Non-surgical Therapy

Extracorporeal Shockwave Therapy

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Extracorporeal shockwave therapy being applied to an arthritic kneeExtracorporeal Shockwave Therapy 

Extracorporeal shockwave therapy doesn’t involve electric shocks. Shockwaves are sudden vibrations. The body is built to absorb shockwaves from activities such as running and jumping. These shockwaves trigger the release of growth factors that promote the development of bone, tendon and ligament. This is part of the reason why athletes have greater bone density than less active individuals.

Growth factors not only promote tissue growth; they are also powerful anti-inflammatories. This anti-inflammatory action can help relieve arthritis pain.

Arthritis, Bursitis, Fasciitis

Extracorporeal shockwave therapy helps relieve the pain of chronic arthritis and other inflammatory conditions. Typically, it is recommended that extracorporeal shockwave therapy be applied a total of once a week for 3 weeks. If the treatment is going to work, benefit should be seen after the first treatment. After the completion of 3 treatments, improved comfort typically lasts for 3 months, after which only a single treatment is needed to provide comfort for each additional 3 month period.

Patients need to have a small area over the affected structure shaved before treatment. Generally, no sedation is required. Minor bruising of the affected area sometimes occurs. Chronic, long standing conditions tend to respond better than recent conditions.

Tendon and Ligament Repair, Resorption of Tendon Calcifications

Treatment protocols vary depending on the nature and severity of the tendon lesion, but extracorporeal shockwave therapy has been shown to be effective in the treatment of damaged tendon and the resorption of tendon calcifications.

Typical protocols involve 3 treatments spaced 2-3 weeks apart, coupled with an appropriate rehabilitation program.

Accelerating bone repair after surgery

Extracorporeal shockwave therapy has been shown to accelerate healing of bone following cruciate surgery, as well as stimulate the healing of bone following fracture repair. Speeding the rate of bone repair can help reduce the chance of complications following cruciate repair or other surgery.

If you would like your pet to receive extracorporeal shockwave therapy, contact information can be found here. If you have further questions, please email info@pointseastwest.com


Stem Cell treatment of partially torn biceps tendon

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Case Report:

Stem Cell treatment of partially torn biceps tendon.

Introduction:

biceps stretch

With a damaged biceps tendon, shoulder flexion like this is very painful.

Biceps tendon injury is a common cause of shoulder pain in dogs.  In veterinary medicine, the traditional treatment has been surgical – the tendon is cut from its attachment point so that it no longer is a source of pain.  The problem is that once cut, the tendon is no longer a source of stability for the shoulder and now there is an increased chance of other injuries occurring, including rotator cuff injuries or damage to the supraspinatus tendon. SURGICALLY CUTTING THE BICEPS TENDON SHOULD ONLY BE USED AS A LAST RESORT AFTER ALL OTHER TREATMENTS HAVE FAILED!

Rehabilitation therapy (the veterinary equivalent of physiotherapy) offers a new option for treating this condition and is successful in most minor cases where the amount of tendon tearing is not too great.  However, some cases fail to respond to rehabilitation, and unfortunately many of those cases then proceed straight to surgery.

Now there is another option for biceps (and many other) tendon injuries if rehabilitation therapy alone is not enough to fix the problem.  We are now able to use stem cells to regenerate new healthy tendon, as well as to resorb scarred or calcified tendon tissue.  Click here to learn more about regenerative medicine options and uses.

Case Example:PEW blog BT injury pre-MSC

Damaged Biceps Tendon Damaged Biceps Tendon Damaged Biceps Tendon

Damaged Biceps Tendon with graphics

This is an ultrasound of a damaged biceps tendon that I examined last summer.  I know, looking at ultrasound images can be confusing, much like trying to read television static, so I added fancy graphics.  Healthy tendon should have an even level of “whiteness” on ultrasound, with easily distinguished fibers running along its length.  Damaged tendon has mixed colouring of light and dark tissue, with disruptions of these fibers.

The blue lines show the outline of the bones.  See how the tendon (in red) crosses from the forelimb on the right to the shoulder blade on the left?  It spans across the shoulder joint, which provides stability and is why we want to preserve it if at all possible.

The tendon itself is outlined in red.  As you can see, there is quite a bit of colour variation and fibre disruption evident.  This is a badly damaged biceps tendon.  We tried fixing the tendon using rehabilitation therapy techniques, but unfortunately those techniques didn’t work in this case.  Without some other treatment, this dog would never return to full and pain free activity again.


PEW blog BT injury 3m post-MSC

PEW blog BT injury 3m post-MSC edited copy

Here is the same tendon 3 months after injection with stems cells collected from the dog’s bone marrow and injected into the damaged tendon.  See the difference?

This tendon has a much better level of “whiteness”, uniform colouring and good fiber definition.  We anticipate that this dog will return to full activity on the shoulder.

If you would like to have your pet assessed and possibly treated using these techniques, please contact one of the hospitals where Dr. Lane works.


