Our highly competent and experienced physicians will provide a comprehensive consultation on your first visit. A full history, physical examination, and review of diagnostic testing will assist the physician in arriving at a diagnosis and proposing a personalized treatment plan. This may include exercise, physical therapy, medications, injections, braces, or referral to other providers as appropriate. After an orthopedic, musculoskeletal, or spinal injury our goal is to help you return to your previous activities as soon as possible.

Electodiagnostic medicine is the study of diseases of nerves and muscles. If you have numbness, tingling, pain, weakness, or muscle cramping your doctor may order this test. An EMG/NCS is a test that examines how your muscles and nerves are functioning. You can have problems in only one part of your body or throughout your body. The test consists of two parts-nerve conduction studies (NCS) and electromyopgraphy (EMG). The NCS shows how well the body's electrical signals are traveling to a nerve. The EMG part uses a small needle to examine the electrical signals in the muscles. The doctor then uses his medical knowledge to decide what could be causing your problem. The results of the tests will help your doctor decide what is wrong and how it can be treated. See Patient Education section for further details.

On site physical therapy is provided under the supervision of the physicians. Our therapists have received superior training and have extensive experience. They have treated disorders of the joints, spine, athletic injuries, post-fracture or post-surgical rehabilitation, gait disorders, and temporomandibular disorders (TMJ), among others. Some of our therapists have expertise in different areas (including spine, sacroiliac joints, and TMJ) as well as performing different techniques (myofascial release, trigger point release, Maitland or Mulligan mobilization, McKenzie). Our approach combines one-on-one treatments tailored to your needs, manual physical therapy, modalities as needed and includes instruction in proper biomechanics and self-care techniques.

A variety of joint, bursa or ligament injections can be performed to assist in the reduction of pain and inflammation. These injections are performed in the office using sterile technique and usually consist of a mixture of cortisone and local anesthetic. Common injection sites include shoulders, knees, hips, carpal tunnel, wrists, and hands. Some knee injections may be performed with a visco-supplementation medication (hyaluronate--Supartz, Synvisc are common brand names). These injections consist of a gelatinous substance that nourishes cartilage, provides "lubrication" to the joint and reduces inflammation. Relief usually lasts longer than with cortisone. Trigger point injections are injections of local anesthetic into trigger points in muscles. A trigger point is a palpable band of muscle which is tender to pressure and palpation and may refer pain to a distant site. These injections are helpful in reducing or resolving persistent muscle spasm and "knots".

Regenerative Injection Therapy with Growth Factors in Platelet Rich Plasma (PRP) is an alternative approach to healing tendon and ligament injuries. Platelet rich plasma, or PRP, is blood plasma with concentrated platelets. The concentrated platelets found in PRP contain huge reservoirs of bioactive proteins, including growth factors that are vital to initiate and accelerate tissue repair and regeneration. These bioactive proteins initiate connective tissue healing, bone regeneration and repair, promote development of new blood vessels, and stimulate the wound healing process. To prepare PRP, a small amount of blood is taken from the patient. Blood is placed in a centrifuge to produce the PRP. The process takes 10-15 minutes and increases the concentration of platelets and growth factors up to 500%. When PRP is injected into the damaged tissue it stimulates the tendon or ligament causing mild inflammation that triggers the healing cascade. See Patient Education section for further details.

Our physicians have received training in performing Botulinum toxin injections for the treatment of spasticity, intractable muscle spasm and painful conditions. (Please note, we do not perform cosmetic Botox). Botox is a toxin that when injected into a specific muscle will block the signal that allows a muscle to contract. It therefore partially paralyzes the muscle. This is only desirable in cases when there is an abnormal amount of muscle spasm, such as with torticollis, stroke, or multiple sclerosis. Botox is not approved for the treatment of pain. However, preliminary studies have shown its efficacy in treating painful chronic conditions, especially those involving severe muscle spasms.

