Often there is more than one cause to pain which is overlooked. For example, the diagnosis of lower back pain is complex and often there is more than one cause for your pain – and sometimes the secondary cause can be overlooked.
For instance, often people are told they have lower back pain from a herniated disk, however, their symptoms don’t match the findings of the MRI. This is most commonly found with Sacroiliac Instability which can be treated with prolotherapy.
Another common misdiagnosis – people are told their symptoms are from a meniscus or a labral tear when the real cause is underlying arthritis. This is most common with shoulders, knees, and hips. If this is the issue, it can be treated with prolotherapy.
In both these examples, surgery will not help and, in fact, can do more damage.
For these reasons, we are happy to provide second opinions.
Cortisone injections can be helpful for inflammatory diseases of the joints and tendons. For example rheumatoid arthritis, inflammatory bursitis, and other autoimmune diseases. It is also used for short term relief in the case of osteoarthritis but repeated use can have unwanted side effects. These would include rupture of tendons and ligaments, deterioration of the cartilage and rarely infection.
Cortisone is a corticosteroid released by the adrenal gland in response to stress and is a potent anti-inflammatory agent. Artificial preparations containing cortisone are injected directly into the affected joint to relieve pain and reduce inflammation. The effects may last for several weeks. Cortisone injections are recommended for injuries that cause pain and inflammation, including those that don’t require surgical treatment. A condition where cortisone works well is a frozen shoulder.
While cortisone injections offer significant relief in pain and inflammation, it can be associated with certain adverse effects. The most common side effect is a “cortisone flare,” a condition where cortisone crystallizes and cause severe pain for a brief period that lasts for a day or two. A cortisone flare can be minimized by applying ice to the injected area. Other adverse effects include whitening of the skin, infection at the injection site, and a transient elevation in blood sugar in patients with diabetes.
Customized Bracing (Referrals for Bracing& Orthotics)
Custom fitting a brace to manage an injury or ailment starts with our team obtaining from our patients a thorough health history including an orthopedic examination. Once the initial assessment is completed, a specific type of brace can then be prescribed/recommended with
precise measurements next taken in order to fabricate a customized brace.
Common Conditions Treated
Carpal Tunnel Syndrome
Knee Meniscal Injury
Knee Meniscal Injury
Referrals for Physical Therapy
We also make referrals for Physical therapy and diagnostic testing when indicated.
Orthopedic surgeons use a variety of diagnostic tests to help identify the specific nature of your musculoskeletal injury or condition. Orthopedists also use results of these tests to plan an appropriate course of treatment. Here are some of the most frequently used diagnostic tests for musculoskeletal injuries and conditions.
Magnetic Resonance Imaging (MRI)
An MRI (magnetic resonance image) uses magnetic fields and a sophisticated computer to take high-resolution pictures of your bones and soft tissues, resulting in a cross-sectional image of your body. It can be used to help diagnose torn muscles, ligaments and cartilage, herniated disks, hip or pelvic problems and other conditions. As with a CT scan, you lie on a table that slides into the tube-shaped MRI scanner. The MRI creates a magnetic field around you, then pulses radio waves to the area of your body to be pictured. The radio waves cause your tissues to resonate. A computer records the rate at which your body’s various parts (tendons, ligaments, nerves) give off these vibrations, and translates the data into a detailed, two-dimensional picture. You won’t feel any pain while undergoing an MRI, but the machine may be noisy. An MRI takes 30 to 90 minutes, and is not available at all hospitals. Tell your doctor if you have implants, metal clips or other metal objects in your body before you undergo an MRI scan.
Arthrography is often used to help diagnose the cause of unexplained joint pain. A contrast iodine solution is injected into the joint area to help highlight the joint structures, such as the ligaments, cartilage, tendons and joint capsule. Several X-rays of the joint are taken, using a fluoroscope, a special piece of X-ray equipment that immediately shows the image. You may be asked to fast prior to the exam. During the examination, you may be asked to move the joint into various positions as the images are taken. It is normal to experience some discomfort or tingling during the procedure. If you are or may be pregnant, or are allergic to iodine or shellfish, notify your physician; you may be at a higher risk of complications.
Computed Tomography (CT Scan)
A CT scan (computed tomography) combines X-rays with computer technology to produce a more detailed, cross-sectional image of your body. It may be ordered if your doctor suspects a tumor or a fracture that doesn’t appear on X-rays (such as in your collarbone or pelvis) or if you’ve had severe trauma to the chest, abdomen, pelvis or spinal cord. The process is painless. You lie motionless on a table as it slides into the center of the cylinder-like CT scanner. An X-ray tube slowly rotates around you, taking many pictures from all directions. A computer combines the images to produce a clear, two-dimensional view on a television screen. You may need to drink or be injected with barium sulfate or a dye so that certain parts of your body can be seen more clearly. The drink has a chalky taste and may make you feel nauseous; a dye injection may be moderately painful. Tell your doctor if you are pregnant before undergoing a CT scan.
