About Moyamoya Inflammation Vascular Treatment
~The cause of prolonged pain and chronic inflammation is in the blood vessels
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Pain is caused by abnormal blood vessels
Most of the pain treated by orthopedic surgeons is actually due to damage to joints, tendons, and other structures,Pain is always felt by the nerves.Is. UsuallyNerves accompany with blood vesselsI am doing it. If pain occurs,Pain substances (e.g., inflammatory cytokines) released from arterial blood vessels stimulate nerves, causing painThe treatment focusing on these blood vessels is known as "blood vessel therapy". Treatment focusing on these blood vessels is calledEmbolization of Abnormal Blood Vessels".
What are moyamoya inflammatory vessels?
In humans, capillaries extend to the periphery of each tissue, but around the tissue causing the pain,Abnormal capillary bloodTube = moyamoya inflammatory vesselshas been found to be able to do so.
Why do morbidly abnormal blood vessels increase?Aging and overuse.Muscle tendons and ligaments, articular cartilageis broken, inflammation occurs as a repair response.However, if the damage is repeated or overused, the repair takes a long time and angiogenesis occurs one after another in order to supply blood flow. These new vessels are "moyamoya inflammatory vessels" (Fig. 1). Moreover, this neovascularizationInflamed blood vessels are "out of production"The local swelling and lack of blood flow are not being corrected.
Further issues are,moyamoya inflammationWhen blood vessels are regenerating, nerve fibers proliferate at the same time.The following is a list of the items that we will make available to you.The blood vessel walls frequently release pain substances (inflammatory cytokines), which transmit pain signals through nerves to the brain, causing hyperalgesia.
When young, the number of new blood vessels is small, so massage reduces the pain, but in middle age and older, the number of new blood vessels increases with years of accumulation, and because of this, the pain does not go away. In other words,Moyamoya InflammationBlood vessels" are the painful blood vessels.This means that it is
Can you check for the presence of moyamoya inflammatory vessels?
The clinic ownsHigh Definition EchoThis inflammatory vessels can be seen visually by using the The moyamoya inflammatory vessels are,Juvenile, tortuous, narrow lumen.Therefore, the flow is slow.Selectively delineate slow-flowing vesselsThe unique features of the Canon Echo (SMI Function), it is quite perceptive,Moyamoya InflammationInflammation of blood vessels can be detected (Fig. 2). Simply by applying an echo to the painful area, the presence of inflammation can be examined immediately without the radiation exposure of an x-ray.
However, of course, deep areas where sound cannot reach or behind bones cannot be evaluated because they cannot be visualized by echo. In such cases, it is possible to see them by inserting a thin tube called a catheter test into a blood vessel and flowing a contrast medium through it.
Pain is reduced when moyamoya and inflammatory blood vessels are eliminated.
Stopping the blood flow in moyamoya inflammatory vessels eliminates the pain. By applying Moyamoya Inflammatory Vascular Therapy, abnormal blood vessels can be reduced. And surprisingly, stopping the flow of abnormal blood vessels immediately improves the pain (a few minutes after the medicine flows). Symptoms are further reduced for about four weeks after that. And it is better than steroids and hyaluronic acid, which are discussed below.Long-lasting effectWe also know that it does.
What treatments are available to reduce moyamoya inflammatory vessels?
◉ Compression (Figure 3) Compression causes blood vessels to collapse and blood flow to cease. Some juvenile blood vessels can clot and become clogged after a few minutes to a few dozen minutes of compression. Although not all inflamed vessels can be eliminated, it is a simple and effective method. Find the site of tenderness and press with your fingers or use a wall to apply pressure.
◉ Extracorporeal shock wave therapy (shock wave) (Figure 4) With our newly introduced shock wave therapy device, sound energy can be used to reduce pathological blood vessels and nerve endings in the periphery. It is said to be particularly effective in cases such as tendon adhesion inflammation.
