Ankle Surgery or Prolotherapy
It is common for Prolotherapists to see people with continued pain complaints after surgery. This is a very common occurrence in our office in Oak Park, Illinois. Often overlooked causes of this post-surgery pain are that the surgery itself may cause ligament injury or the surgery may not repair the ligament injury. When performing surgery, the ligaments are stretched and pulled in order to gain access to the joint.
In 1992, researcher Dr. J. Albert and associates looked at what occurred in the ankle when the joint was opened or distracted for ankle surgery. What they found was that when the joint was opened in the clinically recommended range "complications of pin bending, excessive ligament strain, and bony destruction did occur." Anyone with post-surgery pain should be checked for ligament injury. Prolotherapy to the injured ligaments will eliminate the pain in such a case. Ankle fusion fixes nothing, but may provide some temporary pain relief, at least for a while.
Imagine how much motion your ankle normally has. What is going to happen when all of that motion is lost? Other joints around that fused joint must move more in order to compensate for the fused joint. This will cause excessive strain to these joints or the joints around them. The long-term outlook for fusion patients, no matter which joint, is long-term pain and disability. The reason why people succumb to these operations is that they feel they have no other options. There is an alternative to ankle fusion - Prolotherapy.
Ankle fusions typically have high rates of non-union.
This means that up to 30 percent of fusions fail, meaning that the bones do not hold together. In one study of 42 patients, the overall complication rate was 55 percent, including nonunion, fractures, pin-site infections, and hardware problems.
Yet surprisingly, 85 percent of the people were satisfied with the results. People, we are setting our standards way too low! An operation has a 55 percent complication rate, yet we are satisfied?
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The most common long-term consequence of ankle fusion is arthritis in the joint below the ankle, called the subtalar joint. Guess how long it takes to become arthritic? It does not take long. The average time is about four to five years. Most studies show that after arthrodesis (ankle fusion) the subtalar joint is significantly arthritic in 50 percent of the cases. All that an ankle fusion does is cause arthritis to travel from one joint to the other. On top of that, the fused joint can no longer be moved at all. One study with a follow-up time of 12.3 years showed that 67 percent of people had pain in this subtalar joint and that 75 percent of patients had to wear special footwear after ankle fusion. The author (Ahberg, A. Late results of ankle fusion. Acta. Orthop. Scand. 1981; 52:103-105.) noted, "In conclusion, patients with ankle fusion often have persistent trouble; therefore technical and clinical development of total ankle joint replacements seems to be indicated."
Can you believe this one? -The orthopedist's solution to the ankle fusion failure is "let's come up with another operation" so the sequence of events will continue: ligament sprain, RICE treatment, mild NSAIDs, then stronger and stronger NSAIDs, leading to cortisone shots, then arthroscopy, ankle fusion, and, finally, ankle replacement. We think not! How about just doing Prolotherapy after the initial injury? It is much simpler. Anyone starting out with the RICE treatment is most likely going to end up later in life with several masked people around them with sharp blades. If this is what you want, follow the standard sports medicine protocols. If not, run to a Prolotherapist, if you are still able. Your joints depend on it. The above scenario does not even take into account the dramatic gait abnormalities that occur with ankle fusion. Remember, fusion of the knee, back, or ankle means that the joint can never be moved normally again. At minimum, most of the motion in the subtalar joint will be lost. In regards to ankle fusion, the velocity of the gait will be much slower and the length of the stride will decrease. Other joints around the fused area, as already noted, will have to contract a lot more. This causes the energy expenditure of walking to increase dramatically. -
Thoracic Outlet Syndrome
The thoracic outlet consists of the space between the inferior border of the clavicle and the upper border of the first rib. The subclavian artery, subclavian vein, and brachial plexus nerves (the nerves to the arm) exit the neck region and go into the arm via this space. In Thoracic Outlet Syndrome (TOS), the space is, presumably, narrowed, causing a compression of these structures. The symptoms of TOS include: pain in the neck, shoulder, and arm; coldness in the hand; and numbness in the arm and hand. However, in severe cases of compression of the subclavian vessels, Raynaud’s phenomenon, claudication, thrombosis, and edema can occur in the involved extremity.
TOS is a legitimate condition and does occur but its prevalence is extremely rare! Most people who come to Caring Medical, in Oak Park, Illinois, with the diagnosis of TOS leave with other diagnoses such as glenohumeral ligament sprain, rotator cuff tendinopathy, cervical ligament sprain, or Slipping Rib Syndrome. All of the pain and numbness symptoms of TOS can occur from these later four conditions, all of which respond beautifully to Prolotherapy.
The reason it makes sense that Prolotherapy would be BENEFICIAL for the symptoms of so-called "TOS" is the fact that the condition almost exclusively occurs in women with long necks and low-set droopy shoulders. Activities that involve abduction of the shoulders, such as combing the hair, painting walls, and hanging pictures, cause worsening of the symptoms. Passively abducting the arm (having someone do it for the person) relieves the symptoms. In other words, when the shoulder is actively raised over the head (the person does it themselves) the symptoms of pain and/or numbness down the arms occur, however, when the exact same movement is done passively (by another person) the symptoms do not occur. This type of symptomatology is a perfect description of ligament and tendon weakness (laxity). The injured ligament and tendon give localized and referral pain when doing strenuous movements, but when someone else takes the brunt of the force, no such symptoms occur.
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The doctor said I have Thoracic Outlet Syndrome and I need surgery to give the nerves more room.” Sometimes it is difficult to convince someone they need Prolotherapy. The people with so-called TOS almost unanimously have normal reflexes and nerve conduction studies. This gives further indication that a nerve is not getting pinched. Furthermore, surgically slicing structures to give the nerve more room will not eliminate the symptoms the person is having and could, quite possibly, cause more problems. The person with the symptoms of TOS doesn’t need a surgical procedure to cut out a rib or slice a muscle to give the brachial plexus more room, he/she needs Prolotherapy to the pain-producing structure(s). Prolotherapy to the neck ligaments, shoulder ligaments and tendons, or to a rib that is slipping is all that is needed.
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