We offer appropriate diagnostic and therapeutic measures for a variety of painful musculoskeletal conditions. This includes medication management, spine and orthopedic interventions, neurodiagnostic evaluations, and injection techniques for pain relief with an emphasis on functional gains and return to healthy lifestyle.
We have worked with patients to reduce the life-impacting pain of the spine and extremities. We are dedicated to treating the following conditions with the least invasive techniques.
- Repetitive Strain Injury
- Wrist Elbow Shoulder Tendonitis
- Carpal Tunnel Syndrome
- Cubital Tunnel Syndrome
- Radial Tunnel Syndrome
- Thoracic Outlet Syndrome
- Spinal Disorders
- Cervical Radiculopathies
- Low Back Pain
- Degenerative Spine Conditions
- Failed Back Surgery Syndrome
- Complex Regional Pain Syndrome
- Peripheral Neuropathy
- Myofascial Pain Syndrome
- Sports Injuries
- Disc Bulge and Protrusion
Contact us to learn more about the conditions
Nerve Disorder Treatments
Peripheral Nerve Entrapments
Orthopedic & Sports Injuries
Neck & Back
Shoulder, Elbow & Wrist
Hip, Knee & Ankle
Medical Legal Services
EMG/NCS for Nerve Disorders
Injections and Interventions
We have certification in Injections and Interventions. Here is some more information about our services.
Fluoroscopic guided Facet Joint Injections
Facet joints are small stabilizing joints located between and behind adjacent vertebrae. Occasionally, these become inflamed due to spinal stenosis, spondylolysis, sciatica, herniated disc, or post operative degenerative changes, causing neck and back pain. A facet injection delivers a combination of long-lasting corticosteroid and anesthetic to the facet joints, relieving pain.
Fluoroscopic guided Cervical Epidural Steroid Injections
Cervical epidural steroid injections are done to alleviate inflammation in the cervical, or neck area, by delivering steroid with or without an anesthetic to the epidural space within the spine. This decreases inflammation of the nerve roots, thus healing an injury. This type of injection can cause relief for up to several months. The procedure takes up to thirty minutes plus approximately forty-five minutes recovery time.
Trigger Point Injections
A trigger point forms when a muscle becomes tight and fails to relax. The knot can often be felt under the skin and may twitch involuntarily when touched. A trigger point can irritate surrounding nerves as well as cause referred pain (pain felt in another part of the body). A small needle is inserted into the trigger point and a local anesthetic (e.g., lidocaine, bupivacaine) with or without a corticosteroid is injected. Injection of medication inactivates the trigger point and thus alleviates pain. Sustained relief usually is achieved with a brief course of treatment. The injection may cause a twitch or pain that lasts a few seconds to a few minutes.
Spinal Cord Stimulation
A spinal cord stimulator (SCS), is an implantable medical device used to treat chronic neurological pain. Implanted into the epidural space in the spine, this device sends an electric impulse, altering the body’s perception of pain. This device helps relieve chronic pain disorders such as failed back surgery syndrome, complex regional pain syndrome, and peripheral neuropathy.
Sacroiliac Joint Injections
The sacroiliac joint is the large joint between the sacrum at the base of the spine and the ilium of the pelvis. There are 2 (right and left) and when one becomes painful, it can cause pain in its immediate region or it can refer pain into your groin, abdomen, hip, buttock or leg.
A sacroiliac joint injection may reduce inflammation and provide long term relief. It can also help determine the source of pain, if pain decreases after injection.
Fluoroscopic guided Selective nerve root block
We administer selective nerve root block (SNRB) to diagnose the specific source of nerve root pain and for therapeutic relief of low back pain and/or leg pain. We use fluoroscopy as a rapid and effective means of guiding needle placement when performing selective lumbar nerve root blocks. Fluoroscopic guidance increases the accuracy of needle placement, and thus the specificity of the examination.
Ultrasound guided injections
These injections can be done at various sites, and the needle is visualized in real time as it enters the body by using an ultrasound machine. This allows more precise injections to the intended location.
Fluoroscopic guided Lumbar Epidural Steroid Injections
Lumbar epidural steroid injections are done to alleviate inflammation in the lumbar area of the back, by delivering an anesthetic and steroid to the epidural space within the spine. This decreases inflammation of the nerve roots, thus healing an injury. This type of injection can cause relief for up to several months. The procedure takes up to thirty minutes plus approximately forty-five minutes recovery time.
