Living Pain-Free with Marc Darrow, MD

Five caller issues discussed

• Gary and Douglas discuss knee pain associated with exercise, previous injuries, altered walking, and swelling.
• Tom age 82, asks about bilateral knee arthritis after being told that his knees were “bone-on-bone.”
• Adam Pantrelli and Jill discuss shoulder pain, restricted motion, adhesive capsulitis, PRP, and cellular treatments.
• Bruce asks what exosomes are and how they may be used with PRP and cellular treatments.
• Ross describes returning to pain-free daily activities and golf after shoulder treatment, while Don Ward asks about options his brother might consider before reverse shoulder replacement.

Part 1

MARC DARROW, MD: One of the lines we use on this show is, “Take the surgery out of pain.” Why do people undergo surgery when they may not need it? Why is my office filled with patients whose surgeries failed?

There are certainly situations in which surgery is necessary. In my opinion, however, a rotator-cuff tear, meniscus tear, labral tear, or arthritic finding does not automatically mean that a person needs an operation.

I originally followed a surgical path during my medical training. I was interested in orthopedic surgery, but I also experienced a shoulder operation that did not work out well. I later learned about regenerative medicine, including PRP and cellular treatments intended to stimulate tissue repair.

I have performed regenerative procedures since 1997 and taught at UCLA for approximately 20 years. Today, regenerative medicine is widely available, although the experience and techniques of individual physicians vary.

Treatment is generally performed in the office. Blood can be drawn and processed to prepare platelet-rich plasma, which is then injected into the targeted area. Patients usually leave without general anesthesia.

My own shoulder remained painful and difficult to use for years after surgery. After learning regenerative techniques, I treated the shoulder and experienced substantial improvement. I have also treated my knees, elbows, and wrists over the years.

If you would like to speak with me during the program, call 866-870-5752. To contact the office for a free telephone consultation, call 800-300-9300.

Gary

MARC DARROW, MD: Gary, what is going on with you today?

GARY: I have been experiencing knee pain while walking and exercising. Squats also bother my knees. I have not seen a doctor about it yet, and I wanted to know what I could do.

MARC DARROW, MD: I am cautious about traditional weighted squats when someone has knee or back pain. One alternative is to place your back against a wall, position your feet in front of your knees, lower the thighs to approximately a 45-degree angle, and hold the position. This can strengthen the quadriceps while reducing some of the stress associated with deeper squatting.

I would still need to examine you. A clinician should identify the structure producing the pain instead of assuming that an MRI finding is the cause. Many active middle-aged adults have meniscus tears on imaging without having knee pain.

An ultrasound examination can help identify fluid and evaluate the knee dynamically. If significant fluid is present, it may be aspirated with ultrasound guidance. The larger point is that treatment decisions should not be based solely on an MRI.

Douglas

MARC DARROW, MD: Douglas, what is your question?

DOUGLAS: I originally hurt my knee at about age 15 while playing basketball. It caused intermittent trouble but eventually improved, and I remained very active. Years later, I had an accident involving my back and hip. After those problems improved, the knee became swollen without a clear new injury. I wondered whether altered walking and prolonged strain contributed to it.

MARC DARROW, MD: It could have contributed. Active people accumulate injuries and repetitive stress over time. Sometimes there is a clear traumatic event, while at other times a knee becomes painful or swollen without one identifiable cause.

The most important question is not always where the problem originated but whether we can identify and treat the current pain generator. An examination and ultrasound assessment would help determine what is happening and whether PRP or a cellular treatment might be appropriate.

Tom

MARC DARROW, MD: Tom, what is bothering you?

TOM: I am an active 82-year-old man. My knees have been my weak point for much of my life, and I had knee surgery when I was young. About eight years ago, an orthopedist showed me X-rays and said both knees were “bone-on-bone.” I remained relatively functional, but recently my right knee has become more painful than my left.

MARC DARROW, MD: The phrase “bone-on-bone” is used frequently, but it should not automatically determine treatment. If you still have useful movement and function, that information matters. Imaging can show advanced changes without fully explaining a patient’s pain or limitations.

Previous knee surgery can remove tissue and alter joint mechanics, which may contribute to degeneration over time. Nevertheless, age and imaging findings alone do not determine whether someone may benefit from nonsurgical care.

I would examine both knees and use ultrasound to evaluate the joint, surrounding structures, and any fluid. Depending on the findings, options could include PRP, bone-marrow-derived cells, or a combination. No responsible clinician can predict the number of treatments before examining the patient.

Adam

MARC DARROW, MD: Adam, tell me about your shoulder.

ADAM: I am 56 and have been active throughout my life. Three or four months ago, I pushed myself out of a swimming pool and injured my shoulder. It has been painful ever since, and I do not want surgery. I can move the arm forward and backward fairly well, but lifting it out to the side is more difficult.

MARC DARROW, MD: Retaining substantial range of motion is encouraging, although I would need to examine the shoulder to identify the painful structure. Movement out to the side is called abduction, while movement forward is flexion.

Regenerative treatment is not magic, and patients should have realistic expectations. Some injuries respond to one treatment, while others require more. PRP and cellular treatments are intended to stimulate a healing response, but the treatment plan depends on the examination and ultrasound findings.

Jill

MARC DARROW, MD: Jill, what is happening with your shoulder?

