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Shoulder Arthritis: All You Need To Know

The pain started as a small ache and now has progressed. You don’t recall any specific injury. Conservative care including rest, ice and heat have failed to provide any significant or sustained relief. Your doctor is concerned about shoulder arthritis. What is shoulder arthritis? What are the basic parts of the shoulder joint? What are the different types of shoulder arthritis? What are the most common symptoms of arthritis in the shoulder? What are the risk factors for shoulder arthritis? What are common treatment options for shoulder arthritis? When should you contact your doctor? How is shoulder arthritis diagnosed? What regenerative treatment options exist for shoulder arthritis? Let’s dig in.

Shoulder Arthritis

The shoulder is a truly remarkable joint. It allows you to reach out into virtually all directions: overhead, forward, and backwards. The shoulder joint allows us to reach overhead with heavy weight, grab the water out of the refrigerator, snake our belts through the pant loops, tuck our shirts in and perform pushups or burpees on demand. It is the unique structure of the shoulder joint that allows these motions. Unfortunately, like other joints in the body the shoulder is susceptible to irritation and injury. Osteoarthritis is the most common cause of disability in the United States, affecting up to 32.8% of patients over sixty years of age (1). Shoulder arthritis is a common condition estimated to be as high as 16-20% in the middle aged and elderly population (2). Shoulder arthritis can compromise range of motion, strength and be a source of debilitating pain. This blog will review the shoulder.

Shoulder Anatomy Basics

The shoulder is composed of the following:

Ball-Socket Joint: The head of the long bone of the arm (humerus) fits into a boney socket called the glenoid. It is a shallow joint which allows for the tremendous range of motion.

Secondary Smaller Joint: The collar bone joins the acromion to form the acromioclavicular joint (AC Joint). This is much smaller joint than the ball-socket joint discussed above. It is essential for scapular range of motion and function.

Ligaments: Ligaments are thick bands of connective tissue that connect bone to bone. The major shoulder ligaments are the superior, middle and inferior glenohumeral ligament and the coracohumeral ligament.

Tendons: Tendons are thick bands of connective tissue that connect muscle to bone. The rotator cuff is compromised of 4 tendons and is critical to the stability and the function of the shoulder.

Arthritis can cause injury to the ball socket or AC joint leading to joint damage, cartilage injury, restriction in range of motion and pain.

What Is Arthritis In The Shoulder?

Not all arthritis is the same. There are many different forms of arthritis. The most common include:

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease. This means that immune system attacks its own healthy cells including the shoulder joint. It can also affect other tissues in the body causing problems in the lungs, heart and eyes. The most common symptoms are pain, swelling, tenderness and restriction in range of motion.

Osteoarthritis

Osteoarthritis is the most common form of arthritis. It is commonly referred to as “wear and tear” arthritis. Cartilage is thin, very strong connective tissue that covers the bones in a given joint. Cartilage allows for smooth, pain free motion of a joint. Osteoarthritis involves the breakdown of the cartilage resulting in pain, swelling and restriction in range of motion. Shoulder arthritis has been demonstrated to affect up to 32.8% of the patients over the age of sixty (3). The prevalence of shoulder osteoarthritis increases with age and women appear to be more susceptible than men.

Post-Traumatic Arthritis

Post-traumatic arthritis develops after an traumatic injury to the joint. As opposed to osteoarthritis which develops slowly over time, post traumatic osteoarthritis can develop months to years after the injury. It causes approximately 12% of all osteoarthritis cases and mainly affects younger adults (4).

Avascular Necrosis

Avascular necrosis also known as osteonecrosis is a severe medical condition in which the bone tissue dies. That is right, the bone dies. That was originally thought to be due to a lack of blood supply but other important factors are what contribute to this condition. It is most common in the hip but is also present in the shoulder joint. Risk factors for avascular necrosis include trauma, steroid use and excessive alcohol use.

Rotator Cuff Arthropathy

Rotator cuff arthropathy is a specific type of shoulder degeneration that develops over time after the rotator cuff is damaged. Arthropathy is a term that refers to any diseased condition in the joints. It can involve peripheral joints such as the shoulder as well the facet joints in the spine. Rotator cuff arthropathy affects females more than males and is common in the later decades of life. It is classified according to the severity of the damage ( Type 1 A-Type IIIB). The most common symptom is pain, restriction in range of motion and weakness. Diagnosis is made by physical examination and plain x-ray. The latter is significant for narrowing of the shoulder joint space and upward movement of the arm bone (humerus) in relation to the socket (glenoid)

Symptoms of Arthritis In the Shoulder

Shoulder arthritis typically is gradual in onset. Symptoms can vary from patient to patient depending upon the severity of the arthritis and other co-existing conditions. The most common symptoms of shoulder arthritis include:

Pain in The Shoulder Joint

Pain is the major sign of arthritis. It can be intermittent or constant.

Typically deep in the joint

Pain can also be located on the top of the shoulder in cases of AC joint arthritis.

Night pain is common

Pain may be aggravated by lifting, carrying heavy objects, overhead activities and exercise.

Limited Range of Motion

Normal shoulder range of motion may be restricted.

Difficulty raising arm over head

Difficulty with self-care (combing hair and dressing)

Swelling

Swelling is another sign of shoulder arthritis progression.

Loss of cartilage typically leads to inflammation and joint swelling

Swelling can increase after activity.

Tenderness

Shoulder and or AC joint may be tender to the touch

Tight or compression clothing may cause shoulder irritation

Tenderness and pain may limit use of shoulder

Crepitus (Grinding Sensation)

Popping, grinding or clicking is common

May or may not be painful

Shoulder may lock up due to loss of cartilage

Risk Factors for the Development of Shoulder Arthritis

There are a number of risk factors that have been identified for the development of shoulder arthritis. The most common include;

Advancing age

Shoulder arthritis prevalence rates increase with age from 1.8% in people in their 40’s to 27.5% in those in their 80’s (5).

Genetics

Unfortunately some of us carry that old family gene that predisposes us to degenerative conditions such a shoulder arthritis.

Obesity

This is in part explained by the increased load placed on the shoulder joint in patients with increased body weight.

Excessive Mechanical Loading

Powerlifting, training with heavy weights and repetitive shoulder motions required by some professions can lead to shoulder arthritis.

Shoulder Instability

Stability of the shoulder joint is imperative for optimal joint health and function. Shoulder instability due to ligament laxity or rotator cuff injuries can lead to shoulder instability. In such cases there is excessive motion of the arm bone (humerus) in relation to the socket leading to damage to the cartilage.

Fractures

Fractures can directly damage the cartilage leading to post traumatic osteoarthritis.

Rotator Cuff Injuries

The rotator cuff is compromised of four tendons that stabilize the shoulder, enable elevation and rotation of the shoulder and hold the arm bone (humerus) snuggly into the shoulder socket (glenoid). The four tendons are the supraspinatus, infraspinatus, subscapularis and teres minor. Injuries to the rotator cuff can compromise the stability of the shoulder leading to shoulder arthritis.

Inflammatory Arthritis

Inflammatory arthritis is a group of diseases caused by an overactive immune system. This is also called an autoimmune disorder in which the body attacks it own healthy cells. Examples include rheumatoid arthritis (RA), psoriatic arthritis, juvenile idiopathic and ankylosing spondylitis (AS) and gout.

Common Treatment for Arthritis of the Shoulder

Treatment options for shoulder arthritis depend upon the type and severity of the arthritis. When appropriate conservative care should always be the first step. The most common treatment options include:

Natural Treatments

Examples would include rest, activity modification, heat, ice, Tylenol and safe anti-inflammatory medications such as good quality fish oil and turmeric.

Traditional Non Surgical Treatments

Physical therapy. The Centeno-Schultz Clinic has a fantastic Physical Therapist with years of clinical experience.

Oral or injected steroids

Nonsteroidal Anti-inflammatory medications such as Ibuprofen

Surgical Procedures

When conservative therapy and rest fail to provide significant benefit patients are often referred for surgical consultation. There are a large number of orthopedic surgeries for shoulder arthritis. The specific surgery is dependent upon a number of different factors. The most common surgeries for shoulder arthritis include:

Arthroscopy

Arthroscopy is a minimally invasive surgical procedure in which a small camera is inserted into your shoulder joint to evaluate, diagnose and treat problems inside the joint. The procedure is typically performed in an outpatient setting and takes 30-60 minutes.

