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  • Injectible Therapies | CAM Clinic Toronto

    Injectible Therapy Options Injectible therapies Injectable therapies have the advantage of being a local treatment for what is typically a local problem. The most common application of injectable therapies is for knee osteoarthritis followed by shoulder and hip as these are the joints with the greatest prevalence of osteoarthritis. Injectable therapies can also be used in other joints such as the elbow, wrist, ankle and occasionally in certain small joints of the foot and hand as well as in the spine. ​ Corticosteroid injections ​ ​ Corticosteroid injections have been available for approximately fifty years. Used appropriately, they can effectively treat joint inflammation. They have the advantage of being relatively inexpensive. However their effectiveness is usually short lived, which limits their effectiveness for treating osteoarthritis as it is a chronic condition of aging. Corticosteroids are most effective in managing acute inflammatory flares. They are also often used to manage post-surgical inflammation. However, corticosteroid injections must be used judiciously as they have potential for causing cartilage damage if used inappropriately or excessively. ​ ​ Hyaluronic acid gels Hyaluronic acid gels have been available for twenty-five years. They are a very safe therapy which works by decreasing joint inflammation and lubricating the joint surface. Although there is a wide degree of variability in their effectiveness in any individual patient, there are typically effective in approximately 50-60% of patients, provide symptom relief of approximately 40% and will last around 6-12 months before eventually wearing off and losing their effectiveness. Hyaluronic acid gel therapies are moderately expensive but have been around for such a long period of time that they are now covered on many third-party insurance plans. At Comprehensive Arthritis Management, we believe that the most effective Hyaluronic acid gel product is Synvisc although it should be noted that there are a large number of options currently available. ​ Platelet Rich Plasma (PRP) ​ This therapy represents the first biologic therapy that has become available for the management of osteoarthritis. A biologic therapy is manipulating normal human biology in order to treat osteoarthritis. In the case of PRP, a blood sample is taken from the patient’s arm and placed into a centrifuge which allows the blood to be separated into two layers. The top, lighter layer contains platelets cells that are suspended in the plasma. The lower portion of the sample contains red cells and white cells which cause inflammation and are discarded. The plasma with the suspended platelets is injected into the patients knee and the injected platelets release a large number of anti-inflammatory and growth factor molecules into the joint environment. This is effective in diminishing inflammation and osteoarthritis symptoms in 70-80% of patients, typically decreasing symptom severity by 70-80% and typically lasting in excess of one year with most patients getting multiple years of improvement before the effectiveness wears off. There are some forms of PRP injections which include white cells in part of the injectable cells, but we feel that leukocyte poor PRP in which the white cells are removed is more effective than leukocyte rich PRP. We use a form of PRP injection called autologous conditioned plasma (ACP). ​ nStride ​ ​ nStride is relatively new biologic therapy that is also based on a blood sample but is very different in its mechanism of action than platelet therapy. Click here to see surgical options for osteoarthritis

  • What is Osteoarthritis | CAM Clinic Toronto

    What is Osteoarthritis Overview of osteoarthritis Osteoarthritis is a condition in which the articular cartilage that normally provides a smooth, stable surface, begins to fail leading to breakdown. This compromises the normal smooth, painless functioning of the joint surfaces. The most common cause of osteoarthritis is aging. However, a number of other factors can lead to osteoarthritis including genetic predisposition, gender, joint injury, obesity and overuse. As the cartilage tissue begins to fail, small inflammatory molecules are released into the joint environment which results in inflammatory reaction in joint tissues, most notably the synovium. This inflammatory reaction leads to aching pain, swelling, weakness and stiffness. This inflammation accounts for most of the symptoms experienced by patients with osteoarthritis. Some patients may also experience mechanical symptoms such as crunching, grinding or locking that are caused by unstable fragments of cartilage, loose bodies or unstable soft tissue problems such as meniscus tears. There are a wide range of treatment options that can be effective for osteoarthritis including weight loss, exercise, physiotherapy, pain medication, anti-inflammatory medication, injectable therapies and surgical options. Central role of inflammation It has become apparent that most human disease processes are driven by inflammation. Osteoarthritis is no exception. The broken-down molecules that are released into the joint as cartilage begins to fail, leads to inflammatory changes in the synovium, which is the tissue that lines the joint. This inflammatory reaction drives symptoms such as: Pain; Aching; Swelling; Weakness; Stiffness. Increasingly, the treatment of osteoarthritis has focused on managing inflammation. If the inflammatory reaction of the synovium can be effectively treated, patients can function well with little or no symptoms despite having significant underlying osteoarthritis damage. Mechanical Symptoms Although inflammatory symptoms are more common, some patients have mechanical symptoms which can range from relatively mild clicking to much more significant symptoms such as crunching, grinding or in extreme situations locking or mechanical seizing up of the joint. Patients who have marked mechanical symptoms such as crunching, grinding and locking may require surgical intervention. Initial Triage On initially assessing a patient with osteoarthritis, it is important to determine whether or not there are significant mechanical symptoms which require surgical intervention. Fortunately, most patients do not have marked mechanical symptoms. Thus, surgery does not need to be the initial form of treatment for the vast majority of patients. Most patients presenting with osteoarthritis symptoms can be managed with safer, less invasive therapies that are directed at reducing inflammation. Click here to find more information on non-clinical treatment options

