CONDITION

OSTEOARTHRITIS

Osteoarthritis (OA) is a degenerative joint disease that can impact various tissues within the joint. It is the most prevalent form of arthritis, affecting over 32.5 million adults in the United States, according to the Centers for Disease Control and Prevention.

Previously, OA was referred to as a "wear and tear" condition, commonly linked to aging. However, it is now understood that OA affects the entire joint, including bones, cartilage, ligaments, fat, and the synovium (the tissue lining the joint). It can lead to cartilage breakdown, changes in bone structure, and inflammation, causing pain, stiffness, and limited mobility.

OA can impact any joint, but it most commonly affects the knees, hips, lower back, neck, and hands. The symptoms generally become more noticeable in individuals over 50, but it can also affect younger individuals, especially those who have had previous joint injuries, such as torn ACLs or menisci. OA typically develops slowly over time, but following an injury, it can progress much more quickly, It is not an unavoidable part of aging, and some people never develop it.

While there is no cure for OA, there are ways to manage the condition to reduce pain, maintain physical activity, uphold a good quality of life, and preserve mobility.

TREATMENT

KNEE ASPIRATION & INJECTION

Joint aspiration and injection refer to the placement of a needle into a joint cavity to remove fluid for analysis or study, and to inject medicine for pain relief or treatment of arthritis or other knee conditions.

The skin over the joint will be cleaned with an antiseptic solution. A local anesthetic is used, and you will feel a sting when it is injected. Once numb, a needle is inserted carefully into the joint, and fluid may be withdrawn. Without having to perform an additional needle-stick, the syringe holding the fluid can be removed, and a syringe containing the medicine (cortisone) is placed on the needle. The medicine is inserted quickly, and the needle is removed.

TREATMENT

HYALURONIC ACID INJECTIONS

Hyaluronic acid is a naturally occurring substance that is part of the fluid that helps lubricate and cushion your joints and keeps them working smoothly. When you have osteoarthritis of the knees, the hyaluronic acid in the affected joint thins.

For knee arthritis, our physicians can inject hyaluronic acid into the knee to reduce pain and make it easier to move.

TREATMENT

GENICULAR NERVE BLOCK AND RADIOFREQUENCY ABLATION

When all other conservative treatments fail, many patients consider a total joint replacement. However, not everyone is a candidate for this surgery. Instead, genicular nerve ablation may be considered. The genicular nerves are a group of nerves that provide sensory information to the knee and enable it to feel properly.

Before you have this procedure, our physician will do two “test blocks” with a numbing medication to block the nerves of the knee. This will allow you to feel how much pain relief you would have from radiofrequency ablation. Then, you can decide whether to have the procedure.

Genicular nerve ablation is a method to treat chronic knee pain using controlled radiofrequency energy. Through this treatment, our physician directs heat at specific parts of the knee. The heat “knocks out” the sensory nerves around the knee that send pain signals to the brain. Pain relief lasts 6 to 12 months in most patients and can be repeated should pain return afterwards

TREATMENT

PLATELET RICH PLASMA INJECTIONS

Platelet-rich plasma therapy is a regenerative medicine technique that utilizes the growth factors in our blood cells to stimulate and accelerate the healing of damaged tissue.

TREATMENT

INTRA-ARTICULAR HIP JOINT INJECTION

An intra-articular hip joint injection may be diagnostic and therapeutic. The diagnostic benefits of an intra-articular hip joint injection include determining if the pain is generated by the hip joint, back, and/or sacroiliac joint.

The procedure is performed in the office using ultrasound that enables the physician to visualize the hip joint. A thin needle is guided to the joint and a small amount of local anesthetic is injected to numb the joint. If the local anesthetic relieves hip pain then the hip socket is the likely pain source. An injection of a steroid medication may provide prolonged pain relief.

Intra-articular hip joint injections are a low-risk, quick, and effective treatment to relieve pain. The duration of pain relief depends on many things including the degree of underlying structural damage (i.e. osteoarthritis). Of course, patients are unique and what works well for one may not be as effective in someone else.

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TREATMENT

ULTRASOUND GUIDED SHOULDER INJECTION

An ultrasound-guided cortisone injection into the shoulder is a procedure that uses ultrasound to precisely guide a needle into the shoulder joint to deliver a corticosteroid and local anesthetic. This injection helps reduce pain, inflammation, and irritation, particularly at night and can improve the shoulder's range of motion. Ultrasound guidance ensures accurate needle placement, which minimizes pain, shortens the procedure and improves outcomes. Thinner needles also reduce trauma to surrounding tissues.

Following the injection, patients often experience pain relief and increased mobility, although some may have a temporary "pain flare" the day after the procedure. In such cases, it is important to rest and take any prescribed pain medication. Physiotherapy or primarily home exercises are typically recommended to help restore strength and flexibility in the shoulder. Cortisone injections are commonly used to treat conditions like subacromial bursitis, rotator cuff pain, and calcific tendonitis.

TREATMENT

SMALL JOINT INJECTIONS

A steroid injection reduces swelling and inflammation of the muscles, ligaments, and tendons within your hand and/or foot joint. Generally, less inflammation decreases your pain.

The following conditions of the hands and feet can benefit from cortisone injections:

ELBOW & HANDS

Trigger finger
Carpal tunnel syndrome
Arthritis
Tendonitis
Tennis elbow

ANKLE & FOOT

Gout
Plantar fasciitis
Ankle osteoarthritis
Rheumatoid arthritis
Achilles tendinopathy
Osteoarthritis in ankle
Tarsal tunnel syndrome
Posterior tibial tendonitis

TREATMENT

MEDIAL BRANCH BLOCKS & RADIOFREQUENCY ABLATION

A facet block or medial branch block may be therapeutic and/or diagnostic. One of three things may happen:

The pain does not go away, which means that the pain is probably not coming from the blocked facet joints. This has diagnostic value.
The pain goes away and stays away for a few hours, but the original pain comes back and doesn't get better again. This would mean the block was also of diagnostic value, indicating that the pain is probably coming from the joints but the steroid was not of benefit.
The pain goes away after the block, may come back later that day, but then gets better again over the next few days. This means that the block was of therapeutic value because the steroid had a long lasting effect on the pain.

If you get a positive, lasting benefit from the injections, the block may be repeated. If you get a positive, short-term benefit, another procedure called radiofrequency ablation may be done which may last months to years.

Radiofrequency ablation (RFA) uses radio waves to create a current that heats a small area of nerve tissue. The heat destroys that area of the nerve, stopping it from sending pain signals to your brain. RFA can provide lasting relief for people with chronic pain, especially in the lower back, neck, and arthritic joints.

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