Announcer:
Are you living in pain? Is it joint pain or muscle pain? If so, stay tuned.
Welcome to Living Pain-Free with Dr. Marc Darrow, MD, and Dr. Thomas Grove, DO, from the Stem Cell Institute in West Los Angeles.
Dr. Darrow is a medical doctor and uses stem cell and platelet-rich plasma therapies. He teaches about the use of stem cells, PRP, and Prolotherapy.
Dr. Grove is a regenerative medicine specialist and an expert in ultrasound-guided injections, with extensive experience as an athlete and strength and conditioning coach.
To speak with Dr. Darrow and Dr. Grove, call 866-870-5752.
Ask for a copy of Dr. Darrow’s book, Stem Cell and Platelet Therapy: Regenerate, Don’t Operate.
Now, here’s Dr. Thomas Grove.
Dr. Thomas Grove
Hello, everybody, and welcome back.
You’re listening to Living Pain-Free, and I’m your host, Dr. Thomas Grove. I’m a board-certified physician and sports medicine fellowship-trained.
My passion in life is getting you back in action—getting you back on the field, back on the court, back to your daily walks, and back to work.
If you’ve got any musculoskeletal issues—maybe a ligament strain, tendon strain, muscle strain, arthritis in the joints, or a rotator cuff tear in the shoulder—many musculoskeletal injuries these days can be addressed more conservatively with something called regenerative medicine.
Regenerative medicine is designed to help regenerate tissue and promote the body’s natural healing process. Our big goal is to get you back to business without relying on pain pills or invasive surgery.
One of the alternatives we have today is using injections. We can take your body’s own healing components, such as platelets and stem cells, and inject local structures under image guidance to help promote the healing process.
If you have an area of pain, obviously you want to try to go conservatively where you can, and regenerative medicine is one of the tools available to us.
If you want to talk about your pain, you can speak with me live in the studio at 866-870-5752.
If you’re ready for a free consultation over the phone with our staff, call 800-300-9300.
You can also visit our website to listen to recordings of the radio program, find educational content, and contact us.
We’ve received a lot of great emails, and I want to cover several of them today.
Do You Really Need Ultrasound Guidance for Regenerative Medicine?
The first email reads:
“Hey, Dr. Grove, I hope you can help. I spent a lot of money on stem cells at another clinic with no results, but they didn’t use any ultrasound. Do you really need image guidance for these kinds of procedures?”
When we’re dealing with regenerative medicine, we want to be very specific about where we’re delivering these treatments.
If you’ve got knee pain, for example, some providers perform what we call a blind or landmark-based injection. They’re essentially estimating where they want the injection to go, giving one injection, and calling it good.
But we have to get back to basics.
When someone has an area of pain, we need to perform a good hands-on physical examination. It is vital.
As complicated and advanced as medicine has become, we can’t lose sight of the basics. We need to examine the tissue, determine the location of the pain, and identify which movements or stresses reproduce the symptoms.
We also frequently talk about tissue laxity, or excessive stretchiness of tissues.
Around the knee, for example, there are ligaments connecting the thigh bone, shin bone, and structures around the kneecap. These connective tissues provide structural support to the entire joint.
If I simply perform one injection into the knee joint, I may be missing the problem if the knee is also experiencing ligament laxity.
We need to determine which areas need to be addressed and accurately target them.
That’s where ultrasound becomes so valuable.
With ultrasound, I can scan the area to help diagnose the problem and look at the tissue in real time. It’s essentially a live video of the musculoskeletal anatomy.
I’ve been performing ultrasound-guided injections for almost 20 years, and it’s amazing how much the technology has improved.
The probe is placed on top of the skin and produces an image of the structures underneath. Modern musculoskeletal ultrasound allows us to examine bones, ligaments, tendons, muscles, and joints.
I can look at the tissue from multiple angles. I can also put stress on a joint or ligament while watching it on the screen, which allows for a dynamic evaluation.
You may see a small tear. You may discover that the arthritis isn’t as severe as an X-ray suggested. You may see that there’s actually a reasonable amount of cartilage remaining. Or you may discover excessive movement or laxity in a ligament when stress is applied.
That’s why ultrasound is such an important tool for me.