DISCOGRAPHY:
Discography or a discogram is a diagnostic procedure used to help diagnose the source of neck or back pain. There are many structures in the spine which may become painful. A discogram is a test used to identify a painful disc. During a discogram a needle is inserted into a disc and a liquid dye is injected. If the dye causes a reproduction of the pain, it is very likely that the disc injected is the source of the pain. If the dye does not cause pain, it is unlikely that the disc is the source of pain. This test is usually performed when more than one disc looks abnormal on the MRI and surgery is being considered. The goal is to determine which disc is the painful one so that surgery can target the appropriate disc. See Patient Education section for further details.

EPIDURAL STEROID INJECTIONS:
An epidural steroid injection is basically a "cortisone shot" for the spine. It can be used to treat herniated discs and painful "pinched" or inflamed nerve roots (causing sciatica or radiculopathy). Epidural injections are generally recommended when oral medications and physical therapy have not been effective at reducing pain. Fluoroscopy (low power X-ray) is used for safety and to verify appropriate needle placement. See Patient Education section for further details.

FACET JOINT INJECTIONS:
A facet joint injection is a "cortisone shot" into a joint in the spine. It can be used to treat arthritis or inflammation of the facet joints. There is a right and left facet joint at each level of the spine. These joint can become painful in the same ways that knee, hip, shoulder, or finger joints do. When medication and physical therapy is not effective, steroid injections may reduce pain and inflammation in these joints. It is often very difficult to determine if a particular joint is painful based only on MRI and physical exam, so facet injections also serve as diagnostic procedures to help identify where the pain is coming from. If there is no pain relief at all, the joint(s) injected can be ruled out as possible sources of pain. See Patient Education section for further details.

MEDIAL BRANCH BLOCK (MBB) INJECTIONS:
Medial branch block injections are a diagnostic procedure used to help diagnose the source of neck or back pain. The medial branch nerves of the spine are tiny nerves whose primary function is to allow sensation from the facet joints. There is a right and left facet joint at each level of the spine. These joints can become painful in the same ways that knee, hip, shoulder, or finger joints do. It is often very difficult to determine if a particular joint is painful based only on MRI and physical exam, so medial branch blocks (and sometimes facet joint injections) serve as diagnostic procedures to help identify where the pain is coming from. The procedure "blocks" (with local anesthetic) your ability to feel any sensation coming from whichever joint is targeted. This is not meant to cure the problem. It is only a diagnostic test to identify the source of the pain. You must pay careful attention to how you feel after the injection. A positive response occurs when your pain disappears for the expected length of time (which is different for different anesthetics). Once the painful joint or joints is/are identified, a procedure called radiofrequency ablation (RFA) or radiofrequency neurotomy may be used to achieve long lasting pain relief. See Patient Education section for further details.

RADIOFREQUENCY NEUROTOMY:
Radiofrequency ablation is a procedure used to treat painful joints (facet joints or Z-joints) in the spine as well as sacroiliac joints. During the procedure, a special insulated needle is placed along the medial branch nerves. These are the nerves that carry pain signals from a painful joint. The tip of the needle heats up and coagulates or burns the nerve. This blocks the pain signal, so you can longer feel the joint which was causing the pain. These nerves do not have any other important functions, so it is safe to burn them. They will usually grow back again within one to two years, though, so the procedure may need to be repeated. It can be repeated as many times as is necessary. This procedure should only be done if facet joint injections or medial branch block injections have identified a painful joint which is not improving with more conservative treatments. See Patient Education section for further details.

SACROILIAC JOINT INJECTIONS:
A sacroiliac joint injection is a "cortisone shot" for the sacroiliac joint. The sacroiliac joints are two joints (right and left) which connect the lower spine or coccyx to the pelvis. These joints do not move much, but they can become inflamed and painful, especially after trauma. The only way to determine if a sacroiliac joint is causing pain is to fill the joint with anesthetic and see if the pain disappears. If the joint is inflamed, the anti-inflammatory steroid (the "cortisone") can provide long term pain relief. If the injection is effective, but does not last long, radiofrequency neurotomy can be performed to provide longer lasting pain relief. See Patient Education section for further details.