Sometimes you may be given light sedation during your injection to help with pain and anxiety of getting an injection (especially around the spine). You will remain awake throughout the injection procedure. A thin needle is used guided by a fluoroscope (x-ray) connected to a visual monitor to ensure proper needle placement. A small amount of contrast material will then be injected to verify correct needle position. The local anesthetic and steroids will be injected next, which may create a pressure sensation.

You may experience numbness and/or relief from your symptoms for up to six hours after the injection. Your usual symptoms may then return and may possibly be somewhat more intense than usual for a day or two. The beneficial effects of the steroids usually require 2-3 days to take effect, but can take as long as 10-14 days. In some patients, a second or third injection is required to achieve adequate pain relief. If your pain is not improved after a reasonable period of time, your doctor will want to investigate other possible sources for your pain and determine further evaluation and treatments.

If conscious sedation is given due to the effects of certain medications, your driving reflexes may be impaired. You will need someone to drive you home from your procedure, so please make the necessary arrangements or request assistance in advance from your physician's office.

Special instructions:

Ideally, blood thinners should be stopped 5-7 days prior to the procedure and one should not eat or drink anything four hours prior to the test. Please bring any previous x-rays, CT, or MRI films with you to your exam.

What are the side effects and risks?

Possible side effects of the steroid medications include facial redness, occasional low-grade fevers or flu-like symptoms, hiccups, sweating, anxiety, insomnia, headaches, increased heart rate, increased urination, generalized swelling, and abdominal cramping or bloating. These side effects occur in less than 5% of patients and commonly disappear within a few days after the injection. If your symptoms are lasting more than a week, please contact our office.

If you are a diabetic, follow your sugars carefully for a few days as steroids can make your blood sugar rise. Small risk of infection (although the skin is cleaned thoroughly with an antiseptic solution), and a small amount of bleeding may occur.

If you could be pregnant, please notify your physician prior to or at the time of you procedure.

Should you have any additional questions, please do not hesitate to contact our office. We will be more than happy to answer any questions you may have.

Hyaluronic Acid therapy:

Hyaluronic Acids, which are sold as Supartz, Hyalgan, Synvisc, Orthovisc and Euflexxa are joint fluid therapies approved for the treatment of osteoarthritis (OA) in the knee, in patients who have responded poorly to other therapies, but do NOT need or are NOT ready for knee surgery. These other therapies may have included analgesics (ie: Tylenol, Advil, pain medications, etc), physical therapy, alternative therapies (ie: acupuncture, supplements, etc), and even corticosteroids.

These drugs are a clear, viscous liquid (Hyaluronic Acid) that is injected into the knee joint. It is designed to provide long-term pain relief by supplementing the body's natural synovial fluid which is degraded (or broken down) due to OA. The various formulations are administered by injection once a week for a total of three to five injections (depending on the formulation used).

There are an estimated 25 million individuals suffering from OA in the United States and are more active than ever before. Some people estimate that osteoarthritis of the knee will surpass heart disease as the leading medical problem in the United States over the next decade, and this number increases every year as people are living longer than ever before. A person's joints - most commonly the hands, knees, and hips are affected by degeneration that causes them to be painful and sometimes swollen.

Clinical Results

The effectiveness of these drugs have been extensively studied in patients suffering from OA in the knee in USA, Europe, and Japan. Since its introduction in Japan in 1987, over 100 million successful Supartz injections have been administered.

Mechanism of Action

Viscous hyaluronate is similar to the body's natural synovial fluid, which helps joints function by acting as a lubricant, shock absorber, and analgesic.

Side Effects

Adverse events associated with the use of sodium hyaluronate may include (but are not limited to) the following:

joint pain

injection site reaction (swelling, redness, heat)

mild diarrhea

headache

nausea

Notify your physician if you have a history of allergies to hyaluronan preparations, joint infections or skin infections at the injection site, allergies to bird feathers/eggs, and poultry.

Should you have any additional questions, please do not hesitate to contact our office. We will be more than happy to answer any questions you may have.

Steroid injections ("Cortisone") provide diagnostic data and pain relief by delivering local anesthetic and anti-inflammatory steroid medications into the area or joint in which they are injected. They can be injected into areas around the spine such as the epidural space, facet joints, SI (sacroiliac) joints, bursa sacs, and in other peripheral joints such as hips, knee, shoulders, elbows, ankles, plantar fascia, hamstrings, trigger fingers, etc. These procedures may reduce inflammation, resulting in long-term pain relief, and provides valuable information on the source of your pain.

