Marc Darrow MD,JD

Over the years we have seen a lot of people with knee problems. Many of them with problems of the patellar tendon. They have had many treatments including, cortisone, physical therapy, rest, some of the them wear big braces on their knees. They are doing a consult with me because they are still looking for help. Can stem cell therapy and Platelet Rich Plasma Therapy help them? After an email or a phone call we assesses the person’s situation. If we feel they are a realistic candidate for treatment, they come in for a consultation where we can do an examination and come up with a healing program.

• PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. PRP utilizes the blood’s platelets and their healing and tissue repair factors.
• Stem cell therapy involves the use of your own bone marrow derived stem cells.

Published research on Patellar tendinopathy treatments

A June 2020 study (1) from Stanford University focused on additional treatment options for the two most common causes of front of the knee pain, patellofemoral pain syndrome, and patellar tendinopathy. The researchers wrote: “Conservative management is the first-line treatment for these conditions. For clinicians to maximize the efficacy of conservative treatment options for their patients, they must understand the most up-to-date literature evaluating the potential benefit of taping, bracing, and injections as adjunctive treatments for maximizing treatment success.”
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Marc Darrow MD,JD

We see many people at our practice with a long medical history of thumb pain and thumb pain treatments. These people would up seeing us because their long medical history of conservative  care treatments, possibly surgery or surgical recommendation did not help them and they are seeking stem cell therapy or PRP platelet rich plasma therapy as options. Perhaps as options and an alternative to some type of hand surgery.

Thumb pain is often confused with wrist pain and carpal tunnel pain. The confusion with Carpal Tunnel Syndrome is the belief that there is some type of tendon involvement. The confusion with the wrist pain can lead to the belief that there is a ligament or osteoarthritis involvement. As an added layer of confusion doctors may find it difficult to determine if the person’s pain is coming from the wrist or thumb.

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Marc Darrow MD,JD

I see many people with finger problems. This includes “trigger finger.” For some people they have been to other doctors and have been diagnosed with the more technical term, “stenosing tenosynovitis.” Whether a trigger finger or stenosing tenosynovitis diagnosis, you have been to the doctor because your finger is stuck or locked in a bent position and it is making a loud popping noise that you know is not right.

Over the course of time people try to manage trigger finger on their own. Many go online and look for quick remedies and suggestions.

Many people will:

• Rest their fingers or avoid activities that irritate the situation. This is particular tough on a musician or someone who does a lot of dexterity work with their hands. So these people look for other things that may help.
• They may alternate heat and ice therapy depending on whether they have inflammation or puffiness.
• Sometimes they walk around with their hand a container of warm water to try to get the finger to relax and loosen up.
• Add to this anti-inflammatories.
• Some may also purchase a finger splint at the pharmacy and try to keep their finger extended with the splint and tape.

For those who did not find relief with these remedies, they sought out a doctor. At the doctors they got:

• Stronger medications than the one they were taking: ibuprofen, naproxen or acetaminophen to help manage the pain.
• A better splint

The A1 pulley

Doctors tend to get more technical when the patient is progressing their way towards surgery. Here a doctor may explain to the patient that they have a problem with their A1 pulley and their  flexor tendon. The flexor tendon attaches the muscles of the forearm to the bones of the fingers. In its path from forearm to finger, the flexor tendons passes through a band of tissue that holds it is place along the finger bones called the A1 pulley. When this tendon does not slide properly within the A1 pulley and it becomes irritated and inflamed. If the flexor tendon becomes too enlarged and swells up to the point that it can no longer glide back and forth within the A1 pulley. It gets stuck and so does your finger.

Is there a connection between carpal tunnel syndrome and trigger finger?

A May 2020 study (1) reviewed the connection between Carpal tunnel release and trigger finger. They wrote: “Carpal tunnel release is acknowledged as a predisposing factor for the development of the trigger finger. However, the incidence of new-onset trigger finger after Carpal tunnel release surgery has been inconsistently reported. In this study, we aimed to evaluate the prevalence of Carpal tunnel release as a risk factor of the development of the trigger finger.”

• Post-Carpal tunnel release trigger finger was detected in 26.3% of the 57 patients of this study
• The trigger finger occurred approximately six months after Carpal tunnel release surgery. The thumb and ring fingers were the most commonly involved fingers.
• Ten out of 15 (66.7%) patients who developed a post-Carpal tunnel release trigger finger had mild-to-moderate Carpal tunnel syndrome, and five (33.3%) patients had severe Carpal tunnel syndrome. No significant difference was found between the patients who did and did not develop a trigger finger after Carpal tunnel release surgery.