JILL: I have adhesive capsulitis, or frozen shoulder. I previously had very good results from PRP for meniscus-related knee problems. I am now receiving PRP and laser treatments for my shoulder and want to understand the next steps.

MARC DARROW, MD: Stay with us through the break, and we will continue the discussion in Part 2.

Part 2

MARC DARROW, MD: If an orthopedic procedure is elective, the patient has a choice. Emergency surgery is different, but many orthopedic operations are elective. My preference is to investigate whether the painful tissue can be treated without surgery using prolotherapy, PRP, cellular treatment, or other developing regenerative approaches.

For a free copy of my book, Stem Cell and Platelet Therapy: Regenerate, Don’t Operate, or a telephone consultation with the staff, call 800-300-9300. You can also contact me through StemCellInstitute.com.

Bruce

MARC DARROW, MD: Bruce, how are you?

BRUCE: I have heard that exosomes may make cellular treatments more effective. What are exosomes, and how are they supposed to work?

MARC DARROW, MD: Exosomes are small extracellular vesicles released by cells. They contain signaling materials and are being investigated for their potential role in cell-to-cell communication and tissue responses.

Some regenerative-medicine practices combine exosome products with PRP or cellular preparations in an effort to influence the healing environment. They are also discussed in aesthetic medicine and hair-restoration procedures. Their precise clinical role is still evolving, and patients should understand that the evidence, regulation, and quality of available products vary.

Jill continued

MARC DARROW, MD: Before the break, you were describing adhesive capsulitis. How much can you move the shoulder?

JILL: I have some movement, but not complete motion. I received PRP and had very positive results during the first 48 hours. When would cellular treatment be selected instead of PRP, and how many treatments might be needed?

MARC DARROW, MD: We cannot accurately predict the number of treatments for an individual patient. Each person has a different injury, health history, and capacity to heal.

PRP may be appropriate by itself in some cases. In other cases, a clinician may consider combining platelets with a patient’s own bone-marrow-derived cells. Some practitioners also add other biologic products. My treatment decisions are based on the examination, the condition being treated, previous response, and the patient’s goals.

Since you already experienced improvement with PRP, that response is useful information. Additional treatment should be considered only after reassessing your motion, pain, and function.

Ross from Ventura

MARC DARROW, MD: Ross, how are you today?

ROSS: I previously received treatment from you for a complete rotator-cuff tear. I am now playing golf without pain. I wanted other listeners to know that I am pain-free.

I notice the improvement in ordinary activities. I can raise my arm to blow-dry my hair, pull up my pants without pain, dry my back with a towel, and bring my sleeve to my mouth. Those small movements used to hurt.

My strength has also returned. I recently played golf, and one of the other players asked why I was suddenly hitting the ball farther. I am 80 years old, so I want people to know that improvement is possible in older patients too.

MARC DARROW, MD: I am very happy for you. Your experience also illustrates why an MRI finding and a person’s symptoms do not always match. Another MRI might still describe a rotator-cuff tear even though you now have improved motion, strength, and function.

The treatment goal was not to make the image look perfect. It was to reduce pain and restore useful function. Conversely, a surgically repaired tendon may look improved on imaging while the patient continues to have pain.

Don Ward

MARC DARROW, MD: Don, what would you like to discuss?

DON WARD: I am calling about my brother. He says he is scheduled for a reverse shoulder replacement and has been told that the shoulder is “bone-on-bone.” I encouraged him to speak with you before the operation, but he wants to wait until after his MRI. His other shoulder is also beginning to hurt.

MARC DARROW, MD: A reverse shoulder replacement is a major, irreversible procedure. There are patients for whom joint replacement is appropriate, but the diagnosis and clinical condition should be carefully established first.

I have examined patients whose replaced shoulders remained severely painful or difficult to move. I have also seen adhesive capsulitis mistaken for an arthritic loss of motion. A careful physical examination of both shoulders can help distinguish among arthritis, capsular restriction, tendon injury, instability, and other pain generators.

An MRI may provide useful anatomical information, but it should not replace examining the patient. Imaging findings do not always identify the structure producing the pain.

DON WARD: I have personal experience with your treatment. Years ago, I injured my knee after jumping from a short wall. The knee began clicking and became increasingly painful. You treated it with PRP injections around the knee. A few days later, while walking in my garden and talking to my brother, I suddenly realized that the pain was gone and the knee felt normal.

MARC DARROW, MD: The multiple needle placements were used to treat the structures around the knee, potentially including tissue around the patella. That is different from requiring numerous separate treatment sessions.

Before your brother undergoes surgery, he can still obtain another evaluation and learn whether any reasonable nonsurgical options remain. Surgery can be rescheduled; it cannot be undone.

Closing

MARC DARROW, MD: We are out of time. I apologize to Mark, Sylvia, and Doug, who were waiting but could not be taken during today’s program. Please call again next Saturday.

For a free telephone consultation and a copy of Stem Cell and Platelet Therapy: Regenerate, Don’t Operate, call 800-300-9300. To watch procedure videos or contact me, visit StemCellInstitute.com.

God bless you all, and happy healing ahead.

ANNOUNCER: You have been listening to Living Pain-Free with Marc Darrow, MD. The program is heard Saturdays on AM 870 The Answer. To schedule an appointment, call 800-300-9300 or visit StemCellInstitute.com.