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Cervical Epidural Steroid Injection without Contrast

This injection relieves pain in the neck, shoulders, and arms caused by a pinched nerve (or nerves) in the cervical spine.
Who is the treatment for? 
Patients suffering from conditions such as herniated discs, spinal stenosis, or radiculopathy can compress nerves, causing inflammation and pain. The medicine injected helps decrease the swelling nerves.

Lumbar Epidural Steroid Injection

This injection procedure is performed to treat low back and radiating leg pain. Steroid medication can reduce the swelling and inflammation caused by spinal conditions.

Facet Joint Injection

The facet joints, found on both sides of the back of the spine, can become painfully aggravated or inflamed. A facet joint injection may help diagnose the source of a patient’s pain and/or ease pain and inflammation. Immediate relief of pain may be experienced because of the anesthetic that is dispensed. As the anesthetic wears off, pain may return. The steroid will begin to take effect in the days following the procedure. Steroids reduce inflammation and pain. Pain relief from the injection may vary from several days to several months. Your specialist will prescribe the appropriate number of injections for you.

Surgical Injections

Another effective treatment for orthopaedic conditions is technically a surgical procedure, but requires no incision. Rather, your orthopaedist may recommend a therapeutic injection of an anesthetic and a steroid to reduce inflammation and help relieve or resolve your pain.
There are two primary types of injections.
In both types of injections, the medicine is delivered as close as possible to the spinal nerves. These injections are usually performed under X-ray guidance, called fluoroscopy. This confirms exact placement of the medication and improves safety.

OrthoBiologics (Regenerative Medicine)

Orthobiologics are therapies developed from biologic (natural) that can be used by orthopaedic specialists to help relieve pain and other musculoskeletal conditions, boost the body’s ability to heal from a repetitive use injury, or in some cases, improve the healing after orthpaedic surgery.

This type of treatment is commonly known as orthopaedic regenerative medicine.


Platelet-rich plasma (PRP) injection

Platelet-rich plasma (PRP) is produced from a person’s own blood. It is the concentration of one type of blood cell (platelets), that is critical for blood clotting.

PRP injections are prepared by taking one to a few tubes of your own blood from a vein in your arm. It is then (“spun down”) in a centrifuge that separates the blood into various components: red and white blood cells, plasma, platelets, etc. The platelets are collected and concentrated to anywhere from 2 to 8 times their normal number. The platelets are then mixed into a blood plasma liquid base and injected directly into the area of injury -either blindly, with localization (via X-ray or ultrasound) or with direct visualization at the time of surgery.

How do PRP injections work?

With the administration of PRP, basic science study suggests we can deliver numerous cytokines (substances secreted by cells in our body’s immune system which influence other cells in the body) and growth factors in physiologically relevant proportions to provide positive effects at the site of injection by enhancing the body’s natural healing factors. PRP may derive benefit from encouraging cell production, agenesis (new blood vessel formation), and tissue maturation/remodeling.

What is PRP useful for?

Currently available evidence suggests effectiveness in the non-operative treatment of the following acute or chronic musculoskeletal conditions:

  • Knee osteoarthritis
  • Overuse injuries.
    • Lateral epicondylitis (tennis elbow)
    • Patellar tendinitis (jumpers’ knee)
  • Acute muscle injury
    • Hamstring
    • Quadriceips
    • Adductors

The use of PRP injections as a surgical expansion to the following procedures remain in current investigation, with early studies suggesting potential benefit effects:

  • Rotator cuff tendon repair
  • Achilles tendon repair
  • Anterior cruciate ligament reconstruction
  • Meniscus repair

Will my insurance pay for PRP injection?

Most insurance companies do not currently cover PRP, meaning the patient is responsible for the expense of a PRP injection. The costs of a single treatment with PRP may also differ due to the administration (in the clinic or in the operating room), use of analgesia/sedation, and image guidance (ultrasound or X-ray).

Viscosupplementation Treatment for Knee Arthritis

Another form of biologics used in orthopaedics is called viscosupplementation.  It is another non-surgical treatment your orthopaedic specialist may discuss when dealing with arthritic pain is in its early stages (mild to moderate). 

In this procedure, a gel-like fluid called hyaluronic acid is injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial fluid surrounding joints. It acts as a lubricant to help bones move smoothly over each other and acts as a shock absorber for joint loads. People with osteoarthritis have a lower-than-normal dilution of hyaluronic acid in their joints. The logic is adding hyaluronic acid to the arthritic joint will help movement and reduce pain.

How does the viscosupplementation injection work?

Several preparations of hyaluronic acid are now commercially available, depending on the product used, patients will receive one to five shots over several weeks.

During the procedure, if the patient is experiencing any swelling of the knee, your orthopaedic physician may remove (aspirate) the excess fluids before injecting the hyaluronic acid. For the first 48 hours after the injection (shot), all excessive activity should be avoided by patient (such as jogging, running or heavy lifting). If the injections are effective, they may be repeated after a period, normally 6 months.