Epidural Injections:

For epidural or spinal injections, you may be given light sedation during your injection to help with pain and anxiety of getting the injection. Typically you will remain awake throughout the injection procedure, but you may not remember it (much like a colonoscopy). A thin needle is used guided by a fluoroscope (x-ray) to ensure proper needle placement. This allows for the maximum safety precautions that can be taken with the lowest risk of injury. A small amount of contrast material is used to verify the correct position. Upon injection of the local anesthetic and steroids, you may feel a transient pressure sensation. You may also experience some numbness for several hours after the injection. The beneficial effects of the steroids usually require 2-3 days to take effect, but can take as long as 10-14 days in some patients. Sometimes a second or third injection is required to achieve the desired level of pain relief.

What are the risks of steroid injections?

Possible risks and side effects of the steroids include facial redness, occasional low-grade fevers or flu-like symptoms, hiccups, sweating, anxiety, insomnia, headaches, increased heart rate, increased urination, generalized swelling, and abdominal cramping or bloating. These side effects occur in less than 5% of patients and commonly disappear within a few days after the injection. If your symptoms are lasting more than a week, please contact our office.

If you are a diabetic, follow your sugars carefully for a few days, as steroids can make your blood sugar rise. Small risk of infection (although the skin is cleaned thoroughly with an antiseptic solution), a small amount of bleeding may occur.

Always notify your physician if you are or could be pregnant!

Should you have any additional questions, please do not hesitate to contact our office. We will be more than happy to answer any questions you may have.

Lasers have been and are used for a variety of indications. There are high energy lasers like those used in medical/surgical equipment, X-rays, metal cutting, gamma and microwaves, and low energy lasers used in CD players, NASA space exploration, radio broadcasts, and communications. Lasers include low energy (radio, IR-infrared) to visible (light), to high energy (UV, microwave, X-ray, Gamma). Photo-lasers have been extensively researched including human and animal trials since the late 60's, and are extensively used today throughout the world. Their uses include wound/tissue healing in plastic/cosmetic surgery, treatment of cancers, and a variety of musculo-skeletal conditions, some of which are listed below.

Why should I try it?

It is not surgery. It is not cortisone. It is non-invasive. IT IS NOT PAINFUL!! No risk of cancers. It helps repair, regenerate, and promote healthy tissue. It is safe in skeletally immature individuals (no harmful effects on growth plates). No problems with patients with pacemakers. It has a reasonable rate of success (on average ¾ of patients have a beneficial response). Most conditions on average will respond in 1-4 treatments (some may require up to 8).

What does it do?

IR (infra-red) photo-laser is an FDA approved therapy that utilizes the use of low level laser therapy (LLLT) that operates at the wavelength of 830nm to maximally stimulate the photo-sensitive biological receptors (chromophores) in various cellular tissues that significantly accelerates and enhances the body's own natural defense and repair mechanisms in response to injuries and certain inflammatory disease processes. The photo-laser helps limit inflammatory factors to accelerate repair and healing of tissues, and subsequently provides pain relief. The photo-laser activates ATP synthesis (cellular energy source), increases mast cell and macrophage activity (cellular repair mechanisms), release of endorphins, promotion of oxygen utilization by targeting oxy-hemoglobin. This results in increased protein (collagen) production, enhanced blood flow to treated area, reduction of edema, decrease in pain, and promotion of tissue and bone repair.

What does it NOT do?

It does NOT cause cancers, genetic mutations, tissue breakdown, thermal/heat injury, sunburns, bone, nerve, or muscle injuries. These things occur with high-energy lasers (ie: Gamma, microwave, X-ray, Ultraviolet, etc.)

Recommended precautions:

Eye and thyroid protection. Pregnancy precautions (not directly over uterus). It should not be used directly over soft-tissue tumors. No treatment directly over the cardiac region and vagus nerves (in patients with known heart disease only).

What conditions can it be used for?

IR Photo-laser therapy can be used for but not limited for the following: (please discuss any other conditions or questions with our office)
Acute & chronic bone and soft tissue injuries

Ligament and tendon problems (ie: tennis elbow, patellar tendonitis, plantar fasciitis, Achilles tendonitis, etc.)

Joint injuries (shoulder, elbow, hand/wrist, hip, knee, ankle, feet/toes)

Acute & chronic low back, neck, and spine related pains/problems

Degenerative and osteoarthritic joint problems

Inflammatory conditions (ie: Rheumatoid arthritis, inflammatory arthropathies, Gout, etc.)

Neurologic conditions (neuropathy, carpal tunnel, neuritis, etc)

What should I expect during the treatment?

You may experience transient warmth (< 1 degree C) on the skin directly at the photo-laser site. No sunburn, redness, rashes, etc.

Any special instructions?

Dress in loose fitting comfortable clothing. The photo-laser will not operate or penetrate through clothing. There are no specific restrictions in activity once the therapy is complete.

