Regenerative MedicineWhat is Ultrasound Guided Regenerative Medicine?

A technologically advanced area of medicine with the potential to fully heal damaged tissues, offering solutions and hope for people with conditions that up until today have been beyond repair. It offers the potential to restore cellular and structural integrity of muscles, tendons and nerves with the use of cells from your own blood or bone marrow to rapidly heal or stimulate healing in a quick safe manner.

Through this groundbreaking technology, that is ultrasound driven, Dr. Tireney, and Temecula Valley Advanced Medicine, have been able do clinical studies on a daily basis with their patients. Through this they are actively teaching. Therefore, they are changing the general practice of orthopedic medicine, anesthesia, rheumatology, physiatrist, physical therapy, chiropractic, general practice medicine, military medicine and sports medicine.

Temecula Valley Advanced Medicine is a driving force in the neuro-musculoskeletal healthcare field and is gaining a greater understanding of what actual neuro-musculoskeletal problems consist of. We are working to help not only with regenerative medicine, and the things we do in our office, but also help to direct better and more accurate surgical intervention. Patients who have received treatment have been both mainstream and elite athletes, as well as the general public suffering from chronic nerve, muscle, bone or tendon issues.

If you are suffering with long or short term pain, we have real solutions to help you heal using Regenerative Medicine.

Needle vs. Knife; Regenerative Medicine or the Long Road to Surgery?

Ultrasound guided Regenerative Medicine, like surgery, has no guarantee to fully heal a patient for the rest of their life, but there are so many more advantages in using a needle, and not a scalpel.

Advantages for Regenerative Medicine:

  • Faster recovery time- about 2 to 4 weeks
  • Less trauma- most of the time no pain medication is needed
  • Safer – the procedure does not require general anesthesia because it is less invasive and your body is left with less posterior procedure scarring
  • Minimal nerve damage
  • Performed in house

Disadvantages to Surgery:

  • While surgery is often performed with good valid intent and reasoning, it is going to make a change in your body. Following your surgery your body is going to be different and not always in a good way.
  • Traumatic- surgery can be very traumatic, some patients must stay under anesthesia for long periods of time and may even need to go through multiple blood transfusions.
  • Painful- most surgeries leave patients in a lot of pain that may require they take pain medication for the extent of their healing time if not longer.

How Should you Make Your Decision?

There is a place for surgery at times, but there is no harm in letting our office assist you with the less risky option first. Most people, when faced with the decision between invasive and non-invasive procedures, come to a conclusion that needle is preferred over scalpel.

We are not anti-surgery, if our procedures are not going to work or be your best option, we will direct you to the best professional for your care, whether therapist, chiropractor, pain specialist or other provider. We work closely with physical therapists on site, so we further customize your rehab process to get you where you want to go. Regenerative Medicine from Temecula Valley Advanced Medicine may be your best path to a path to a fully functional, healthy body. Ultimately, we strive to provide you with the information needed for you to make the best decision for you.

Our Practitioners main goal are to make a difference in our patients for the better. We do not cause differences in your body that will leave you feeling worse. The value, cost and demand for effectiveness of Regenerative Medicine preparations require high-resolution ultrasound guidance to insure the best possible placement of the regenerative agent leading to the best possible end result.

How will you feel after your Ultra Sound Guided Regenerative procedure?

Following your ultrasound guided regenerative or decompression procedure, you are most likely going to be better, different or the same.

Our Success Rate using Regenerative Medicine is higher than most would expect. If you are interested in reading about our patients who can now live their life to the fullest because of their procedure, see their testimonials. These patients are excited to share the stories of their experiences in recovery, and how they now live life without pain. Regenerative medicine offers initial improvement within two weeks, and full benefit to be appreciated within 1 year.

Why go to Temecula Valley Advanced Medicine over other medical offices for these procedures?

There are many offices offering this technology, but to put it simply, it is not the same as going to Temecula Valley Advanced Medicine. Our technology is unmatched. What is available now for use in regenerative medicine was not available until 2014. Implications: It is likely that our office is one of the only medical facilities to have this high quality equipment as it was purchased last year.

Our staff is equally unmatched in talent and credentials. Dr. Tierney has treated most members of the U.S. Water Polo Team, The U.S. Olympic Swim Team and professional athletes from the MLB and NFL. Temecula Valley Advanced Medicine’s association with teaching through Dr. Tierney keeps us on the technological cutting edge of regenerative medicine. Dr. Tierney is a recognized expert and teacher of ultrasound guided regenerative medicine. As we are involved in teaching, cellular industry leaders bring the newest technologies to our patients faster.

The likelihood of us being able to find and accurately define a poorly diagnosed or poorly treated problem, and help resolve it is very high. This has led to an overwhelming need for our Pain Management Specialists’ solve dilemma cases with patients who have experienced high failure rates with other treatments.

What is a Diagnostic Musculoskeletal Ultrasound?

