weddings, going to the gym, going to restaurants, meeting friends, all that kind of stuff. And yet I think it’s important to understand that as human beings, we’re literally built for this kind of uncertainty. If you go far enough back in anyone’s family lineage, you’ll find people who went through a high degree of chaos, uncertainty, and troubled times. And the reality is that, as hard as right now is, there’ve been times in human history where people, our own family members, have had to go through things that are dramatically worse. We are built for this physically, mentally, emotionally. It’s hard, but we are really built for this, to be hardy and adaptable, to take these kind of things on. And I think that that understanding of uncertainty that that’s what life is, is helpful for not only on an individual level, but understand that even on a macro level, in terms of how science works, how medicine works, that uncertainty is part of the process. And so it’s frustrating for a lot of people to hear the CDC give guidance, one thing, or doctors saying one thing about maybe this medication works, maybe do this, maybe wear masks, don’t wear masks. And then later on, they change it up. But the reality is that’s how science and that’s how medicine works. It works based on understanding to the best of your ability what is going on now, and as more information comes in, to then adapt and change to what the new information is. That’s literally how science works. And while it may be unsettling for people to hear that, the reality is that uncertainty is part of the strength of the system, that it adapts to what the new information is. It considers what it already understands, but then adds on and layers on that new information. And the better people understand that that’s how science works, that’s how medicine works, it’s not static, it’s dynamic, it’s learning, it’s growing and understanding, I think people will feel a little bit better in terms of the advice and guidance that they’re hearing from authorities and their physicians. The last thing is you need to have trusted sources. You need to be really clear what people, organizations, news sources can you trust and that you should rely on. We live in a world where it’s great to have so much information, but there’s just so much noise. It’s overwhelming to hear the discordance in terms of what people are thinking and talking about. You need to be able to judge who you trust so well. That’s no different than how it was pre-COVID. It’s just now there’s so much noise. You really need to be very clear what physician do you trust. What higher authority organizations on a medical level do you trust? What policy organizations and other sources do you trust? Understand that they may not always be right. I think one way that you know you’re dealing with a legitimate organization or person is, are they willing to admit when they’re wrong, and when they’ve made a mistake. When can they admit that my prior belief and understanding was this way, and as information has adapted and changed, now I’m thinking this. That sort of humility is very important. And understand that when it comes to things like science and medicine, you really should trust science, scientists and doctors who are actually experts in their field of study rather than trusting necessarily political sources, other news sources, but actually trusting people who are experts at what they’re doing. So, expertise is helpful, but a sense of being humble and humility when they’re expressing that, and a dynamic process of adjusting that information as things go along because the reality is circumstances change in life. Understanding changes as well, and you know a trusted source is on it when their opinions slowly adjust over time, not someone who’s changing every week or every day what they’re recommending, but somebody who, as they gather more information, can give you more updated, sensible understanding of what you should be thinking and doing. So to me, those are the big things. Uncertainty is difficult at this time, but the same rules apply pre-COVID as they do right now. Understand that there are things that you can focus on, and that’s what you should really be focused on, the things that you can control. Number two, having a big picture understanding of how you approach life and relying on those when times are more difficult. Number three, accepting that uncertainty is part of how life is. And then lastly, making sure you have good trusted sources that can guide you during this process as well. Until next week, I appreciate your time. As a reminder, we do this twice per week, Mondays and Wednesdays. Until the next time, have a good day, be well, live well, bye bye.


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Chicago Arthritis Blog

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***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
Determine if you are a Regenerative Medicine treatment candidate:

Candidate Form

Contact us for more information or to schedule an appointment:
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MEDICAL ADVICE DISCLAIMER: All content in this message/video/audio broadcast and description including: infor­ma­tion, opinions, con­tent, ref­er­ences and links is for infor­ma­tional pur­poses only. The Author does not pro­vide any med­ical advice on the Site. Access­ing, viewing, read­ing or oth­er­wise using this content does NOT cre­ate a physician-patient rela­tion­ship between you and it’s author. Pro­vid­ing per­sonal or med­ical infor­ma­tion to the Principal author does not cre­ate a physician-patient rela­tion­ship between you and the Principal author or authors. Noth­ing con­tained in this video or it’s description is intended to estab­lish a physician-patient rela­tion­ship, to replace the ser­vices of a trained physi­cian or health care pro­fes­sional, or oth­er­wise to be a sub­sti­tute for pro­fes­sional med­ical advice, diag­no­sis, or treatment. You should con­sult a licensed physi­cian or appropriately-credentialed health care worker in your com­munity in all mat­ters relat­ing to your health.