Hemiarthroplasty

A hemiarthroplasty is a partial shoulder replacement in which the ball portion of the arm bone (humerus) is replaced with an implant. This surgical procedure is indicated in severe cases of shoulder arthritis in which only the ball socket is damaged.

Shoulder Replacement (Arthroplasty)

Total shoulder replacement surgery involves surgically removing both the ball and socket portion of the joint and replacing it with artificial implants. The most common indication is severe shoulder arthritis in patients with compromised range of motion who have failed conservative therapy. The two most common types of replacements are the total shoulder replacement and the reverse shoulder replacement. Both are major surgeries associated with risks that include infection, failure, bleeding, persistent pain, nerve damage and implant fracture or displacement.

When Should You Consult Your Doctor?

Shoulder pain and limited range of motion can be debilitating. In many cases it can be due to overuse and typically gets better in several days. You know the weekend warrior events or over zealous workouts that trigger your shoulder pain. If however the pain and restriction persists, it is time to consult your doctor. Common symptoms that warrant a call to your doctor include:

Persistent redness

Persistent swelling

Severe Pain

Continued restriction in range of motion despite conservative care and rest

How to Diagnose Shoulder Arthritis?

Not all shoulder pain is due to shoulder arthritis. It is important to establish a correct diagnosis. The diagnosis of shoulder arthritis starts with a comprehensive evaluation with your doctor. The duration of the shoulder pain, its severity, aggravating and alleviating factors will be identified along with any events that may have triggered it. Past medical history is also important such as previous trauma, surgeries or co-existing problems such as diabetes.

Physical examination will include range of motion, shoulder strength and specific shoulder tests that evaluate the rotator cuff and labrum. The tests should include both shoulders in addition to a complete neurologic examination to ensure that shoulder weakness is not arising from an irritated or compressed nerve in the neck.

Radiographic studies will include an x-ray. Additional tests such as an MRI are often required. The MRI is a remarkable imaging study that can evaluate the rotator cuff tendons, labrum and cartilage surfaces.

At the Centeno-Schultz Clinic an in-office ultrasound is performed. Ultrasound is a powerful imaging modality that can provide immediate evaluation of the stability of the shoulder joint and integrity of the rotator cuff tendons, biceps and AC joint. No need to wait for lengthy pre-approval process required by insurance companies for an MRI or CT scan. Ultrasound in most cases can provide immediate information for the patient and the physician alike.

Regenerative Treatment Options for Shoulder Arthritis

The physicians at the Centeno-Schultz Clinic are experts in the evaluation and treatment of shoulder injuries and arthritis. We offer a comprehensive approach that is referred to as the SANS approach.

It stands for Stability, Articulation, Neurologic and Symmetry.

Stability is a very important, often overlooked issue that when compromised can lead to popping, cracking of the shoulder in addition to injury to the rotator cuff tendons and cartilage.

The shoulder is a shallow ball socket joint. It is held in position by the supporting ligaments and muscles. In some cases through trauma or loose ligaments, the ball portion of the shoulder can be dislocated or pulled out or socket. Why is this important? Once dislocated, the shoulder capsule can become stretched out or loose predisposing the shoulder to chronic instability. This is illustrated below.

Normal shoulder movement is illustrated on the left. Shoulder instability is illustrated on the right. Note there is excessive movement within the shallow shoulder socket that allows the ball portion of the joint to strike and injure the little gray triangle which is the labrum. Shoulder instability can lead to labrum injury and shoulder osteoarthritis.

Neurologic issues are also an important but often overlooked. At the Centeno-Schultz Clinic we always evaluate the patient as a whole a opposed to focusing only on the shoulder. The cervical spine is included in the examination as many cases of “shoulder pain” are actually pain being referred from an irritated or injured cervical facet or disc.

Treatment options vary depending upon the specific injury, its severity and presenting symptoms. Treatment options include PRP and bone marrow concentrate which is rich in stem cells. Both are powerhouses of healing.

The injections are demanding and require a thorough understanding of the shoulder anatomy. All injections are performed under ultrasound or x-ray guidance, or both. These injections can not be performed by your PCP or orthopedic surgeon. To watch one of my ultrasound guided shoulder injections please click on video below.

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In Conclusion

Shoulder osteoarthritis is a common cause of pain and disability.

The shoulder is a shallow ball socket joint supported by ligaments and tendons. There is a second, larger joint called the AC joint.

There are many different forms of shoulder arthritis which include Rheumatoid, Osteoarthritis, Post-Traumatic, Avascular Necrosis and Rotator Cuff Arthropathy

The most common symptoms of shoulder arthritis include pain, limited range of motion, swelling, tenderness, and crepitus.

Risk factors for the development of shoulder arthritis include advancing age, genetics, obesity, excessive mechanical loading, shoulder instability, fracture, rotator cuff injuries, and inflammatory arthritis.

Common treatment options include conservative care, steroids, and surgery.

Symptoms that warrant a call to your doctor include persistent redness, swelling, pain and restricted range of motion that has not responded to rest and conservative care.

Diagnosis of shoulder arthritis starts with a thorough history and physical examination and radiographic studies such as an x-ray or MRI.

In-office ultrasound is a powerful, convenient imaging modality that can accurately access the integrity of the shoulder.

Regenerative treatment options include the use of PRP and bone marrow concentration that allows patients use their own cells to accelerate healing and forgo life changing shoulder surgeries.

If you or a loved one has ongoing shoulder pain that has not responded to conservative care please schedule a telemedicine consultation. A board certified, fellowship trained physician will review your history, imaging and discuss appropriate treatment options.

Persistent shoulder pain, swelling and restricted movement is a warning signal that you have a problem that warrants evaluation. If ignored, the injuries can progress often times causing permanent, irreversible changes. Avoid the pain and suffering and learn what the issues are and what regenerative options are available.

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1.Chillemi C, Franceschini V. Shoulder osteoarthritis. Arthritis. 2013;2013:370231. doi:10.1155/2013/370231

2.Ibounig T, Simons T, Launonen A, Paavola M. Glenohumeral osteoarthritis: an overview of etiology and diagnostics. Scand J Surg. 2021 Sep;110(3):441-451. doi: 10.1177/1457496920935018. Epub 2020 Jul 14. PMID: 32662351.

3.Chillemi C, Franceschini V. Shoulder osteoarthritis. Arthritis. 2013;2013:370231. doi:10.1155/2013/370231

4.Punzi L, Galozzi P, Luisetto R, et al. Post-traumatic arthritis: overview on pathogenic mechanisms and role of inflammation. RMD Open. 2016;2(2):e000279. Published 2016 Sep 6. doi:10.1136/rmdopen-2016-000279

5.Kobayashi T, Takagishi K, Shitara H, Ichinose T, Shimoyama D, Yamamoto A, Osawa T, Tajika T. Prevalence of and risk factors for shoulder osteoarthritis in Japanese middle-aged and elderly populations. J Shoulder Elbow Surg. 2014 May;23(5):613-9. doi: 10.1016/j.jse.2013.11.031. Epub 2014 Feb 20. PMID: 24561177.

from Centeno-Schultz Clinic https://centenoschultz.com/shoulder-arthritis-all-you-need-to-know/

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centenoschultz1 · 2 years

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ACL Tear Treatment Without Surgery: Our New Publication!

It all happened so suddenly. You were running down the field and made a quick cut. You heard an audible pop followed by searing knee pain and then collapsed to the ground. Your doctor thinks your tore your ACL and has referred you to a surgeon. What is the Anterior Cruciate Ligament? What is the function of the ACL? Are there different types of ACL injuries? What is ACL surgery? What are the risks associated with ACL surgery? Are there ACL tear treatments without surgery? What are their results and have they been published? Let’s dig in.

What Is the Anterior Cruciate Ligament (ACL)?

