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Friday, August 18, 2017
By Edward Dieguez Jr. MD PA
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WHAT IS IT AND WHAT ARE THE CAUSES?

 Scoliosis is a sideways curvature of the spine of 11 degrees or more that occurs most often during the growth spurt just before puberty. The cause of most cases of scoliosis is unknown, and for that reason it is called idiopathic scoliosis. Other causes may include neuromuscular conditions such as Poliomyelitis, injuries or infections of the spine, and birth defects. Scoliosis can run in families.

 

WHAT PROBLEMS DEVELOP IN PATIENT WITH SCOLIOSIS?

Most patients have a mild form of the disorder. However most adults that developed scoliosis as children are more likely to have chronic back pain than the general population. 

In patients who develop severe scoliosis the rib cage may press against the lungs and heart, making it more difficult to breathe and harder for the heart to pump.

As scoliosis gets worse, it can cause more noticeable changes in the body. These include unleveled shoulders, prominent ribs, uneven hips, and a shift of the waist and trunk to the side. Patients with scoliosis often become self-conscious about their appearance.

 

HOW IS IT DIAGNOSED?

 A history and simple physical exam is usually all that is needed. Plain X-rays can confirm the diagnosis of scoliosis and reveal the severity of the spinal curvature.

 

HOW CAN WE TREAT THE CHRONIC PAIN OF SCOLIOSIS ? 

Not all adult patients with chronic pain from scoliosis are surgical candidates! In fact the majority are not! Surgery is generally utilized for severe scoliosis. So you may ask, what are the alternatives besides bracing, electrical stimulation, dietary supplements and chiropractic manipulations that many times fail to correct the pain by themselves? Since scoliosis involves the spine moving in the wrong direction, treatment should be aimed at why this is occurring and correcting the problem. Ligament laxity at the apex of the scoliosis curve is probably the main plausible explanation for the development of scoliosis and its pain. One promising alternative treatment is Prolothreapy. Since the pain in scoliosis is related to overstretching of ligaments of the spine and instability with its accompanying stresses of the structures of the spine, strengthening the ligaments and stabilizing the structures by stimulating the growth of ligaments and tendons that hold the spine together will result in less pain.

 
Tuesday, August 15, 2017
By Edward Dieguez Jr. MD PA
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WHAT IS IT AND WHAT ARE THE SYMPTOMS?

 It is one of the more common causes of heel pain. It is an inflammation of a thick band of fibrous tissue that runs across the bottom of you foot and connects your heel to your toes. The patient commonly feels a stabbing pain first thing in the morning in the heel area of the foot when he/she takes the first step. It can get better as the day goes by but after resting a while the pain is back. It is more common in runners, overweight patients and people that ware shoes without proper arch support.

  

WHAT CAUSES IT?

 Normally, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. Tension and stress on that bowstring can become too great and small tears can arise in the fascia. Repeated stretching and multiple tears can cause the fascia to become irritated, inflamed and sore. However in many cases of plantar fasciitis, the cause isn't clear.

 

WHAT ARE THE RISK FACTORS?     

  • Age. It is more common in the 40 to 60 y/o age group
  • Certain types of exercise that place great stress on the heel and tissues attached. This include running, ballet, aerobic dance and jumping.
  • Obesity. Being overweight can put a lot of stress on the plantar fascia.
  • Occupation. Those that require you being on you feet constantly during the day specially on a hard surface.

 

 WHAT ARE THE COMPLICATIONS?

Letting plantar fasciitis go unchecked for a long time can lead to chronic heel pain that hinders your regular activities. Additionally changing the way you walk to avoid the pain can lead to ankle, knee, hips or back problems.

 

 HOW IS IT DIAGNOSED?

The history and a physical exam is usually enough. It is important to locate the area of tenderness.

 

ARE IMAGING STUDIES NEEDED?

Usually not, however if the doctor has any concerns he may order and MRI or x-ray but, since he may want to rule out a fracture or check for bone spurs.

