Investing in Research That Restores Function, Reduces Pain and Improves Lives

The Napa Medical Research Foundation supports a team of local researchers, led by Dr. Marko Bodor, to investigate new therapies and medical procedures that can more effectively treat common orthopedic, musculoskeletal and neurologic disorders in both children and adults.

CURRENT RESEARCH PROJECTS

Sever’s Disease Study (Achilles Tendon)

Severs Disease HeelBACKGROUND: Pain in the heel and Achilles tendon is a common complaint among children between the age of 7 and 12. The condition was first described by Sever in Boston in 1912 and has been attributed to apophysitis or inflammation of the bone. The treatment has consisted of relative and absolute immobilization using orthotics, cast-boots or casts. Despite treatment, over 50% of children have ongoing or recurrent problems.

HYPOTHESIS: With careful reconsideration of the pathophysiology of the disease, we believe it is caused by a problem of tendon and a failure of adaptation to increasing loads imposed by rapid growth. Specifically, we have found there is an exponential increase in load on muscles and tendons as children grow. This relationship was the basis of a new theory on the pathophysiology of Duchenne Muscular Dystrophy, published in the journal Muscle & Nerve in September 2013.

CURRENT RESEARCH FINDINGS: We have found that implementation of  a specialized 12-week exercise program can result in total resolution of symptoms in as quickly as 2 weeks. By eliminating the use of ineffective orthotics and cast-boots, children are allowed greater mobility during treatment and enjoy a rapid return to sports and physical activities.

40 children have completed the 12-week program, with all experiencing marked improvement in their conditions after finishing the first 2 weeks of treatment. Children were recruited through ads placed through the Napa Valley School District and Napa Valley Register.

GOAL: We are establishing a 16 patient randomized control group to better confirm our findings. There are currently 4 children enrolled. The Foundation is compensating participants in the blind study control group $150 for their time with the additional guarantee that all children will receive the fully effective treatment after the study concludes. Please contact Yvette Uribe to learn more. Once this data is compiled, we will prepare the study results for publication in The American Journal of Sports Medicine.

Cervical Facet Arthritis Study

Cervical Facet ArthritisBACKGROUND: Neck pain is a common complaint among individuals age 50 and over. Among those 50 and over with chronic neck pain and restriction of range of motion, up to 40-50% suffer from osteoarthritis of the facet joints. Current treatments include corticosteroid injection and the delivery of biologic agents, such as platelet-rich plasma or bone marrow aspirate concentrate containing stem cells.

Prior to the refinement of ultrasound-guided delivery methods, many the facet joints could only be injected using fluoroscopic (x-ray) guidance. The disadvantages of x-ray include: 1) radiation exposure, 2) a 2-dimensional approach that often necessitates painful contact with the bone, and 3) use of a contrast agent to ensure needle placement which reduces the space available for the therapeutic medication, possibly neutralizes the effectiveness of biologic agents, and risks allergic reaction. Difficult to perform and time consuming, the fluoroscopic technique may be less than 80% accurate.

When unsuccessful, many patients are driven toward a significantly more costly and invasive procedure: radiofrequency ablation of the medial branch nerves using microwaves. These nerves contribute to rotation and angulation of the head and neck. Ablating these nerves in the lumbar spine has been shown to accelerate disc degeneration and could do the same in the cervical spine.

HYPOTHESIS: Using our ultrasound-guided technique, full doses of biologic agents can be delivered with greater accuracy directly to the affected area without harm of radiation.

CURRENT RESEARCH FINDINGS: In Phase I we have recently shown that our minimally invasive, less costly ultrasound-guided cervical facet injection technique has 95-100% accuracy. The data has been shared and analyzed by Dr. Naveen Murthy from the Mayo Clinic.

GOAL: With  the study complete, Dr. Bodor and his assistant Yvette Uribe will begin preparing their findings for submission to a peer-reviewed journal. We anticipate a publication date of October 2017.

Hip / Greater Trochanteric Pain Syndrome (GTPS) Study

Hip/Greater Trochanteric Pain Syndrome (GTPS) StudyBACKGROUND: Pain in the lateral hip or greater trochanteric pain syndrome (GTPS) affects a large number of middle-aged and older individuals. Most general practitioners and orthopedists currently attribute this to bursitis. The treatment typically involves rest, ice, heat, stretching and strengthening and non-steroidal anti-inflammatory drugs (NSAIDs). With no improvement, a corticosteroid injection is often given resulting  in the resolution of symptoms, often temporarily. Patients experiencing recurrent symptoms receive repeated injections, the continued success of which decreases over time (see Rompe JD, Segal NA et al., Home Training, Local Corticosteroid Injection or Radial Shock Therapy for GTPS, American Journal of Sports Medicine, 2009).

