Ask Dr. C – Episode 2

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There are still a slew of great questions coming in for “Ask Dr. C”, so I thought I would go with a second episode to get them answered. Again, I love seeing what patients ask as it lets me know whether my educational efforts are succeeding or where I need to work harder to get the message out. Let’s dig in.

Do PRP treatments work as well in the small joints of the fingers and toes as they do in large ones?

To review, PRP stands for platelet-rich plasma. This is where the doctor concentrates blood platelets laden with healing growth factors and injects those to help tissue heal. The most common use of PRP to treat orthopedic injuries is for knee arthritis and tennis elbow. However, PRP is really used all over the body by Regenexx clinics. That includes smaller joints like the hands or facet joints in the spine. Below is a shortlist of every condition where we use PRP:

  • Arthritis of the knee, hip, shoulder, hands, wrist, elbow, ankle, feet, TMJ, spinal facet joints, and SI joints
  • Degenerative disc disease, sciatica, low back, and neck pain
  • Lax ligaments or damaged ligaments like knee ACL/MCL, or the commonly injured outside ankle ligaments
  • Damaged tendons like tennis elbow, golfer’s elbow, rotator cuff tears, etc…
  • Damaged meniscus or spacer structures like shoulder or hip labrum
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Because discs don’t have any blood supply can stem cell injections help and if so how?

Spinal discs lose their blood supply when we age past our teenage years. After that, the spinal discs, which act as shock absorbers between the neck and back bones, get their nutrition from something called “imbibition”. This is basically a sponge-like action that pumps fluids through the disc as we walk.

As the disc degenerates, it loses chemicals inside it called glycosaminoglycans (GAGs). These hold onto water giving the disc it’s shock-absorbing abilities. Once the cells that produce this chemical die off, the disc can no longer hold onto water and may slowly deflate over time, leading to decreased disc height.

So what can stem cells do for a spinal disc? I first injected the disc with stem cells in 2005/6, long before anyone had ever conceived of doing it, and I expected them to rebuild the deflated disc as that had happened in animal experiments. That didn’t happen in humans. Yet, through the years, we learned that stem cell injections in the disc were good for:

  • Torn and painful discs
  • Disc bulges

How could this work when the disc has no blood supply? Stem cells secrete a growth factor called VEGF, which can build new blood vessels. If you want to learn more about stem cells and discs, please see my video below:

I am confused about whether donated stem cells are living. I know of one prominent doctor who uses donated cells exclusively, eschewing bone marrow as the source. Please clarify whether donated stem cells will work.

No, there are no products in the US that contain living stem cells from a donor. Hence if your “prominent doctor” is telling you that he or she is performing stem cell injections from a donor, they aren’t keeping up with the research in this area. So while they may be expert in their area of medicine, they are not an expert in regenerative medicine.

To learn more on this topic and to see the supporting data that shows that the donor birth tissue products used by clinics claiming to contain stem cells do not contain any living stem cells, see my video below:

The upshot? Thanks for another round of great questions! Keep them coming!

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This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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5 thoughts on “Ask Dr. C – Episode 2

  1. David Watson

    Can PRP or Stem cells help a person who has neuropathy ( burning and painful feet ) due to possible sciatic nerve damage ?

  2. Bob Truelove

    how come when I use a inversion table, my back pain goes away, even after a few minutes and doesn’t come back for many days?

    Bob Truelove

  3. Barry Wertheimer

    I note some groups suggest multiple PRP injections given a few weeks apart to treat knee arthritis. Do you feel, at anytime; this plan is better then a one shot regimen?

  4. Sheree

    Daughter 28 years getting surgery Sept 1st but I’m concerned and have questions
    -She has got an MRI done
    -MRI shows cyclop lesion on ACL due to reconstruction surgery 10 years ago along with bucket tear of the meniscus surgery
    -MRI shows meniscus tear also
    -Do you have surgery to remove lesion?
    -Is surgery the only and best option to remove lesion ?
    -If so does your clinic do these types of surgery and then of course stem cell therapy for meniscus
    -The surgeon is wanting to fix meniscus which as a mother I’m opposed to since it has already been worked on 10 years ago and viewing your articles this is not a good idea
    -Thank you for your advice!

    1. Chris Centeno, MD Post author

      I would have to know more. Happy to jump on a Telemedicine visit to look at the images. Generally, a cyclops lesion means a big piece of abnormal tissue in the middle of the knee near the ACL. Generally, I would say that we can treat ACL retears with grafts due to old surgeries, but this abnormal growth should likely be surgically removed. We don’t recommend partial meniscectomy (which is what they are likely going to do with the bucket handle tear) which is cutting out the torn part, as the research shows that surgery has no benefit. As far as treating with stem cells, we do have sites that could both do the surgery and treat the knee with stem cells.

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