◉ steroid injection Our clinic actively uses echography to pinpoint and identify moyamoya and inflammatory blood vessels through echo-guided injections. We reduce the side effects of steroids by injecting a smaller amount of steroids than conventionally used in the same area.
◉ Prolotherapy This is an injection therapy using glucose solution. It is actively practiced overseas. In our clinic, we use a highly concentrated glucose solution of about 25% to take advantage of the embolic effect caused by its high osmotic pressure. It has fewer side effects than steroids and can be administered during lactation.
◉Hydrolysis and hyaluronic acid injection (Fig. 5) Injection of saline or hyaluronic acid can peel nerve adhesions in addition to increasing local tissue flexibility and gliding. Although it must be done several times, the treatment has minimal side effects, as does prolotherapy. However, in the case of hyaluronic acid injections, insurance coverage is limited to periarthritis of the shoulder joint and osteoarthritis of the knee.
◉ Catheter vascularization (filling blood vessels) A catheter is inserted into the artery upstream from the site of inflammation and the embolizing material is pumped into the artery. Embolic material can clog vessels at the site of inflammation because moyamoya and inflammatory vessels are thin and flow slowly. Normal peripheral blood vessels flow quickly and have a large lumen, so they do not become clogged. Even if an embolization is blocked, the use of an embolization material that is immediately broken down improves blood flow within 2-3 minutes.
The treatment takes approximately 15 minutes. Local anesthesia is administered around the artery of entry. A catheter tube used for intravenous infusion is then inserted into the artery and antibiotic particles are administered. After that, the patient will be sent home after adequate pressure hemostasis is applied to confirm that no hematoma has formed. On the day of the procedure, the patient should rest as much as possible, but can take a shower and lead a normal life.
A feeling of hotness, pain, or dull ache occurs when the drug is administered, but please be assured that this is temporary and not a problem. Most of them also cause skin tone changes, but this is also transient and there is no need to worry.
The effects may be felt in a few days, but most often, improvement takes several weeks to 1-2 months. If there is incomplete improvement in symptoms, two successive treatments are more effective, but three treatments are also possible. The interval between treatments should be at least one month.
In general, the older the patient, the more difficult it is to achieve an effect. This is believed to be because moyamoya inflammatory vessels have proliferated over the years and do not respond easily to treatment, and because structural changes other than inflammation have also occurred.
Indications for Moyamoya Inflammatory Vascular Therapy
Upper extremity (elbow to fingertip), lower extremity (knee to toe)Chronic diseases in the following areas are good indications. Other sites may also be indicated if the vessel to be punctured is relatively shallow and large. Specifically, the following diseases are indicated
<Hand disease
Heberden's nodes
Bouchard's node
trigger finger
carpal tunnel syndrome
CMarthrosis of the thumb
rheumatoid arthritis
Chronic ligamentous injuries with little instability
Postoperative pain in fingers
Lateral epicondylitis of the humerus (tennis elbow)
Medial epicondylitis of the humerus (golf elbow)
Baseball shoulder and elbow
TFCC injury
de Quervain's disease
elbow osteoarthritis
osteoarthritis of the shoulder
rotator cuff tear
Periarthritis of shoulder joint (frozen shoulder, frozen shoulder)
Other inflammatory diseases of the upper extremity
<Foot Disease
plantar tendonitis
painful external tibia
hallux valgus
Achilles tendonitis (peri-Achilles tendonitis, peri-Achilles tendon bursitis, Achilles tendon adhesion inflammation, partial Achilles tendon rupture, Achilles tendinopathy)
Morton's disease
Pain due to flat feet
Tibialis posterior tendonitis/tendonitis
osteoarthritis of the hip
osteoarthritis of the knee
osteoarthritis of the foot
Medial meniscus injury, lateral meniscus injury
arthro-labial injury
iliotibial tuberculitis
moniliasis
jumper knee
Osgood's disease
divided patella
chronic myalgia
synthrpint
Runner Disney.
