Office Procedures

Temporomandibular Joint (TMJ) Steroid:

  • Indication: Jaw pain, facial pain, shoulder/neck pain, jaw stiffness, popping/clicking jaw, headaches, difficulty chewing
  • Diagnosis: Temporomandibular Joint Dysfunction/Disorder
  • Cause: trauma, teeth grinding, arthritis, stress
  • Procedure: Injection to the joint with local anesthetic and steroid under ultrasound guidance

Botox

  • Indication: Head pain, headache, stress
  • Diagnosis: Migraines, Tension Headaches
  • Cause: Stress, muscle spasms
  • Procedure: Series of injection of Botulinum Toxin A around the forehead, temples and neck
    Find more information regarding this procedure here: https://www.botox.com/

Occipital Nerve Block

optical nerve block
  • Indication: Tension Headaches, Migraines
    Diagnosis: Occipital Neuralgia, Cervicogenic Headache
  • Cause: Stress, weather changes, injury, muscle strain, arthritis
  • Procedure: Nerve block using local anesthetic and a steroid under ultrasound guidance

Sphenoganglion (SPG) Nerve Block

  • Indications: Headache/Migrain
  • Diagnosis: Headache/Migraine
    Cause: Stress, weather changes, sinus
  • Procedure: A small thin plastic tube is inserted into the nasal cavity and introduces local anesthetic to
    the SPG to help treat headache and facial pain
  • Find more information regarding this procedure here: https://sphenocath.com/

Suprascapular Nerve Block

  • Indication: Diffuse pain in the shoulder between the neck and armpit
  • Diagnosis: Suprascapular Neuralgia
  • Cause: Aggravation of the nerve from increased/repetitive overhead activities, trauma to the Rotator Cuff, frozen shoulder, degenerative arthritis, and shoulder fractures.
  • Procedure: Nerve block using local anesthetic and a steroid under ultrasound guidance

Shoulder Bursa Injections: A bursa is a jelly like sac that contains a small amount of fluid.

Subacromial Bursa

  • Indication: Shoulder stiffness and pain, pain that wakes you up at night, difficulty sleeping on the side
  • Diagnosis: Subacromial Bursitis
  • Cause: Overuse/repetitive motion to the shoulder
  • Procedure: Injection to the bursa using local anesthetic and a steroid under ultrasound guidance

Scapulothoracic Bursa

  • Indication: Snapping (audible or palpable) commonly known as “snapping scapular syndrome”.
  • Diagnosis: Scapulothoracic Bursitis
  • Cause: Repetitive overhead activities such as throwing, tennis, swimming, weight lighting
  • Procedure: Injection to the bursa using local anesthetic and a steroid under ultrasound guidance

Scapulotrapezial Bursa

  • Indication: Pain near the shoulder blade
  • Diagnosis: Scapulotrapezial Bursitis
  • Procedure: Injection to the bursa using local anesthetic and a steroid under ultrasound guidance

Subscapularis Bursa

  • Indication: Pain that gets worse at night, shoulder weakness, pain lifting your arm
  • Diagnosis: Subscapularis Bursitis
  • Cause: Overextension of the arm, Degeneration
    Procedure: Injection to the bursa using local anesthetic and a steroid under ultrasound guidance

Acromioclavicular Joint

  • Indication: Pain at the top of the shoulder where the collarbone (clavicle) meets the highest point of the shoulder blade
  • Diagnosis: Sprain/Strain/Arthritis
  • Cause: Trauma to the shoulder, Degenerative changes, general wear and tear
  • Procedure: Injection to the joint with local anesthetic and steroid under ultrasound guidance

Bicep Tendon Steroid

bicep tendon steroid
  • Indication: Pain and weakness in the front of the shoulder
  • Diagnosis: Bicep Tendinitis
  • Cause: Repetitive motion of the arm and shoulder, Injury to the area, wear and tear on the muscle
  • Procedure: Injection to the tendon insertion of local anesthetic and steroid under ultrasound guidance

Barbotage

  • Indication: Diffuse shoulder pain with calcium deposits
  • Diagnosis: Calcific Tendinitis
  • Cause: Calcium deposits
  • Procedure: Needle insertion into the calcium to break the deposits up and allow the body to reabsorb
    them

Carpal Tunnel Injection

  • Indication: Wrist pain, inflammation or a burning sensation into the fingers
  • Diagnosis: Carpal Tunnel Syndrome
  • Cause: Pressure on the median nerve, inflammation
  • Procedure: Injection into the carpal tunnel space using local anesthetic and a steroid under ultrasound
    guidance

De Quervain Injection

  • Indication: Pain in the thumb, specifically with a twisting motion
  • Diagnosis: De Quervain Tenosynovitis
  • Cause: Overuse of the thumb and wrist. Common during pregnancy and breastfeeding.
  • Procedure: Injection around the tendon using local anesthetic and steroid under ultrasound guidance

Basal Joint Steroid

  • Indication: Stiffness, swelling or clicking at the base of the thumb
  • Diagnosis: Osteoarthritis of the thumb (Carpometacarpal/CMC Joint)
  • Cause: Age, Previous trauma
  • Procedure: Injection to the joint with local anesthetic and steroid under ultrasound guidance

