It’s said that if you’re a hammer, you view the world as if everything is a nail. The problem with this approach in medicine is that it leads to a one size fits all approach to patient care. It leads to unnecessary procedures and worse outcomes.
An alternative approach is to have multiple tools, and use them expertly to treat people with nuance and as individuals. For pain related to arthritis this means considering treatment of structural joint damage, lax ligaments that support the joint, weakened tendons/muscles that support and power the joint, and the nerves that provide sensation to the area affected. These require a diverse set of tools and experience knowing when and how to use those tools.
I frequently see people who tell me they have cartilage degeneration causing their pain. They generally have been recommended either arthroscopic surgery to shave down the cartilage or replacement surgery to cut out the joint. These treatments focus on one component that may be contributing to pain, but ignore the other components. No wonder these treatments are recommended to so many people- if you’re a hammer, the whole world looks like a nail.
A more thoughtful approach to care in this scenario is to evaluate the patient with an open mind, and actually treat all the components that lead to pain in this particular case rather than just using the one tool available to that sort of physician. Appropriately selecting candidates for treatment, treating all pain generators, and using the multiple different tools available is a better approach. Prolotherapy, Platelet rich plasma, and Bone marrow derived stem cells are all useful regenerative tools in the treatment of arthritis and tendinitis.