With the use of Diagnostic Musculoskeletal Ultrasound we can see and diagnose with a tenth of a millimeter accuracy not only the anatomic issue you may have but also prove with diagnostic injection under ultrasound guidance that that particular issue is actually the cause of your pain. If you have an anatomic injury that shows up on medical imaging and no diagnostic injection is obtained it is not clear if that identified injury is actually the cause of your pain. Now with the expert use of musculoskeletal ultrasound we can identify the anatomy and push on it externally while we watch the pressure penetrate to the anatomic structure of question. If it is identified as painful we can then under real time visualization administer a small amount of local anesthetic to verify that the structure of question is actually what is causing your pain. Once the cause of your pain is clearly identified we can discuss realistic options to treat the optimal resolution of your symptoms.

This is vastly different from the older style of using medial imaging technology, which may deduce that a procedure including invasive surgery is required based on pain in an area and an abnormal anatomic finding on some type of diagnostic imaging. With this approach it is too often that procedures are performed to correct structures that are not the source of pain and disability. The result with the older system is too often the procedure was a success yet pain and disability remain unchanged. With this newer technology that is extending across of fields of health care including Orthopedic Surgery, Rheumatology, Sports Medicine, Anesthesiology and Pain, Physiatry, Chiropractic, Physical Therapy, Military Combat Medicine, this are changing and we are honored to be a part of that change. A visit to our Musculoskeletal Sonography and Regenerative Medicine Department will insure that you are afforded the best in Diagnosis and Treatment options that we are aware of.

With this technology we have the ability to more clearly diagnose your problem than is most typically offered in musculoskeletal health care today. Once we identify the cause of your pain, which may be nerve impingement, ligament tear, muscle tear, cartilage tear, boney degeneration we can work with you to establish the optimal way for you find resolution or at least optimal treatment of your particular problem. This treatment may involve physical therapy, hydrodissection / fluid decompression of nerve, nerve block, regenerative injections, surgery, rest, structural support, nutritional support, functional medicine, or allopathic medication.

If surgery is required you will be referred to an appropriate trusted surgeon.

The Regenerative Medicine Department at TVAM applies the latest advances in Neuro-Musculoskeletal Technology to provide relief of pain and restore function after injuries. Most issues in Orthopedic or Sports Medicine can be diagnosed and resolved using Ultrasound-Guided Injection Treatments. Using high-resolution ultrasound, we gain the ability to visualize nerves, muscles and tendons of the human anatomy, enabling very accurate diagnosis. Using human biologics like Platelet-Rich Plasma, Stem Cell Therapy, and Placental Matrix, we can enhance the body’s ability to heal itself.

Many sports medicine issues are even more effectively diagnosed and treated under ultrasound than traditional magnetic resonance imaging (MRI). With the 10th of a millimeter accuracy of high-resolution ultrasound, we can accurately visualize and place your treatment. Because we have a greater understanding of what actual neuro-musculoskeletal problems consist of, we can decrease your recovery time and minimize your need for repetitive procedures.

We commonly treat orthopedic issues such as Rotator Cuff Tears, Lateral Epicondylitis, Patellar Tendonitis, Achilles Tendonitis, Meniscus Degeneration and many other conditions that involve development of scar tissue or non-healing tissue.

We are at the cutting edge of the technology, so we are always adapting and modifying our treatments to provide you the best chance of restoration of function. What we have learned through anatomical and clinical study, we are actively teaching in international courses through the Musculoskeletal Ultrasound organization ( We are driving neuro-musculoskeletal healthcare toward a greater understanding of what actual neuro-musculoskeletal problems consist of. We are changing the general practice of orthopedic medicine, anesthesia, rheumatology, physiatrist, physical therapy, chiropractic, general practice medicine, military medicine and sports medicine. We are working to help not only with regenerative medicine, and the things we do in our office, but also help to direct better and more accurate surgical intervention.

Most people, when faced with the decision between invasive and non-invasive procedures, come to a conclusion that needle is preferred over scalpel. We are not anti-surgery in any way. If our procedures are not going to be the best for you, we will direct you to the best professional for your care, whether it be surgeon, physical therapist, chiropractor, pain specialist or other provider. There is a place for surgery at times, but we want to assist you with a less risky option first. We work closely with all of the TVAM providers, to we further customize your recovery and healing process, to get you where you want to go.

After a thorough diagnostic musculoskeletal ultrasound exam, we may offer you one of the following common procedures: Nerve Hydrodissection, Platelet Rich Plasma (PRP), Placental Matrix Tissue Allograft, or Stem Cell (Bone Marrow Aspirate Concentrate). Ultimately, we strive to provide you with the information needed for you to make the best decision for you.

Nerve Hydrodissection

Pinched nerves cause many pain issues. Consider Sciatica, Chronic Headaches and Carpal Tunnel Syndrome for example. We can carefully use gentle fluid pressure through the conduit of a needle, called nerve hydrodissection, to open up the space around the nerve, separating tissues permanently and offering lasting relief from pain.


Platelet-Rich Plasma (PRP) is a type of cellular medicine. PRP is a concentration of growth factors and stem cells from your own blood that can stimulate regeneration and heal musculoskeletal injuries.

