ORTHOPAEDIC MEDICINE SPECIALTIES FOR PAIN TREATMENT
Orthopaedic medicine is a specialty devoted to the evaluation, diagnosis and non-operative treatment for pain caused by musculoskeletal diseases to aid in pain management. Diagnostic modalities include a comprehensive history, a detailed and specific physical examination, radiologic evaluations and local anesthetic blocks for pain treatment. Therapeutic modalities for pain management encompass manipulations, corticosteroid or proliferant injections with and without fluoroscopic guidance, therapeutic exercise and use of pharmaceutical, nutriceutical, herbal and/or homeopathic based pain treatment.
The evolution began in 1741 when Nicholas Andre, at that time a Professor of Medicine at the University of Paris, coined the word “orthopaedic”. He published a book with the same title. The etymology of orthopaedic is based on two greek roots: “orthos” and “paedia” which translate to “straight” and “rearing of children” respectively. His illustration of a staff that is used to straighten a growing tree is known world wide.
For more than two centuries orthopaedists were physicians or surgeons concerned with musculoskeletal deformities: scoliosis, infections of bones and joints, poliomyelitis and congenital defects such as Erb’s palsy, clubfoot and hip dislocations. Until the 20th century most orthopaedic treatments were manipulations and mechanical support with braces and plaster casts.
The American Orthopaedic Association was founded in 1887. The separation of orthopaedic surgery from general surgery took place in 1934 with the establishment of a separate board. According to the late Dr. Cyriax, orthopaedic medicine was established in 1929. The American Association of Orthopaedic Medicine was founded in 1982.
The accumulation of knowledge remains constant. The evolution of pain management continues.
The diagrams above are from a recent study where the stem cells were placed blindly into the joint (intra-articular) versus exactly on the lesion (local adherent). The control was just injection of saline, which is far left. Notice that the purple stained cells on the surface are new cartilage cells (the blue cells under that are bone). The control shows little change. The intra-articular blind injection isn’t much better, and when the cells are placed directly on the specific damaged spot within the joint (far right local adherent) we see good cartilage repair. The same would hold true to injecting cells into a specific tendon, ligament, part of a meniscus, labrum, etc.
Additionally, one problem for collecting bone marrow stem cells is that the area at the back of the hip where they are harvested has some pitfalls. If the doctor performs this type of collection without imaging guidance (blind without using either fluoroscopy or ultrasound), the chance of taking cells from the wrong area goes up dramatically. In this area of the back of the hip, there’s a paper thin part of the pelvis that if tapped by the doctor, will almost always result in a blood collection only, rather than a bone marrow aspirate. Precision is the key to a Regenexx physician’s ability to maximize stem cells during the harvesting procedure.