Pain Management Procedures

//Pain Management Procedures
Pain Management Procedures 2018-03-27T14:07:56+00:00

Fluoroscopy Guided Injection

Fluoroscopy is a type of medical imaging that shows a continuous X-ray image on a monitor, much like an X-ray movie. During a fluoroscopy procedure, an X-ray beam is passed through the body. The image is transmitted to a monitor so the movement of a body part or of an instrument or contrast agent (“X-ray dye”) through the body can be seen in detail.

  • Lumbar
    • Interlaminar epidural steroid injection
    • Transforaminal epidural steroid injection
    • Caudal epidural steroid injection
    • Selective nerve root block
    • Medial branch block
    • Medial branch RFA
    • Coccyx injection – steroid injection
    • Coccyx injection – ganglion Impar block
    • Sacroiliac joint injection
  • Shoulder
    • Intra-articular steroid injection
    • Capsular distension arthrography
    • Platelet-rich plasma
  • Knee
    • Genicular block
    • Genicular RFA
  • Hip
    • Intra-articular steroid injection

Ultrasound Guided Injection

Ultrasound imaging, also called ultrasound scanning or sonography, is a method of obtaining pictures or images from inside the human body. It involves sending very high frequency sound waves through the body. The reflections are then processed by special instruments and powerful computers that subsequently measure and create a visual image of the organs. Ultrasound images are captured in real time and displayed on a television monitor to increase the accuracy of certain injections and procedures

  • Diagnostic examinations:
    • Shoulder Pain
    • Elbow Pain
    • Wrist Pain
    • Hand Pain
    • Hip Pain
    • Buttock Pain
    • Knee Pain
    • Ankle Pain
    • Foot Pain
  • Joint injections (both diagnostic and/or therapeutic)
    • Shoulder
    • Elbow
    • Wrist
    • Hand
    • Trigger finger
    • Hip
    • Knee
    • Ankle
    • Foot

Trigger Point Injections For Muscular/Myofascial Pain

A Trigger Point Injection is a procedure that is designed to reduce or relieve the pain of trigger points. Trigger points are small, tender knots that can form in muscles or the fascia (the soft, stretchy connective tissue that surrounds muscles and organs). A Trigger Point Injection is a non-surgical procedure for pain that only takes a few minutes to complete in the office.

What to expect

In preparation for a Trigger Point Injections for pain, the patient is placed in a comfortable position. The Pain Management Physician will then press and pinch the skin to locate the targeted trigger pain.  Next a needle will be carefully inserted into the trigger point injecting an anesthetic mixture which will cause the trigger point to relax.  While it is common to feel relief after the initial injection, some patients may require several injections for the most effective results

Peripheral nerve blocks/hydrodissection procedures for:

A peripheral nerve block is accomplished by injecting a local anesthetic near the nerve, or nerves, that control sensation and movement to a specific part of the body. This injection will temporarily numb the area in question, resulting in a number of benefits including: determining the underlying cause of pain, predicting how pain will respond to long term treatment, and potentially treating the actual cause of pain.

Hydrodissection is a technique that utilizes a pressurized water stream to develop tissue planes or to divide certain soft tissues with less trauma than with a sharp instrument.  This treatment uses computer-guided imaging to separate the entrapped/pinched nerve from the surrounding muscle and fascial tissue.  The procedure will free up the involved nerve from the dysfunctional adhesions and/or scar tissue. Hydrodissection has been shown to significantly reduce pain and allow the patient to return to their active lifestyles

  • Ailments that can benefit from Peripheral nerve blocks/hydrodissection procedures:
    • Carpal tunnel syndrome
    • Tarsal tunnel syndrome
    • Ulnar neuropathy
    • Lateral femoral cutaneous neuropathy
    • Suprascapular neuropathy
    • Platelet-rich plasma injections
    • Tendinopathy
    • Partial thickness tendon tears
    • Meniscus tears
    • Osteoarthritis

Percutaneous Needle Tenotomy

Ultrasound Guided Percutaneous Needle Tenotomy  is a procedure where a needle is advanced through the skin, under the visual guidance of Ultrasound, to make small holes and slices in a tendon.  This is done in order to treat tendinopathy and its tendon-related pain via causing microtrauma and breaks in the scar tissue. This causes local inflammation and thus increases the circulation to the area, which allows for an increased rate of healing. This procedure is utilized to repair/heal the degenerated tendons.

