Treatments

• Therapeutic Ultrasound

  Therapeutic Ultrasound offers accurate needle placement with ability to watch needle advance to desired target and confirm medication placement.  Conditions treated include:      

  • Joint injections and aspirations
  • Bursal injections and aspirations
  • Tendon injections

   After the diagnostic ultrasound, your provider will guide the needle to the target location and inject medication in real time.

• Diagnostic Ultrasound

  Diagnostic Ultrasound offers point-of-care imaging in the office to evaluate for musculoskeletal injuries both statically (without motion) and dynamically (with motion). Conditions that can be diagnosed with ultrasound include:      

  • Ligament and tendon injuries (i.e. Complete and partial tears, hyperemia and tendinopathy)
  • Joint effusion (fluid within the joint)
  • Muscle injuries

  Benefits:

  • Immediate diagnostic information in the clinic
  • Information can help with obtaining MRI approval
  • Can be used for patients who are unable to proceed with an MRI (i.e. Patients with cochlear implants, non-MRI compliant pacemakers/spinal stimulators, severe claustrophobia, etc.)

  During this treatment your provider will apply an "ultrasound medium” (ultrasound gel or viscous barrier) to the skin before placing the ultrasound probe on the point of interest.  The provider will move the ultrasound probe around the area being evaluated and images will be saved securely on the ultrasound machine to document findings. 

• Nerve Hydrodissection

  Nerve Hydrodissection is a procedure involving the use of fluid pressure injected from small needles using ultrasound guidance to free up fascia / connective tissue around nerves or other tendon / ligament structures. Nerve Hydrodissection can treat patients with increased pain from chronic nerve compression or tissue adhesions 

  The goal of the procedure is to gradually improve pain by reducing nerve compression, thus allowing it to return to normal size and function.

  What to expect during this treatment:

  • Your provider will evaluate the nerve/soft tissue in question under ultrasound and determine what areas require treatment.
  • You may experience increased “pressure” in the target region due to the volume of fluid injected within the soft tissues to achieve the tissue dissection.
  • Expect some soreness or mild pain for one-to-three days following each injection for most areas of body. 
  • You will likely experience nerve irritability. This is on and off tingling, pins & needles, shooting pains, “zaps,” etc.  These are common for the first 2 weeks and rarely persist for more than 6 weeks.  They should be lessening with time.

  • Follow-up will generally be at 6 weeks. If you have had at least moderate improvement, but are not very close to 100% better, we will often repeat the procedure at that visit. For some patients it can take 2-3 treatment for complete relief.
• TenJet (Percutaneous Tendon Debridement)

  TenJet is a minimally invasive surgical procedure completed under ultrasound guidance. This is done by using a small waterpik-like instrument to wash out and remove damaged tendon fibers. Conditions treated include:

  • Chronic tendinopathy/tendinosis (aka chronic thickening of tendon fibers)
  • Calcific tendinopathy (tendons that have accumulated calcium deposits)
  • Partial tendon tears

  This minimally invasive procedure can help fix partial tendon tears, remove the calcium deposits, and improve chronic tendinopathy by stimulating your body’s natural healing response after having removed damaged or “worn” tissue.

  What to expect during this treatment:

  • This is done at same-day in an ambulatory surgical center
  • Local anesthesia will be administered and a numbing medication will be applied to the area
  • A small incision (4-5 mm) will be made over the target location
  • The TenJet instrument will be introduced to the site. You should only feel pressure during this.
  • The procedure will take approximately 10-20 minutes
  • You will be monitored for about 15 minutes before you will leave
  • Physical therapy will start 2 weeks following the procedure
  • Prescription will be provided for 12 weeks, however most can expect to progress through rehab quicker, without the need for the entire 12 weeks.
  • For more chronic and long-standing issues, expect that it may take slightly longer.
  • 6 Weeks Post-Op: Experiencing more “good days” than “bad days.”
  • 3 Months Post-Op: Nearing new “baseline.”
• Sports Medicine and Joint Preservation

  Sports medicine is a specialized field of medicine that deals with the prevention, diagnosis, treatment, and rehabilitation of injuries and conditions related to physical activity and sports participation. This can include injuries to the muscles, bones, joints, tendons, and ligaments, as well as other conditions that affect physical performance, such as asthma or overtraining syndrome. Sports medicine physicians work with athletes and active individuals of all ages and levels to help them optimize their physical performance and prevent or recover from injuries. They may use a variety of non-surgical and surgical techniques to treat injuries and work closely with other healthcare professionals, such as physical therapists and athletic trainers.