I wouldn’t want to perform these injections without ultrasound today.
Experience With Ultrasound Matters
The challenge is that ultrasound machines are expensive, and proper training requires considerable time and investment.
Ultrasound is also very provider-dependent. Taking a one-day course isn’t the same as having years of experience using ultrasound to diagnose and treat musculoskeletal problems.
That’s particularly important when we’re injecting areas where nerves, blood vessels, or other important structures are nearby.
We need to understand the anatomy, identify the ligament or tendon we’re targeting, and recognize the neighboring structures that we don’t want to hit with the needle.
When these procedures are performed properly, the goal is to make them as safe and precise as possible.
If you aren’t aiming accurately, however, you don’t necessarily know where the needle is going.
You don’t want to put a needle into a blood vessel and cause bleeding. You don’t want to put a needle into a nerve.
The physician has to understand what the anatomy should look like, identify that anatomy on the ultrasound screen, and then guide the needle while avoiding the structures that shouldn’t be touched.
This becomes particularly important in areas such as the spine, where you have the spinal cord, major nerve roots, and blood vessels nearby.
With ultrasound, we can identify our targets and choose an appropriate angle and needle length.
For many reasons, image guidance can improve the accuracy of these injections and help us avoid important neighboring structures.
If you’re investing significant money in regenerative medicine, I think it’s important to find somebody with substantial ultrasound training and experience.
I also like allowing patients to watch the ultrasound screen.
I’ll point out what we’re looking at. If there’s a small tear in the rotator cuff, for example, the patient can see it. Then they can actually watch the needle being guided toward the area we’re treating.
It gives patients a better understanding of their anatomy and what we’re trying to accomplish.
To me, that’s a much better approach than having a 30-second conversation, performing one injection, and hoping something works.
The technology is better today, but we still have to start with the basics: perform a good physical examination, determine what’s actually causing the symptoms, decide whether the person is a good candidate for treatment, and then accurately and safely deliver the treatment.
These procedures aren’t inexpensive. We want to give the patient the best opportunity for a successful outcome.
How Long Until My Pain Goes Away After Treatment?
Here’s another question I get all the time:
“How long until my pain goes away after treatment?”
There’s a tremendous amount of variation.
It depends partly on the extent of the tissue damage. In general, less severe damage may heal more quickly, but there’s no universal timetable.
Sometimes you treat an injury that you think will require several treatments and months of healing, and the patient responds quickly.
Other times, an injury that appears relatively minor takes longer than expected.
I’ve injected many areas of my own body, and I’ve experienced this myself. Sometimes the injuries you expect to heal quickly don’t, while the ones you think will take a long time improve relatively quickly.
The patient’s overall health also matters.
Another important factor is what the patient does after treatment.
For example, if I perform a knee injection and the patient immediately returns to heavy squats, running, tennis, or long hikes, that’s probably not a good idea.
We want to allow the tissue to begin healing after treatment.
That doesn’t necessarily mean you can’t exercise. You may be able to exercise other areas of the body, but you don’t want to immediately overload the tissue we just treated.
Inflammation and the Healing Process
The first phase of healing involves inflammation.
With a regenerative medicine treatment such as PRP, we’re trying to support the body’s healing response.
That’s why we discuss the use of anti-inflammatory medications with patients.
NSAIDs are nonsteroidal anti-inflammatory drugs. They include medications such as ibuprofen and naproxen.
I understand why people take them. I used these medications extensively during my college football career. I was a linebacker at the University of Nebraska, so I’m certainly no stranger to pain.
When you’re hurting, you naturally want something that provides relief.
But following regenerative treatment, we’re trying to initiate and support a healing response. Suppressing inflammation may work against what we’re trying to accomplish.
The goal isn’t simply to cover up the pain. We want to address the injured tissue and promote healing so that hopefully the patient doesn’t have to continue relying on pain medication.
Patients also need to be patient with the process.
We’re generally looking at an initial inflammatory phase lasting several days, followed by a period in which the tissue begins proliferating and building collagen.
Collagen is an important structural protein found throughout the musculoskeletal system, including muscles, ligaments, tendons, and cartilage.
Over the following months, that tissue continues to mature and remodel.
Healing is a process.
