Next to my hands, I consider needles and hypodermic needles one of the most important tools in my bag. Injections can be important for both diagnostic and therapeutic reasons. Diagnostic injections can be helpful in determining pain coming from nerves, ligaments, tendons, muscles, joints, connections of these or from a combination of these. Then we can usually use therapeutic injections containing local anesthetics, botulinum toxin, Taumeel™, or in some instances steroids to provide different degrees of relief.
We can also use regenerative injection techniques such as Platelet Rich Plasma (PRP) or Prolotherapy to help in the healing or pain relief in ligaments, tendons or joints that have not healed properly or are causing chronic pain. Referrals may be made to broaden the team to Interventional Specialists that have further expertise in spinal injections such as epidurals, facet joint injections, nerve root injections or radio frequency ablations.
Commonly Performed Injection Procedures:
- Botulinum Toxin – Botox™ and Xeomin™ for Chronic Migraine and Cervical Dystonia. Botulinum toxin, is a neurotoxin thought to inhibit nerve signaling and many different pain messengers. It has been used for decades and is considered a conventional therapy. I have had over a decade of experience with it and find it very helpful in my practice.
- Trigger Point Injections – injections into various muscles causing pain and spasm around the head and neck as well as middle and lower back
- Ligament and Tendon Injections – injections from all peripheral joints and peripheral spinal areas. Shoulder, Elbow, Wrist, Pelvis, Spine, SI, Hip, Knee, Ankle. Can be used for diagnostic or therapeutic purposes.
- Peripheral Nerve Blocks – Occipital, Trigeminal, Sphenopalatine, Suprascapular. Can be used for diagnostic or therapeutic purposes.
- Joint and Bursa Injections – Knee, Shoulder, Hip, Thumb, Wrist. Can be used for diagnostic or therapeutic purposes.
- Platelet Rich Plasma (PRP) – uses your own body’s platelets that have growth factors thought to promote healing and inflammation relief. It is used in ligaments, tendons and joints that can often be chronic sources of pain. PRP has a growing body of research and is gaining in popularity as part of a group of regenerative medicine therapies. Traditional therapies have often used steroids, unsafe analgesics, NSAIDs and surgery that may not always be ideal or cause adverse side effects. This procedure is not reimbursable, not-conventional and is fee for service. It will be performed with Ultrasound and at competitive pricing. We are utilizing 7-8x PRP.
- Prolotherapy (Prolo) – Prolotherapy is an injection of any substance intended to be an “irritant” that promotes growth of normal cells, tissues, or organs . Also known as proliferative therapy, non-surgical ligament and tendon reconstruction and regenerative joint injection, is an orthopedic procedure that stimulates the body’s healing processes to strengthen and repair injured and painful joints and connective tissue (AOAPRM). It has been in use for decades and is thought to stimulate inflammation in an effort to promote the body’s own stimulation of inherent healing and growth factors. Hypertonic Dextrose (d-glucose), a form of Glucose found normally in the body is used. This procedure is not reimbursable, not-conventional and is fee for service but often cheaper than PRP.
- Viscosupplementation – sometimes called hyaluronic acid injections, these lubricating fluids are commonly injected into the knee joint for mild to moderate arthritis that is causing pain. One of the most common products is Synvisc-One™.
- Steroid Injections – although these are often reimbursed by insurance and very commonly used for many musculoskeletal disorders as conventional therapy, there is mounting evidence that they can be harmful to cartilage, soft tissue and impair the body’s natural ability to heal. If possible, I prefer to avoid them and use many of the options discussed above. Steroids should be used sparingly, at the lowest possible doses and only in necessary instances when other options are not available or have been exhausted.
Please see Recommended Resources for further information and citations about the information above, especially in regard to non-conventional treatments listed above.
* Article last updated 10/28/2018.