***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses dealing with uncertainty in life and medicine.

Weekly Educational Broadcast- 20200727- Can regenerative treatments help in bone on bone arthritis?

weekly education 20200727

img

Weekly Educational- 20200727- Replay
Can regenerative treatments help in bone on bone arthritis?
Importance of variables such as age, range of motion, which joint is affected, and patient goals of treatment.
Importance of stability, alignment, inflammation, and optimizing cellular health of the affected joint.
Cases- Hip, Knee, Ankle examples.

Content- Weekly Education
Live Weekly educational meeting for the team at Chicago Arthritis and Regenerative Medicine where we discuss the basics of what we do for arthritis, tendinitis, injuries, and back pain.
Watch live on FB/IG/Youtube every monday.
https://www.Instagram.com/ChicagoArth…
https://www.Facebook.com/ChicagoArthr…
https://www.youtube.com/c/chicagoarth…

***For more educational content:
Sign up for our email newsletter:
https://www.chicagoarthritis.com/news…

See our blog:

Chicago Arthritis Blog

Listen to the Regenerative Medicine Report podcast:
https://www.chicagoarthritis.com/rege…

***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
Determine if you are a Regenerative Medicine treatment candidate:
https://www.chicagoarthritis.com/rege…

Contact us for more information or to schedule an appointment:
https://www.chicagoarthritis.com/cont…