 

WHAT IS THE BEST AND MOST EFFECTIVE TREATMENT?

 

Most patient that visits our office has tried oral anti-inflammatories, ice, physical therapy and even steroid injections with only obtained temporary and partial relief. One innovative type of treatment provided in our office that produces excellent results is called Prolotherapy. It is great for treating this condition.

Prolotherapy is a technique consisting of injecting tissue irritating substances, such as hypertonic glucose(sugar water), among others, into the tissues. These tissue irritating substances called prolifereantsstimulate healing, tissue regeneration and repair when injected into precise points called the enthesis. Basically the enthesis is the point where tendons and ligaments attach to the bone. The proliferant when injected into these very precise points stimulate tissues to proliferate (therefore thename Prolotherapy) and heal.

Arch supports are also very important in patient with low and high arches. The extreme inward foot motion caused by pronation, forces the knee and hip out of alignment. This movement places added pressure through the knee, shin, thigh, pelvis and back. The excessive foot rotation can lead to foot and ankle injuries, achilles tendonitis, heel pain, kneecap inflammation, bunions, shin splints, ailments of the hip and lower back, as well as injury to muscles, tendons and ligaments in the lower leg.

 
Friday, August 11, 2017
By Edward Dieguez Jr. MD PA
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WHAT IS TENNIS ELBOW?

 It is also called lateral epicondilytis. It is a pain focused on the outside of the arm, where your forearm meets your elbow. When you constantly use your arm in a repetitive motion, the tendons at the elbow end of a certain muscle -- the extensor carpi radialis brevis (ECRB) muscle --- may develop small tears. Tennis elbow affects up to 3% of the population, particularly adults between 30 and 50 years of age. But, less than 5% of cases are linked to tennis.

 

 WHAT CAUSES TENNIS ELBOW?

 It is a repetitive stress injury to the muscle. Any activity like hitting the ball back hand in tennis, too tight a grip on the racket, or any jobs or activities that involve repetitive arm motion, such as:

  • Tree-cutting (repetitive use of a chain saw)
  • Painting
  • Carpentry
  • Playing some types of musical instruments
  • Butcher

 

WHAT ARE THE SYMPTOMS?

Commonly a soreness develops on the outer elbow and as it gets worse the pain may be unbearable to the point of not been able to pick up anything with that arm.

 

WHAT IS THE BEST TREATMENT? Prolotherapy treatment produces great results even in cases of refractory Tennis elbow that have not responded to other therapies. Cortisone injection can makes matters much worse. Remember that the problem here is a small tendon tears and cortisone weakens the tendons even more and can lead to complete rupture of the tendon. Check this article out:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751593/

 
Tuesday, August 08, 2017
By Edward Dieguez Jr. MD PA
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Also known as iliotibial band friction syndrome, is a common and often stubborn injury. It mostly plagues runners, plus a few unlucky cyclists and hikers, and causes pain mainly on the lateral aspect of the knee. It is interesting that it can also develop after total hip replacement surgery. Underlying instability of the posterolateral ligaments structure of the knee can cause the iliotibial band to contract and be under tension. 

 

FIRST OF ALL WHAT IS THE ILIOTIBIAL BAND?

The iliotibial band is usually described as a tendon. A big one. It’s so big that it’s also called the iliotibial track. No other tendon is known as a “tract”! It is often called the largest tendon in the body, but it is not just any tendon. The iliotibial band is a thick band of fascia (tissue) that begins at the iliac crest in the pelvis, runs down the lateral or outside part of the thigh, and crosses the knee to attach into the top part of the tibia or shinbone. It forms from the tensor fascia lata and two of the gluteal muscles (gluteus medius and gluteus minimus) in the buttock and then stretches across the knee. 

 

WHAT ARE THE SYMPTOMS THE PATIENT EXPERIENCES?

