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Questions for Dr. Kennedy
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prolotherapy: sodium morrhuate
Posted by: Justin
Date: March 15, 2003 5:25 PM

I have now had six injections for an unstable shoulder with accompanying RTC tendonitis. Because of my athletic lifestyle and Army Reserve duty, I require the full use of the shoulder. In treatment, we have used the standard dextrose/glycerine/local anesthetic solution, but I would really like to undergo a full course of 3-6 sodium morrhuate injections. However, one major thing concerns me: It is my understanding that sodium morrhuate induces high levels of arachidonic acid production at the sight of injection. Strong peripheral inflammation can cause an increase in interleukin 1 in circulation; this ligand can bind to the endothelial cells of the BBB, inducing them to produce prostoglandin E2 which may in turn, turn on production of arachidonic acid and other inflammatory compounds in the brain. Recent studies indicate that NSAIDS might help slow down the progression of - or even reduce the chances of developing neurodegenerative diseases, so I wonder if unchecked (since NSAIDS and prolo don\'t mix) long term, repeated peripheral inflammation might not pose a risk for developing neural problems later in life. What sort of indicators might there be that a particular patient is, or is not at risk? So far, I have not required pain meds and have not experienced a flair reaction. As far as I know, I have not gotten a fever after injection, though I generally do have increased symptoms of elbow tendonits post injection but I assume the latter to be a result of compensation. In other words, I think the inflammation stays pretty local. Assuming that, and assuming if the morrhuate doesn\'t make me sick, using it should be fairly safe? If I do try it and get sick from it, should I keep some NSAIDs on hand just in case?

RE: prolotherapy: sodium morrhuate
Posted by: Justin
Date: March 17, 2003 2:11 AM

I am not advocating the use of NSAIDS during prolotherapy treatment because an anti-inflammatory compound would negate the action of prolotherapy. Instead, I suggested its use only in a case where an unwanted global, rather than focal inflammatory reaction was caused; if such were the case, sodium morrhuate would be discontinued and all subsequent treatments would be with the dextrose solution. It seems that being only a week away from my last treatment, a gallium contrast MRI might be a bit premature. A radiologist unfamiliar with prolotherapy might mistake any signal from a recent inflammatory response as a sign of pathology. I'm also worried as to what effect the contrast agent might have on the healing process. Shall I wait 6-8 weeks before having the MRI, and, not being a radiologist myself, what exactly does one look for to determine whether or not the capsule is stretched enough to warrant surgery? The last statistic I read for capsular shrinkage was only a 60% success rate and, never having had a frank dislocation, I believe the Bankart procedure is probably far too invasive for my particular condition. Perhaps the dismal failure of arthroscopic capsular shrinkage is due to the use of excessive temperatures (in some cases) that ultimately damage tissue rather than promote a renaturing of collagen. What advances have been made in surgical procedures for restoring shoulder function?

RE: prolotherapy: sodium morrhuate
Posted by: Email to Ron Kennedy, M.D.
Date: March 17, 2003 2:19 AM

You are better advised to put these types of questions to your orthopedist where you will get better answers. I am not a surgeon. I do know this. Gallium leaks through structural defects, so I doubt that having had a prolo treatment would make much difference. As to capsular shrinkage, you are just guessing at the diagnosis. Could be an exostosis wearing away a tendon. There are criteria for determining if surgery is indicated but I am not intimately familiar with them.



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