Regenerative Medicine Is Not a Steroid Injection
One mistake patients sometimes make is comparing regenerative medicine with a steroid injection.
Steroids can produce relatively rapid symptom relief because they’re strong anti-inflammatory medications.
Regenerative medicine works differently.
Following treatment, we may actually expect some initial stiffness and soreness. Then we allow time for the healing process to occur.
We generally wait at least a couple of weeks before evaluating the early response, and meaningful improvement can take considerably longer.
There’s a wide range.
I’ve personally had treatments where I’ve noticed improvement within days. Other times, it has taken a couple of months.
That’s why it’s important to have realistic expectations.
Be patient with the process. Take care of your body. Don’t immediately overload the treated tissue.
Nutrition, hydration, adequate protein intake, and good sleep are also basic components of recovery.
Protect your sleep. A cool, dark, quiet room can help. Alcohol at night and caffeine late in the day can disrupt sleep.
There are many variables that can influence recovery, and we want to optimize as many of those factors as possible so we can get you back in action safely.
I Hurt My Knee Trail Running. Do I Need Surgery?
Here’s another email:
“Hi, Dr. Grove. I tweaked my knee while trail running, and now I have some throbbing pain on the inner half of my knee. Do I need surgery?”
This is another common question.
Someone texts, calls, or emails me and asks, “Do I need surgery?”
The first thing I need to do is examine you.
A proper in-person, hands-on physical examination is non-negotiable. Then I can use ultrasound to look at the tissue and determine which structures may be damaged.
There are many possible causes of knee pain.
One of the most common findings is a meniscus tear.
The meniscus acts partly like a shock absorber between the thigh bone and shin bone and contributes to the function and stability of the knee.
As we get older, however, you’re going to find plenty of people who have meniscus tears on imaging but have absolutely no pain.
That’s an important point.
Finding a meniscus tear does not automatically mean the meniscus tear is causing the patient’s symptoms.
We need to correlate the imaging with the patient’s symptoms and physical examination.
When Does a Meniscus Tear Need Surgery?
With some meniscus procedures, damaged portions of the meniscus are trimmed or removed arthroscopically.
But the meniscus serves an important function in the knee, including shock absorption.
Therefore, if we’re going to perform surgery, we need a good reason.
One of the questions I ask is whether the patient has significant mechanical or obstructive symptoms.
A large meniscus tear can sometimes cause the knee to lock. The patient may have significant difficulty bearing weight. Some of those patients may appropriately require surgical treatment.
But not every person with knee pain and a meniscus tear needs surgery.
Sometimes the problem is a sprained ligament or another structure around the joint.
This patient described pain along the inside of the knee.
There are many structures on the medial side of the knee that can become injured without the problem necessarily originating inside the joint itself.
For example, a patient may have some arthritis inside the knee, but the actual source of pain may be the medial collateral ligament, or MCL.
The MCL runs along the inner portion of the knee from the femur toward the tibia. Even a relatively small MCL injury can be painful.
I’ve experienced that myself. I had a partial MCL tear a couple of years ago, and it was very painful.
The important point is that finding arthritis on an image doesn’t automatically mean the arthritis is causing the pain.
We have to perform a good hands-on examination and identify which structures reproduce the patient’s symptoms.
A trail runner, for example, might take an awkward step and experience a valgus movement where the knee collapses inward. That can stretch structures along the medial side of the knee and produce pain.
The physical examination helps us pinpoint the location.
So, based only on an email asking, “Do I need surgery?” my answer is: I don’t know yet.
I need to examine you.
We need to determine what’s going on, perform a physical examination, scan the area, and identify the structures responsible for the symptoms.
Then we determine whether you’re a good candidate for conservative treatment such as regenerative medicine or whether you genuinely need surgery.
The important thing is not to treat every patient who walks through the door.
We need to determine whether we’ve seen this type of problem before, whether it’s something we can reasonably treat, and whether we can give the patient realistic expectations.
Clinical experience matters.
Can Regenerative Medicine Help Thumb Arthritis?
Here’s another email:
“Hey, Dr. Grove. Do you ever see thumb arthritis in your office? Is there any chance you can help?”
Yes. This is something we see frequently.
In the upper extremity, the thumb is one of the common places where we see arthritis, particularly in people who use their hands extensively.