  • Ailments that can benefit from Percutaneous needle tenotomy:
    • Achilles tendinopathy
    • Gluteus medius tendinopathy
    • Gluteus minimus tendinopathy
  • Iliotibial band hydrodissection
  • Orthotic prescriptions

Viscosupplementation

Viscosupplementation is a medical procedure during which lubricating fluid is injected into a joint. This procedure is also known as hyaluronic acid injections or hyaluronan injections, viscosupplementation is most commonly used to treat symptoms of symptoms of knee osteoarthritis. Hyaluronic acid is a key component of the joint fluid in healthy joints, but is found in lower concentrations in osteoarthritic joints.  By increasing the hyaluronic acid in a joint this procedure can: increase joint movement, reduce pain, and potential slow the progression of osteoarthritis

This injection can be used on patients who have attempted to use other non-surgical procedures to reduce arthritis with minimal benefits. Following the injections, it is often recommended that patients engage in a rehabilitation program that includes gentle, strengthening and stability exercises The goals of rehabilitation are to improve range of motion and develop muscle strength to support the affected joint

  • Ailments that can benefit from Viscosupplementation
    • Knee OA
    • Hip OA
    • Ankle OA
    • Shoulder OA

Botox Injections

Botox therapy is used to treat patients with spasticity that restricts function or causes pain.  It attaches to nerve endings and prevents the release of chemical transmitters, which activate muscles. These chemicals carry the ”message” from the brain that tells a muscle to contract, by blocking this message this injection can prevent prolonged muscle spasms.

 

However, nerve endings usually grow new connections to muscles that have not yet been exposed to Botox. So, treatment may be repeated as often as every three months. Botox usually takes full effect within two to four weeks after injection. Patients should resume physical activity slowly and carefully after Botox injection.

  • Ailments that can benefit from Botox injections
    • Upper limb spasticity
    • Lower limb spasticity
    • Blepharospasm
    • Cervical dystonia
    • Migraine headaches

Pulsed Radiofrequency Ablation (RFA)

Pulsed Radiofrequency Ablation (RFA) involves giving short pulses of radiofrequency waves twice a minute. This technique differs from standard radio frequency procedures in that the tissue is seldom brought up to temperatures above 42 degrees Celsius. By keeping the temperatures this low it prevents any damage to the cells. The advantage to pulsed radiofrequency ablation is that it’s safe, particularly for use around the dorsal root ganglion or for peripheral nerves. It is particularly useful in treating pain going down the leg from inoperable spinal stenosis, and for treating back, shoulder and groin pain.

    • Geniculate nerve
    • Suprascapular nerve
    • Lateral femoral cutaneous nerve

Electrodiagnostic testing to diagnose/rule-out

An electromyogram (EMG) is a test that measures the electrical activity of a muscle. It detects any signs of blocking or slowing down of responses to nerve stimulation. The test provides information about the muscle itself and shows how well it receives stimulation from the nerve.   EMG’s are often used to evaluate unexplained muscle weakness, twitching or paralysis, and to find the causes of numbness, tingling and pain. EMG testing can differentiate between true weakness and reduced use because of pain or lack of motivation. It can also determine whether a muscle disorder begins in the muscle itself or is caused by a nerve disorder.

 

In an EMG your physician will insert a needle, which serves as an electrode, through the skin into the muscle. With the electrode in place, the patient is asked to slowly contract the muscle—for example, while the electrical activity is being recorded. The activity can be displayed visually on a screen. The results can provide information about the ability of the muscle to respond to nerve stimulation.

 

  • EMG’s can be used to diagnose:
    • Peripheral neuropathy
  • Median neuropathy (CTS)
  • Ulnar neuropathy
  • Cervical radiculopathy
  • Lumbar radiculopathy
  • Tarsal tunnel syndrome
  • Peroneal neuropathy
STAY CONNECTED

Follow us

STAY INFORMED

Subscribe

Subscribe to our newsletter

QUESTIONS?

Don’t hesitate to contact us

2781 Shell Rd, Suite 101, Brooklyn, NY 11223
MAKE AN APPOINTMENT

QUESTIONS?

Don’t hesitate to contact us

718-648-1239

2781 Shell Rd, Suite 101, Brooklyn, NY 11223

MAKE AN APPOINTMENT