  • Research | CAM Clinic Toronto

    Research Focus Areas : ​ • Community-wide clinical registry supporting long-term observational studies ​ • Retrospective and prospective analysis of clinical outcomes to evaluate the effectiveness of non-surgical treatments ​ ​ • Building partnerships for advancing the science and real-world study of emerging cell-based therapies CAM is strongly committed to collecting real-world evidence with the goal of driving positive change in the management of arthritis Our emphasis is on the evaluation of biologic and injectable treatments as alternatives to traditional surgical options Research Programmes

  • Therapies | Comprehensive Arthritis Management | Toronto

    Osteoarthritis Treatment Options Click to learn more Exercise & Weight Loss Non-clinical Corticosteroids Injections Arthroscopy Surgeries Physiotherapy & Braces Hyaluronic Acid Partial Joint Replacement Alternative Medicine Platelet Rich Plasma Total Joint Replacement Pain Medication nSTRIDE Osteotomy Increasing invasiveness and risk For more information, see our FAQ page and brochures for PRP , Synvisc , and nSTRIDE with post-treatment information Therapy Selection Strategy Therapies are progressively selected based on these clinical priorities: 1. Control Inflammation ​ 2. Strengthen Joint 3. Enhance Physical Activity Periodic follow-up and use of quantitative clinical performance scoring are keys to facilitating favourable progression Following an initial consultation and exam, a personalized treatment programme is developed for each patient, including: • Step-wise treatment plans, built on the patient’s history and unique needs • Schedule of periodic follow-ups • Home care guidelines • Detailed descriptions and references

  • CAM Clinic | CAM Clinic Toronto

    CAM Clinic PHONE: (647) 624-5171 ​ FAX: (855) 607-3858 ​ HOURS: Mon-Fri 8am to 5pm ET ​ EMAIL: ​ ADDRESS: (Within the Emkiro Clinic) 70 University Avenue, Suite 120 Toronto, ON M5J 2M4 (at corner of University & Wellington) Map Link ​ 70 University Ave Street Level Access Parking available under 70 University Avenue Impark 372 Lot -- accessed at 19 Emily Street ​ TTC Access via St. Andrew or Union Stations

  • About | Comprehensive Arthritis Management | Toronto

    About CAM Comprehensive Arthritis Management, Inc. is a private orthopaedic practice based in Toronto, Canada, specializing in advice and treatment options to manage pain and functional disability caused by osteoarthritis. We develop personalized treatment plans for each patient, focusing on the incremental application of safer and less invasive therapeutic options, leaving surgical interventions as a last resort. Our research supports the further development and validation of the non-invasive treatment programmes, through a community-wide clinical registry and study of patient outcomes over time for different treatment paths. K. Wayne Marshall, MD, PhD, FRCSC CAM Vision ​ Apply a programmatic approach to arthritis care, emphasizing the use of non-surgical therapies as safe and effective alternatives, leaving invasive surgical options as the last resort. Osteoarthritis Overview About OA Osteoarthritis is a joint condition in which the articular cartilage that normally provides a smooth, stable surface, begins to break down. This compromises the normal smooth, painless functioning of joint surfaces. Common causes of OA are aging, genetic predisposition, gender, joint injury, obesity and overuse. Symptoms As joint cartilage begins to fail, small molecules are released which cause an inflammatory reaction. This leads to aching pain, swelling, weakness and stiffness. Mechanical symptoms such as crunching, grinding or locking may also occur, caused by unstable fragments of cartilage or soft tissue problems such as meniscus tears. Treatment The treatment of osteoarthritis focuses on managing inflammation as a first step. If the inflammatory reaction of the joint can be effectively treated, patients can function well with little or no symptoms despite having significant underlying OA damage. For certain joints with advanced OA, surgical options may be required. Triage When assessing a patient for OA, the key is to determine whether there are significant mechanical symptoms that necessitate surgical intervention. Fortunately, most patients do not require surgery, and less invasive therapy options directed at reducing inflammation can be considered. Learn more about therapies >