Sports injuries can also affect the thumb. You might get your thumb caught on a jersey, for example, causing it to bend backward and sprain.
One area we commonly evaluate is the base-of-the-thumb joint, called the CMC joint—the carpometacarpal joint.
The thumb has a unique range of motion, which is part of what makes the human hand so functional. But that mobility also creates opportunities for injury.
When we’re evaluating thumb pain, we’re not just looking at the joint.
There are small muscles crossing the area as well as collateral ligaments and other structures. Ultrasound allows us to examine these individual pieces of anatomy and determine which structures may actually be damaged.
The hands and feet are particularly interesting because there are so many anatomical structures packed into a very small area.
That’s where understanding the anatomy and knowing how to identify those structures on ultrasound becomes extremely valuable.
Once we’ve identified the damaged structure, we can determine whether treatment may be appropriate and precisely guide the injection into a very small target area.
I’ve personally dealt with thumb problems, ankle and toe injuries, turf toe, plantar fasciitis, wrist sprains, thumb sprains, and other injuries.
One lesson I’ve learned from experience is that large needles hurt.
When I’m treating the hands and feet, I try to use very small needles whenever possible to minimize discomfort.
Ultrasound allows us to be extremely precise even when we’re working in these very small anatomical areas.
End of First Segment
That’s the end of the first half of our segment.
You’re listening to Living Pain-Free. I’m your host, Dr. Thomas Grove.
We’re talking about sports medicine, musculoskeletal medicine, PRP, stem cells, and regenerative medicine.
To call the studio: 866-870-5752.
For a free consultation with our staff: 800-300-9300.
I’ll catch up with you after the break.
Announcer:
You’re listening to Living Pain-Free with Dr. Marc Darrow and Dr. Thomas Grove. Their practice is located at the Stem Cell Institute in West Los Angeles.
To schedule an appointment, call 800-300-9300.
Dr. Thomas Grove:
All right, everybody. Welcome back. You’re listening to Living Pain Free. I’m your host, Dr. Thomas Grove, a board-certified, fellowship-trained sports medicine physician.
We’re talking about all things sports medicine. If you’ve got an ache or pain involving a joint, ligament, tendon, or muscle, give us a call and we can talk about it.
Remember, one of our favorite tools in the toolbox for addressing these issues without surgery or pain pills is regenerative medicine. The idea is to use your body’s own healing cells, delivered through image-guided injections, to help promote the healing process and get you back in the game.
If you or a loved one is dealing with pain, give us a call at 866-870-5752.
For a limited time, we’re also sending listeners a free copy of our book, Stem Cell and Platelet Therapy: Regenerate, Don’t Operate.
If you’re ready for a free consultation over the phone with our staff, call 800-300-9300.
You can also visit our website for videos about the procedures, educational content, and recordings of the radio program at StemCellInstitute.com.
Caller: Don from Culver City
Dr. Grove:
We’ve got a caller coming to us here. Don from Culver City. Don, how are you?
Don:
Hi, Dr. Grove. Thank you for taking my call.
Dr. Grove:
Of course. How can I help you?
Don:
I’m calling on behalf of my sister, who has developed plantar fasciitis. She’s been online researching different things—rollers for the feet and things like that.
Sometimes she’s okay in the morning and then it comes back, and she’s limping around.
I mentioned your show and stem cell therapy to her, and she said, “There are just too many problems with that.” I wasn’t going to argue with her.
Dr. Grove:
That’s a big part of my job. There seem to be a lot of misconceptions about these treatments.
We’re not putting foreign drugs into your body. Our bodies have an inherent ability to heal tissue. The challenge is that as we get older, that process may become less efficient, or there may simply be too much damage for the body to heal without some type of intervention.
What we’re doing is taking the body’s own healing cells, concentrating them, and delivering them directly into the tissue we’re trying to help heal.
You’re talking about plantar fasciitis, which I’ve personally had a couple of times during my athletic career.
Don:
That’s on the bottom of the foot, right?
Dr. Grove:
Exactly.
Don:
I’ve been listening to you guys for a while, so I’m getting the whole thing. I’m actually thinking about coming in for my knees.