Other diseases with inflammation of the lower extremities
For those with severe joint destruction, the pain is not only caused by moyamoya or inflammatory blood vesselsTherefore, the effect of treatment may be minimal. Before the treatment, we will evaluate the degree of joint destruction by X-rays, etc., and examine the presence of inflammation by echo.
If the artery nourishing the affected area is in addition to the vessel to be infused, the anastomosis may dilute the drug, making it less effective than expected, or it may not be possible to treat the patient if vascular puncture is difficult.
(Please consult your physician for further details and indications other than those listed above.)
Indications for Moyamoya Inflammatory Vascular Therapy
Diseases of the upper limb |
|---|
Heberden's nodes |
Bouchard's node |
CMarthrosis of the thumb |
rheumatoid arthritis |
carpal tunnel syndrome |
Tennis elbow (lateral epicondylitis) |
Golf elbow (medial epicondylitis) |
osteoarthritis of the shoulder |
elbow osteoarthritis |
osteoarthritis of the hand |
de Quervain's disease |
TFCC injury |
Baseball shoulder and elbow |
Postoperative inflammatory pain |
trigger finger |
rotator cuff tear |
Periarthritis of shoulder joint (frozen shoulder, frozen shoulder) |
Diseases of the lower extremities |
|---|
plantar tendonitis |
painful external tibia |
hallux valgus |
Morton's disease |
Chronic arthritis of the toes |
achilles tendonitis |
tibialis posterior tendonitis |
osteoarthritis of the hip |
osteoarthritis of the knee |
osteoarthritis of the foot |
meniscus injury |
arthro-labial injury |
iliotibial tuberculitis |
jumper knee |
Osgood's disease |
synthrpint |
Runner Disney. |
Characteristics of Moyamoya Inflammation Vascular Treatment
- Can reduce pain in multiple limbs at the same time
- Reduces tissue damage due to inflammation and prevents worsening of disease
- Possible to resume daily life immediately after treatment
- Less pain during treatment
- No bleeding or treatment scars
- day trip
- Fewer complications
Drugs Used in Moyamoya Inflammatory Vascular Therapy
The embolization material is an antibiotic called imipenem cilastatin. This is made up of tiny particles that are hard to dissolve and will clog and embolize blood vessels in the narrower areas of blood vessels. Because it was originally an approved antibiotic, it is a safe drug as long as you are not allergic to it.
It has the characteristic of melting in a few minutes, and in normal vessels, blood flow resumes immediately after a blockage. In juvenile moyamoya and inflammatory vessels with poor blood flow, blood flow does not resume and the vessel becomes necrotic. Imipenem cilastatin is such an excellent agent that the microparticles themselves select the vessels to be embolized.
Are there any disadvantages to moyamoya inflammatory vascular treatment?
Although the treatment is approximately safe, there are some complications to be aware of. First, when the drug is injected into the artery, there may be temporary skin discoloration, pain, or discomfort due to the temporary hemodynamic inhibition. In most cases, however, these changes are transient. They disappear within half a day to several days. In some cases, hyperpigmentation may persist for several weeks, but in most cases, it resolves spontaneously.
Other side effects include subcutaneous hematoma (blue bruise or induration) at the puncture site, hypersensitivity due to needlestick, infections associated with the operation, allergic reactions to antibiotics used, interactions between oral medications and antibiotics used if the patient has pre-existing medical conditions (ganciclovir: a treatment for cytomegalovirus, sodium valproate: for epilepsy), and allergic reactions to local anesthetics. Allergic reactions include urticaria, nausea, fever, and dizziness, but rarely lead to anaphylactic shock, which requires caution. Blood clots and arterial dissection may also occur, but both are considered infrequent. Treatment may not be possible if the vessel is too small to be technically pierced or if the vessel has no perforating or traffic branches to begin with. Treatment is not possible if you are using drugs that interfere with the coagulation of blood. For more information, please ask your doctor during your consultation.
