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Procedures

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Botulinum toxin (Botox)

  • cervical dystonia

  • migraines

  • spasticity

  • cosmetic

  • other conditions

Dry needling

Joint injections

  • Shoulder (glenohumeral)

  • Shoulder (subacromial)

  • Elbow

  • Wrist/hand joints

  • Finger joints

  • Sacroiliac joints

  • Hip (femoroacetabular)

  • Hip (bursa)

  • Knee 

  • Ankle

EMG-guidance is utilized to maximize efficacy

Ultrasound-guidance is available when injecting near a large blood vessel, to confirm that the injection is not being injected intravenously 

Cervical dystonia: also called spasmodic torticollis, is a painful condition in which your neck muscles contract involuntarily, causing your head to twist or turn to one side. Cervical dystonia can also cause your head to uncontrollably tilt forward or backward.  We provide botulinum toxin injections as a treatment option when appropriate. 

Migraine management: we provide botulinum toxin to treat and prevent chronic migraine headache episodes for people who experience migraine symptoms for 15 or more days each month with headaches lasting 4 or more hours per episode.

Spasticity management: spasticity is a common complication related to CNS injury (e.g., SCI, stroke, cerebral palsy). We provide botulinum toxin injections to improve function and decrease pain.

Cosmetic: if the cosmetic appearance of wrinkles on your forehead are impairing your quality of life, we offer cosmetic Botox injections.  Note that this is typically not covered by insurance.  Pricing varies by the amount of Botox needed.  

Botulinum toxin has various other uses which can be discussed at an appointment.  Some of the uses would be performed by a different type of physician (for example, bladder injection is performed by a Urologist).  

Ultrasound-guidance can reveal scar tissue and other myotendinous injuries

Dry needling refers to insertion of a needle into a musculotendinous area to break up scar tissue, tense muscle fibers, areas of spasm, and more.  

Ultrasound-guidance used when needed to confirm that the needle tip is in the joint space

Peripheral joint injections: injections to help diagnose and treat bone and soft tissue disorders often seen in orthopedic, rheumatologic, and sports medicine disorders such as knee osteoarthritis, rotator cuff tendinopathy, and epicondylitis.

Nerve blocks

  • Intercostal (rib) nerve blocks

  • Lower extremity nerve blocks

  • Occipital nerve blocks

  • Trigeminal nerve branch blocks

  • Upper extremity nerve blocks

Ultrasound-guidance always used

In some cases, temporarily blocking a nerve signal to an area of pain can provide long lasting relief.   

Regenerative

  • Prolotherapy

  • Platelet Rich Plasma (PRP)

  • Others require discussion with physician and private purchase 

It has become standard practice in physical medicine and orthopedics to utilize, in select patients, various regenerative injection options.  

Prolotherapy is a solution of a sterile mixture of glucose (sugar) and water that is injected into a chronic musculotendinous pathology (such as a mild to moderate rotator cuff tear) to facilitate your body's own ability to mobilize growth factors that circulate in your blood to the area of pathlogy.

 

Platelet rich plasma (PRP) is found in 1% of your blood.  With a PRP injection, your blood is drawn and the sample of your blood is the spun in a centrifuge.  The centrifuge isolates the PRP portion of your blood.  This can be aspirated and used as a regenerative mixture to inject in a joint or musculo-tendinous structure to facilitate healing. 

There are other regenerative products on the market such as stem cell treatments and amniotic-fluid derived growth factors (Amniofix).  These would not be available in the clinic and are typically not covered by insurance.  This doesn't mean that these products do not work and does not mean that we cannot inject them for you.  You would first need to review the product with the doctor and the reason for the product.  If agreed, you may private purchase a product and bring it to the clinic for injection.  You would assume the risks associated with the product's disclaimers. 

Trigger point injections

Trigger point injections: injecting local anesthetic and/or anti-inflammatory medication can be used as an adjunct to proper exercise and physical therapy to treat trigger points, thought to be sources of chronic myofascial (soft-tissue) pain.

Electrodiagnostics

EMG (electromyography): inserting fine needle electrodes in muscles and observing the recorded motor unit potentials when the muscles are activated to help distinguish whether weakness is due to muscle or nerve dysfunction (i.e., myopathy vs. neuropathy).


NCS (nerve conduction studies): use of electrodes to record motor and sensory responses that are propagated by electrical stimuli. This test can help distinguish location of a nervous system lesion (radiculopathy, peripheral neuropathy, motor neuron disease, or neuromuscular junction).

Musculoskeletal ultrasound

Musculoskeletal ultrasound: ultrasound is now increasingly being used in the outpatient setting to supplement the musculoskeletal evaluation through visualization of the structures. Ultrasound may be used to evaluate for soft tissue abnormalities in commonly examined joints and structures. This technology is also now frequently used to guide injections, as it allows for improved placement of needles for delivery of treatment without exposure to ionizing radiation.

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