I’ve been told I have “bone-on-bone” arthritis in my knees, but I don’t have general pain. I mainly feel it when I’m walking downhill or downstairs. I don’t have pain just bending my knee.
Dr. Grove:
That’s a good sign.
“Bone on bone” is one of those phrases that I don’t particularly like. True bone-on-bone arthritis means the cartilage has essentially worn away. Typically, someone with severe disease has significant difficulty putting weight on the knee and may have substantially limited range of motion.
Sometimes “bone on bone” becomes a phrase people use very loosely.
But getting back to your sister’s plantar fasciitis, the first thing is bringing her in and evaluating her because sometimes the problem isn’t actually the plantar fascia. There’s a lot of anatomy in the foot.
Plantar fasciitis is certainly common, though.
A little bit about my background: I came from the world of high-level athletics. I was a team captain on the University of Nebraska football team. I was around professional athletes from the time I was a teenager. Later, I trained professional athletes in strength, conditioning, and nutrition internationally, and I spent years as a team physician.
I’ve always been obsessed with figuring out how we can help the body heal as quickly as possible because athletic performance demands it.
The nice thing today is that you don’t have to be a professional athlete to have access to these types of treatments.
Plantar fasciitis can be difficult to treat once it becomes chronic. Think about the biomechanics of the foot. You’re putting multiples of your body weight through that tissue. Even a relatively small injury or strain of the plantar fascia can be very painful.
Classically, the first few steps when you get out of bed can cause significant pain. It’s also a weight-bearing structure, so walking, running, and jogging can aggravate it.
Don:
She doesn’t run, but she walks every day.
I also have a couple of other issues. Years ago, I was hiking in the San Gabriel Mountains and jumped down into a ravine and injured my knee. I damaged my medial meniscus, and there was material floating around in the knee. I eventually had arthroscopic surgery.
I was in very good shape at the time. The surgery was successful enough that nine weeks later I was backpacking down into the Grand Canyon and back out.
But my knees sometimes click when I bend them.
I also wondered whether I might have Dupuytren’s contracture. I had a nerve conduction test on my left hand, and they told me the nerve signals were pretty bad.
I’m a bluegrass guitar player, and it’s interfering with my playing. So I’ve got a couple of issues I’d like you to look at if I come in.
Dr. Grove:
When I hear things like that, I get excited because I want to get you in here and figure out what’s actually happening.
A lot of diagnoses rely heavily on imaging and specialized testing, but you still have to evaluate the person face to face.
For example, Dupuytren’s contracture isn’t really diagnosed with a nerve conduction study. It involves thickening of tissue in the hand that can cause a finger to become contracted. Sometimes hand conditions can also be confused with things such as trigger finger.
We treat hand problems in the clinic, particularly when manual dexterity is important.
Don:
My little finger has a bend in it. I can’t completely straighten it, which makes it difficult to form a full chord on the fretboard.
Dr. Grove:
We treat a lot of artists here in Los Angeles. If you’re a piano player, guitar player, studio mixer, or anyone else who relies on their hands, a hand problem can be devastating.
Music is such an important part of the human experience.
Don:
I love Dr. Darrow’s bumper music. I’m a bluegrass and bottleneck slide blues guitar player. I’ve adapted by playing more slide guitar because I don’t have to fret the strings in quite the same way.
But I still have to convince my sister to come in. She has a negative impression of these treatments, and there’s also the insurance issue.
Dr. Grove:
I always try to reassure people because sometimes they’re nervous that if they come into the clinic, they’ll immediately be pressured into doing something.
That’s not the case.
My goal is to determine what’s going on and then lay out the treatment options, including the pros and cons.
I’m biased toward being conservative. I want to avoid prescribing pain pills when possible, and I want to keep people out of the operating room when there are reasonable alternatives.
Don:
I’ve heard you talk about that, and I’m impressed with your attitude.
My knees have stopped me from doing two things I was heavily involved with for about 20 years: mountain biking and rock climbing.
Certain movements and stepping up onto things became difficult because of my knees.
Dr. Grove:
That’s where it’s important to talk about alternatives.
One thing people don’t always understand about major surgeries, especially joint replacements, is that function can be permanently changed afterward.
My goal is to preserve as much natural function as possible.