Hello, everyone. This is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine, and welcome to our weekly educational broadcast that is live. It’s July 27th, 2020, and thank you for joining me today. So, on this weekly broadcast I focus on questions that my own team and patients are frequently asking, or from the past week, and applying that to cases that I’ve seen in the last week to give some perspective and go over kind of big picture principles in terms of what we’re doing here at Chicago Arthritis and Regenerative Medicine, where our focus is on evaluation and treatment of arthritis, tendonitis, injuries and back pain, with the most cutting edge treatment options available that are low-risk and high in terms of benefit. So, a question that Jackie from my office kind of transferred over to me from a patient, or a potential patient, was can regenerative treatments help in bone on bone arthritis? A really super common question, and the intention is that this is likely someone who is seeing their physician, either orthopedic surgeon or primary care doctor, and has been told that on their x-ray they have significant arthritic issues, and have been told that they have bone on bone arthritis, and that they may not be, that they may only be a candidate for a replacement surgery or some other kind of similar treatment protocol. And really common question that comes up, because the reality is that most people, when it comes to their musculoskeletal health generally are approaching it as something that they’re really only addressing when things have progressed to a severe stature, and obviously it’d always be helpful if you can catch this at an earlier stage. But the reality is there’s nuances to when we say someone has bone on bone arthritis. To begin with, it depends on what joint’s affected, it depends on the range of motion, and it depends on what the goals are of treatment. So, range of motion is a big one in the sense that if range of motion is still intact, or still fairly good, you have to ask, “What exactly do we mean by bone on bone?” If you’re really, truly bone on bone, you really shouldn’t have regular range of motion, and an example of that would be someone who has significant hip arthritis and can’t really move the hip, let’s say inward, or internal rotation. On the other hand, you can have someone that has really advanced or severe arthritis of the knee, and their range of motion is still close to intact or still very good. And so it’s important to understand that sometimes what we see in x-ray does not necessarily translate to what’s actually happening to that individual, and may not necessarily be fully representative of what the problem is. So, a classic example of that is someone who has, let’s say pain in one knee, let’s say their right knee, and their x-ray shows advanced arthritis, and they also happen to have an x-ray of the left knee, and it turns out the x-ray of the left knee actually looks worse than the right knee, and they don’t actually have any pain in the left knee. And it’s a great example of where imaging or x-rays don’t always call out the full, don’t always tell the full story. And it’s important to understand that x-rays and imaging can tell you one thing, but they don’t give you the full story. The other aspect to that is, let’s say somebody’s had an MRI and shows significant findings. Now their pain, someone that has a degenerative process, their pain does not only come from what you see in the cartilage wear, they have pain that’s coming from the bone, from the soft-tissue structures, they have pain that’s coming from various other areas as well, and so these are other areas that can still be treated. And range of motion is a big one because if your range of motion is still intact, it likely indicates that you can still benefit from treatment. The other part of that is also what joint is affected. So, it’s super common that I hear patients who’ve got knee arthritis say that, hey, they have bone on bone knee arthritis, or they’ve been told that, and can these treatments help? And the reality is that the evidence out there for platelet-rich plasma and bone marrow derived stem cells is that wear and tear arthritis in the knee, that even when it’s advanced that people can still get a good degree of pain relief and functional improvement. In fact, there is suggestion that degree of arthritis when it comes to the knee does not make a difference in terms of the ability to have improvement in symptoms. Now, the flip side is if somebody has more advanced hip arthritis where range of motion is gone, then that’s a more challenging category, and that’s someone who likely is a better candidate for let say, hip replacement surgery. So, it does matter which joint is affected, and it does matter, range of motion as well. So, those are really the two big things. Then I think the last thing is what are the goals of treatment that are being pursued. So, in someone that has bone on bone arthritis, we can still help in the following ways, we can help with stability, we can help with chronic inflammation, we can help with alignment, and we can help by improving and optimizing the cellular health of the joint. All of those things can be done non-surgically. They can be done either utilizing just good strengthening exercises, weight loss, over the counter supplements, bracing, and also regenerative medicine treatments, including platelet-rich plasma, bone marrow derived stem cells, adipose micro-fragmented cells, and even dextrose prolotherapy. All of those things can actually be helpful, when your goal is pain relief and functional improvement, and that’s because we can help in those other aspects, we can help with stability by strengthening the soft tissue structures, with strengthening exercises, not to mention with the regenerative medicine treatments, we can help with inflammation with over the counter supplements, dietary changes, and there’s also benefit from the regenerative medicine treatments when it comes to reducing inflammation longer term. Alignment can be improved with physical therapy and bracing, and optimizing the cellular health, meaning you take a joint where the cells are chronically damaged and no longer functioning well, you can get them to function better by injecting the right kind of cells in there. Bone marrow aspirate concentrate has mesenchymal stem cells, and the growth factors within that as well can help to stimulate the local cells in the joint that had been damaged. Optimizing the cellular health along with those other factors can help with pain relief and functional improvement. So, if the goal is improving pain and function, then even if you have bone on bone arthritis, in the right occurrences and in the right patients, you can still get those kind of outcomes. So, a couple of patient examples from this past week where I think that’s all very relevant. So, the first is a woman who is in her early 70s, she is still an active nurse, she actually works in a hospital where she’s actively kind of running things, and she’s very active, walking, almost running around just because it’s so busy, and she’s developed pain in her left hip. So, her range of motion is still intact, the issues in her case are, number one, what’s her degree of arthritis, because we know in someone, when it comes to hip arthritis in particular, as they get older they become a harder and harder candidate with these kind of treatments. And so it’s going to be important to get the right kind of imaging, meaning an MRI to figure out, along with her symptoms, which is pain in the groin in front of the hip, that is she a proper a candidate. And if her MRI shows that she’s got mild to moderate arthritis, and her range of motion is still intact, then despite her age, she’s someone who could still benefit from treatment. On the other hand, if her hip MRI shows more advanced arthritis and she’s really at the tip of really kind of progressively getting dramatically worse, then anything from the regenerative medicine treatment standpoint might be more short term oriented, might be able to help with some of the soft tissue kind of strains and pains that can occur in the degenerative arthritis, but she may be someone who’s headed towards hip replacement faster. So, in that case, telling whether somebody is quote-unquote, “bone on bone,” will make a big difference. Another example would be a woman who I’ve seen kind of for the last, I think seven years, and she intermittently, we’re treating, you know, maybe a hip, a knee, an ankle, a lower back over the last seven years, probably three or four times we’ve treated something or another. And in her case, she really does have pretty significant knee arthritis. What’s been described on x-rays as bone on bone. And she’s someone where her range of motion is still intact, she’s still very highly physically active, still in good general health, and she’s someone who with just platelet-rich plasma has done great. Even though her x-ray shows, you know, bone on bone, she’s someone who, because we’ve been able to help with stability, chronic inflammation, alignment, and optimizing the health of the joint, we’ve been able to give her, really, a great degree of pain relief and functional improvement over the last several years. And a contrast to, let’s say a hip patient, where someone who can still do really, really well. The last one is a patient of mine who I treated four years ago, he has a pretty bad ankle. And he’s someone who has a baseline pseudo-gout, and so he’s had chronic inflammation that caused bad damage in his ankle, and by the time he came to me, he had, you know, what’s been called bone on bone arthritis in the ankle, and that’s very legitimate. He had limited range of motion in the ankle, and he’s someone who I would say is a very challenging candidate for treatment. He had originally bone marrow aspirate concentrate, utilizing his own stem cells from the bone. As well as platelet rich plasma to treat the ankle joint, and he’s done quite well actually in terms of pain relief and functional improvement. He’s had a 70% improvement in terms of pain. He’s been able to reduce his chronic anti-inflammatory medications. And he’s generally done very well. He’s someone who I would say was a very hard candidate for treatment, very challenging candidate, but because we’ve been able to help with all those other variables, improving stability, inflammation, alignment, and really optimizing the health of the joint, he’s had a good result. Someone where traditional treatment or traditional approach would say this is a challenging candidate because it’s bone on bone, but someone who because we’ve taken a comprehensive approach to treating it, and that means treating not only the joint that is damaged, treating the bone that is chronically swollen, treating the ligaments that are chronically lax and unstable, and treating even some of the nerves around the leg, and the ankle, and the lower back has given him better pain relief than he had expected, or that his imaging would really predict. And that’s really the key. Make sure you’ve got the right diagnosis, make sure you’ve got the right understanding of the severity. Make sure you’ve got the right comprehensive treatment approach, and make sure your goals of treatment are aligned with what the patient’s goals are. And if so, you can take somebody who still has bone on bone arthritis, and still give them a good result in the right cases. Great! Well, thank you for your time. Until next week, I hope everyone does well. As a reminder, we do this live event on Mondays and Wednesdays. This Wednesday is my live-live event, I may have a guest on with me, and we’ll have some conversations about some exercise and physical therapy related issues when it comes to arthritis, and issues related to the aging athlete. And I look forward to that conversation. Until then, have a good day and live well. Bye-bye!