The knee has four major ligaments which are illustrated to the right. They include:

Anterior Cruciate Ligament (ACL)

Posterior Cruciate Ligament (PCL)

Medial Collateral Ligament (MCL)

Lateral Collateral Ligament (LCL)

The Anterior Cruciate Ligament (ACL) extends from the thigh bone (femur) to the shin bone (tibia) and limits forward and rotational movement of the knee. It is a key stabilizer in the knee. It is composed of two separate ligament bundles which include the Anterior Medial and the Posterior Lateral.

What Is the Function of the Anterior Cruciate Ligament?

The ACL is a major stabilizer of the knee that limits forward movement of the Femur on the Tibia (shin-bone)(1). It also restrains rotation of the Tibia.

Are there Different Types of ACL Injuries?

The ACL is the most commonly injured ligament in the body and occurs at an estimated incidence of 200,000 cases per year. However not all ACL tears are the same. It is important to know the specific type of tear. There are three principal types of ligament tears: partial thickness, complete thickness, and complete thickness with retractions

Partial Thickness Tear

This is where a portion of the ligament is torn.

Full Thickness, Non-Retracted Tear

This is a more severe injury. The tear extends across the entire surface of the ligament but the ligament is still held together by small remaining fibers.

Full-Thickness Retracted Tear

This is the worst-case scenario. The tear extends across the entire surface of the ligament and the ligament itself rips apart like a rubber band. The single ACL ligament is ripped apart with two ends that are no longer connected. A full-thickness, retracted ACL tear requires surgery.

What Is ACL Surgery?

ACL surgery is a major surgery that involves cutting out your torn ACL and replacing it with a GRAFT. What is a graft? It is a tissue taken from one site that is used in a different site in the body. The grafts themselves are not ligaments but rather are tendons taken from other areas of the body. There a 4 different types of grafts used in ACL surgery (3). They include:

Hamstring Tendon Graft

The Hamstring is the large muscle in the back of the thigh.

Patellar Tendon Graft:

The Patellar tendon is the large tendon in the front of the knee that connects the knee cap to the shin.

Quadriceps Tendon Graft

The Quadricep is the large muscle in the front of the thigh.

Cadaveric Tendon Graft

A cadaver is an individual that has died but has given permission to use their body tissues for medical use. They may be young or old, female or male.

Note that all the grafts used in ACL surgery are tendons and NOT ligaments.

What Are the Risks Associated with ACL Surgery?

ACL surgery is a major surgery that involves removing the damaged ligament and replacing with a patient’s tendon or cadaveric graft. There are significant risks associated with the surgery that include:

66% of teens who undergo ACL surgery will get Arthritis by age 30 (2).

Compromised positional sense and strength (3).

Increased risk of graft rupture for patients younger than 20 years of age (4).

Hamstring atrophy in patients who undergo a hamstring graft (5).

Knee instability

Diminished performance. Many professional athletes fail to return to their pre-surgery level of performance. Are there Alternatives to ACL Surgery?

ACL Tear Treatment Without Surgery ?

The Regenexx Percutaneous ACL Repair (Perc-ACLR) procedure is an advanced x-ray guided procedure where a patient’s own bone marrow concentrate which contains stem cells are injected into the damaged/torn ACL. It is a great ACL tear treatment without surgery option. Stem cells are your body’s own powerhouses of healing and can coordinate cells throughout the body to assist in the reorganization and healing of ligament injuries. We have published our results in two peer-reviewed journals (6)(7). MRI images of the ACL prior to and following bone marrow concentrate treatments have demonstrated profound healing. To review pre and post-procedure MRIs please click on the video below.

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New Centeno-Schultz Clinic Publication

The Centeno-Schultz Clinic is excited about our newest peer reviewed publication. Publication is part of our commitment to advancing the field of Orthobiologics. We have a large number of publications which sets us apart from other clinics. To see the list of our publications please click here.

Our newest publication is a midterm analysis of patients with ACL tears that underwent x-ray guided injections of bone marrow concentrate and platelets into the ACL tears. Bone Marrow Concentrate is rich in stem cells. 50 patients were randomized into one of two groups: exercise therapy vs treatment group. Patients were 18-65 years of age with MRI evidence of ACL tear and pain or instability despite 3 months of conservative therapy. Pain and function were assessed at baseline and 1, 3, 6, 12 and 24 months. Results: Patients treated with Bone Marrow Concentrate injections had significant improvement in pain and function in comparison to the exercise group. In addition, they had significant improvement in their post treatment MRI scans consistent with healing.

Patients with ACL tears now have a non-surgical treatment option and can avoid the risks and extensive downtime associated with surgery and rehabilitation.

To learn more about non surgical treatment of ACL tears using your own cells, please click on the video below

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In Summary

The Anterior Cruciate Ligament (ACL) is one of four major ligaments in the knee.

The ACL is a major stabilizer of the knee that limits forward movement of the Femur on the Tibia.

There are three principal types of ligament tears: partial thickness, complete thickness and complete thickness with retractions.

ACL surgery is a major surgery that involves cutting out your torn ACL and replacing it with a graft.

Major risks associated with ACL surgery include early onset knee Arthritis, compromised positional sense, graft rupture, Hamstring shrinkage and knee instability.

Regenexx Percutaneous ACL repair is an advanced x-ray guided procedure where a patient’s own bone marrow concentrate which contains stem cells are injected into the damaged/torn ACL.

Our newest peer reviewed publication demonstrated reduction in pain and improved function and post procedure MRI scans in patients treated with bone marrow concentrate in comparison to the controls.

Regenexx Percutaneous ACL repair is an alternative to ACL surgery and allows patient to avoid the risks associated with surgery.

If you or a loved one has sustained an ACL tear, please schedule a telemedicine consultation. Surgery is associated with long-term risks including graft rupture and then need for future surgeries. Learn from a board certified, fellowship trained physician your nonsurgical, regenerative treatment options.

1.Noyes FR. The function of the human anterior cruciate ligament and analysis of single- and double-bundle graft reconstructions. Sports Health. 2009;1(1):66-75. doi:10.1177/1941738108326980

2.Barenius B, Ponzer S, Shalabi A, Bujak R, Norlén L, Eriksson K. Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial. Am J Sports Med. 2014 May;42(5):1049-57. doi: 10.1177/0363546514526139. Epub 2014 Mar 18. PMID: 24644301.

3.Bączkowicz D, Skomudek A. Assessment of neuromuscular control in patients after anterior cruciate ligament reconstruction. Ortop Traumatol Rehabil. 2013 Jun 28;15(3):205-14. doi: 10.5604/15093492.1058410. PMID: 23897997.

4.Webster KE, Feller JA, Leigh WB, Richmond AK. Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. Am J Sports Med. 2014 Mar;42(3):641-7. doi: 10.1177/0363546513517540. Epub 2014 Jan 22. PMID: 24451111.

5. Snow BJ, Wilcox JJ, Burks RT, Greis PE. Evaluation of muscle size and fatty infiltration with MRI nine to eleven years following hamstring harvest for ACL reconstruction. J Bone Joint Surg Am. 2012 Jul 18;94(14):1274-82. doi: 10.2106/JBJS.K.00692. PMID: 22810397.

6. Centeno C, Markle J, Dodson E, et al. Symptomatic anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow concentrate and platelet products: a non-controlled registry study. J Transl Med. 2018;16(1):246. doi: 10.1186/s12967-018-1623-3.

7.Centeno CJ, Pitts J, Al-Sayegh H, Freeman MD. Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series. J Pain Res. 2015;8:437-47. doi: 10.2147/JPR.S86244.

from Centeno-Schultz Clinic https://centenoschultz.com/acl-tear-treatment-without-surgery-our-new-publication/

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centenoschultz1 · 2 years

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Pain in Left Side of Neck: Causes and Treatment Options

It started as a low grade ache and has now progressed to a constant burn. Conservative care and medications have failed. Why is there pain in the left side of your Neck? How does the pain in the left side of Neck feel? What may be causing the Neck pain? What is the diagnostic process? What are the treatment options for pain in the left Neck? What are the Regenerative treatment options? Let’s dig in.