Obviously, we can’t help everybody without surgery. Sometimes surgery is absolutely necessary. If you have broken bones or loose pieces of tissue in a joint, for example, surgery may be the appropriate option.
But sometimes people move toward surgery before they’ve adequately explored conservative approaches.
It’s not only about whether surgery might reduce pain. You also have to ask: What will the function of that body part be afterward? Will I still be able to do the things I love?
That’s why, getting back to your sister, my approach is simply to lay out the options and their advantages and disadvantages.
Ultimately, these are elective procedures. It’s always the patient’s decision. It’s a very low-pressure environment. We’re there to figure out what’s happening and hopefully find a conservative path forward when appropriate.
Don:
I definitely want to come in because I just turned 80.
I was still rock climbing until about seven years ago. I loved rock climbing and mountain biking at Mammoth.
I was very fit. I worked in construction and carpentry, worked out four or five days a week, did weight training, and went rock climbing about three days a week.
Dr. Grove:
I love hearing that.
There’s a vitality and energy there. One of the things I’m trying to accomplish with patients is keeping that energy going.
I want to keep people moving.
When I meet people who remain energetic and independent later in life, I always want to know what they’re doing. What allows them to maintain that vitality?
Physical mobility is such an important component.
One of the most common answers I hear is, “I’m moving my body. I’m having fun. I’m getting out there.”
When pain prevents someone from doing those things, it can become a major fork in the road.
The goal is to address those issues and get people back to living a full life and doing the things they enjoy.
Don:
I completely understand. When I tell people I turned 80 in June, they look at me and say, “Don’t lie to me.”
Dr. Grove:
That’s what I want to be like when I’m your age, Don. You’ve got to tell me your secret sauce!
Keeping the body moving is non-negotiable for me.
Of course, we want to be safe with the activities we’re doing and avoid major injuries. But especially when you’re active, things happen. You slip, you fall, you hurt something.
The question becomes how we respond to that injury and what options we explore.
It’s exciting that today we have more conservative options that may help people preserve the activities they enjoy.
Don:
Thank you so much for taking my call, Dr. Grove. I love listening to your show with you and Marc Darrow.
And tell Dr. Darrow I love the music. I don’t know whether he plays bluegrass-style banjo or not.
Dr. Grove:
We’ll have to get you guys together for a bluegrass battle!
Don:
Sounds good to me. I go to a jam every Sunday at a park about five minutes from me. Five or six guys get together for a bluegrass jam.
Dr. Grove:
That’s fantastic. Keep doing your thing, Don. I really appreciate the call. I hope to see you and your sister soon.
Don:
You’ll probably see me before you see her. I still have to convince her!
Dr. Grove:
Fantastic. Talk to you soon, Don. Thank you.
Why the MRI Doesn’t Always Identify the Pain Generator
Dr. Grove:
Great talking points there.
Anytime we get callers like that, I get inspired. It’s a fun service that we get to provide.
There are relatively few areas of medicine where you get an opportunity to address an injury while trying to preserve someone’s function. It’s great when you receive a text or video from a patient saying, “Look at me. I’m doing the things I love again.”
I had an interesting case a couple of days ago involving someone who was convinced he needed shoulder surgery.
He had shoulder pain, got an MRI, and was told he had a small tear involving the supraspinatus, which is one of the four rotator cuff muscles. It’s one of the most commonly injured rotator cuff structures and helps raise the arm away from the body.
He came in convinced the supraspinatus was causing his problem.
But during the physical examination, the pain wasn’t coming from anywhere near the supraspinatus. His pain was actually located around the rhomboids on the back side of the shoulder toward the spine.
Even on ultrasound, the area didn’t look particularly dramatic. It appeared to be a relatively minor strain, but that was where his pain was coming from.
When we tested the supraspinatus, there was no loss of function and no pain when we stressed it.
So although the MRI showed a small tear, it was probably an older finding that wasn’t responsible for his current symptoms.
This is something that’s difficult for people to understand.
Many of us have abnormalities in our bodies—small tears, strains, or degenerative changes—without having pain or loss of function.
There are studies looking at people who have no symptoms at all, and imaging still finds abnormalities. You can find rotator cuff tears in shoulders, labral tears in hips, meniscus tears in knees, and degenerative discs in the spine in people who aren’t experiencing pain.