Fluoroscopic guided Thoracic Epidural Steroid Injections
Thoracic epidural steroid injections are done to alleviate inflammation in the thoracic area of the back, by delivering an anesthetic and steroid to the epidural space within the spine. This decreases inflammation of the nerve roots, thus healing an injury. This type of injection can cause relief for up to several months. The procedure takes up to thirty minutes plus approximately forty-five minutes recovery time
Bursa injections can help diagnose the source of pain and provide relief by delivering local anesthetic and anti-inflammatory steroid medications into specific synovial fluid filled fibrous sacs (bursa), which are adjacent to joints in the body. This procedure may reduce inflammation, resulting in long-term pain relief..
Piriformis Muscle Injections
This type of injection is both diagnostic and therapeutic. The piriformis muscle begins in the pelvis and connects to the sacrum. Because it sits on top of the sciatic nerve, pain in the piriformis muscle can cause symptoms of sciatica. Piriformis injections can help pinpoint the source of pain and can relieve back pain if the piriformis is the culprit.
Medial Branch Blocks
A medial branch block can relieve pain primarily in the neck or back, caused by arthritic changes in the facet joints for mechanical low back pain. These blocks consist of injecting medication outside the joint space near the nerve that supplies the joint called the medial branch (steroid may or may not be used). Multiple injections may be required, depending upon how many joints are involved. A block may be therapeutic and/ or diagnostic.
Costochondral Joint Injections
A Costochondral joint injection is used to treat refractory cases of costochondritis, which causes severe pain. Lidocaine, or a combination of corticosteroid and lidocaine, is injected.
Fluoroscopic guided Caudal Epidural Steroid Injections
Caudal epidural steroid injections are done to alleviate inflammation in the caudal area of the back, by delivering an anesthetic and steroid to the epidural space within the spine. This decreases inflammation of the nerve roots, thus healing an injury. This type of injection can cause relief for up to several months. The procedure takes up to thirty minutes plus approximately forty-five minutes recovery time
Radiofrequency (RF) rhizotomy or neurotomy is a therapeutic procedure designed to decrease and/or eliminate pain symptoms arising from degenerative facet joints within the spine. The procedure involves destroying the nerves that innervate the facet joints with highly localized heat generated with radiofrequency. By destroying these nerves, the communication link that signals pain from the spine to the brain can be broken. This procedure could provide prolonged pain relief for up to 2 years.
Stellate Ganglion Blocks
A block that is performed under fluoroscopy or ultrasound to determine if there is damage to or alteration in the sympathetic nerves, which can cause arm pain. A local skin anesthetic is given near the base of the neck on the affected side. Anesthetic is then injected near the transverse process of the cervical spine. The procedure takes less than thirty minutes, followed by evaluation and recovery for several hours.
Intercostal Nerve Blocks
An intercostal nerve block is an injection of a steroid or other medication around the intercostal nerves that are located under each rib. The steroid injected reduces the inflammation and/or swelling of tissue around the intercostal nerves, in between the ribs or in the chest wall. This may in turn reduce pain, and other symptoms caused by inflammation or irritation of the intercostal nerve and surrounding structures. Herpes zoster or shingles pain in the chest is commonly treated with intercostal blocks. Pain around a chest scar after a chest surgery may also respond well to intercostal blocks.
Lumbar Sympathetic Blocks
A block that is performed to determine if there is damage to or alteration in the sympathetic nerve chain and if it is the source of pain. This is a diagnostic test primarily, but it may provide relief far in excess of the duration of the anesthetic. A local skin anesthetic is given in the lumbar area of the back. A needle is then inserted into the back under fluoroscopy next to the vertebral body. The block may be performed on both sides of the spine. An anesthetic medication will be injected into the area.
Electromyography/ Nerve Conduction Studies
This type of test is used to detect nerve damage. In the first part of the test, electrodes are placed on the skin, and the nerve is stimulated to measure how fast and how well the nerves are conducting. In the second part of the test, a small needle is used to measure electrical activity in muscles.
Contact us to learn more about the conditions