Understanding What’s Behind the Pain in Left Side of Neck

Almost everyone has experienced a sore or stiff Neck at some point. The overall prevalence of Neck pain ranges from 04. to 86.8% of the general population (1). Read more to learn the signs, symptoms, causes of treatment options for pain in the left side of Neck.

Why Is There Pain In The Left Side of Your Neck?

Neck pain can arise from a number of different conditions. Common causes of minor, intermittent Neck pain include fatigue, improper sleeping position, stress and overactivity. If neck pain persists it is a warning sign that you may have a problem that warrants investigation. Think of it as the red engine light on your car. It is warning that if left unchecked can progress to serious and expensive consequences.

What Does the Pain in the Left Side of the Neck Feel Like?

Neck pain can present in a number of different ways. Location and severity can very from patient to patient depending upon the injury and past medical history. Common examples include:

Neck stiffness

Sharp-shooting pain on the left side of the Neck

General soreness on the Neck area

Limited range of motion and flexibility

Headaches

Lightheadedness

Muscle tightness and spasm

Localized pain at the base of the skull

Possible Conditions Causing The Pain

Pain in the left side of the Neck can arise from many different sources. It is important to understand and identify where the pain is arising from. In doing so the best treatment plan can be started. Common causes of Neck pain include:

Cervical Disc Injury

Sandwiched between the boney building blocks in the Neck is a Disc. It functions as an important shock absorber and allows for motion between adjacent segments. It is susceptible to injury and degeneration. Common examples include Disc Protrusions, Annular Tears and Disc Herniations. Cervical Disc injury can cause pain in the left side of the Neck.

Muscle Tension

Muscles provide important stability and movement in the Neck. Muscles can be injured due to fatigue, trauma, repetitive activity, and poor ergonomics. Muscle tension can cause pain on either side of the Neck. When severe it limits your ability to move your Neck.

Cervical Facet Injury

A Facet joint is a paired joint located on the backside of the spine. Paired means that there is a right and left Facet joint. Facet joints are present at each level of spine and provide stability to the spine and limit movement. Like your knee or ankle joint, Facet joints are lined with cartilage which allows for smooth, pain free movement of the joint. Cervical Facet joints can become irritated or injured resulting in pain in the left side of the Neck.

Whiplash

Whiplash is a Neck injury due to forceful, rapid back-and-forth whipping motion of the head and Neck. Whiplash can also be described as “an acceleration-deceleration mechanism of energy to the Neck” (2). Whiplash is common with an estimated 1,000,000 cases per year in the United States (3). Whiplash type injuries can cause significant Neck pain and restriction in range of motion.

Ligament Injuries

Ligaments are thick pieces of connective tissue that connect bone to bone. Think of them as human duct tape. Ligaments provide stability to the Spine. Ligament injuries can compromise the stability of the Spine leading to dysfunction and pain in the left side of Neck. The great news is that many Grade 1 and 2 injuries can be treated with ultrasound and x-ray guided Regenerative treatments.

Cervical Radiculopathy

Cervical Radiculopathy is a painful medical condition that occurs as a result of irritation or compression of nerve in the Neck. Often times it is referred to as a ” pinched nerve” and can involve radiating arm pain, weakness and numbness. Pain is typically burning or electrical in character and unresponsive to Opioid therapy.

Cervical Fracture

Bones in the Spine are susceptible to fracture which can cause pain in left side of Neck. X-ray and CAT scans are useful in identifying fractures.

Infection

Infection of skin, muscles, tendons, bone and coverings of the Spinal Cord and Brain can cause pain in left side of Neck. Trauma is the most common cause. Treatment involves antibiotic treatment.

Torticollis

Torticollis is a painful medical condition in which the muscles in the Neck spasm and cause the head and neck to twist to one side. The exact cause of Torticollis is unknown. Symptoms include pain, inability to turn the head and muscle spasm.

Spinal Stenosis

Spinal Stenosis is a medical condition in which there is narrowing of the spaces within your Spine. This can put pressure on the nerves traveling within your Spine resulting in pain, dysfunction, weakness and numbness.

Spinal Tumor

Tumors in the Spine can occur causing pain, neurologic symptoms and restriction in range of motion. The good news is that some Spinal tumors are benign.

Diagnostic Process To Treat Symptoms

Neck pain is not a diagnosis but rather is a symptom. An accurate diagnosis is essential to best clinical outcomes. Masking pain with medications and injections is a disservice as it risks the underlying problem most likely getting worse. Establishing an accurate diagnosis starts with history of the current Neck pain, aggravating, alleviating factors and triggering event. Review of past medical, surgical history and traumas is important. Thereafter a physical examination will focus on range of motion, muscle symmetry and an intact neurologic system. Radiographic studies are often recommended and may include flexion, extension x-ray, CT scans and MRI. At the Centeno-Schultz Clinic an in office ultrasound examination is used to evaluate tendon, ligament and muscle integrity.

Treatment Options for Pain in Left Neck

Physical Therapy

Conservative care when appropriate should be the first line treatment. This would include Physical Therapy with emphasis on neutral Spine alignment, improved stability, range of motion and strength. The Centeno-Schultz Clinic has an outstanding Physical Therapist in house that can assist and guide patients in their care. To learn about Mark Reilly and treatment options more please click here.

Pain Relief Medications

The most common pain relief medications include:

NSAIDs

Persistent pain is often treated with NSAID’s which have significant side effects and risks. These medications are powerful anti-inflammatory agents that reduce inflammation. Common examples include Ibuprofen, Naproxen, and Diclofenac. Major risks include dependence, stroke, sudden-death, GI bleeding and depression of stem cell activity.

Narcotics

If pain persists and is not responsive to NSAID’s, some providers recommend oral Narcotics. This can be extremely dangerous as Narcotics have significant side side effects including dependence. Masking the pain with NSAID’s and Narcotics does not address or treat the underlying problem.

Oral Steroids

Steroids are powerful anti-inflammatory agents. Common examples include Prednisone, Methylprednisolone, Dexamethasone. Steroids have significant side effects that include increase risk of serious bone disease, depression of your stem cells and damage to tendons, ligament and cartilage. To learn more about the Steroid risks click here.

Corticosteroid Injections

When conservative care and medications fail some patients are referred to Steroid injections. While steroids are powerful anti-inflammatory agents they have significant risks which were discussed above. Steroid injections may actually make the pain worse long-term as Steroids can damage ligaments tendons and the cartilage of joints.

Surgery

Surgery is often recommended when pain persists despite conservative care, medication management and Steroid injections. There are many different types of surgeries and which will depend upon the underlying condition and its severity. Common risks associated with surgery include bleeding, infection, failure, escalation of pain, Adjacent Segment Disease and irreversible change in the biomechanics of the Cervical Spine. Surgery should be avoided if possible.

Home Strategies You Can Try For Pain in the Left Side of Neck

For acute pain that is mild in nature you may consider one of more of the following home treatments:

Rest: It’s best to stop the offending trigger or activity and give your body the chance to heal.

Heat: Heat improves the blood flow to a given area which can accelerate the healing process. Blood flow to an area of damage is like water in a garden. It promotes healing and recovery.

Good Posture: Extended periods of screen time on our phones and computers has compromised our posture and neutral spinal alignment. Good posture is essential of a healthy, happy and pain free Neck.

Good Sleeping Postures: Sleeping posture is strongly related to the quality of sleep (4). The two best positions are lying on your back or on your side. Sleeping on your back maintains normal spinal curvature (5)

Regenerative Treatment Options for Pain in Left Side of Neck

The Physicians at the Centeno-Schultz Clinic are experts in the treatment of Neck, Thoracic and Low Back Pain. Not all clinics or treatments are the same. Important differences between the Centeno-Schultz Clinic and others are:

Comprehensive Approach

The human body is a remarkable unit of nerves, muscles, tendons and bones that work together in a synchronistic way. Each body part works together and is reliant on other body parts. Remember the old Dem Bones song ” Shoulder bone is connected to the neck bone. Neck bone is connected to the head bone….” It is all interconnected. In evaluating a patient with Neck pain, the Shoulders, Thoracic and Low Back should also be examined. This is the SANS approach and stands for Stability, Articulation, Neurologic and Symmetry. To learn more about this unique approach click here.