That’s why we have to be careful when determining the actual cause of someone’s symptoms.
You can’t make that determination based solely on an image.
Imaging is important. It gives us useful information and can help guide us toward where symptoms might be coming from.
But we have to correlate those findings with the location of the pain, the activities that provoke the pain, and, importantly, the hands-on physical examination.
That’s how we get a more complete picture.
Unfortunately, the direction of health care can sometimes make this difficult. Physicians may be required to see more patients in less time, which can result in very quick visits.
Instead of performing a thorough physical examination, it can become, “Let’s get an MRI and see what’s going on.”
But sometimes that’s going to miss the actual problem.
That can result in an incorrect diagnosis or an ineffective treatment plan.
It’s particularly concerning when we’re talking about surgery.
Performing surgery on a body part that isn’t causing the symptoms is obviously problematic. There’s little potential upside if you’re treating the wrong structure, while surgery itself carries potential risks.
If someone is going to accept the risks and recovery associated with surgery, we want to be confident that we’ve identified the true source of the problem and that reasonable conservative options have been considered.
This case was a classic example of the imaging report telling one story while the patient’s body told us another.
The patient was already meeting with surgeons because the MRI showed a small tendon tear in the shoulder.
But operating on that tendon wouldn’t address pain coming from the rhomboid area on the back.
That’s why identifying the actual pain generator is so important.
Email Question: Neck Pain and Limited Motion
Here’s another question:
“I’ve got pain in my neck when I turn my head and a tender spot at the base of my neck on the right. The pain limits my motion. Can you help?”
We’re dealing with a spine issue here, specifically the neck.
Remember, there are numerous muscles, tendons, and ligaments connecting the vertebrae and surrounding structures.
I treat a lot of spine problems in the clinic. It’s actually one of my favorite areas to treat.
I’ve spent considerable time training in the use of ultrasound for injections in these areas because there’s a lot of important anatomy in and around the cervical spine.
The first area I treated on my own body was actually my lower back, so I understand how limiting spinal pain can be.
We see patients with problems following concussions, whiplash injuries, falls, and strains involving structures around the spine.
In this person’s case, there’s neck pain and a tender spot near the base of the neck.
Without examining the patient, we can only speculate about the cause.
One possibility involves the suboccipital muscles. These are small muscles that connect the base of the skull to the upper cervical spine.
They’re commonly strained with falls, whiplash injuries from automobile accidents, and sometimes concussion-related injuries.
Problems in this area can become extremely painful and may be associated with headaches.
Another possibility is irritation where a muscle or tendon attaches to the bone.
When we look at the spine as a whole, there are also very strong supporting ligaments, including the interspinous, supraspinous, and nuchal ligaments. These structures contribute to spinal stability and can become strained.
These ligaments aren’t always a major focus of an MRI report.
That can create a confusing situation for patients. Someone may be told, “Your MRI looks normal. There’s nothing wrong.”
But during a physical examination, we may find evidence suggesting a ligament or tendon strain that wasn’t emphasized on the imaging study.
Again, that’s why the physical examination is so important.
When considering injection procedures around the cervical spine, image guidance is particularly important because of the sensitive anatomy in this region.
There are major nerves and other important structures nearby. We want to be very specific about where we’re placing an injection.
So when I hear about someone with neck pain, tenderness at the base of the neck, and limited motion, I want to evaluate them and determine where the pain is actually coming from.
Once we’ve identified the pain generator, we can discuss the available treatment options.
Closing
We’re coming to the end of the program.
Thank you again for tuning in.
If you’d like a free consultation over the phone with our staff, call us at 800-300-9300.
You can also visit StemCellInstitute.com for educational information, videos, and recordings of the radio program.
This is Dr. Thomas Grove signing off. Thank you for tuning in. We’ll see you next week.
Announcer:
You’ve been listening to Living Pain Free with Dr. Marc Darrow and Dr. Thomas Grove.
Call the office at 800-300-9300 to speak with a member of the staff and ask for a copy of Dr. Darrow’s book, Stem Cell and Platelet Therapy: Regenerate, Don’t Operate.
To schedule an appointment, call 800-300-9300 or visit StemCellInstitute.com.