  • Arthritis Treatment Options | Comprehensive Arthritis Management | Toronto

    Advancing personalized treatments to improve patient experience in arthritis care Learn more about treatment options > A specialty orthopaedic practice applying personalized treatment programmes which prioritize safer, less invasive therapies, leaving surgical options as a last resort 1 in 5 of Canadians suffer from arthritis, with 40% of those reporting pain that limits activity 1, 2 20% of total knee replacement recipients reported being dissatisfied with the outcome 3, 4 CAM Clinic - Toronto A co-located partner clinic of The CAM Clinic offers several injectable therapies, and personalized consultation and planning, with the aim to avoid surgery if possible. ​ Available therapies and support: • Corticosteroid injections • Hyaluronic acid gels • Platelet Rich Plasma (PRP) therapy • nSTRIDE Autologous Protein Solution therapy • Consultation on surgery, biologics, clinical trials, and emerging experimental cell therapy options ​ For information , call 647-624-5171 To schedule an appointment, fax the referral and MRI or x-ray report taken within the past year to 855-607-3858 (fax) Visiting Us >

  • Privacy-TOU | CAM Clinic Toronto

    Privacy Policy – Comprehensive Arthritis Management, Inc. Last updated: 9/28/2020 Comprehensive Arthritis Management, Inc. ("us", "we", or "our") operates (the "Site"). This page informs you of our policies regarding the collection, use and disclosure of Personal Information we receive from users of the Site. We use your Personal Information only for providing and improving the Site. By using the Site, you agree to the collection and use of information in accordance with this policy. Information Collection And Use While using our Site, we may ask you to provide us with certain personally identifiable information that can be used to contact or identify you. Personally identifiable information may include, but is not limited to your name ("Personal Information"). Log Data Like many site operators, we collect information that your browser sends whenever you visit our Site ("Log Data"). This Log Data may include information such as your computer's Internet Protocol ("IP") address, browser type, browser version, the pages of our Site that you visit, the time and date of your visit, the time spent on those pages and other statistics. In addition, we may use third party services such as Google Analytics that collect, monitor and analyze this for purposes of improving the services we provide to you. Communications We may use your Personal Information to contact you on subjects related to the services we provide, along with, on rare occasion, newsletters, marketing or promotional materials. Cookies Cookies are files with small amount of data, which may include an anonymous unique identifier. Cookies are sent to your browser from a web site and stored on your computer's hard drive. Like many sites, we use cookies to collect information. You can instruct your browser to refuse all cookies or to indicate when a cookie is being sent. However, if you do not accept cookies, you may not be able to use some portions of our Site. Security & Privacy The security and privacy of your Personal Information is important to us, but remember that no method of transmission over the Internet, or method of electronic storage, is 100% secure. We use commercially acceptable means to protect your Personal Information, consistent with the laws and regulations in Ontario, Canada. However, we cannot guarantee the absolute security of information that you share with us. Changes To This Privacy Policy This Privacy Policy is effective as of 9/28/2020 and will remain in effect except with respect to any changes in its provisions in the future, which will be in effect immediately after being posted on this page. We reserve the right to update or change our Privacy Policy at any time and you should check this Privacy Policy periodically. Your continued use of the Service after we post any modifications to the Privacy Policy on this page will constitute your acknowledgment of the modifications and your consent to abide and be bound by the modified Privacy Policy. If we make any material changes to this Privacy Policy, we will notify you either through the email address you have provided us, or by placing a prominent notice on our website. Contact Us If you have any questions about this Privacy Policy, please contact us. Terms of Use – Comprehensive Arthritis Management, Inc. Last updated: 9/28/2020 Please read these Terms of Use ("Terms", "Terms of Use") carefully before using the website operated by Comprehensive Arthritis Management, Inc. ("us", "we", or "our"). Your access to and use of the Service is conditioned on your acceptance of and compliance with these Terms. These Terms apply to all visitors, users and others who access or use the Service. By accessing or using the Service you agree to be bound by these Terms. If you disagree with any part of the terms then you may not access the Service. Sharing and Accessing Private Healthcare Information and Related Content Visiting this site may involve the sharing, viewing or modifying of your private, protected healthcare information. If you wish to access this Site, you may be asked to supply certain information. Our Service allows you to upload, store, share and otherwise make available certain information, text, graphics, videos, or other material ("Content"). Comprehensive Arthritis Management, Inc. agrees to comply with the laws and regulations of its local jurisdiction, Ontario, Canada, as it relates to the handling and processing of this information and content. ​ Termination We may terminate or suspend access to our Service immediately, without prior notice or liability, for any reason whatsoever, including without limitation if you breach the Terms. All provisions of the Terms which by their nature should survive termination shall survive termination, including, without limitation, ownership provisions, warranty disclaimers, indemnity and limitations of liability. Links To Other Web Sites Our Service may contain links to third-party web sites or services that are not owned or controlled by Comprehensive Arthritis Management, Inc. Comprehensive Arthritis Management, Inc. has no control over, and assumes no responsibility for, the content, privacy policies, or practices of any third party web sites or services. You further acknowledge and agree that Comprehensive Arthritis Management, Inc. shall not be responsible or liable, directly or indirectly, for any damage or loss caused or alleged to be caused by or in connection with use of or reliance on any such content, goods or services available on or through any such web sites or services. ​ Changes ​ We reserve the right, at our sole discretion, to modify or replace these Terms at any time. If a revision is material we will try to provide at least 7 days' notice prior to any new terms taking effect. What constitutes a material change will be determined at our sole discretion. Contact Us If you have any questions about these Terms, please contact us.

