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Noninvasive or Minimally Invasive Treatments for Healing Injured and Arthritic Joints

The Importance of Diagnosing Painful Joints: Options and Benefits of Minimally Invasive Treatments Joint pain is a prevalent issue among millions of people worldwide. However, before diving into the sea of available treatments, it is crucial to undergo diagnostic tests to understand the underlying pathology. Accurate diagnostics can lead to more targeted and effective treatment options, including several noninvasive and minimally invasive options.

Noninvasive and Minimally Invasive Treatments:

1. Extracorporeal Shockwave Treatments: Extracorporeal shockwave treatments, such as radial and focused orthopedic treatments, have emerged as innovative solutions to tackle joint pain. The main biological effects of these treatments are:

  • Mechanotransduction: This is a process where cells convert mechanical stimuli into chemical activity.

  • Stimulation of fibrocytes and osteoblasts.

  • Increased Blood Flow: Essential for transporting nutrients and oxygen to damaged areas and removing waste products.

  • Increased Cell Wall Permeability: This helps in speeding up cell metabolism and recovery.

  • Release of Substance P: Substance P is a neurotransmitter and modulator of pain perception.

Nortanicola and Moretti (2012) showcased that shockwave treatments have success rates of 60% to 80% for various conditions. Research indicates that shockwaves decrease the expression of inflammatory mediators, resulting in tissue repairing effects in musculoskeletal tissues.

2. Guided Nerve Blocks: Using ultrasonic and x-ray guidance, nerve blocks are administered to interrupt pain signals, offering temporary relief.

3. Prolotherapy: This involves injecting an irritant solution into the affected area, which can lead to localized inflammation. This inflammation can stimulate the body's natural healing processes.

4. PRP and Bone Marrow Injections: Platelet-rich plasma (PRP) and bone marrow injections have gained attention due to their potential in speeding up healing. PRP involves extracting a patient's blood, processing it, and injecting the concentrated platelets into the injured area. These platelets release growth factors, assisting in tissue repair and regeneration. Similarly, bone marrow injections utilize stem cells from the patient's bone marrow, promoting regeneration and healing.

Research Evidences: Several studies underscore the benefits of these treatments:

  • Moya et al (2018):

Highlighted the efficacy of radial extracorporeal shockwave therapy in treating shoulder adhesive capsulitis.

  • Schroeda et al (2021): Noted that ESWT is a viable option for in-season athletes as it requires minimal time away from sports.

  • Celik & Alton (2020): Emphasized the pain-relieving and functional benefits of ESWT for back pain.

Studies like Nadelka et al (2014) on lumbar facet joint pain have shown significant success rates

Proposed Mechanisms of Healing: Biological Effects of Shockwaves:

  • Stimulation of Microcirculation: This boosts blood and lymph flow.

  • Stimulation of Growth Factors: It aids in neogenesis of vessels and bone collagen.

  • Anti-inflammatory Effects: These assist in faster recovery and pain reduction.

  • Stimulation of Stem Cells: They play a vital role in cell proliferation, transport, differentiation, and rejuvenation.

In conclusion, before considering invasive surgical procedures, it's crucial to explore the realm of noninvasive and minimally invasive treatments. They not only offer a safer and sometimes more effective solution but also allow for quicker recovery. Always consult with a healthcare professional for personalized advice and treatment options. References The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders VL - 100 DO - 10.2106/JBJS.17.00661 JO - The Journal of bone and joint surgery. American volume Schroeder AN, Tenforde AS, Jelsing EJ. Extracorporeal Shockwave Therapy in the Management of Sports Medicine Injuries. Curr Sports Med Rep. 2021 Jun 1;20(6):298-305. doi: 10.1249/JSR.0000000000000851. PMID: 34099607. Valchanou VD, Michailov P. High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop 1991;15:181–184. - PubMed Schleberger R, Senge T. Non-invasive treatment of long-bone pseudarthrosis by shock waves (ESWL). Ar

ch Orthop Trauma Surg 1992;111:224–227. - PubMed Haake M, König IR, Decker T, Riedel C, Buch M, Müller HH. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis: a randomized multicenter trial. J Bone Joint Surg Am 2002;84:1982–1991. - PubMed Haake M, Buch M, S

choellner C, et al. Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trial. BMJ 2003;327:75. - PMC - PubMed Çelik A, Altan L, Ökmen BM. The Effects Of Extracorporeal Shock Wave Therapy On Pain, Disability And Life Quality Of Chronic Low Back Pain Patients. Altern Ther Health Med. 2020 Mar;26(2):54-60. PMID: 31221949. Nedelka T, Nedelka J, Schlenker J, Hankins C, Mazanec R. Mechano-transduction effect of shockwaves in the treatment of lumbar facet joint pain: comparative effectiveness evaluation of shockwave therapy, steroid injections and radiofrequency medial branch neurotomy. Neuro Endocrinol Lett. 2014;35(5):393-7. PMID: 25275264.

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               Deborah Westergaard, MD

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