Timing of treatment and effectiveness in preventing disease progression
Eliminating moyamoya and inflammatory blood vessels can slow the progression of the disease because the destruction of tissue due to inflammation stops. Since tendon and joint injuries are difficult to heal, it is very important to stop the progression of the disease. It is recommended that moyamoya inflammatory vascular treatment be performed before too much joint destruction or tendon damage occurs.
Number of treatments
Also, the actual effect of the treatment can be seen after a month, even if there is no effect immediately afterwards,Delayed effects may be feltSo, please follow the progress of the disease. However, it is not possible to remove all moyamoya and inflamed inflammatory vessels in one treatment. Therefore,2 to 3 consecutive sessions of inflammatory vascular therapy, spaced 1 to 2 months apartIt is said that it is effective to Please consult with us about the number of treatments depending on the effectiveness.
Treatment Appointments
Important] In addition, treatment will be provided after the first medical examination, if it is judged to be indicated,(on) a subscription basisThe Company conducts its business in the following manner.Cannot be performed at the first visitPlease note that the first consultation is covered by medical insurance. (The first visit is covered by medical insurance.)
About the cost of treatment
At present, unfortunately, treatment of moyamoya inflammatory vessels is not covered by insurance.
The cost of treatment will be as follows
<Subject disease for 25,000 yen (excluding tax) (27,500 yen including tax) per treatment per site
Heberden's nodes, Bouchard's nodes, mucus cysts, spring fingers, carpal tunnel syndrome, thumb CM arthritis, rheumatoid arthritis, chronic ligamentous injuries with little instability, postoperative pain in the fingers,
＜ One time 35,000 yen (including tax) (38,500 yen including tax) per part of the subject disease＞ ＜ One time 35,000 yen (including tax) per part of the subject disease＞ ＜ One time 35,000 yen (including tax) per part of the subject disease
Plantar tendonitis, painful external tibia, hallux valgus, Morton's disease, pain due to flat feet, tibialis posterior tendon tendinitis
<50,000 yen (including tax) per visit per site (55,000 yen including tax)Target diseases of >.
Lateral humeral epicondylitis (tennis elbow), medial humeral epicondylitis (golf elbow), baseball elbow, TFCC injury, Docheruban disease, Achilles tendonitis (peri Achilles tendonitis, peri Achilles tendon bursitis, Achilles tendon adhesion, partial Achilles tendon rupture, Achilles tendinopathy), knee osteoarthritis, osteoarthritis of the foot, meniscus injury, thrush, Jumper's knee, Osgood's disease, Split patella, Chronic separation of the knee (lower leg), Shin splints, Osteoarthritis of the elbow
＜1per part1counter for games, rounds, etc.77,000Target diseases for which the price is ¥2,000 (including tax) >.
Shoulder osteoarthritis, hip osteoarthritis, baseball shoulder, rotator cuff tear, shoulder periarthritis (frozen shoulder, frozen shoulder), shoulder and hip labral injury, iliotibial ligament injury, chronic torn labrum (thigh)
◉Deductions for medical expenses
Medical treatment expenses may be deductible as a medical expense deduction when filing a tax return. The medical expense deduction is a system established to reduce the burden of medical expenses. If you paid medical expenses for yourself or your family, you are entitled to a certain amount of income deduction.
If you or your spouse and other relatives with whom you share a living arrangement paid medical expenses between January 1 and December 31 of the same year, the medical expense deduction will be applied to your tax return in the following year, and your taxes will be refunded or reduced.
However, medical expenses paid during the year must be 100,000 yen or more, and the maximum amount that can be reported is 2 million yen. In addition, those whose total income is less than 2 million yen can file a tax return if the medical expenses actually incurred account for 5% or more of their total income.
Please contact your local tax office for details.
Responsibility: Dr. Yuki Toya, Orthopedic Surgeon, Hand Surgery Specialist/Supervisor
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