Two very different kinds of tests may be called bone scans. One type tests the density of the bone and is used to diagnose osteoporosis. This type of bone scan uses narrow X-ray beams or ultrasound to see how solid the bone is. No preparation is required for this test, which takes only a few minutes and has no side effects. (See Dual-Photon Absorptiometry, Dual-Energy X-ray Absorptiometry, and Peripheral Bone Density Testing.)
The second type of bone scan is used to identify areas where there is unusually active bone formation. It is frequently used to pinpoint stress fracture sites or the presence of arthritis, infection, or cancer. About three hours before the scan, you will be given a dose of a mildly radioactive substance called “technetium” through an intravenous line (IV). This substance occurs naturally in your body and is used in the bone formation process. The bone scan itself is performed about three hours later, which gives the bone time to absorb the technetium. As you lie on a table, a special nuclear camera takes a picture of your entire body. This process takes 30 to 90 minutes. Areas of abnormal bone formation activity will appear brighter than the rest of the skeleton.
No fasting or other preparation is required. The amount of radioactivity absorbed during a technetium bone scan is minimal, and there are usually no side effects. You may feel some discomfort as the IV line is placed. Some people may feel nauseous. Tell your physician if you are or may be pregnant or are a nursing mother before you schedule this test.
Laboratory studies of blood, urine or joint (synovial) fluids are used to identify the presence and amount of chemicals, proteins, and other substances. Your doctor may order various laboratory studies depending on what he or she finds during the initial examination. For example, laboratory studies can identify the amount of uric acid in the blood, which is an indicator of gout. A high white blood cell count in joint fluid may indicate severe inflammation or infection. Laboratory tests are usually required before surgeries to identify medical abnormalities.
You may be required to fast for a specific number of hours before donating samples for a laboratory test.
An orthopedist who suspects that you have a blockage in the blood vessels of your legs or arms may prescribe an ultrasound test. An ultrasound uses high-frequency sound waves that echo off the body. This creates a picture of the blood vessels. The Doppler audio system transmits the “swishing” sound of the blood flow. This is a noninvasive test that has no side effects.
A clear jelly is applied to the skin over the blood vessels being tested. The technician uses a sensor that looks like a microphone. The sensor is placed against the skin and moved up and down across the area being tested. The technician will apply pressure every few inches to see if the blood vessels change their shape. The test takes about 30 minutes, and most people experience no pain or discomfort.
An electromyography (EMG) records and analyzes the electrical activity in your muscles. It is used to learn more about the functioning of nerves in the arms and legs. For example, a fracture of the upper arm bone (humerus) may tear or pinch the radial nerve. An EMG can be used to identify the damage if nerve function doesn’t return within 4 months of the injury.
During an EMG, small, thin needles are placed in the muscle to record the electrical activity. When the needles are inserted, you may feel some pain and discomfort. The doctor will ask you to relax the muscle and then to tense it slightly. The electrical signals generated by your muscle are broadcast on a TV-like screen. When the needles are removed, you may experience some soreness and bruising, but this will disappear in a few days. There are no long-term side effects. If you are taking blood-thinning medications, have lung disease or are at risk for infection, tell the physician who is conducting the test. On the day of the test, do not put any lotions or creams on the area to be tested and do not wear any jewelry. Usually, you can get the results immediately after the test.
Joint Aspiration and Analysis
Joint aspiration may be both a diagnostic test and a treatment option. In conditions such as bursitis, there is a fluid build-up that results in swelling and pressure. A similar fluid build-up around the joints can occur with injuries and arthritis.
Aspiration, or removing the fluid through a syringe, can reduce swelling and relieve pressure. The doctor will swab the skin with an antibacterial solution before inserting the aspirating needle. You may feel some pressure and pain as the needle is inserted, but this should be relieved as the fluid is removed.
After the test, your doctor may send the fluid to a laboratory for analysis. In an injury situation, there may be blood present in the fluid or fat droplets from bone marrow, which indicates the presence of a fracture. The analysis can also determine if the fluids result from an infection or an inflammatory response.
Nerve Conduction Study (NCS)
Nerve conduction studies are often done along with an electromyogram to determine if a nerve is functioning normally. It may be recommended if you have symptoms of carpal tunnel syndrome or ulnar nerve entrapment. The doctor conducting the test will tape wires (electrodes) to the skin in various places along the nerve pathway. Then the doctor stimulates the nerve with an electric current. As the current travels down the nerve pathway, the electrodes placed along the way capture the signal and measure its speed. In healthy nerves, electrical signals can travel at speeds of up to 120 miles per hour. If the nerve is damaged, however, the signal will be slower and weaker. By stimulating the nerve at various places, the doctor can determine the specific site of the injury. Nerve conduction studies also may be used during treatment to test the progress being made. Although you may initially be startled by the suddenness of the stimulation, it is not usually painful and most people are comfortable during the testing procedure. The shock is similar to one received when you touch a doorknob after walking across carpeting.