Treatments and Conditions

Botox (Onabotulinumtoxi-A): While historically used for cosmetic reasons, Botulinum injections have emerged as a viable treatment for headaches. Relief from headaches after Botulinum injections has lasted anywhere from two to six months. It is primarily used for certain types of migraine headaches.

Bursa injections: Bursitis is a painful condition where bursas (fluid filled sacs positioned near joints throughout the body) become inflamed. Steroid and local anesthetic is injected into these joints using anatomical landmarks and fluoroscopy. The most common joints are shoulders and hips.

Epidural Steroid Injections: Nerve irritation can be caused by tissues compressing and touching nerves. Epidural Steroid Injections are a minimally invasive procedure that use anesthetic and steroid medication injected into the epidural space of the cervical, thoracic, lumbar, or caudal space to reduce inflammation and pain that exists around those affected nerves.

Facet Joint Injection: Facet joint injections are given to decrease pain and inflammation which are then used to confirm a specific diagnosis within the zygapophysal joints on either side of the spine.

Ganglion Impar Nerve Block: Anal, rectal, coccyx and pelvic pain can be related to inflammation of nerves near the sacrococcygeal junction. The ganglion impar block is a type of injection that uses a local anesthetic and steroid injected into the ganglion impar to disrupt pain signals specifically related to coccydynia and rectal pain.

Intra-articular (Shoulder, Knee, and Hip) steroid injection: Inflamed joints are often a result of repetitive trauma or stress. They can be treated by delivering local anesthetic with or without steroid into the affected joint to decrease inflammation. This can be done using anatomical landmarks or fluoroscopy.

Kyphoplasty: Vertebral compression fractures are a painful spinal fracture that develops as a result of trauma or as a consequence of osteoporosis. This procedure is performed by expertly placing cement into the vertebral body to provide stability and decrease pain and discomfort.

Medial Branch Blocks: Facet joint pain often presents itself with rotational motion within the spine. Medial Branch Blocks are a non-surgical procedure for neck and back pain which are diagnostic in nature and are performed to determine if specific joints supplied by sensory nerves is the source of pain. If the results return in the affirmative for this procedure, a radiofrequency ablation is indicated.

Radiofrequency Ablation: Facet related back pain can be difficult to treat however Radiofrequency ablations (RFA) can provide 6 to 24 months of relief. Used in concert with medial branch blocks, RFAs use specialized electrodes to disrupt nerve conduction. A probe is inserted through a needle and a controlled delivery of heat is used to cut signaling from the sensory nerve to the brain.

Sacroiliac (SI) joint injection: A diarthrodial joint, the sacroiliac joint is located in the lateral part of the spine and is connected to the hip. It is very stable and can only be moved by a patient with limited mobility. A layer of cartilage covers the ileum and the sacrum. The fluid that fills these structures is known as synovial fluid. Sacroiliac joint dysfunction is often difficult to diagnose due to the symptoms that mimic other conditions such as disc herniation and radiculopathy. Studies have shown that peri-articular and extra-articular steroid injection within the joint can provide more pain relief than placebo. These treatments are also more effective than standard treatment options.

Sacroiliac joint injection can be performed when sacroiliac joint dysfunction is suspected. This procedure involves the insertion of a needle into the joint and the use of contrast dye. A numbing medication is injected into the joint in addition to a steroid.

Spinal Cord Stimulation: When pain is unresponsive to multiple treatments including surgery and epidural steroid injections it may be that the body is sending too many pain signals to the brain. This can be related to post-laminectomy syndrome, complex regional pain syndrome or even lumbar radiculopathy. In this instance a spinal cord stimulator or “pacemaker for pain” may be helpful. The SCS works by sending low level electrical signals near the spinal cord to disrupt signaling and provide significant pain relief. SCS requires a trial phase after which an implantable device is used to provide more permanent pain relief.

Sympathetic Nerve Blocks: Overactivity of our central nervous system can sometimes lead to challenging uncontrollable pain. Examples of this include complex regional pain syndrome, cancer pain, and even brown recluse spider bite pain. A sympathetic nerve block is an injection that blocks the transmission of sympathetic nerve signals at the nerve roots so that the sympathetic nervous system can no longer contribute to unregulated and uncontrollable pain.

Trigger Point Injection: Trigger points or tender points of inflammation and spasm can occur at multiple locations within the body including the trapezius and rhomboid muscles as well as multiple other muscle groups. Trigger point injections (TPIs) are injections of local anesthetic and occasionally steroids into these contracted knots of muscle to allow for relaxation and down regulation of pain.

Viscosupplementation: Osteoarthritis of the knees presents a difficult problem for many active patients who may not be able or are unwilling to undergo knee replacement surgery. The injection into the knee joint of hyaluronic acid or viscosupplementation using either anatomical landmarks, ultrasound, or fluoroscopy can be a valuable option for these patients.