If you are experiencing joint or muscle pain, we encourage you to stay tuned. This program aims to provide effective solutions for the pain you have been living with.
Meet the Experts
Welcome to Living Pain-Free with Dr. Marc Darrow, MD, and Dr. Thomas Grove, DO, from the Stem Cell Institute in West Los Angeles. Dr. Darrow is a medical doctor, board certified through his studies at UCLA.
Dr. Darrow utilizes stem cell and platelet-rich plasma (PRP) therapies to help heal your body. He also educates about the use of stem cells, PRP, and prolotherapy as treatment options.
Dr. Grove is a regenerative medicine specialist and an expert in ultrasound-guided injections. He brings extensive experience as both an athlete and a strength and conditioning coach.
Regenerative Medicine: A New Path to Healing
Today’s program could open up a new life without pain for you. Our goal is to help people return to an active lifestyle where they can continue doing the things they love. We specialize in orthopedic sports medicine, and one of our most valuable tools is regenerative medicine. This approach allows us to help your body heal its own tissues using concentrated healing cells like stem cells and platelets.
With a simple set of injections, we deliver these concentrated healing cells directly to the affected area to promote the healing process. Many injuries can now be fixed without surgery or pain medications.
Our focus is on encouraging the healing process from the inside out, rather than merely covering up the pain.
Understanding Knee Injuries and Meniscus Tears
This week brought a variety of interesting cases, with a noticeable trend among patients presenting knee injuries. Many individuals reported concerns and complaints about meniscus tears, including those who had undergone multiple surgeries addressing these issues.
It is important to revisit the basics when discussing knee pain and meniscus-related procedures. The knee joint consists of the thigh bone (femur), the shin bone (tibia), and the kneecap (patella). Together, these bones create a reliable hinge joint, but the knee is susceptible to a range of problems, such as arthritis, ligament injuries, and meniscus tears.
Arthritis can lead to chronic inflammation and gradual cartilage breakdown, while ligament injuries are also common given the many ligaments stabilizing the knee. Ligaments connect bones, including those on the inner and outer halves of the knee, as well as those attaching the kneecap to the femur and tibia.
Meniscus Surgery
Despite its crucial function, the meniscus is one of the most frequently operated-on tissues in the body. In the past, surgery was the primary solution for meniscus tears. Today, however, most meniscus surgeries are unnecessary, with only rare cases requiring surgical intervention. Preserving the meniscus is essential due to its role in shock absorption; removing or trimming the meniscus increases force on the joint cartilage, which can accelerate cartilage wear and lead to arthritis. If arthritis progresses, the end result may be joint replacement surgery—an outcome best avoided.
Risks Associated with Surgery
Surgery carries inherent risks, especially when anesthesia is involved. Some patients may have adverse reactions or difficulty recovering from anesthesia, leading to prolonged brain fog that can last months. More severe complications include deep vein thrombosis (blood clots), pulmonary embolism, heart attack, or stroke. Additionally, any incision into a joint increases the risk of infection. Joints have poor blood supply, so even a small amount of bacteria can result in a septic joint, requiring multiple surgeries and intravenous antibiotics to clear the infection.
With the high volume of surgeries performed each year, it is important to consider whether the risks outweigh the benefits. Many patients present with surgical scars and worsened symptoms, highlighting the importance of careful decision-making before undergoing these procedures.
Impact of Meniscus Surgery on Joint Stability and Health
Trimming tissue during surgery often makes the joint less stable, as the capsule and ligaments attached to the meniscus are affected. Removing part of the meniscus reduces shock absorption in the knee, which can accelerate arthritis, especially in younger athletes. This process increases wear on the joint cartilage and may eventually lead to total joint replacement surgery.
Preserving the meniscus is critical. Instead of surgical intervention, the focus should be on supporting the internal environment of the joint to promote healing and stability.
Alternatives to Surgery: Regenerative Medicine
A promising alternative to surgery is regenerative medicine. This approach uses the body’s own healing cells, such as platelets from the blood and stem cells from bone marrow, to promote recovery. By injecting these cells into areas of pain or damage, regenerative medicine seeks to encourage natural healing and tissue regrowth.
Rather than trimming away tissue, which leads to instability and accelerated arthritis, regenerative therapies aim to optimize the joint’s internal healing environment and help patients avoid the path toward major surgeries and joint replacement. Preserving and regenerating the meniscus is a key goal in managing knee pain and maintaining joint health.
