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Why are MSCs better than joint replacement?

• In the course of the progression of OA, treatment with MSCs can performed much earlier than joint replacement, which allows the patient to stay healthy by remaining active.
• MSCs do not show the kinds of complications that can occur with joint replacement.
• MSCs can be repeated if needed without complications.

What effect does OA have on my overall health?

• The move towards inactivity in the presence of OA pain is usually slow, but eventually, patients become sedentary.  This damages health and shortens lifespan.  It also means that the later years of life are less fun, that the patient excludes themselves from activities with others that could enrich their life.
• The inflammation that is part of OA doesn’t just stay in the joint – it affects the whole body.  Those with OA end up with more heart disease, for example.

What is happening in my osteoarthritic joint?

• Previously, we thought that osteoarthritis was just wearing down of the cartilage in the joint, but we now recognize that it is a complex process in which the production of destructive inflammatory compounds and enzymes is triggered within the joint.  Every tissue in the joint, even the bone, is targeted, resulting in progressive damage.
• What is equally important is that these inflammatory compounds leak from the joint into the bloodstream, causing damage to other parts of the body.

How do MSCs address the joint destruction in OA?

• Within an osteoarthritic joint, inflammation and the production of destructive enzymes work to affect every component of the joint, not just the cartilage.  Over time, this leads to joint breakdown.
• By continually releasing certain anti-inflammatory compounds into the joint (e.g., interleukin-1 receptor antagonist – interleukin-1 is a particularly bad actor that needs to be stopped), these processes are arrested.
• Since the MSCs are your live cells, they continue to reside in the joint after injection and do their work for years.
• MSCs stimulate cartilage cells to make more glycosaminoglycans (GAGs), important for cartilage strength.

In what ways is ultrasound superior to other imaging methods?

• Ultrasound has greater resolution than MRI or any other imaging methods, which means we can see things in greater detail.
• With ultrasound, we can observe things moving (dynamic imaging).  For example, we can observe a ligament pulling away from a bone to which it is supposed to be attached.
• It emits no radiation, unlike x-rays, fluoroscopy, CT scans and nuclear medicine imaging.  Ultrasound is just sound waves that produce a detailed image.  A brilliant invention.
• Structures can be imaged in any plane, so if a tendon or ligament lies at some angle not captured by MRI, we can get a nice long-axis view of it with ultrasound.

How does a doctor become an expert at musculoskeletal (MSK) ultrasound?

• MSK ultrasound is taught in most sports medicine fellowships, but this constitutes only an introduction.  You have to go to many courses.
• Teach MSK ultrasound, as Dr. Adams does.
• Be a member of an ultrasound study group.  Dr. Adams is a member of Teach the Teachers, a small group of about 45 physicians who are national experts.

How has the use of musculoskeletal ultrasound changed our understanding of disease?

• We understand tendon disease much differently than before.
• Lateral hip pain is not bursitis.
• Lateral elbow pain (tennis elbow) is not inflammation.
• We appreciate the scope of ligament sprains and now take them more seriously.
• We can see tears in fascia.  No other imaging method can unless the tears are very severe.  This applies particularly to the back.
• We can see if someone is properly engaging their core muscles by dynamic imaging.
• We can see nerve abnormalities as a consequence of nerve entrapment, inflammation or trauma.  MRI is limited in this regard.
• Ultrasound has taken musculoskeletal care to a new level.

What types of neuromusculoskeletal conditions are treatable with PRP?

• Tendon tears (strains) and tendinosis, such as tennis elbow, rotator cuff and lateral hip
• Chronic ligament tears (sprains), such as ankle, lateral elbow and sacroiliac joint
• Tears of fascia, such as the dorsolumbar fascia of the low back
• Non-healing fractures, especially stress fractures
• Nerve entrapment injuries, such as carpal tunnel, deep branch of the radial nerve, and others

How do I know if PRP is right for me?

• It starts with accurate and thorough diagnosis of the cause of your pain.
• PRP works best when other components of a healthy lifestyle are in place.
• You are willing to work with us on a careful return to activity.

Why aren’t you calling them stem cells?

Dr. Arnold Caplan, the scientist who discovered mesenchymal stem cells, has recently told the cell therapy community (Dr. Adams was at that conference when this occurred) that they are more properly called signaling cells (Dr. Caplan actually recommended the term “Medicinal Signaling Cells”), because they produce compounds that signal other cells to heal and limit inflammation.

What are the symptoms of chronic exertional compartment syndrome?

• Almost always pain in the lower legs
• Pain that appears with exercise and diminishes with rest
• Some patients have lingering pain that takes a whole day or several days to diminish after exercise.
• The pain is severe enough that exercise has to be paused or stopped.
• There may be numbness on the bottom or top of the foot.  It is important to note which it is, if present.

What is the treatment for CECS?

• Runners may benefit from a special program.
• Surgical release of the fascia can be curative, but we would make sure you go to someone who is well experienced in this.

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