TREATMENTS

Facilitate Healing

Education and Exercise

We try to identify which environmental and lifestyle factors may be contributing to a problem. Gaining an understanding can facilitate healing. Exercise has many benefits, ranging from increasing collagen production in weak tendons and ligaments, to building bone and muscle to preventing falls and injuries.

Shock Wave Therapy

Shock wave therapy can provide an exercise stimulus to tissues when the person is unable to exercise because of pain or other disability. Shock wave therapy can help resolve chronic myofascial and tendon problems and is being researched to facilitate recovery from muscle injuries and for its anti-inflammatory effects. Shock wave therapy is performed once a week for 4 to 6 weeks.

Classic Injections

Classic injections for musculoskeletal disorders and entrapped nerves have traditionally employed corticosteroids, which shrink swollen tissues and create space for healing. Corticosteroids are useful in conditions involving excessive pressure in the carpal tunnel, shoulder impingment and spinal stenosis (compressed nerves in the spine). For some conditions, a simple combination of local anesthetic and dextrose – a sugar, same as glucose, typically used in IV fluids – triggers a local healing response.

Biologic Interventional Techniques

The most common biologic interventional techniques involve platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC). Platelets injected into degenerated tissues are able to heal tears and initiate a regenerative response. Since 2013, the Bodor Clinic has had a 70% success rate for good to excellent results in the cervical, thoracic and lumbar spine. In 2020, Ryan Dregalla PhD, Yvette Uribe BS and Dr. Bodor published on how BMAC injected into disc material was capable of synthesizing hyaluronic acid, the gel in cartilage and discs. In 2021, they published on the safety and efficacy of combining PRP with local anesthetics to optimize patient comfort. Ongoing studies include using BMAC to heal the torn ACL, for which using a special ultrasound-guided technique the team is having a 90% success rate at restoring at least one bundle of the torn ACL and an 89-92% scores on the KOOS at 1 year. BMAC is most often used for osteoarthritis.

Ultrasound-Guided Surgery

Mini-open and arthroscopic carpal tunnel releases have provided the fastest recoveries and best outcomes. Now carpal tunnel release can be done even less invasively, with the camera (ultrasound transducer) on the outside, providing an even faster recovery and best final outcome. We perform ultrasound-guided surgery for vaccination-related shoulder dysfunction, calcific tendonitis, tendon contractures and exertional compartment syndrome.

Frequently Asked Questions

We like to use platelet rich plasma (PRP) that is leukocyte poor at concentrations from 5 to 10 fold baseline concentration with a minimum of red blood cells. We sometimes activate the platelets in order to induce adhesion, contraction and formation of a fibrin matrix, and at other times we will let the platelets self-activate when they come in contact with exposed collagen, resulting in a slower and more sustained release of platelet growth factors. Our decision as to what concentration and volume of platelets to use and whether to activate them or not depends on our analysis of the injury, its architecture and precise calculations performed on the basis of MRI and ultrasound imaging.

The speed of recovery and resolution of symptoms depends on the size and nature of the injury and how amenable it is to biologic treatments. Small muscle and tendon tears can respond as quickly as 1 -2 weeks, whereas long-standing disc tears may take longer than 8 weeks. PRP and stem cells for joints can take up to 1 – 2 months to start to get better and generally continue to improve over a number of months.

In general we allow activities as tolerated as long as one is not taking anything to relieve pain. Platelets and stem cells amplify the normal communication between injured tissue and the brain providing an added level of safety from overload. Most commonly we advise to let pain be the guide. We encourage exercise and activities of daily living as soon as possible while protecting the injured area from any movements or loading that provoke the pain. A mild sensation of pain with activities is generally acceptable assuming that nothing is taken to mask the pain response.