The patient, usually a runner experiences pain on the outer side of the knee, lateral and superior to the patella usually when running and the heal strikes the ground. Some patients may feel a snapping or popping sound at the knee, and there may be some swelling either where the band crosses the femoral epicondyle or below the knee where it attaches to the tibia. Occasionally, the pain may radiate along the course of the IT band all the way up to the outer side of the thigh to the hip.

 

HOW IS IT DIAGNOSED? 

Usually it is mainly a clinical diagnosis based in the history the patient gives you and physical examination. MRI may be used to look for inflammation surrounding and beneath the iliotibial band. The MRI can also exclude other causes of outer knee pain. These include torn cartilage (lateral meniscus tear) sprained lateral collateral ligament, muscle tendon inflammation, and problems between the kneecap and the femur (patellofemoral pain).

 

HOW TO TREAT IT?

Conventional approaches such as rest, ice, steroid injections and physical therapy have a very poor track record when it comes to iliotibial band syndrome. So if you are sick and tired of iliotibial band stretches with no results, try Prolotherapy.   Prolotherapy and platelet rich plasma (PRP) injections injected into the injured IT band will give you the best results. It will strengthen the tissues and repair the IT band allowing athletes to return to their sport. Dr. Centeno has also treated patients successfully with stem cell injections. 

Please check out the following link to an interesting article: http://www.prolotherapy.com/Murphy_Road%20to%20Prolotherapy.pdf 

 
Monday, August 07, 2017
By Edward Dieguez Jr. MD PA
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WHAT IS IT?

 Golfer’s elbow is also called medial epicondylitis. It is not as frequent as lateral epicondylitis or tennis elbow . Both of these condition arise from overuse.

Besides golf, medial epicondylitis can be seen in any throwing sports in addition to archers, bowlers and weight lifters.

 

 WHERE IS THE PROBLEM? 

It affects mainly the dominant elbow of the patient. The site of the pathology is at the interface or attachment to the medial epicondyle of the pronator teres and the flexor carpi radialis muscles. Immunohistologic studies have shown that long-standing epicondylitis is associated with a degenerative state instead of a traditional inflammatory process and probably should more accurately be called "epicondylosis." This is problably why Prolotherapy and PRP work so well for this condition.

 

 WHAT ARE THE SYMPTOMS AND EXAM FINDINGS?

Patients will c/o pain in medial aspect of the elbow and when it is chronic they may c/o grip weakness. On exam there is palpable tenderness over the medial elbow and pain with resisted wrist flexion and pronation.

 

It is important to examine the Ulnar Collateral Ligament (UCL), especially in baseball players. Chronic UCL deficiency is more common than medial epicondylitis in throwing athletes. However, because the origins of the flexor mass and the UCL are relatively close together, both chronic UCL deficiency and medial epicondylitis may present with medial elbow pain. A magnetic resonance imaging (MRI) study may be useful in differentiating these injuries, if they are not clinically apparent. A pronation weakness at 90 degree of flexion of the elbow is a reliable sign of medial epicondylitis.

 

WHAT CAN BE DONE ABOUT IT?

 Physical therapy, cortisone injection have been tried without much long-term success. Injections with cortisone is basically a no no since they may the problem worse. Surgery is much more successful but why summit yourself to surgery and all its risks plus those of anesthesia when you can treat it as successfully or even with more success with Prolotherapy and/or PRP?

 

All patients stated that the pain and stiff- ness in their elbows was better after prolotherapy. Over 78% per- cent said the improvements in their pain and stiffness since their last prolotherapy session have continued 100%. Sixty-three per- cent received greater than 75% pain relief. In regard to quality of life issues prior to receiving prolotherapy: 77% were totally independent in activities of daily living, but this increased to 94% after prolotherapy. In regard to exer- cise ability before prolotherapy, only 33% could exercise greater than 30 minutes but, after prolotherapy, this increased to 87% These numbers are pretty hard to ignore when choosing your treatment specially when you consider there is basically no risk!

 
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