Knee Meniscus Tears: Rethinking Surgical Intervention
If you’re ever told you have a meniscus tear and you’re considering whether surgery is necessary, it is important to pause and review the available evidence. There is a substantial amount of data indicating that opting for surgery, such as “cleaning out” the meniscus, is often not the best approach for most cases.
Instead, the recommendation is to explore a variety of non-surgical options before considering major invasive procedures. While there are exceptions—such as trauma cases from car accidents or sports injuries, where the knee may sustain significant damage like multiple ligament ruptures or bone fractures—these situations clearly warrant surgical intervention. However, for common degenerative meniscus tears, surgery is generally not advisable.
Research consistently shows that surgery does not provide additional benefit for degenerative tears, and patients also face the risks associated with undergoing the procedure itself. Therefore, when you hear that you have a meniscus tear, exercise caution before immediately deciding on surgery. It is one of the most frequent scenarios observed in clinics: patients come in with MRI results showing a meniscus tear and assume that surgery is required. In reality, many of these cases can be managed successfully without surgical intervention.
Before moving forward with surgery, take time to consider all available options. There is a strong likelihood that non-surgical treatments can resolve the issue and restore knee function.
Evaluating Meniscus Tears: Matching Symptoms to MRI Findings
A classic scenario often encountered in clinical practice involves patients who receive MRI reports indicating a tear in the lateral meniscus, yet their pain is located on the inside half of the knee. For example, a patient might email saying, “Hi, Dr. Grove. My MRI says I have a tear in my lateral meniscus, but the pain is on the inside half of my knee. Should I get surgery?”
This situation highlights a common misconception: believing that a meniscus tear automatically requires surgical intervention. In reality, if the pain is in a different location from where the meniscus damage is reported, it is unlikely that the tear is the cause of the discomfort. Therefore, surgery is not advised.
Understanding Meniscus Tear Locations
The lateral meniscus is located on the outer half of the knee joint. When an MRI shows a tear here, but the patient’s pain is felt on the inner side, it suggests a disconnect between imaging findings and clinical symptoms. The most important question to ask is: what is actually causing the pain? Identifying the main pain generator is essential before considering any invasive procedure.
The Importance of Physical Examination
Relying solely on radiology reports, such as those from MRI scans, can sometimes lead to unnecessary surgeries. It’s crucial to perform a thorough hands-on physical exam to pinpoint the anatomical structure causing the symptoms. Symptoms can manifest as tightness, looseness, instability, pain, clicking, or catching sensations. Only a physical exam can clarify the source.
Integrating Imaging and Clinical Assessment
While imaging reports provide valuable information, they should be considered alongside the patient’s description of their symptoms and findings from a physical exam. Musculoskeletal ultrasound, which offers high-definition, dynamic imaging, can be particularly helpful in evaluating the meniscus and other knee structures in real-time and from multiple angles.
The Diagnostic Process
Effective medical care starts with an accurate diagnosis. A big pitfall is relying only on MRI findings, which can sometimes distract from the true cause of symptoms. Occasionally, findings on MRI are unrelated to the patient’s pain. Therefore, matching the location and nature of symptoms with clinical and imaging findings is essential.
Common Causes of Inner Knee Pain
Pain on the inner half of the knee is frequently observed, as most weight is distributed through this area. Medial meniscus injuries and medial collateral ligament (MCL) injuries are common causes of pain in this region. It’s important to distinguish these from lateral meniscus tears to ensure the correct diagnosis and treatment plan.
Medial Collateral Ligament Injuries: Experience and Treatment
The medial collateral ligament (MCL) connects the thigh bone (femur) to the shin bone (tibia). It plays a critical role in stabilizing the inner side of the knee.
Having personally experienced an MCL injury years ago, I can attest to its severity. It was one of the more painful injuries I’ve had.
Fortunately, I was able to treat my own injury with an injection. While some may find it unusual for someone to treat their own injuries, my experience in operating rooms and witnessing outcomes that are sometimes less than ideal has made me more comfortable managing my own care.
Once you have seen the results of various treatments and surgeries, especially when the outcomes are not good, you become more inclined to try and handle your own injuries when possible.
MCL injuries are common, and my experience allows me to speak to their management. It is essential to use diagnostic tools such as ultrasound to pinpoint the exact source of pain.
Ultrasound imaging helps identify the location of the pain, which is crucial for determining the appropriate treatment. In my case, ultrasound was instrumental in diagnosing and guiding a successful, single treatment.
I was fortunate to resolve the injury with one treatment, allowing me to return to normal activities quickly.
