Patient care can be complex. Medical specialization has led to fragmentation of care. A patient will go to one care provider for their cardiovascular health and a different one for their musculoskeletal care. This can lead to less than optimal results. At the Centeno-Schultz Clinic we embrace a larger view; we evaluate a patients’s major complaint but then identify the factors that led to this injury or pain. It is comprehensive view termed Orthopedic 2.0. The textbook is now available.
RC is a patient who benefited from this approach. RC is a 47 y/o patient who was referred for platelet rich plasma injection into his left Achilles tendon. He had undergone surgical repair and extensive physical therapy without significant benefit. A major tendon transfer and bone graft was his next option. RC’s Achilles pain was intermittent in frequency, 6/10 in severity, nonprogressive in nature and prevented him from exercising or engaging in athletic activities with his family.
After the first ultrasound guided PRP failed to provide significant benefit, I scheduled RC for a comprehensive evaluation which was significant for the following:
1) Use of Simvastatin, a cholesterol medication which has been linked to tendon weakness and tears.
2) Significant myofascial dysfunction involving his lower back and leg which placed increased strain on the Achilles.
3) Weakness in the lower extremity consistent with lumbar disc compression of an exiting nerve root. Subsequent MRI of lumbar spine was significant for multi-level degenerative disc disease, two level disc bulge and compression of two nerve roots.
After discontinuing Simvastatin, RC underwent x-ray guided injection of platelet derived growth factors into the lumbar spine , myofascial release of dsyfunctional muscles, PRP injection into Achilles and ultrasound guided core strengthening. RC reports a 70% improvement in Achilles pain. Practicing comprehensive care, as embodied in Ortho 2.0 enablabed RC to avoid a very large surgery and resume his athletic activities with his family.