Board Certification and Fellowship Trained Physicians

In medicine you get what you pay for. Years of study and experience are required for mastery in Orthopedics and Regenerative medicine. There are very few dedicated Fellowship programs solely focused on the use of PRP and using your body’s own healing agents like Bone Marrow Concentrate which contains your own stem cells for common Orthopedic conditions. Mid-levels such a PA’s and NP lack this expertise.

Extensive Publications

At the Centeno-Schultz Clinic were have a large number of peer reviewed publications. Collectively they represent over 40% of all the publications in the world on. To view the list click here.

Clinical Registry on Outcomes

Following clinical outcomes is critical to patient care as it allows both provider and patient to identify successes and areas that require additional improvement. Our registry track is easily accessed and tracks changes to pain, function and overall improvement. To see the registry please click here.

Clinical Experience

The Centeno-Schultz Clinic has 17 years of clinical experience in the treatment of common orthopedic conditions utilizing PRP and Bone Marrow Concentrate. There are no Botox injections , medication management or Radiofrequency Ablation procedures. Our exclusive focus is the advancement of Orthobiologics so that patients can avoid unnecessary and often times life changing orthopedic surgery. To learn more about Orthobiologics and how it can help you with your ongoing orthopedic pain, please watch the video below.

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State of the Art Laboratory

At the Centeno-Schultz Clinic we have a university level laboratory staffed with Cell Biologists including a PhD. This allows us to use advanced, proprietary lab processing techniques to ensure we have the right concentrations of cells to treat your specific injury. In contrast most Regenerative clinics use one-size-fits-all bedside centrifuges which can lead to suboptimal clinical results. Each individual’s body and injury is unique and as such requires a tailored, customized PRP and or Bone Marrow Concentrate for optimal healing. Don’t cheat yourself.

Guidance on All Procedures

All injections are performed under X-ray or Ultrasound guidance to ensure that the cells are accurately injected into the targeted structures. Blind injections are below our standard of care and can limit patient’s success. The procedures are demanding as they require detailed understanding of the anatomy along with the ability to accurately place the needle into the targeted structure. These injections can not be performed by your PCP or Orthopedic surgeon. To watch a Cervical injection please click on the video below.

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In Summary

Neck pain is common

Persistent Neck pain is a warning sign that warrants investigation.

Neck pain can present in a number of different ways which include stiffness, sharp shooting pain, soreness, and limited range of motion.

Possible causes of Neck pain include:

Cervical Disc injury

Muscle Tension

Cervical Facet Injury

Whiplash Injury

Cervical Radiculopathy

Cervical Fracture

Infection

Torticollis

Spinal Stenosis

Spinal Tumor

Treatment options for pain in Left neck include physical therapy, medications, steroid injections and surgery.

Regenerative treatment options exist that identify the cause of the pain and treat it using your own PRP and Bone Marrow Concentrate.

If you or a loved one have pain in Left neck that has not responded to conservative therapy, please schedule a Telemedicine consultation. Avoid the dependence of medications and periodic steroid injections. Stop the suffering and learn from a Board Certified, Fellowship trained Physician what your Regenerative treatment options are today.

1.Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol. 2010 Dec;24(6):783-92. doi: 10.1016/j.berh.2011.01.019. PMID: 21665126.

2.Pastakia K, Kumar S. Acute whiplash associated disorders (WAD). Open Access Emerg Med. 2011;3:29-32. Published 2011 Apr 27. doi:10.2147/OAEM.S17853.

3.Rosenfeld M, Seferiadis A, Gunnarsson R. Active involvement and intervention in patients exposed to whiplash trauma in automobile crashes reduces costs: a randomized, controlled clinical trial and health economic evaluation. Spine (Phila Pa 1976). 2006 Jul 15;31(16):1799-804. doi: 10.1097/01.brs.0000225975.12978.6c. Erratum in: Spine (Phila Pa 1976). 2012 Nov 15;37(24):E1537- 40. PMID: 16845354

4.Jeon MY, Jeong H, Lee S, Choi W, Park JH, Tak SJ, Choi DH, Yim J. Improving the quality of sleep with an optimal pillow: a randomized, comparative study. Tohoku J Exp Med. 2014 Jul;233(3):183-8. doi: 10.1620/tjem.233.183. PMID: 25008402.

5Lee WH, Ko MS. Effect of sleep posture on neck muscle activity. J Phys Ther Sci. 2017;29(6):1021-1024. doi:10.1589/jpts.29.1021.

from Centeno-Schultz Clinic https://centenoschultz.com/pain-in-left-side-of-neck-causes-and-treatment-options/

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Occipital Cervical Fusion: Is There an Alternative?

The brain fog, dizziness and functional compromise continue to progress despite conservative care. Your doctor referred you for surgical consultation. The surgeon discussed treatment options. What is a Fusion? What is the Occiput? What is the Craniocervical Junction (CCJ)? What is an Occipital Cervical Fusion? What are the indications for an Occipital Cervical Fusion? What are the risks associated with Occipital Cervical Fusion? Are there alternatives to Occipital Cervical Fusion? What is the PICL procedure? Let’s dig in.

What Is a Fusion?

Fusion is a major surgery in which the spine is stabilized by a series of screws, bolts and plates. Fusion surgery can be performed in the neck, thoracic and lumbar spine.

What Is the Occiput?

The Occiput is the back of your skull. Otherwise known as your noggin. The skull resides on top the Cervical Spine. In fact the occiput forms a joint between the base of the skull and the top of the neck that is called the Craniocervical junction. To learn more about this important structure please click here.

What Is the Craniocervical Junction?

The base of the Occiput has a large opening called the Foramen Magnum. Important structures that pass from the skull through the Foramen Magnum include (1):

Spinal Cord

The Spinal Cord consists of neural tissue that starts at the base of the Brain and extends down into the low back. It is a cylindrical bundle of nerve fibers that control our voluntary and involuntary bodily functions. It carries signals between the brain and the rest of the body. As the Spinal Cord descends it is protected on all sides by Spinal bones. These bones provide boney armor to protect against injury. The Spinal Cord has an additional layer of protection afforded by the Spinal Fluid. The Spinal Fluid is also known as Cerebral Spinal fluid. It surrounds the Spinal Cord and extends the entire length of the Spine. The image to the right is a side view of the Spinal Cord as it exits the Brain. The Spinal Cord is black in color. The white that surrounds the Spinal Cord is the Spinal Fluid.

Cranial Nerves

As the Spinal Cord descends through the Foramen Magnum and Spine, important nerves branch off traveling to different parts of the body. There are a large number of nerves. These include the 12 Cranial nerves some of which control muscles whereas others are connected to internal organs such as the heart and lungs.

Arteries and Veins

Arteries and veins provide blood flow to and from important structures in the head, neck, and body. Without blood flow, the body cannot function.

Ligaments

Ligaments are the human duct tape that keeps everything in alignment and stable. The are many ligaments in the neck that provide stability. Two very important ligaments in the upper neck are the Alar and Transverse ligaments. To learn more about these ligaments please click here.

What Is an Occipital Cervical Fusion?

An Occipital Cervical Fusion also known as Occipitocervical Susion is a Major Surgery. It is not a routine operation and is a challenging procedure due to complex anatomy of the upper neck. The procedure involves rods, plates and screws that are placed into the Cervical Spine and Occiput. A plate secured by screws are placed at the base of the Occiput. Screws are also placed into one or more Cervical bones. Rods then connect the Occipital plate to the Cervical screws as shown below. The goal of Occipital Cervical Surgery is a boney fusion between the skull and neck and to relieve any abnormal pressure on the Brain Stem and Spinal Cord.

What Are the Indications for Occipital Cervical Fusion?

Occipital Cervical Fusion is used to treat various disorders of the Craniocervical Junction. The most common indication for Fusion is Craniocervical instability, and Brain Stem/Spinal Cord compression (2).

Craniocervical instability (CCI) is a medical condition where the strong ligaments that hold your head onto your neck are loose or lax (3). The major ligaments involved are the Alar, Transverse and Accessory ligaments. To learn more about CCI please click on the video below.