HYPOTHESIS: Through ultrasound examination, we have found many patients with recurring symptoms show tendon tears of the rotator cuff of the hip: the gluteus minimus tendon and the anterior and posterior gluteus medius tendons. We believe an injection of concentrate of plasma-rich platelets into the tendon defect can result in healing and permanent improvement of symptoms in approximately 4 weeks.

CURRENT RESEARCH FINDINGS: We are in the process of finishing retrospective chart review assessing the outcomes of all patients who have received PRP for gluteus medius tendon tears. Our results show 80-90% of patients have experienced complete resolution of symptoms at 1 month sustained at 12 months, thus improving function and quality of life months sooner than for alternative treatments without decrement at 1 year.

GOAL: To enroll an additional set of patients in order to limit variables and obtain current data.

Disk Degeneration Platelet Rich Plasma Injection Study – Lumbar, Thoracic and Cervical

Cervical Disk Degeneration Platelet Rich Plasma Injection StudyBACKGROUND: Low back pain is the number one cause of musculoskeletal disability world-wide.  Neck pain, although less prevalent than back pain, is attributed to similar causes.  Disc degeneration starts with a tear of the annulus fibrosus that can result in acute and chronic pain and progress to disc herniation and degeneration.   We have experienced success with disc injections of platelet-rich plasma (PRP) to augment the natural healing response. The  technique and rationale can be found in “Platelet Rich Plasma”, editor Lana, publisher Springer, 2014.

CURRENT RESEARCH FINDINGS: As of late May 2017, Dr. Bodor has delivered intradiscal PRP to 187 patients, treating 444 discs – including cervical, thoracic, and lumbar – through a total of 224 procedures. Approximately 75% of patients have experienced good to excellent outcomes in 6 – 8 weeks following the injections. Dr. Bodor and his research team will complete a one-year follow up with 300 patients who have received PRP treatment for degenerative disc disease.

HYPOTHESIS: We hypothesize that the best outcomes will occur in patients who obtain a positive response to an anesthetic discogram, who have a history of an acute injury to their disc or findings of annular tear and who have lower risk factors for ongoing disc degeneration.

GOAL: We hope to establish the efficacy of similar PRP injection in the cervical spine and will continue to prove the effectiveness on the lumbar and thoracic spine for eventual publication.

Nerve Cross-Sectional Area Study

BACKGROUND: Carpal Tunnel Syndrome and other focal neuropathies are very common around the world. The standard for diagnosing these conditions, Electromyography (EMG) and Nerve Conduction Studies (NCS) studies,are both painful and invasive. Ultrasound measurement of the median nerve cross-sectional area at the wrist has been explored by  Drs. Walhout, Van den Burg, Bathala and Visser and have shown it to be a useful diagnostic test for Carpal Tunnel Syndrome.

HYPOTHESIS: The primary objective of our study is to make a correlation between a person’s height and cross-sectional area of the median nerve. If our mathematical model is viable, we will be able to calculate standard measurements for nerves which can help us to diagnose common pathologies. Our second objective is to help establish this as an effective technique for diagnosing Carpal Tunnel Syndrome and other focal neuropathies as opposed to the current standard use of EMG and/or NCS.

CURRENT FINDINGS: We are currently enrolling an additional 10-20 subjects at the tall end of the height spectrum to complement data already obtained among 6 – 10 year old children.

GOAL: We are working to develop a viable mathematical model that can help us create standard values for nerves that can provide for the diagnosis of Carpal Tunnel Syndrome and other common pathologies.  Currently, we have achieved 85% success rate in proving our proposed correlation. Following the enrollment of a few more study participants, we can proceed to data review.

RELATED STUDY: Along with colleagues from Ljubljana, Slovenia, Dr. Bodor recently published a research paper titled “Nerve Conduction Velocity and Cross-Sectional Area in Ulnar Neuropathy at the Elbow” in Muscle & Nerve (March 2017 edition).

Benefits of Participating in Our Research Studies

Precise Diagnosis & Assessment

Customized Treatment Plan

Careful Follow-up

We assess our clinical study participants carefully using a number of highly specialized technologies all available in the same clinic setting on the same day. After establishing a precise diagnosis, our researchers develop a customized treatment plan incorporating both currently established and leading edge methods, if applicable. We view each participant and their condition as complex and unique. Every study participant is treated like a member of the Napa Medical Research Foundation family. Our research team is readily available by phone or email for any questions and we continue personal follow-up with each participant.

Interested in learning more about our current research projects?

For more information, access the publications library:

Funding

All the research conducted through the Napa Medical Research Foundation, a 501©(3), is fully funded through generous donations received from private individuals as well as from government and community grants. We welcome private contributions to help fund and expand our research so we may continue to help improve people’s lives who have been suffering from chronic pain and limited movement. Every donation makes a difference.