“The rate of developing a post-Carpal tunnel syndrome trigger finger was remarkable in our study.” The authors of this study suggested that patients under going Carpal tunnel release be advised of the potential of developing trigger finger.

Non-Surgical options : Cortisone, PRP and Stem Cell Therapy

Since trigger finger is considered a problem of inflammation some will think that the obvious treatment should be a strong anti-inflammatory, such as a cortisone injection. Others would rather not go down the cortisone route because of the well known side-effects and the simple fact that cortisone is not a healing treatment, it is a symptom suppression treatment.

PRP vs cortisone

A research team in November 2020 (2) announced that they would conduct a study to compare PRP injections to cortisone injections for trigger finger. There is limited research on PRP effectiveness for trigger finger outside of research that suggests “Platelet-rich plasma (PRP) has been shown to be safe and to reduce symptoms in different tendon pathologies, such as DeQuervain’s disease (painful thumb tendons).”

Further they write:

“PRP has been shown to reduce symptoms in different tendon pathologies with the rationale to potentially accelerate the healing process. PRP has positive effects on both short-term and long-term pain on tendon and ligament healing. PRP contains various growth factors that have potential tendon-healing properties. PRP has been previously used in hand pathologies such as osteoarthrosis.

Injection of corticosteroids in the vicinity of the A1 pulley is generally accepted as a first-line therapy, although recurrence rates up to 33% have been reported. Moreover, up to 5.8% of major adverse events have been reported in soft-tissue injections of cortisone (defined as those needing intervention or not disappearing). As some authors have stated superiority of PRP compared to cortisone in select musculoskeletal disorders,, investigating the clinical efficacy of PRP in treating trigger finger is warranted.”

We have seen many people with problems of trigger finger. We have helped many with PRP treatments. Equally we have helped a lot of people with stem cell therapy for their trigger finger problems.

Stem Cell therapy

In our practice, Stem Cell Therapy is a treatment for musculoskeletal disorders. We treat degenerative joint disease, degenerative disc disease of the spine, and tendon and ligament injury. We offer stem cells drawn from patient’s own bone marrow. Stem cells are “de-differentiated pluripotent” cells, which means that they continue to divide to create more stem cells; these eventually “morph” into the tissue needing repair — for our purposes, collagen, bone, and cartilage.

There is no direct study on the effect of stem cell therapy on trigger finger. Like PRP above there is an expectation that the treatment would be beneficial based on successful treatments documented in the medical literature on other types of tendinopathies.

More recently a January 2020 study (3) suggested: “there have been over 100 studies using MSCs for tendon healing, and the majority of these studies has been published in the last 5 years. These studies have used the traditional bone marrow derived stromal cells (BMSCs), adipose derived stem cells (ASCs), endogenous ligament derived stem cells (LDSCs) or tendon derived stem cells (TDSCs), and MSCs from other sources, such as synovial fluid. MSC-based therapies have been applied to augment tendon and ligament healing in several different ways.” What we see is an explosion in research based on the concept that stem cell therapy may be very beneficial for tendon injuries such as those found in a trigger finger.

Doctors writing in the medical journal Hand Surgery suggested that bone-marrow derived stem cells accelerate tendon healing in animal studies.(4) Doctors know that chronic tendon injuries present unique management challenges because of the long-held belief that they result from ongoing inflammation. This thinking has caused physicians to rely on treatments demonstrated to be ineffective in the long term—e.g., anti-inflammatory medications and cortisone shots.

Published in the Journal of Muscles Ligaments Tendons, researchers from Italy wrote: “Tendon injuries represent, even today, a challenge, as repair may be exceedingly slow and incomplete. Regenerative medicine and stem cell technology have shown to be of great promise.” (5)

Most recently, a study from the Feinstein Institute for Medical Research indicated the potential effectiveness of bone marrow (stem cells) for Achilles tendon healing, particularly during the early phases.(6)

Do you have questions? Ask Dr. Darrow

Over the years we have seen many people with various finger and hand problems and we have helped many people.