  Joint Preservation is done by utilizing potential non-surgical treatment options coupled with lifestyle modification. The goal is to optimize joint care at any stage and tailor treatments specific to an individual patient while working closely with the patient’s interdisciplinary team (surgeons, physical therapists, personal trainers, etc).

  • Lifestyle modification to include weight management and nutrition counseling, activity modification and physical therapy.
  • Orthobiologics and Regenerative Medicine treatments including Hyaluronic Acid/Visco-supplementation, Platelet Rich Plasma, Bone Marrow Concentrate, and Lipoaspirate.
• Regenerative Medicine

  Orthobiologics are an emerging treatment group consisting of therapies that use the body’s own tissue and cells to help heal and regenerate. Most commonly, this includes treatments like platelet rich plasma (PRP), bone marrow concentrate (BMC) and lipoaspirate. Conditions treated include:

  • Osteoarthritis of large and medium sized joints (ie. knees, shoulders, hips, ankles, elbows).
  • Tendon and ligament tears
  • Tendinopathy/Tendinosis (chronic thickening of tendon fibers)

  All of these treatments offered simply use your body’s own ability to heal itself. Your body is an amazing machine that has everything within itself to accomplish this, however sometimes it requires procedures like this to deliver the concentrated message directly where it needs to go. In most cases, this will be accomplished by your physician targeting a “complex” of areas under ultrasound guidance with the specific treatment chosen.

  Treatments:

  Platelet Rich Plasma (PRP):

  Platelets contain growth factors that assist the body’s own healing and regeneration process. Whole blood contains a small percent of platelets. PRP is obtained by drawing your own blood and then using a centrifuge to spin it down. This creates a smaller volume of concentrated platelets for the injection. This process reduces red blood cells, white blood cells and other aspects of “whole” blood that are thought to inhibit the healing process. Ideally this helps to assist the body in healing and regenerating damaged or degenerative tissue.

  What to expect: The procedure starts with drawing a small amount of your own blood. The whole blood is then spun down in the centrifuge for about 20 minutes and will produce a platelet rich plasma. A special centrifuge is used to obtain a higher platelet concentration from your whole blood. Once the PRP is obtained, the injection is done under ultrasound guidance to improve accuracy. The injection can be painful and pre-treatment medication can be used to help with this, if needed.

  Bone Marrow Concentrate (BMC):

  Bone marrow is a rich source of mesenchymal stem cells and hematopoietic stem cells. Stem cells can be drawn from many different areas and tissue types, but bone marrow is most commonly used. Stem cells are known to have the ability to differentiate into many types of tissue like muscle, tendon, ligament, bone, blood cells, and others. This gives the potential for a self-renewal process that can improve and heal degenerative and damaged tissue.

  What to expect: Bone marrow is typically harvested from your posterior iliac crest (top of your hip where you would rest your hands.) The area will be numbed with lidocaine prior to the procedure. You should only experience pressure and possibly mild discomfort. Once the bone marrow is harvested, it is spun down and concentrated in a centrifuge similar to the PRP process - this will take about 20 minutes and leaves a higher concentration of stem cells. The concentrated injection is done under ultrasound guidance to improve accuracy. The injection can be painful and pre-treatment medications can be used to help with this, if needed.

  Lipoaspirate

  Adipose or “fat tissue” is another rich source of mesenchymal stem cells. This type of tissue also provides an extracellular matrix as well as desired growth factors. This small amount of fat tissue is typically harvested from your abdomen or “love handle” area. This tissue source, while providing access to stem cells and growth factors of the body, also provides a “scaffolding” structure. This scaffolding serves as a “filler” for the damaged tissues that can allow the stem cells and growth factors to adhere to in order to help heal defects and regenerate damaged tissue.

  What to expect: Adipose tissue is typically harvested from your abdomen (love handles). The area where the fat tissue will be harvested from will be numbed extensively. Once this is complete, a simple liposuction procedure will be performed. The fat tissue that is harvested will then be resized, then reinjected into the target area under ultrasound guidance to improve accuracy.