Accurate diagnosis is vital. Understanding the cause of pain, rather than simply masking symptoms, should always be the priority. This approach ensures targeted and effective treatment for MCL injuries and other knee conditions.
We’re discussing a variety of topics related to sports medicine, orthopedics, and musculoskeletal medicine. These areas encompass the treatment and management of pain, joint problems, ligament injuries, tendon issues, muscle complications, and concerns with joint capsules.
Regenerative Medicine: A Changing Landscape
If you’re experiencing persistent pain or dealing with joint, ligament, tendon, muscle, or joint capsule problems, it’s worthwhile to consider regenerative medicine. The field is evolving, moving away from elective orthopedic surgeries and instead focusing on innovative approaches to healing. Many cases that previously required surgery can now be addressed with regenerative techniques.
The Process and Benefits of Regenerative Medicine
Regenerative medicine utilizes the body’s own healing cells, including platelets and stem cells. These potent cells are concentrated and delivered accurately to the affected area using advanced image-guided procedures, such as musculoskeletal ultrasound. This approach promotes the healing process, aiming to regenerate damaged tissue, decrease long-term inflammation, restore function, and manage pain effectively. The goal is to help individuals return to their active lifestyles without dependence on pain medications or undergoing elective orthopedic surgery.
Personal Experience and Evolving Tools
It is disheartening to witness patients choosing unnecessary surgeries or experiencing worse outcomes after surgical procedures. Today, there are more tools available than ever before, and regenerative medicine stands out as a valuable option. This method has proven beneficial for many, including myself. As a former linebacker at the University of Nebraska, a multi-sport athlete in high school, and a mixed martial arts competitor, I’ve trained professional athletes worldwide and had my own fair share of aches and pains.
Case Study: Post-Surgical Nerve Compression and Foot Drop
In this case, a patient experienced foot drop following back surgery, which initially did not alleviate their condition. Recovery occurred over months of physical therapy, but a complication arose: nerve compression caused by surgical positioning, leading to symptoms like weakness and numbness. A thorough examination and dynamic ultrasound revealed the specific location of the nerve compression, prompting treatment through nerve hydrodissection. This new procedure, facilitated by advancements in ultrasound technology, significantly improved the patient’s symptoms. The case underscores the relevance of understanding peripheral nerve entrapment, also seen in conditions like carpal tunnel syndrome, where diagnostic and treatment principles remain consistent across various nerve issues.
Cubital Tunnel Syndrome and Ulnar Nerve Compression
Compression of a nerve at the elbow, particularly the ulnar nerve at the cubital tunnel, can lead to classic symptoms. Many people have experienced striking their “funny bone,” resulting in a shock-like sensation that radiates through the pinky and ring fingers. This sensation is directly related to the ulnar nerve.
Such compression may arise from trauma or previous surgical interventions, such as the development of scar tissue that puts pressure on the nerve. Identifying the source of these symptoms is essential for effective treatment.
Diagnostic Approach
The key to managing peripheral nerve entrapments is to match the patient’s symptoms with the anatomical location of the affected nerve. Utilizing diagnostic musculoskeletal ultrasound allows clinicians to visualize the site of nerve compression and confirm whether it aligns with the clinical presentation.
Treatment Procedures and Outcomes
The procedure to relieve nerve compression is straightforward, often requiring only a few minutes. Small needle insertions and gentle pressure are used to free the nerve and restore its function. This process helps the nerve regain its ability to transmit signals, alleviating symptoms such as numbness and weakness.
It is important to note that medical outcomes are never guaranteed. While many patients experience significant improvement, results can vary.
Timing and Prognosis
Early intervention tends to yield the best results for peripheral nerve entrapments. When nerves are compressed for extended periods—years, for example—the chances of full recovery decrease, and permanent nerve damage may occur. Therefore, prompt attention to symptoms such as numbness, tingling, pins and needles, or intermittent weakness is critical.
Those experiencing these symptoms should seek evaluation from a professional trained in diagnostic musculoskeletal ultrasound to determine whether a peripheral nerve entrapment is present. This approach is relatively quick and can lead to effective relief for many patients.
Disc Bulge and Pain
Many people send in emails with questions about their back pain and MRI findings. One common scenario is a patient reporting a disc bulge on the right side but experiencing pain on the left side. This raises the question: does a disc bulge always require surgery?
Most often, disc bulges occur in the lower lumbar spine—the lower back. The intervertebral discs act as shock absorbers between the vertebrae and contain a jelly-like substance inside. If there is a weakness in the disc’s outer wall, this inner jelly can protrude outward, pressing on nearby nerves. This is referred to as a disc bulge or herniation.