  • HCProfessionals | CAM Clinic Toronto

    Information for Healthcare Practitioners The CAM Clinic is a Toronto-based private practice providing orthopaedic patient care. The services offered include treatment types that are available in Canada, either on or off-label, but are not readily available to patients within the public system and/or potentially not covered under the Ontario Health Insurance Plan (OHIP). As a result, CAM's services are generally provided to patients on a cash-pay basis and we rely on close collaboration with referring physicians and practices within the public system. ​ As part of this collaboration, we encourage our referral partners to participate in the follow-up assessment of patients and capture the valuable outcomes data in our clinical registry. As patients are referred to us, we will provide instructions back on how to participate in the registry, and for access to the research findings. See the Research page on this website for additional information on our study goals and approach. ​ If you would like to learn more about our practices, its policies & procedures, and registry, or if you would like to initiate a referral to us, please contact our office at (647) 624-5171. ​ ​

  • Careers | CAM Clinic Toronto

    Careers There are no currently open opportunities

  • Surgical Options | CAM Clinic Toronto

    Surgical Options for Osteoarthritis Surgical Options Arthroscopy The least invasive surgical procedure that may be effective in osteoarthritis is arthroscopy. Its greatest strength is in treating mechanical symptoms such as unstable flaps of articular cartilage, loose fragments or very unstable meniscus tears. It also has the potential to treat inflammatory symptoms as the pro-inflammatory molecules released from failing cartilage are washed out of the joint at the time of arthroscopy. However, the surgical trauma created by the arthroscopic procedure creates an acute post-surgical inflammation. In effect, acute inflammation is being created by the procedure that is attempting to alleviate chronic inflammation by removing pro-inflammatory cartilage debris from the joint. Thus, it is very important to aggressively treat post-surgical inflammation in order to maximize the potential benefits from arthroscopy. The use of arthroscopy in the management of osteoarthritis, particularly knee osteoarthritis has been controversial with studies both supporting and other studies questioning the effectiveness of arthroscopy. ​ Total knee replacement Total knee replacement is a surgical procedure in which the osteoarthritic cartilage and adjacent underlying bone is removed and metal and plastic prostheses are cemented into place. This is a thirty year old technology that revolutionized the management of arthritis. However it is extremely invasive, hugely expensive and can have significant complications. Multiple studies have documented that 20-30% of patients are dissatisfied with their outcome. Importantly, recent data has indicates that total knee replacements have a higher rate of opioid use than any other surgery performed. Disturbing data coming from the U.S. indicates a 15% chronic opioid addiction rate after total knee replacement. Thus, although joint replacement has been life changing for many patients, it is the most expensive, invasive and riskiest treatment for managing osteoarthritis and is best used as a last resort. ​

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