Radiology of Regenerative Medicine

09/04/2024

An X-ray showing the three anterior fat pads of the knee. From top to bottom they are the darker black areas:

1. Prefemoral fat pad
2. Suprapatellar fat pad
3. Infrapatellar fat pad.

They can be a significant pain generator when inflamed and respond very well to orthopedic regenerative medicine procedures such as Shockwave therapy, Class IV MSK Laser and PRP injections.

Which fat pad is painful in Hoffa’s disease?

28/12/2023

A CT scan of calcific tendinitis of the hamstrings insertion compared to an x-ray. The CT shows the muscle as well tapering into the tendon.

28/12/2023

X-ray and CT scan of calcific tendinitis of the hamstrings tendon insertion.

Symptoms can include pain in the back of the thigh, buttock, knee, or even the lower leg. Weakness or tingling in the back of your thigh which can mimic sciatica.

We treat this with focused Shockwave to stimulate healing and tissue regeneration as well as occasional ultrasound guided PRP injections directly into the diseased area of the tendon.

Pain relief begins with the first treatment with maximum results within 3 months as the regenerative process finishes resulting in the tendon have greater tensile strength, healthy and organized tendon cells and fibers, improved blood supply, and resolved pain.

18/12/2023

Four sites of enthesophytes (spurs) on the calcaneus. The two smaller spurs are along the insertions of the short and long plantar ligaments, the third is on the plantar fascia, and the fourth is along the Achilles tendon. These spurs are secondary evidence of chronic inflammation at these locations. If the patient was symptomatic at any of these sites they may be candidate for noninvasive or minimally invasive regenerative treatments.

08/12/2023

Type 5 AC separation. An old x-ray of the same shoulder is shown for comparison.

16/11/2023

28/10/2023

One reason we get multiple views of structures is that sometimes pathology like this simple toe fracture can be hard to see on a simple frontal projection (image 1) but is very obvious on an oblique view (2nd image).

01/10/2023

Most if not almost all people think heel spurs grow into the plantar fascia. The spur (enthesophyte) forms as a result of chronic inflammation and is a result of the plantar fasciitis and is not the cause of the pain.

Surgery to “remove heel spurs” does not work by removing the spur. The surgery’s purpose is to cut the plantar fascia which may reduce pain but compromises the structural integrity of the foot. They remove the spur as part of the debridement process of removing the damaged tissue.

We manage plantar fasciitis by using the non-invasive treatment modality Shockwave to stimulate healing, decrease inflammation, reduce scar tissue, and eliminate pain by regeneration of the plantar fascia along the insertion.

We also can use ultrasound-guided platelet rich plasma (PRP) in more advanced or chronic cases to add in the powerful healing elements of PRP with regenerative stimulation by fenestration of the fascia with the needle. This creates multiple small holes in the tissue to signal healing, break up scar tissue, aid in fluid/oxygen tissue exchange, and deliver the PRP directly into the tissue to heal from the inside out.

This CT scan (second image) shows the spur is underneath the plantar fascia, the gray band marked by arrows. This soft-tissue structure is targeted, the spur is irrelevant in causing clinical symptoms. Many people have spurs with no pain, and some have extreme pain without a spur present. A spur just indicates that this is a site where chronic inflammation is or has been present.

14/08/2023

“Ball and socket” ankle joint is the term given to this appearance. The talus is spherical and the distal tibial plafond is concave. It is considered either congenital (present at birth) or acquired before age 5. It can lead to pain and limited mobility from subtalar joint or ankle joint arthritis. The surgical outcomes from ankle fusion or replacement are inferior to those seen in patients with normal baseline ankle joint configuration. Regenerative and manipulative medicine goals are to maintain strength and mobility and treat any associated soft tissue pathology with physical medicine modalities and PRP if indicated. Subtalar arthritis can also be addressed with ultrasound or fluoroscopic guided PRP injections.

17/02/2023

How could plantar fasciitis cause lateral foot numbness? Most people with plantar fasciitis are so consumed with the pain that they might not notice the lateral part of their foot may be numb or have pins and needles sensation. Some don’t have this problem at all. But in the few that do there is an explanation. The tibial nerve branches just past the ankle and the lateral plantar branch crosses to innervate the lateral foot. In doing so it comes close to the swollen, inflamed plantar fascia which in severe cases can cause irritation and compression on that nerve causing lateral foot parasthesias. We treat the plantar fascia which reduces a the compression on the nerve and reduces symptoms.

10/02/2023

Enthesophyte (bone spur) forming along the iliolumbar ligament due to chronic disease. Most people are familiar with spurs on the heel from plantar fasciitis. But spurs can form other places on the skeleton where a ligament or tendon inserts. And these can cause as much pain as a plantar fasciitis patient feels. A diseased iliolumbar ligament causes low back pain, slightly off the one side. X-rays can show the spur which is a reaction of the body to the chronic diseased ligament. Image 1 shows a CT scan in the frontal projection showing the ligament as the gray structure between L5 and the ilium. Image 2&3 show the spur as a bump along the top of the pelvic bone. The last image is the patient’s other side which did not have pain and the ligament is not thickened and has no spur. We treat this ligament with focused Shockwave which stimulates a brisk healing response from the body to repair this structural tissue providing more pain free support to the lumbar spine.

26/01/2023

CT scans of a patient before and a year after after having plantar fasciotomy to treat plantar fasciitis. The plantar fascia is difficulty to see on CT scan and is much better defined on MRI. But if you look carefully at image 1, the plantar fascia is marked by arrows and is a thin, tight light gray band. The second image is a year later and the arrows show where the band used to be.

This patient unfortunately continued to have heel pain even after surgery which is often related to continued inflammation where the fascia inserts into the heel. Another recognized risk is flattening of the foot secondary to loss of the arch support from cutting this strong fibrous band.

The lighter gray structures in the middle of the image are some of the very many muscles along the bottom of the foot. As you might notice, these muscles have atrophied (lost size and strength) following surgery.

Surgery is typically only used as a last resort after conservative measures such as rest, PT, orthotics, Shockwave Therapy, and platelet rich plasma (PRP) injections have failed.