Medial and Lateral Epicondyle Steroid

  • Indication: Pain in the elbow
  • Diagnosis: Lateral Epicondylitis or Medial Epicondylitis – Commonly referred to as Golfers Elbow or Tennis Elbow
  • Cause: Overuse of the forearm/wrist due to repetitive activity.
  • Procedure: Injection to the elbow with local anesthetic and steroid under ultrasound guidance

Trigger Finger Injection

  • Indication: Popping/clicking/catching sensation as the finger opens, Finger stiffness in the morning,
    tenderness at the base of a finger, finger locked in a bent position
  • Diagnosis: Trigger Finger
  • Cause: unknown
  • Procedure: Injection to the tendon sheath with local anesthetic and steroid under ultrasound guidance

Cluneal Nerve Blocks

  • Indication: Pain, tension or stiffness in the area around the pelvis and buttocks.
  • Diagnosis: Cluneal Neuralgia, Sacroilitis
  • Cause: Acute injury, Overuse of muscles
  • Procedure: Nerve block using local anesthetic and a steroid under ultrasound guidance

Trigger Point Injections (TPI)

trigger point injections
  • Indication: Painful “knots” in your muscles causing tightness or spasms to the area, muscle pain, limited range of motion.
  • Diagnosis: Myofascial Pain, Muscle Strain
  • Cause: Acute trauma or repetitive use and be very sensitive to touch/pressure, Fibromyalgia,
    Post Herpetic Neuralgia, muscle injury, stress
  • Procedure: Injection to the muscle using local anesthetic and a steroid

Piriformis Injection

  • Indication: Pain in the hip and buttock which sometimes radiates into the low back or down the leg
  • Diagnosis: Piriformis Syndrome
  • Cause: Inflammation/spasm to the muscle near the sciatic nerve
  • Procedure: Injection to the muscle using saline and a steroid under ultrasound guidance

Trochanteric Bursa

  • Indication: Pain on the outside of the hip
  • Diagnosis: Trochanteric Bursitis
  • Cause: Repetitive stress or overuse to the hips, fall onto the area, laying on the same side of the body
    for long periods of time.
  • Procedure: Injection to the bursa using local anesthetic and a steroid under ultrasound guidance

Ischial Bursa Injection

  • Indication: Pain in the buttock region
  • Diagnosis: Ischial Bursitis
  • Cause: Sitting for long periods of time on a hard surface, direct trauma to the area, injury to the
    hamstring muscle through running or bicycling. Chronic or continuous irritation to the area.
  • Procedure: Injection to the bursa using saline and a steroid under ultrasound guidance

Coccyx Steroid

  • Indication: Pain around the tailbone
  • Diagnosis: Coccydynia
  • Cause: Direct trauma to the area, hyper/hypomobility of the sacrococcygeal joint,
  • Procedure: Injection to the area surrounding the coccyx with local anesthetic and steroid under
    ultrasound guidance

Iliotibial Band

  • Indication: Pain between the outer aspect of the hip and the knee
  • Diagnosis: Iliotibial Band Syndrome
  • Cause: Excessive foot pronation, running, cycling, swimming, hiking
  • Procedure: Injection along the tissue using local anesthetic and steroid under ultrasound guidance

Pes Anserine Bursa

  • Indication: Pain on the inside of the knee
  • Diagnosis: Pes Anserine Bursitis
  • Cause: Irritation to the area which causes increased fluid in the bursa causing pain and swelling to the
    area
  • Procedure: Injection approximately 2-3 inches below the knee joint with local anesthetic and steroid
    under ultrasound guidance

Knee Steroid

  • Indication: Diffuse pain around the knee, Swelling/Inflammation.
  • Diagnosis: Knee pain
  • Cause: Trauma, overuse, age, general wear and tear
  • Procedure: Injection to the joint with local anesthetic and steroid under ultrasound guidance

Hyaluronic Acid Injections (Viscosupplementation)

  • Indication: Knee pain
  • Diagnosis: Osteoarthritis
  • Cause: Hyaluronic acid is a naturally occurring substance which is found in the synovial fluid.
    Osteoarthritis causes patients to have a lower than normal concentration of hyaluronic acid in their
    joints. This gel like medication is used to act as a lubricant which helps the bones move slowly over each other and act as a shock absorber.
  • Procedure: Injection to the joint space of Hyaluronic Acid under ultrasound guidance

Genicular Nerve Block

  • Indication: Diffuse knee pain
  • Diagnosis: Osteoarthritis of the knee
  • Cause: Age, previous trauma
  • Procedure: Injection to the nerves surrounding the knee of local anesthetic under ultrasound guidance

Ankle Joint Pain

  • Indication: Pain the ankle joint
  • Diagnosis: Osteoarthritis of the ankle
  • Cause: Trauma, autoimmune disease, age
  • Procedure: Injection to the ankle joint with local anesthetic and steroid under ultrasound guidance

Plantar Fasciitis

  • Indication: Pain in the bottom of your foot near the heel
  • Diagnosis: Plantar Fasciitis
  • Cause: new/increased activities, repetitive high impact activities (running, dancing, sports), prolonged standing especially on hard surfaces, flat feet, high arches, tight calf muscles,
  • Procedure: Injection to the tissue in the plantar fascia with local anesthetic and steroid under ultrasound guidance.