MEDICAL ADVICE DISCLAIMER: All content in this message/video/audio broadcast and description including: infor­ma­tion, opinions, con­tent, ref­er­ences and links is for infor­ma­tional pur­poses only. The Author does not pro­vide any med­ical advice on the Site. Access­ing, viewing, read­ing or oth­er­wise using this content does NOT cre­ate a physician-patient rela­tion­ship between you and it’s author. Pro­vid­ing per­sonal or med­ical infor­ma­tion to the Principal author does not cre­ate a physician-patient rela­tion­ship between you and the Principal author or authors. Noth­ing con­tained in this video or it’s description is intended to estab­lish a physician-patient rela­tion­ship, to replace the ser­vices of a trained physi­cian or health care pro­fes­sional, or oth­er­wise to be a sub­sti­tute for pro­fes­sional med­ical advice, diag­no­sis, or treatment. You should con­sult a licensed physi­cian or appropriately-credentialed health care worker in your com­munity in all mat­ters relat­ing to your health.

***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses whether regenerative treatments can help in bone on bone arthritis.

Weekly Education Broadcast- Replay 20200720

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Weekly Education Broadcast- Replay 20200720
-Bone Spurs, when are they significant?
-Instability and Regenerative medicine.
-Cases where bone spurs are not significant and can just be followed.
-Cases where treating can be helpful- calcific tendinitis, tendon impingement.
Instability, Calcifications, and When are bone spurs significant.

Content- Weekly Education
Live Weekly educational meeting for the team at Chicago Arthritis and Regenerative Medicine where we discuss the basics of what we do for arthritis, tendinitis, injuries, and back pain.
Watch live on FB/IG/Youtube Monday at 915a cst.
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MEDICAL ADVICE DISCLAIMER: All content in this message/video/audio broadcast and description including: infor­ma­tion, opinions, con­tent, ref­er­ences and links is for infor­ma­tional pur­poses only. The Author does not pro­vide any med­ical advice on the Site. Access­ing, viewing, read­ing or oth­er­wise using this content does NOT cre­ate a physician-patient rela­tion­ship between you and it’s author. Pro­vid­ing per­sonal or med­ical infor­ma­tion to the Principal author does not cre­ate a physician-patient rela­tion­ship between you and the Principal author or authors. Noth­ing con­tained in this video or it’s description is intended to estab­lish a physician-patient rela­tion­ship, to replace the ser­vices of a trained physi­cian or health care pro­fes­sional, or oth­er­wise to be a sub­sti­tute for pro­fes­sional med­ical advice, diag­no­sis, or treatment. You should con­sult a licensed physi­cian or appropriately-credentialed health care worker in your com­munity in all mat­ters relat­ing to your health.

***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses bone spurs, when they are significant and when not, and when to treat.

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Weekly Live Live broadcast replay 20200715

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Weekly Live Live broadcast replay- 2020/07/15
-Covid19
Rising numbers in the country, stabilized numbers here locally.
Staying focused on prevention.
Vaccine.
-Cases
Different sorts of patients, different expectations of regenerative treatments.
Case 1: Young man with shoulder instability.
Case 2: Advanced knee arthritis.
Case 3: Advanced hip arthritis.