Local Injections
Cortisone
Cortisone injections can treat many conditions including tendonitis, bursitis, arthritis, capsulitis, and fasciitis. These are all areas with inflammation and cortisone is a strong anti-inflammatory.
Examples
- Shoulder: Rotator cuff tendonitis, bursitis and impingement, frozen shoulder and arthritis.
- Elbow: Tennis or golfer’s tendonitis, bursitis.
- Wrist and Hand: Arthritis, tendonitis, trigger finger or trigger thumb, carpal tunnel syndrome.
- Hip: Bursitis and arthritis.
- Knee: Arthritis, tendonitis and bursitis
- Ankle and foot: Tendonitis, heel spurs/plantar fasciitis.
Trigger point injections
Trigger points are painful “knots” in muscles that most commonly occur in the upper back and may cause a radiating pain syndrome. They are often treated with massage and direct pressure, but when necessary they can be injected with anesthetic agents and a small amount of cortisone to give relief.
Viscosupplementation injections for the knee
The FDA has OK’d these injections for knee osteoarthritis. An artificial joint fluid, hyaluronic acid, is injected into the knee and has been shown to give pain relief for up to 6 months. They work best in mild to moderate arthritis where some joint cartilage is still present. These are given as single injections once per week for a total of 3 injections.
Musculoskeletal ultrasound
Just as ultrasound is used to look at structures such as gallbladders, veins and fetuses, it also can visualize problems in tendons and ligaments. This is especially useful in the shoulder with the rotator cuff tendons. Tears and other problems of tendons, ligaments and bursa can be seen.
Ultrasound guided injections
Ultrasound imaging is used while injecting to guide the needle towards the desired point of pathology. The most common cause of injection failure is not getting medication where it is needed. For example, shoulder bursa injections without guidance have a low level of accuracy. Studies show that injections are accurate only between 29% and 70 % even for skilled injectors. A recent study in The Journal of Rheumatology [2004 Feb; 31 (2) 308-314] showed a 35 point improvement on a 100 point visual analog pain scale with ultrasound guided injections while those without ultrasound guidance improved only an average of 7 points.
Ultrasound guidance can be used for many injections including those of the knee, hip and shoulder.
Prolotherapy
Also known as proliferative therapy, prolotherapy places a solution of dextrose into a damaged tendon or ligament. The dextrose acts as a proliferant by triggering the bodies’ natural healing system which then begins to repair and strengthen injured ligaments and tendon. This reduces pain and produces and more stable joint. Prolotherapy is used to treat chronic joint pain caused by ligament or tendon damage. Examples include osteoarthritis also known as degenerative arthritis. As the joints wear down ligaments become loose and tendon insertions may be painful. Almost any joint can be treated from shoulder, hips and knees to feet, fingers and toes. Chronic tendonitis such as the elbow, shoulder, knee or foot respond well to prolotherapy. Chronic back and neck pain unresolved with other treatment may respond to prolotherapy.
Prolotherapy is not used for other types of arthritis such as rheumatoid arthritis or other inflammatory arthritis and connective tissue diseases. Generally it is not used for new or acute injuries.
Prolotherapy is considered experimental treatment and is not covered by most insurance companies including Medicare. It is usually reserved for problems that haven’t responded
to traditional methods including medication, physical therapy and cortisone injections.
Prolotherapy involves injections into the tender areas throughout the painful area. There is usually some increased pain for a few days after the treatment. This is treated with ice and Tylenol. Anti-inflammatory medications should not be used after the injection. These include aspirin, Advil (ibuprofen), Aleve (naproxen) or other “NSAID” drugs including prescription medication. Injections are done in a series every 2-4 weeks. Most problems need between 2 and 4 sets of injections. Being in good health and eating good sources of protein with supplemental vitamins that help healing can produce a better result.
The cost for prolotherapy is between $150 and $300 per area treated depending on the area for each set of injections.
PRP Injections
Dr. Frye has started an exciting new injection procedure. He has been training with Dr. Steven Sampson at the TOBI Institute to bring this exciting procedure to Topeka. To learn more about PRP, Platelet Rich Plasma injections
click here
