Prolotherapy
"Over one year ago (July 1998), I was injured on the job - (right arm, shoulders and neck). I was sent to a Work Comp. Doctor that gave me some medication and sent me back to work. I was at work for about 2 hours and was in a tremendous amount of pain before I was sent back to the Work Comp. Doctor. this time who gave me some medication for the pain and again I was sent back to work. After about 2 hours of trying to work, the pain was becoming even more intense, and again they sent me back to the same Doctor. This time he put my arm in a sling and suggested that I go see an Orthopedic Doctor that they would recommend. The Orthopedic Doctor told me that I was suffering from Carpal Tunnel Syndrome of the right wrist and severe Tendonitis of the right elbow. After pain medications, splints and casts, not to mention all the physical therapy I went through – (which by the way did more harm than good), I had wasted about 7 or 8 months and my symptoms were actually worse than before!
I finally got mad and demanded to see another Doctor. Wok Comp sent me a list of Doctors that I could go see. I started running my finger down the list and by the Grace of God, my finger stopped at Dr. Alvin Stein. Work Comp. Made the appointment and I went in to see the Doctor on February 11th / 99.
Dr. Stein started his magic immediately. He gave me the therapy injections in the pain areas of my head, neck, shoulders and right arm. By my next visit – (Feb 15th), my right arm was free of any pain, so I have no idea where the first Orthopedic Doctor came up with the diagnosis of Carpal Tunnel and Tennis Elbow, my arm was fine, but the pain in my neck and shoulders had returned.
Dr. Stein gave me another set of injections but these too eventually wore off and the pain returned. After two more sessions with Dr. Stein, I was beginning to wonder if I was ever going to get better. On August 3rd / 99, Dr. Stein gave me a set of injections in my neck and spine area, for four days afterwards, I was in pain and stiff in my neck area. Then after those four days the pain started to ease up and, within seven days I was pain free!
It is now August 17th / 99 and I can honestly say that I am healed. God helped me through all of this, but Dr. Stein’s expertise and knowledge of the human body, healed me. I will thank God every day for stopping my finger on Dr. Steins name and many, many thanks to you Doctor Stein for this relief. I will definitely be telling anyone I know about the care you show your patients, especially those in need of relief from pain. I just hope that more people don’t have to go through what I did until they can see a truly wonderful and exceptionally caring Doctor who knows what he is doing. Thank you again."
Sincerely,
Tom Latzke
Shoulder pain is a common type of pain treatable by prolotherapy. Much of the
shoulder joint pain is associated with bursitis. This is an inflammation of
the tissue lying above the rotator cuff tendon. The bursa or potential fluid
filled sac becomes inflamed from irritation associated with overuse or with
rubbing of the tendon on the bone that is above the shoulder, the acromion process.
In order to explain this we need to understand some of the anatomy related
to the shoulder. The shoulder is a joint that has a great deal of mobility and
that allows us to move our arms freely and in many different directions. This
occurs because there is a relatively small bone to bone surface hold as compared
to the hip joint, but a large amount of ligament restraint to keep the bones
in place. The bones I talk about are the humerus and the scapula with its glenoid
and the acromion process.
The scapula or wing bone provided the socket that is called the glenoid. It
is a relatively small and shallow dish like structure that allows the humeral
head to articulate with it. The humeral head is held in place by the capsule
of the shoulder joint, which has several specialized areas in its structure.
These specialized areas are reinforced into ligaments, which stop the head of
the humerus from sliding out of place. These ligaments are called the anterior
and posterior glenohumeral ligaments. In the anterior capsule there are three
such ligaments, the superior, middle and inferior glenohumeral ligaments. The
inferior is the most important and thickest one of the three. Its job is to
prevent the humeral head from sliding forward and upward. If the head of the
humerus slides forward and upward it interferes with the normal arc of movement.
This allows the humeral head to come closer to the acromion process that is
above the shoulder. The acromion acts as an attachment for the muscles that
move the shoulder, especially the deltoid muscle and all of its specialized
parts.
As the humeral head comes closer to the glenoid the space allowed for the rotator
cuff tendon is reduced and the tendon gets caught between the two bones and
starts to get inflamed. This causes the bursitis in the shoulder. As the bursitis
gets worse, the inflammation weakens the rotator cuff by rubbing away some of
its fibers, if the process continues unchanged, the result if a rupture or tear
of the rotator cuff and the need for reparative surgery to reestablish the continuity
of the tendon. This condition is called IMPINGEMENT SYNDROME.
Conventional recommendations for the treatment of bursitis are the use of anti-inflammatory
medications and cortisone injections into the shoulder. This will get rid of
the pain and the patient will go on until the next episode. Here they are often
referred to physical therapy for exercises to strengthen the rotator cuff in
an effort to bring the head of the humerus into the proper place. This makes
the assumption that the muscle is weak, and needs strengthening and that the
inflammation is primary, or else secondary to muscle weakness. The conventional
treatment does not consider ligaments being loose allowing the humeral head
to move out of place causing the inflammation and or the weakness.
When the bursitis becomes chronic and the tendonitis becomes chronic, the patient
often stops using the shoulder and the loss of function is called a frozen shoulder
which usually requires a lot of treatment leads to a prolonged morbidity associated
with this condition. SURGERY is often recommended and at times, it is the only
thing to do. This involves removal of the undersurface of the acromion and repair
of the rotator cuff, if it can be accomplished. The postoperative treatment
includes a lot of physical therapy and home exercise and often still leave the
patient with weakness and pain BECAUSE THE UNDERLYING PROBLEM IS NOT SOLVED
BY THESE SURGICAL PROCEDURES! The surgery treats the effect and not the cause.
It treats the immediate cause of the pain, but not the cause of the condition.
The surgery takes away a piece of bone as if that suddenly grew large and became
the culprit. Although removing that piece of bone usually does no harm, (note
I said usually) that is not always the case. Postoperatively, enough patients
have more problems that they bargained for because the primary cause of their
problem was not dealt with at all. The repaired rotator cuff can wear out again
and rupture anew perhaps making it unrepairable.
This is where prolotherapy comes in and can help, preferably before
all the damage has occurred, but even afterward. Using prolotherapy,
we inject the glenohumeral ligaments in the anterior and posterior
capsule of the shoulder. This causes the ligaments to tighten and
pull the head of the humerus back into the normal position in relationship
to the glenoid. It pulls the humeral head down away from the acromion.
That allows the rotator cuff to have the room it needs to work without
being impinged and without getting inflamed and without the bursitis
and the pains that are present with and without activity.
The plan is for an examination and an x-ray of the shoulder. If
there is any instability and/or tenderness in the area of the ligaments
in the capsule, injections are given to the entire anterior capsule.
The ligaments are injected with the proliferant solutions to force
these tissues to return to their normal size and length thereby
restoring the proper anatomy and relieving the problem. Sometimes
only one injection session is all that is needed. On other patients
two or three sessions may be needed. The healing then begins. Results
are usually seen in two to six weeks. The improvement is usually
permanent. The injection can be repeated if needed without and adverse
effects. This treatment does not do any damage to the shoulder.
PROLOTHERAPY IS ALSO USEFUL IN RECURRENT DISLOCATION OF THE SHOULDER
WHEN USED IN THE SAME FASHION DESCRIBED ABOVE!
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