Should you have any additional questions, please do not hesitate to contact our office. We will be more than happy to answer any questions you may have.

The injection causes a localized inflammatory reaction, which increases the blood supply to the area and stimulates and promotes the body's natural healing response. The inflammatory response after the injection can be fairly painful for a period of several days. The body's healing response consists of stimulating certain cells (macrophages, fibroblasts) and growth factors to produce new collagen (a protein found in ligament & cartilage tissue) at the same time it helps inhibit the body's destructive factors. It promotes healing, NOT scarring of tissue.

What are some advantages?

It is safe.
There is very little "down time".
It is not surgery.
It is not cortisone.
It can be safely repeated without limits until the painful condition is resolved (cortisone injections are limited).
It has a very good rate of success (on average ¾ of patients have a beneficial response).
Most conditions will respond in 3-6 treatments (some may require less and others more).

Tends to be less effective in smokers and diabetic patients, but still maybe an effective treatment.

What conditions can it be used for?

Chronic low back pain and spine pain

Joint injuries (shoulder, elbow, hip, knee, ankle)

Arthritic joint problems

Sprains and strains (ie: tennis elbow, patellar tendonitis, plantar fasciitis, etc.)

Other musculoskeletal conditions not listed above may also be treated (discuss with your doctor)

What should I expect?

Moderate pain and a pronounced swelling (inflammatory response) at the site of the injection within 1-2 days, lasting several days (usually 4-5 days),and resolves after 10 days.

Response to the therapy is determined by improvement in pain. The therapy is coordinated with a good strength and conditioning program by your physical therapist and good nutritional intake. Repeat therapy is usually done at 3-4 week intervals if necessary.

Should you have any additional questions, please do not hesitate to contact our office. We will be more than happy to answer any questions you may have.

Glucosamine is found naturally in the body. It stimulates the formation and repair of articular cartilage. Over-the-counter supplements come from animal sources. Chondroitin sulfate is another natural substance found in the body. It prevents other body enzymes from degrading the building blocks of joint cartilage. The type sold in health-food stores and pharmacies is derived from animal products.

The hope and the hype

People who use these nutritional supplements hope that they will relieve the pain of osteoarthritis, and perhaps even repair or restore the joint cartilage. Recent evidence seems to support the first claim. Both glucosamine and chondroitin sulfate have been used in Europe for several years, with few reported side effects. Both supplements also have some anti-inflammatory effects that may account for the pain relief.

But there is no proof that either substance, taken singly or in combination, will actually slow the degenerative process or restore cartilage in arthritic joints. All studies done to date have been short and focused on pain relief. A long-term study is just beginning, sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Center for Complementary and Alternative Medicine.

Dietary supplements like glucosamine and chondroitin sulfate are not tested or analyzed by the Food and Drug Administration before they are sold to consumers. That means consumers can't be sure they're getting what they pay for when they purchase bottles labeled "Glucosamine/Chondroitin." In fact, recent studies by several investigators showed that more than half of the glucosamine/ chondroitin supplements tested did not contain the labeled amounts of ingredients.

It is a "Buyer Beware" market when it comes to supplements. I recommend you consult your physician or pharmacist if you have any concerns or questions regarding supplements.

Decision guidelines

If you're considering taking nutritional supplements to help your arthritis, you may want to follow these guidelines:

1. Talk to your doctor. Although many people believe that traditional physicians will dismiss their interest in supplements, many doctors are actually quite open to complementary treatments. However, these supplements are not appropriate for all forms of arthritis or for all people. Diabetics and pregnant women, for example, should be especially cautious.
2. Don't stop your current regimen of diet, exercise, medication or other therapies. The effectiveness of these treatments is proven, and nutritional supplements should remain just that - complementary to your good health practices. You may need to take the supplements for a couple of months before you see any results, which makes it all that more important to continue your current treatments.
3. Do some research first. Find out about the supplement you are considering. Are there any side effects? Will it interact with your current medication? Write to the manufacturer and ask for documentation that supports their claims. For additional information on glucosamine, check the web site for the National Institute's of Health (www.nih.gov).
4. Stick with a reputable manufacturer. Because these products are not regulated, consumers are on their own. Even products labeled "standardized" don't meet outside standards; just internal ones set by the manufacturer. Standards can vary among manufacturers, so avoid brand names you don't know.
5. If anything does go wrong and you experience some adverse side effects, report them to your doctor quickly and stop taking the product. Remember that any supplement potent enough to help is probably also strong enough to harm if taken inappropriately.

Should you have any additional questions, please do not hesitate to contact our office. We will be more than happy to answer any questions you may have.