Veterinary Regenerative Medicine Overview

Posted on in Non-surgical Therapy, Regenerative Medicine, Uncategorized Comments Off on Veterinary Regenerative Medicine Overview

 

Overview of Veterinary Regenerative Medicine

(Tendon and Joint Injections of Hyaluronic Acid,

Stem Cells, and/or Platelet Rich Plasma)

 

coming off a fram contact

Even though it is still young, the field of regenerative medicine is showing great promise for treating many musculoskeletal conditions that we couldn’t before.  Already we are seeing great successes.  As with every new field of science, it is also rapidly changing.  Each year, protocols and techniques evolve as we learn more.

Regenerative medicine involves isolating the body’s own tissue repair mechanisms and then placing them in high concentration at the site of injury.  The goal is to accelerate healing and generate new healthy tissue.  Below is a brief overview of the regenerative medicine options available for treating musculoskeletal issues in dogs.

 Hyaluronic Acid Joint Injections

Duffy after regionals

Hyaluronic acid (HA) is a key component of healthy joint fluid and cartilage, and is depleted in arthritic joints, which leads to worsening arthritis, which causes it to be more depleted, which worsens the arthritis…. There are effective oral and subcutaneous injection products that help boost HA levels, but direct injections into the joint achieve the highest level of HA replenishment.

HA can be used on its own for early or mild arthritis, or combined with steroids for more advanced and/or painful conditions.  Although we frequently use HA injections for severely arthritic joints, the best effects are seen when it is given earlier in the disease process.

Although HA injections into the joint are helpful, especially when combined with steroids, the effects don’t last as long as they do with PRP injections.

 PRP (platelet rich plasma)

he joy twoPlatelets are the body’s front line soldiers for repairing damaged tissue.  They clot the wound to stop bleeding, then release a number of growth factors to initiate the healing process.  By collecting a sample of blood from your dog, concentrating down the platelet fraction and then re-injecting this platelet rich plasma (PRP) where it is needed, we see a number of positive effects.

PRP accelerates healing and decreases inflammation associated pain.  It also magnifies the benefits of stem cells when the two are mixed together.

When injected into arthritic joints, it gives pain relief for 80% of patients (which is the same as either HA or stem cell injections) that lasts about 9 months (which is much longer than HA injections, and almost as much as stem cell injections).  The pain relief provided is as good as, if not better, than that provided by combining HA with steroids.

When injected into injured tendons, PRP appears to accelerate repair.  In the dog world, most of the research on tendon injury remains unpublished, and involves shoulder injuries.  To see a specific example of how well PRP combined with stem cells works, click here.

Compared to stem cells PRP is a less invasive and less expensive technique (about 1/3 the cost of stem cell injections).  Depending on the joint being injected, the entire process can happen with only mild sedation, or even no sedation in some dogs.

 Stem Cells

 

These cells were collected from the bone marrow and the stem cells are being concentrated for injection

These cells were collected from the bone marrow and the stem cells are being concentrated for injection

Stem cells were one of the first regenerative medicine tools to be used.  Mesenchymal stem cells are very different than embryonic stem cells.  We only use mesenchymal stem cells.  Our bodies constantly undergo some degree of damage and repair, and stem cells are a big part of that repair.  They can be found in many tissues, and once stimulated, will begin to grow new healthy tissue.  They are found in high levels in the marrow and periosteum of bone, and play a big role in fracture repair (along with platelets).

In veterinary medicine, we commonly harvest stem cells from two locations: fat or bone marrow.  Fat derived stem cells  are typically sent to an outside lab for processing which often means a second anesthesia for your pet, but bone marrow origin  stem cells can be processed and re-implanted immediately.

When MSCs were first injected into joints, we were hopeful that they would regrow healthy cartilage and reverse arthritis.  Unfortunately, they do not.  They do however provide good pain control in most patients for 11 months on average (see PRP above).

However, when injected into damaged tendons, stem cells do regrow normal tissue, as well as resorb scar tissue and mineralization.  It is an excellent tool for tendon repair, and combined with PRP is the treatment of choice.  It can also be used to accelerate the healing of broken bones.

 Summary

Regenerative medicine is fast becoming a key tool for addressing and decreasing the progression of arthritic pain and for treating damage tendons, especially for shoulder and groin injuries.  If you would like to have your pet assessed and possibly treated using these techniques, please contact one of the hospitals where Dr. Lane works.

Click on this case study to see an example of how stem cells were used to treat a tendon injury.

 Summary of different regenerative medicine options:

Indications
Pro’s
Con’s
HA +/- steroids
  • Pain control and prevent further degeneration of arthritic joints
  • Less expensive than PRP and stem cells
  • Less invasive than stem cells
  • Better alternative than daily anti-inflammatories
  • Effects do not last as long as either PRP or stem cells
PRP
  • Pain control and prevent further degeneration of arthritic joints
  • Facilitate healing of mildly damaged tendons
  • Less expensive than stem cells (about 1/3 the cost)
  • Effects on arthritis last much longer than HA, and almost as long as stem cells (9 months)
  • Better alternative than daily anti-inflammatories
  • Does not fully heal badly damaged tendons as well as stem cells do
Stem Cells
  • Pain control and prevent further degeneration of arthritic joints
  • Facilitate healing of badly damaged tendons
  • Can regenerate and heal badly damaged tendons
  • Provides joint pain relief for 11 months on average
  • Better alternative than daily anti-inflammatories
  • More expensive than HA or PRP
  • Collection process requires a general anesthetic