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What Are the Risks Associated with Occipital Cervical Fusion?

The upper Cervical Spine is a very complex area rich in nerves, arteries, veins, ligaments, tendons, and muscles. The risks associated with Upper Neck Fusion are significant and include (4).

Infection

An infection can be localized to the skin or may penetrate deeper into the muscles or bone. Antibiotics are oftentimes required for skin infections. Bone infections require additional surgery.

Screw Loosening

The implanted screw can back out of the bone over time compromising the stability of the upper neck.

Rod/Screw Failure

The screws that are inserted into the Occiput or C1 or C2 as well as the connecting rods can fracture, bend or break. In most cases surgical revision is necessary.

Failed Fusion

Despite the implanted screws and hardware, the Occiput and Cervical Spine may not fuse together. This is called Pseudoarthrosis and compromises the spinal stability.

Cervical Facet injury

A Cervical Facet is a paired joint that resides at each level of the Spine. A poorly placed surgical screw can be advanced into the Facet joint thereby injuring the joint cartilage leading to arthritis, pain, and restriction in range of motion.

Hematoma

A collection of blood that can compress or injure nerves, arteries, and veins.

Nerve Injury

The Upper Cervical Spine is rich in nerves that are susceptible to injury due to traction, cutting of tissue or poorly placed surgical screws.

Continued Pain and Dysfunction

Despite Fusion some patients fail to obtain a reduction in pain and improvement in function.

Vertebral Artery Injury

The Vertebral Artery provides critical blood flow to the Spinal Cord and Brain. The artery can be compressed, irritated, or injured during the surgery.

Dural Leak: The Dura is a thin layer of connective tissue that covers the Brain and Spinal Cord. It can be injured during the surgery resulting in leakage of Spinal Fluid (5).

Limited Neck Range of Motion

Fusion of the Skull Base to the Upper Neck can severely restrict the range of motion in the neck.

Death

Adjacent Segment Disease (ASD): Fusion of the Spine significantly alters the biomechanics of the Spine. The fused segment is no longer able to absorb the forces of daily living. As such these forces are then transferred above and below the Fusion. This additional force can overload the Discs, Facet joints, muscle, and ligaments above and below the Fusion which start to break down. This is called Adjacent Segment Disease. To learn more about this please click on the video below.

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Are there Alternatives to Occipital Cervical Fusion?

Yes!

n 2015 a nonsurgical treatment option for Cranial Cervical Instability was developed at the Centeno-Schultz Clinic. It involves the injection of a patient’s own Bone Marrow Concentrate into the damaged Alar and Transverse ligaments. The procedure is for mild to moderate cases of Craniocervical Instability that have not responded to conservative and Upper Cervical injection therapy. The procedure is very demanding and only performed at the Centeno-Schultz Clinic in Broomfield Colorado. The procedure is called Percutaneous Implantation of Cervical Ligaments (PICL) To learn more about this groundbreaking procedure please click on the video below.

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In Summary

Fusion is a major surgery in which the Spine is stabilized by a series of screws, bolts and plates.

The Occiput is the back of your skull.

The Craniocervical Junction is where the Occiput and the Upper Neck bones come together to form a joint.

The Craniocervical Junction contains vital structures that include the Spinal Cord, Cranial Nerves, arteries, veins and ligaments.

An Occipital Cervical Fusion is a major surgery that involves screws, plates and rods that are placed into the Upper Cervical Spine and Occiput.

Occipital Cervical Fusion is used treat various disorders of the Craniocervical Junction. The most common indication is Craniocervical Instability (CCI) and Brainstem/Spinal Cord compression.

The risks associated with Occipitocervical Fusion are significant and include:

Infection

Screw Loosening

Rod/Screw Failure

Failed Fusion

Cervical Facet Injury

Hematoma

Continued Pain and Dysfunction

Vertebral Artery Injury

Dural Leak

Limited Range of Motion

Adjacent Segment Disease

Percutaneous Implantation of Cervical Ligaments (PICL) is an non surgical treatment option for mild to moderate cases of Craniocervical Instability that have not responded to conservative care.

If you or a loved one continue to suffer from headaches, dizziness, brain fog and chronic fatigue that has not responded to conservative therapy please schedule a telemedicine consultation. A board certified, fellowship trained Physician will review your history, imaging and discuss appropriate treatment options.

1.Flanagan MF. The Role of the Craniocervical Junction in Craniospinal Hydrodynamics and Neurodegenerative Conditions. Neurol Res Int. 2015;2015:794829. doi:10.1155/2015/794829

2.Deutsch H, Haid RW Jr, Rodts GE Jr, Mummaneni PV. Occipitocervical fixation: long-term results. Spine (Phila Pa 1976). 2005 Mar 1;30(5):530-5. doi: 10.1097/01.brs.0000154715.88911.ea. PMID: 15738785.

3.Offiah CE, Day E. The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. Insights Imaging. 2017;8(1):29–47. doi:10.1007/s13244-016-0530-5

4.Kukreja S, Ambekar S, Sin AH, Nanda A. Occipitocervical Fusion Surgery: Review of Operative Techniques and Results. J Neurol Surg B Skull Base. 2015;76(5):331-339. doi:10.1055/s-0034-1543967.

5.Upadhyaya M, Jain S, Kire N, Merchant Z, Kundnani V, Patel A. Surgical, clinical, and radiological outcomes of occipitocervical fusion using the plate-screw-rod system with allograft in craniocervical instability. J Craniovertebr Junction Spine. 2019;10(4):216-223. doi:10.4103/jcvjs.JCVJS_87_19

from Centeno-Schultz Clinic https://centenoschultz.com/occipital-cervical-fusion-is-there-an-alternative/

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Ligaments of the Spine: Understanding Their Importance

It started as a dull ache and now has progressed. It feels like a knife in the back of your neck and is preventing you from daily activities. Medications, rest and conservative treatments have failed. Your doctor noticed on x-ray that the bones are out of alignment. He thinks you may have suffered a ligament injury. What is a ligament? What is the function of ligaments in the Spine? What are the 5 main ligaments of the Spine? Are there different types of ligament injuries? What can happen if Spinal ligaments are injured? Can ligaments heal on their own? What are the treatment options for ligaments of the Spine injuries? Let’s dig in.

What Is a Ligament?

A ligament a thick piece of connective tissue that connects bone to bone. Think of it as duct tape that holds bones together.

What Is the Function of Ligaments in the Spine?

Ligaments function to stabilizes the Spine, hold the Vertebral bodies together, limit Spinal motion and protect the Discs (1).

What Are the 5 Main Ligaments of the Spine?

Review of basic spinal anatomy will help you better appreciate the major ligaments of the Spine and their location. In this post I will be discussing the Cervical Spine: AKA the neck. All the ligaments discussed below are in the Cervical Spine but actually run the length of the Spine into the Sacrum.

The Spine is composed of boney building blocks that stack on upon another. These are called Vertebral bodies. In the Cervical Spine there are 7 boney building blocks which are numbered from 1 to 7. They are preceded by the letter “C” which refers to Cervical. Sandwiched between each of the building blocks is a spongey shock absorber called a Disc. At each level of the spine, Nerves exit through a boney doorway called the Neuroforamen.

There are a large number of both large and small ligaments in the Spine. The 5 main ligaments of the Spine include:

Anterior Longitudinal Ligament (ALL)

A one-inch thin ligament that is located on the front of the Spine. It starts at the base of the skull and extends into pelvis. To learn more about the Anterior Longitudinal Ligament please click here.

Posteror Longitudinal Ligament (PLL)

A one-inch thin ligament that is located on the backside of the boney building blocks of the spine (Vertebral bodies). Like the ALL, the PLL starts at the base of the skull and extends into the pelvis.

Supraspinous Ligament

On the backside of the Spine is a projecting bone that is easily felt. It is present at each level and is located in the midline. If you run your hand down someone’s neck these pointed bones are easily identified. These are the Spinous Processes. The Supraspinous ligament connects each of the Spinous Processes from C7 down to L4.