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

1 Aspinen S, Nordback PH, Anttila T, Stjernberg-Salmela S, Ryhänen J, Kosola J. Platelet-rich plasma versus corticosteroid injection for treatment of trigger finger: study protocol for a prospective randomized triple-blind placebo-controlled trial. Trials. 2020 Dec;21(1):1-9.
2 Shafaee-Khanghah Y, Akbari H, Bagheri N. Prevalence of Carpal Tunnel Release as a Risk Factor of Trigger Finger. World Journal of Plastic Surgery. 2020 May;9(2):174.
3 Leong NL, Kator JL, Clemens TL, James A, Enamoto‐Iwamoto M, Jiang J. Tendon and ligament healing and current approaches to tendon and ligament regeneration. Journal of Orthopaedic Research®. 2020 Jan;38(1):7-12.
4 He M, Gan AW, Lim AY, Goh JC, Hui JH, Chong AK. Bone marrow derived mesenchymal stem cell augmentation of rabbit flexor tendon healing. Hand Surg. 2015 Oct;20(3):421-9. doi: 10.1142/S0218810415500343.
5 Tetta C, Consiglio AL, Bruno S, Tetta E, Gatti E, Dobreva M, Cremonesi F, Camussi G. Muscles: the role of microvesicles derived from mesenchymal stem cells in tissue regeneration; a dream for tendon repair? Ligaments Tendons J. 2012 Oct 16;2(3):212-21. Print 2012 Jul.
6 Shapiro E, Grande D, Drakos M. Biologics in Achilles tendon healing and  repair: a review. Curr Rev Musculoskelet Med. 2015 Feb 6. PubMed. 1376

Marc Darrow MD,JD

In this article I will focus on the problem of avascular necrosis in the ankle, mainly the talus bone in the ankle, and to suggest if stem cell therapy may be an effective treatment in helping you avoid ankle replacement or ankle fusion surgery.

Many people that contact me asking about their ankle pain tell me about a terrible accident or injury that they had in the past. Their ankle was damaged and surgery or long bouts of casting and immobilization was able to put their ankle back together as best as possible. Over the years these people managed along managing various bouts of pain and stiffness. At some point osteoarthritis developed in the ankle and their surgeon recommended an ankle replacement or an ankle fusion. Many declined these surgeries as they saw the surgery as the end of their activities and the welcoming point of a sedentary lifestyle.

Once having declined the surgery, these people now resorted to ankle braces, cortisone and hyaluronic acid injections. Treatments and remedies that had now become ineffective for them.

I also have people contact me who have had a degree of success in pain alleviation with stem cell therapy but have plateaued, they still cannot return to activities such as work, golf, or even stand for any length of time. These people want to know how they may get closer to their treatment goals of being near of fully functional again.

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Marc Darrow MD,JD

I am an avid golfer. People who are my patients understand my great passion for this game. Many of these people are my patients because of a back pain problem that is impacting their ability to play golf. In April 2019, Tiger Woods, arguably the greatest golfer of all time, won the Pro Golfers Tour (PGA) Master tournament after years of physical decline and back surgeries. Woods’ victory was considered remarkable and miraculous because of the numerous failed back back surgeries he had. For Woods, it was the fourth surgery that was the “charm.”

Some of our patients have asked us about the spinal fusion surgery (the 4th surgery) that Tiger Woods had 4 years ago in 2017, this was the “successful” surgery. They want to know if this surgery may be right for them? We tell our patients the reality is very likely not. How come? I will let the spinal surgeons and back pain researchers discuss this with you now in this article.

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Marc Darrow MD,JD

We will often receive emails from people who will say “I am 59 years old, very active. I have wear and tear damage in my knee I am being told to lay off or stop weight lifting and running. I can still play golf but it now hurts on some of the swings. My orthopedist is suggesting a knee replacement to keep my active. Can your treatments get me back to my running and weight lifting and make golf less painful for me?”

Someone who is still active, even through some pain, is usually a good candidate for stem cell therapy, but candidacy for treatment is something that would usually require a physical examination to confirm. But can stem cells offer some hope? I will talk about this later in this article.

I will also get emails asking me about golf after knee replacement. Generally speaking, some can play golf, some have difficulty but typically, people who play golf are not among the most enthusiastic about getting a knee replacement. Especially now when a knee replacement may be 6 – 9 – 12 months away.