It’s important to understand that disc bulges are extremely common and, in many cases, do not cause any pain. When someone has an MRI showing a disc bulge, the clinical picture must be carefully matched with their symptoms. For example, if a patient has a disc bulge on one side but pain on the other, it’s unlikely that the bulge is responsible for the symptoms.
Other structures in the spine, such as ligaments and muscles, can frequently cause pain. Common sources include ligament and tendon injuries, muscle strains—especially in the lower back—and even the gluteal muscles, like the gluteus medius, which sits higher up near the lower back. These injuries can result in narrow bands of pain and are often mistaken for disc-related pain after imaging.
Physical examination is crucial for determining the actual source of pain. If stressing the affected disc does not reproduce the patient’s symptoms, the disc bulge is probably not the culprit. Instead, clinicians should focus on matching physical findings with imaging results, using hands-on exams and ultrasound scans to pinpoint the source of pain.
Ultimately, having a disc bulge does not necessarily mean it will cause pain. Many patients present with disc bulges on MRI that are unrelated to their symptoms. In these cases, the disc bulge is not a significant concern, and careful clinical evaluation is needed to guide appropriate treatment.
Case Study: Persistent Pain Following Ankle Surgery
We recently received an email seeking advice: “Dr. Grove, please help. I broke my ankle and had surgery, but I still have pain. Is there anything that we can do?” This serves as an excellent opportunity to discuss the complexities involved in bone fractures and their recovery.
The Mechanics of Bone Fractures
Bones are generally very strong and difficult to break. Typically, a significant amount of force is required to cause a bone fracture, especially in healthy individuals. Exceptions include conditions like osteoporosis, where bones are more fragile and susceptible to injury.
Associated Injuries and Post-Surgical Pain
When someone suffers an ankle fracture, it’s likely that other neighboring structures—such as ligaments, tendons, muscles, and joints—are also impacted by the trauma. Even after surgery is performed to restore the bone to a proper anatomical position, patients may continue to experience pain.
Identifying the Source of Pain
The persistence of pain following surgery often stems from injuries to surrounding tissues rather than the bone itself. The ankle, for example, contains numerous ligaments, tendons, and small joints. Post-surgical pain may be related to strains or damage in these neighboring structures.
Clinical Evaluation and Management
It is common for patients to be cleared by their orthopedic surgeon after imaging shows the bone has healed. However, some individuals still experience pain or other symptoms. A thorough hands-on physical exam can reveal issues in the tissues around the surgical site. Many of these cases respond well to targeted evaluation and treatment, addressing injuries outside the primary fracture site.
Joint Replacement and Persistent Symptoms
Similar challenges arise in patients who have undergone joint replacement procedures. While the artificial joint itself (composed of plastic and metal) may be functioning well, pain can persist due to strains or injuries in nearby ligaments, muscles, or tendons. For example, knee replacement patients may develop strains in the collateral ligaments adjacent to the surgical area.
Challenges with Surgical Hardware and Healing
When plates and screws are used in bone surgery, the way new tissue or prostheses heal may not perfectly replicate the original anatomy. Even small deviations in height or alignment can place additional strain on neighboring structures, leading to ongoing symptoms.
Importance of Comprehensive Assessment
Persistent pain after surgery should not always be addressed with more surgical interventions. Instead, it is vital to pause and consider whether nearby tissues may be contributing to the symptoms. These cases often benefit from a detailed physical exam and diagnostic imaging, such as ultrasound, to identify treatable conditions. Many patients find relief once these secondary issues are managed appropriately.
Shoulder Dislocation: Evaluation and Management Options
A patient describes dislocating their shoulder and receiving a recommendation for surgery from their orthopedic specialist. However, they express reluctance about undergoing a surgical procedure and inquire about alternative treatments.
Understanding the Injury
Shoulder dislocations typically result from a significant force and are considered one of the most common large joint dislocations encountered clinically. While the bone can often be repositioned either by the patient, in the emergency room, or on the field during sporting events, the injury often involves more than just the bone.
Damage to Supportive Structures
When a shoulder dislocation occurs—most often anteriorly, with the joint popping out through the front—there is considerable stretching of the ligaments that connect bone to bone. Even after the shoulder is put back into place, these supportive tissues may remain damaged or stretched.
Healing these structures on their own can be challenging, and there is a high risk of repeat dislocations if the underlying tissue injury is not addressed. Treating the bone alone may not be sufficient; ongoing instability and pain can persist unless the surrounding tissues are also managed.