Interspinous Ligament

Like the Supraspinous Ligament, the Interspinous Ligament connects each of the Spinous Processes of the Spine. It is slightly deeper than Supraspinous Ligament. Its most supeficial fibers connect with the Supraspinous Ligament whereas the deeper fibers connect with the Ligamentum Flavum. Conceptually it is sandwiched between the Supraspinous Ligament and the Ligamentum Flavum

Ligamentum Flavum

The Ligamentum Flavum is a thick ligament that connects the Spinal bodies together. Specifically it connects the Lamina two adjacent Vertebral bodies. It is sandwiched between the Interspinous Ligament and the Dura. It starts in the C2 bone and extends down into the Pelvis. It is an important landmark for anesthesiologists when advancing their needle for epidural injections. The Ligamentum Flavum is thick and there can be significant change in the needle pressure when advancing into the Ligamentum Flavum. The technique is called Loss of Resistance (LOR). The Ligamentum Flavum can increase in thickness causing narrowing of the Spinal Canal, a condition known as Spinal Stenosis.

Can You Tear or Injure Ligaments in the Spine?

Ligaments in the Spine are susceptible to injury. Motor vehicle accidents, sports injuries, other traumatic events, and repetitive motion over time are the most frequent causes of ligament injury (2)

Are There Different Types of Ligament Injuries

Absolutely! Various types of trauma including motor vehicle accidents that can cause ligament injury. These injuries are classified into three grades.

Grade 1 sprain: Mild and includes slight stretching of the fibers and partial tear of the ligament.

Grade 2 sprain: More severe and involves a full thickness partial tear but the ligament is still intact.

Grade 3 sprain: Most severe and involves the entire ligament. The two edges of the ligament are pulled apart. This is otherwise known as a rupture.

What Happens if the Ligaments in the Spine Are Injured?

Spinal Ligaments provide important stability, limit motion, and protect the Spinal Discs. Injury to Spinal Ligaments is graded based upon the severity of the ligament injury. Injury of Spinal Ligaments can cause any of the following.

Slippage of vertebral body backwards in relation to the other spinal bones: retrolisthesis

Spinal Instability: The Spinal bones stack one upon another. They are supported by Spinal Ligaments. Injury to these ligaments can cause one or more of the Vertebral Bodies (boney building blocks) to move. This is referred to as Listhesis. If the bone is moved forward in relation to the adjacent bone it is called Anterolisthesis. Conversely if the bone is moved backwards in relation to the adjacent bone it is called Retrolisthesis.

Disc Injury: Movement of the Vertebral Bodies creates a shearing force on the Disc. This force can lead to Disc irritation, injury and degeneration. In addition, the loss of support provided by the ligament can cause Disc protrusions or Herniations.

Nerve Injury: Movement of one or more Vertebral Bodies can also irritate exiting nerve roots causing radiating extremity pain, numbness and tingling.

Spinal Stenosis: Movement of one or more Vertebral Bodies can narrow the Spinal Canal.

Facet Injury: Ligament instability in the Spine can lead to Facet overload, irritation, and injury which in turn can result in debilitating pain

Does an MRI Show Ligament Injury?

Yes! MRI is an effective radiographic study to evaluate injuries to the ligaments of the Spine (3). Common findings include blood or swelling adjacent to the ligament tear.

Can Ligaments of the Spine Heal?

Healing is dependent upon the severity of the injury. Ligament healing is an extensive 3 phase process that takes months. If a given ligament is allowed sufficient time to heal and is supported during the healing phase many Grade 1 injuries can heal. The problem with Spinal Ligament injuries is twofold:

Patients rarely allow sufficient time to heal which requires significant activity modification for months.

External bracing is not a practical option. Unlike a knee or ankle ligament injury where a knee or ankle brace can be applied, external Spinal braces are rarely used and poorly tolerated by most patients.

Treatment Options for Ligaments of the Spine Injuries

At the Centeno-Schultz Clinic treatment of Spinal Ligaments is a central portion of our philosophy and treatment protocol. We view the Spine as a collection of many parts working in a synchronized fashion. This approach is known as the Functional Spinal Unit (FSU) and is radically different from the approach used in most pain clinic which focus on one or more “Pain Generators”. To learn more about this approach please click here.

Spinal Ligament injuries can be treated by precise injections of PRP or Bone Marrow Concentrate under X-ray or ultrasound guidance. Blind injections are below our standard of care and place the patient at risk for Nerve, Disc and Vascular injuries. The injections are demanding and cannot be performed by your Orthopedic Surgeon or Family Physician. Below is a x-ray image of a Interspinous Ligament injection at C2. Below is an x-ray image of a Cervical Interspinous Ligament injection from my clinic. It was performed under x-ray guidance in a patient with Cervical Instability. .

Healing of ligaments following PRP or Bone Marrow Concentrate injections takes time. There are three distinct phases: inflammatory, proliferative and tissue remodeling. To learn more about ligament healing click on video below.

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In Summary

A ligament a thick piece of connective tissue that connects bone to bone.

Ligaments function to stabilizes the spine, hold the Vertebral Bodies together, limit Spinal motion and protect the Discs.

There are 5 major ligaments of the Spine:

Anterior Longitudinal Ligament

Posterior Longitudinal Ligament

Supraspinous Ligament

Interspinous Ligament

Ligamentum Flavum

Ligaments of the Spine are susceptible to injury.

Ligament injury is graded based upon severity: grade 1, 2 and 3.

Injury to the Ligaments of the Spine can cause Spinal instability, Spinal Stenosis and injury to the Discs and Facets.

Grade 1 and some grade 2 ligaments can heal on their own if allowed sufficient time and bracing. Unfortunately, this is poorly tolerated by most patients.

Ligament injuries can be treated with precise x-ray and or ultrasound guided injections of PRP or Bone Marrow Concentrate allowing patients the opportunity to avoid surgery.

If you or a loved one has sustained trauma to the spine and has not responded to conservative therapy please schedule a Telemedicine consultation. Injury of the ligaments of the Spine are quite common and often times missed leading to Spinal Instability, and injury to the Spinal Discs, Facets and Nerves. Stop the suffering and learn what your Regenerative options are from a board certified, fellowship trained physician today.

1.Damm N, Rockenfeller R, Gruber K. Lumbar spinal ligament characteristics extracted from stepwise reduction experiments allow for preciser modeling than literature data. Biomech Model Mechanobiol. 2020;19(3):893-910. doi:10.1007/s10237-019-01259-6

2.Panjabi MM. A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. Eur Spine J. 2006;15(5):668-676. doi:10.1007/s00586-005-0925-3

3.Katzberg RW, Benedetti PF, Drake CM, Ivanovic M, Levine RA, Beatty CS, Nemzek WR, McFall RA, Ontell FK, Bishop DM, Poirier VC, Chong BW. Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center. Radiology. 1999 Oct;213(1):203-12. doi: 10.1148/radiology.213.1.r99oc40203. PMID: 10540663.

from Centeno-Schultz Clinic https://centenoschultz.com/ligaments-of-the-spine-understanding-their-importance/

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Anterior Longitudinal Ligament: Could This Be Responsible for Your Ongoing Neck Pain?

The neck pain is unrelenting, and all started after being rear ended at a stoplight. Spine X-rays demonstrated some abnormal movement of the Spinal bones. Both conservative care and medications have failed. Your doctor thinks you have injured a Spinal ligament. What is the Anterior Longitudinal Ligament? What is the role of the Anterior Longitudinal Ligament? What ligaments are injured in a Whiplash type accident? Are there different types of ligament injuries? What happens if the Anterior Longitudinal Ligament is injured? Does MRI show ligament injuries? Can Spinal ligaments heal and what are the limitations? What are the treatment options for injuries to the Anterior Longitudinal Ligament? Let’s dig in.

What Is the Anterior Longitudinal Ligament (ALL)?

A ligament is a thick piece of connective tissue that connects bone to bone. Think of it as duct tape that holds bones together. The Anterior Longitudinal Ligament (ALL) is an important ligament located in the front of the neck. It starts at the base of the skull and extends down across the Cervical, Thoracic and Lumbar Spine ending at the Sacrum. It is approximately one inch is width and has three layers: superficial, intermediate and deep.