Golf and wearing out the knee replacement

Let’s go right to a December 2020 study (1) on golf and knee replacement. In this research doctors discovered that golfers are wearing out the knee replacements much faster than they should. Here is what the orthopedic surgeons of this study said, the ending is somewhat remarkable.
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Marc Darrow MD,JD

When someone contacts our office and they tell us that they have been diagnosed with Post Laminectomy Syndrome we have to get information from them that will allow us to make a realistic assessment if they are someone that stem cell therapy can help. We can help some people with Post Laminectomy Syndrome, we may not be able to help others. How do we know who we may be able to help? We talk to people on the phone, we discuss their pain and symptoms and what happened after the surgery. If we think we can help someone, we tell them to come in for a consultation.  If we do not think we can help, we don’t.

I want to turn this article over to the surgeons so they can explain how a patient may develop Post Laminectomy Syndrome. This first study was published in the medical publication Biomed Central research notes.(1)

Although not well known, post-laminectomy syndrome is an important cause of chronic back pain, which may lead to decreased quality of life, disability and psychological disorders. The prevalence of post-laminectomy pain was 60 % (in this study group). Most of the patients assessed in this study were male. . .  their mean age was 45 years. All of the patients presented with chronic, intense pain that had lasted an average of 7.22 years. None of the patients exhibited high levels of physical fitness.

Lumbar laminectomy is one of the surgical procedures used to treat intervertebral disc protrusions (a bulging or herniated disc). It consists of removing the vertebral lamina to expose and allow access to the disc that is responsible for the nerve root compression. Although the vast majority of lumbar sciatic pain is mechanical in nature, the surgical procedure is required in only 1–3 % of cases.

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Marc Darrow MD,JD

Many times a prospective patient will come into our office for a consultation and ask if we can do both Platelet Rich Plasma injections and Stem Cell injections at the same time. The idea comes from visits to other clinics where it is discussed with patients that Platelet Rich Plasma injections either prior to or at the same visit will make stem cell therapy more effective. The answer we give is no, the use of bone marrow concentrate more commonly bone marrow stem cell therapy contains a rich source of blood platelets. Simply, it is getting both treatments at once.

Give me a chance to back this up with some research.

Let’s start with a 2012 study. (1) Here the research team wanted to determine whether platelet-rich plasma (PRP) could be made into a bioactive scaffold capable of endogenous (using the body’s own healing and response system), growth factor release for cartilage repair. In essence these researchers made a patch of platelets.

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Marc Darrow MD,JD

Many people, or should I say many runners, will reach out to me to ask whether stem cell therapy or Platelet Rich Plasma therapy will help them with their knee problems. They have what you probably have. They have pain in the front of their knee, it is coming from behind their knee cap. They hear grinding noises, popping noises, and crunching noises coming out of that knee. These runners can be any age but are typically someone who has a lot of wear and tear damage in their knees. They will have an MRI that may be inconclusive of the grade of their problem and a recommendation for some type of arthroscopic clean up. The more athletic of these people will stop running and move over to cycling or swimming. The person who has a job that puts a lot of wear and tear on their knee will probably switch over to a bigger knee brace and worse, more medications to get them through their work day.

Patellofemoral Pain Syndrome is one of the most common problems we see in our new patients.

In our office we have understood this to be a wide reaching problem and this has been confirmed by researchers who say patellofemoral pain is diagnosed in up to 7% of patients seeking medical care within the United States. Females experienced patellofemoral pain more often than males. The diagnosis of patellofemoral pain increased with age and the 50-59 year old age group had the most cases.(1)

Patellofemoral pain can be a tricky problem to surgically repair as noted in the literature: “Management of chondral (cartilage) defects in the athlete is complex and multifactorial. There is little high-level evidence to support one (surgical) procedure over another. (2)

The patella is covered with a layer of smooth (articular) cartilage. This cartilage normally glides effortlessly across the knee during activities such as running or stair climbing, where bending the knee is involved in the activity.

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Marc Darrow MD,JD

I regularly see patients who have been told by another doctor that they need a neck surgery to prevent the further degeneration of their cervical spine. Some of these patients are very frightened by what their doctor told them. Some were told that if their symptoms progress they could risk permanent damage to their ability to function maybe to the point of paralysis.

“I am worried if I do not get surgery my neck will get worse”

Research has strongly suggested that many patients decide on cervical fusion surgery because they fear a progression of their problem that will lead to permanent disability. However, follow-up data on patients with degenerative disease of the upper (cervical) spinal vertebrae show little or no evidence of worsening degeneration over time. Recently, doctors published findings that suggested that the majority of these patients may be stable and do not develop progression of disease or catastrophic neurologic deficits.
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