Non-Surgical Approaches
Regenerative medicine offers an alternative to surgery for some cases. By targeting the neighboring structures—such as ligaments and tendons—these treatments aim to restore joint stability and function, reducing the risk of future dislocations. Simple injections may help support healing and improve function, especially when there is no significant bone fracture.
When Surgery Is Necessary
Surgical intervention may be required if there is a major bone fracture or other severe injury as a result of the dislocation. Proper imaging is essential to rule out these injuries and determine the best course of treatment.
Treatment Goals
Ultimately, the objective in managing shoulder dislocation is to restore and maintain joint function, minimize pain, and allow patients to lead active, healthy lifestyles. Regenerative medicine can be a valuable, low-risk tool to help achieve these goals, especially for those wishing to avoid surgery.
A recent email raises an important question regarding the discovery of a labrum tear in the hip that is not causing any pain. The sender is concerned about whether surgery is necessary to prevent the condition from worsening.
Understanding Labrum Tears
Often, patients may experience pain in one area, such as the hip, prompting imaging of both hips. It is common for imaging to reveal pathology, like a labrum tear, on the side without any symptoms. This situation frequently leads to consideration of unnecessary surgery, despite the absence of pain.
If a labrum tear is detected but is not associated with symptoms, it is generally not advisable to pursue surgical intervention. Many individuals have labrum tears in the hip with no symptoms whatsoever.
Should Surgery Be Considered?
There is strong evidence against performing surgery on asymptomatic patients for findings seen only on imaging. Surgical procedures carry inherent risks, and the typical approach for labrum surgery involves trimming the torn tissue. In cases of larger tears in younger patients, a labrum repair might be attempted, but this is a challenging procedure with variable outcomes.
When surgery is performed, multiple incisions are made in the joint, tissue is trimmed, and the joint can become more unstable. Removing protective tissue increases the risk of arthritis, making it advisable to avoid surgery if possible.
Anatomy and Function of the Labrum
The labrum is present in both the shoulder and the hip, which are ball-and-cup joints. The labrum is a tough piece of fibrocartilage, similar to the meniscus, lining the cup side of the joint. Its function is to provide stability by keeping the ball suctioned into the cup.
Trimming out the labrum can result in increased instability after surgery, complicating recovery and healing, especially with regenerative medicine.
When Is Surgery Appropriate?
Surgery is generally reserved for cases where mechanical symptoms are present, such as locking of the joint due to a large tear. If the tear flips into the joint and movement becomes blocked, accompanied by significant pain, surgery may be necessary.
In most instances, pain may be attributable to a simple strain of the joint capsule—a joint sprain—which is basic to treat and does not require surgery.
Clinical Recommendations
Overall, the best advice is to avoid surgery unless absolutely necessary. A hands-on physical exam and ultrasound imaging can help determine if the labrum is truly the source of pain. For patients who do not have pain on the side with a labrum tear, surgery is not a good idea.
Overview of Femur Neck Pinning Surgery
Femur neck pinning is a surgical procedure commonly performed to address fractures in the neck of the femur, which is often referred to as a “broken hip.” This surgery aims to realign the bones and restore proper anatomy by using pins to stabilize the fracture, a method known as internal fixation.
Anatomy of the Hip Joint
The hip joint consists of a ball-and-cup structure, with the ball being the femoral head and the cup as the acetabulum. The neck of the femur is located just below the ball and is a frequent site for fractures due to its unique blood supply.
Blood Supply and Complications
The primary blood supply to the femoral head comes from the medial femoral circumflex artery. When a fracture occurs, this blood supply can be disrupted, potentially leading to avascular necrosis (AVN), a condition where the bone tissue dies due to lack of blood flow.
Postsurgical Issues
After femur neck pinning, patients may experience issues such as AVN or joint inflammation. If the joint remains intact and the cartilage is preserved, problems may still arise from cartilage damage or inflammation. In cases where arthritis is present, a total joint replacement may be considered instead of pinning.
Other Bones with Similar Healing Challenges
Several other bones in the body, such as the base of the fifth metatarsal (Jones fracture) and the scaphoid bone in the hand, also have poor blood supply and can face similar healing challenges after trauma or fracture.
Regenerative Medicine and Healing
One promising approach to improving healing in these situations is regenerative medicine. By introducing stem cells or platelets, the process of angiogenesis—the formation of new blood vessels—can be stimulated. This enhances blood flow to the affected area and supports the healing process, making it a valuable tool for recovery after femur neck pinning and similar injuries.