What Is the Role of the Anterior Longitudinal Ligament?

To understand the role of the role of the ALL it is important to review some spinal anatomy. The Spine is composed of boney building blocks that stack on upon another. In the Cervical Spine there are 7 boney building blocks. Sandwiched between each of the building blocks is a sponey shock absorber called a Disc. At each level of the Spine, Nerves exit through a boney doorway called the Neuroforamen. The Anterior Longitudinal Ligament covers the front portion of the Spine. It covers both the boney building block and the Disc.

The Anterior Longitudinal Ligament has 3 important roles:

Stabilizes the Spine

Limits motion

Confines, supports, and reinforces the anterior wall of the Disc

Which Ligaments Are Injured in Whiplash Type Accident?

Whiplash is a neck injury due to forceful, rapid back-and-forth whipping motion of the head and neck. Whiplash can also be described as “an acceleration-deceleration mechanism of energy to the neck” (1). The incidence of Whiplash injuries varies greatly between different parts of the world. For example, in Quebec Canada incidence is as high as 70 per 100,000 (2). It is estimated that there are 1,000,000 cases of Whiplash per year in the United States. Injuries can be significant and long lasting. Approximately 50% of Whiplash patients have reported chronic neck pain 15 years after the trauma (3).

Whiplash trauma can cause injury to multiple Spinal structures and ligaments, Facet joints, Discs, Muscles, Tendons and Nerves. The Anterior Longitudinal Ligament is particularly susceptible to injury due to the rapid back and forth whipping motion of the neck (4).

Are there Different Types of Anterior Longitudinal Ligament Tears?

Absolutely! Various types of trauma including motor vehicle accidents that can cause injury to the Anterior Longitudinal Ligament. Ligament injuries are classified into three grades.

Grade 1 sprain: Mild and includes slight stretching of the fibers and partial tear of the ligament..

Grad 2 sprain: More severe and involves a full thickness partial tear but the ligament is still intact.

Grade 3 sprain: Most severe and involves the entire ligament. The two edges of the ligament are pulled apart. This is otherwise known as a rupture.

What Happens if the Anterior Longitudinal Ligament is Injured?

The Anterior Longitudinal Ligament provides critical support to the Spine and Discs. Injury to the ALL can cause the following:

Spinal instability: Movement of one or more of the Vertebral Bodies (boney building blocks). This is referred to as Listhesis.

Loss of support and reinforcement of the Disc making the Disc vulnerable to injury including Disc Protrusion and Herniation.

Disc Injury: Movement of the Vertebral bodies creates a shearing force on the Disc creating irritation and injury

Nerve Injury: Movement of one or more Vertebral Bodies can also irritate exiting nerve roots causing radiating extremity pain.

Spinal Stenosis: Movement of one or more Vertebral Bodies can narrow the Spinal Canal

Injury to the ALL can cause irritation or injury to the Nerves within the Longitudinal Ligament resulting in pain and restriction in range of motion.

ALL Injury can also lead to bone formation within the ligament causing pain and dysfunction.

Does an MRI Show Ligament Injury?

Yes! MRI is an effective radiographic study to evaluate injuries to the Cervical ligaments which include the Anterior Longitudinal Ligament (5). Common findings include blood or swelling adjacent the ligament tear. In addition, there may be movement of the boney building blocks in the Spine such that one or more move backwards in relationship to the others. This is called Retrolisthesis.

Can Spinal Ligaments Heal?

Ligament healing is an extensive 3 phase process that takes months. If a given ligament is allowed sufficient time to heal and is supported during the healing phase many Grade 1 injuries can heal. The problem with Spinal ligament injuries is twofold:

Patients rarely allow sufficient time to heal which requires significant activity modification for months.

External bracing is not a practical option. Unlike a knee or ligament injury where a knee or ankle brace can be applied, external Spinal braces are rarely used and poorly tolerated by most patients.

Treatment Options for Anterior Longitudinal Ligament Injuries

At the Centeno-Schultz Clinic treatment of Spinal ligaments is a central portion of our philosophy and treatment protocol. We view the Spine as a collection of many parts working in a synchronized fashion. This approach is known as the Functional Spinal Unit (FSU) and is radically different from the approach used in most pain clinic which focus on one or more “Pain Generators”. To learn more about this approach please click here.

Anterior Longitudinal Ligament injuries have been successfully treated using precise ultrasound and x-ray guided injections. Blind injections, those without guidance are below the standard of care and put the patient at risk for Nerve, Disc and blood vessel injury.

Dr. John PItts was instrumental in developing this injection technique. An intimate working knowledge of the Spinal anatomy along with years of x-ray and ultrasound guided injections allowed for him to develop and refine this injection. We have all mastered this injection. It is a complex, highly skilled injection that you family doctor or orthopedic surgeon cannot perform. Below is x-ray image of my recent Anterior Longitudinal Ligament injection.

Healing of ligaments following PRP or Bone Marrow Concentrate injections which contain stem cells take time. There are three distinct phases: inflammatory, proliferative and tissue remodeling. To learn more about ligament healing click on video below.

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In Summary

The Anterior Longitudinal Ligament is a small ligament in the front of your neck. It starts at the base of the Skull and extends into the Sacrum.

The Anterior Longitudinal Ligament has three important roles: stabilization, limits movement and supports the front wall of the discs.

Whiplash type traumas can cause injury to multiple structures in the spine including the Anterior Longitudinal Ligament.

Ligament injuries are graded based on the severity of the injury: Grade 1, Grade 2 and Grade 3.

Injury of the Anterior Longitudinal Ligament can result in Spinal Instability, Spinal Stenosis and injury to the Discs, Nerves and Facet joints.

MRI is an effective radiographic imaging technique to identify ligamental injury.

Most Grade 1 and some Grade 2 injuries can heal on their own if allowed to. Unfortunately, effective bracing of the spine of prolonged periods is rarely tolerated.

At the Centeno-Schultz Clinic we have pioneered a procedure where the Anterior Longitudinal Ligament injures can be treated with precisely guided injections of PRP or Bone Marrow Concentrate.

If you or a loved one has sustained trauma to the spine and has not responded to conservative therapy please schedule a telemedicine consultation. Ligament injuries are quite common and often times missed leading to Spinal Instability, and injury to the Discs, Facets and Nerves. Stop the suffering and learn from a board certified, fellowship trained physician what your Regenerative treatment options are today.

1.Pastakia K, Kumar S. Acute whiplash associated disorders (WAD). Open Access Emerg Med. 2011;3:29-32. Published 2011 Apr 27. doi:10.2147/OAEM.S17853.

2.Rosenfeld M, Seferiadis A, Gunnarsson R. Active involvement and intervention in patients exposed to whiplash trauma in automobile crashes reduces costs: a randomized, controlled clinical trial and health economic evaluation. Spine (Phila Pa 1976). 2006 Jul 15;31(16):1799-804. doi: 10.1097/01.brs.0000225975.12978.6c. Erratum in: Spine (Phila Pa 1976). 2012 Nov 15;37(24):E1537- 40. PMID: 16845354.

3.Squires B, Gargan MF, Bannister GC. Soft-tissue injuries of the cervical spine. 15-year follow-up. J Bone Joint Surg Br. 1996 Nov;78(6):955-7. doi: 10.1302/0301-620x78b6.1267. PMID: 8951014.

4.Stemper BD, Yoganandan N, Pintar FA, Rao RD. Anterior longitudinal ligament injuries in whiplash may lead to cervical instability. Med Eng Phys. 2006 Jul;28(6):515-24. doi: 10.1016/j.medengphy.2005.09.011. Epub 2005 Nov 10. PMID: 16289824.

5.Katzberg RW, Benedetti PF, Drake CM, Ivanovic M, Levine RA, Beatty CS, Nemzek WR, McFall RA, Ontell FK, Bishop DM, Poirier VC, Chong BW. Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center. Radiology. 1999 Oct;213(1):203-12. doi: 10.1148/radiology.213.1.r99oc40203. PMID: 10540663.

from Centeno-Schultz Clinic https://centenoschultz.com/anterior-longitudinal-ligament/