The basic science behind PRP involves platelets from your own blood that become activated after injection into a tendon or soft tissue. Platelets used for the procedure are autologous (from your own blood) and separated from the remaining blood components by centrifugation in a special chamber. Once harvested, the platelets are injected into diseased tissue under ultrasound guidance to direct the needle to the exact area in question. Once injected, the platelets become activated and release numerous growth factors into the wound and into the circulation. These growth factors also recruit stem cells and other proteins that will create new, healthy tissue.

PRP can be skillfully injected under ultrasound guidance into the injured area to repair tendon tears, meniscus tears, ligament strains, and to heal Osteoarthritis and moderately degenerated joints. PRP can also regenerate aging skin and stimulate other tissue growth, as a potential alternative to plastic surgery.

PRP is used to treat athletes with common sports injuries, such as, pulled hamstring muscles and knee sprains. PRP is commonly used to treat partial tears of muscles to accelerate healing and allow recovery with healthy tissue. PRP is also effective in the treatment of chronic tendon injuries around the elbow. PRP heals major joint instabilities, rotator cuff tears, labral tears, meniscus tears, and ACL ruptures, as well as most musculoskeletal pathologies.

Prior to the PRP injection, the diseased tendon is usually fenestrated to increase blood flow to the area, provide channels for the PRP, and to loosen diseased tissue from traction spurs and osteophytes (Ultrasound Guided Tenotomy).

PRP provides no instant pain relief, but instead leads to healing of previously unhealthy tissue. Resting for two weeks after the procedure will ensure appropriate healing, and full healing benefit of the PRP is achieved in six to twelve months.

Overall success rate of PRP is about 80%. Outcomes are less optimal in in smokers, diabetics and others with compromised microcirculation.

The effectiveness of PRP can be enhanced by including additional autologous biologics, such as Autologous Fibrin Glue and Alpha-2-Macroglobulin. Using fibrin from your own blood, we gain better success in tendinopathies, as we can glue torn tissues back together very effectively as the PRP stimulates growth and regeneration. The use of Alpha-2 Macroglobulin, also from your blood, specifically prevents inflammatory breakdown of joints and tissues, which results from the breakdown of joint tissue. It is very effective to add to PRP when treating joints and meniscal degeneration.

Placental Allograft Tissue Matrix

TVAM offers an innovative therapy called Placental Tissue Matrix Allograft, created by Skye Biologics of California. Placental Tissue Matrix Allograft is a product that has been proven to replace damaged tissue, control inflammation and pain, support the regenerative process, and reduce scar tissue formation.

The Regenerative Medicine Department of TVAM injects the spine with Placental Tissue Matrix Allograft to reverse the breakdown and stimulate the healing and regeneration of arthritic joints. We also effectively use PX50® to regenerate and heal injured tendons, ligaments, fascia, and nerves of the shoulders, hips, knees, ankles, feet, and hands.

Placental Allograft Tissue Matrix is as effective as PRP or Stem Cells, and it contains more growth factors per unit volume. One benefit of Placental Tissue Matrix Allograft is that it can be used on patients who’s own blood is not safe for autologous treatments, such as geriatric patients, patients who smoke, or patients with cancer. Additionally, Placental Tissue Matrix Allograft does not cause such a flare-up of pain post procedure. TVAM uses Placental Tissue Matrix Allograft in the spine, as well as in the small joints and tendons of the body.

Placental tissues have been used in tens of thousands of procedures in the use over the past two decades. PX50® comes from the placenta of female volunteers from California, donated after their successful C-sections. There are no tissues from the mother or from the baby.

PX50® contains the following:

  • Scaffold Components2
    Collagen 1, III, IV, V, and V1, hyaluronan, fibronectin, laminins
  • Growth Factors3
    Fibroblast (bFGF), Epidermal (EGF), Keratinocyte (KGF), Platelet-derived AA (PDGF-AA), Platelet-Derived BB (PDGF-BB), Transforming-a (TGF-a), Transforming-b1 (TGF-b1), Transforming-b2 (TGF-b2), Transforming-b3 (TGF-b3), and Vascular Endothelial (VEGF)
  • Metalloproteinases (MMP) Inhibitors4
    Tissue inhibitors of metalloproteinases (TIMP-1, TIMP-2, TIMP-4)
  • Anti-inflammatories5
    Interleukins (Il-04 and Il-10)

Stem Cell (Bone Marrow Aspirate Concentrate) ​

Stem cells are powerful cells extracted from your bone marrow that release growth factors, anti-inflammatory factors and regenerate your injured tissue and/or cartilage. Stem Cells are often used to heal osteoarthritis of the spine and the knees, as well as the hips and the shoulders. It can be very restorative to patients with severe degeneration who are seeking an alternative to a joint replacement. Your joint or spine would be evaluated with sonographic imaging first. Next, a plan would be made to draw your blood, harvest the stem cells from your hip bone, and use both the platelets from your blood and the stem cells from your bone marrow to repair your degenerated issue.