Frozen shoulder occurs commonly in people in their middle ages and most commonly in diabetics. A frozen shoulder is what it sounds like. The shoulder does not move as well as it should and progressively stiffens. This situation results in a lot of pain, even at rest and is very amenable to in-office treatment.

Diagnosis

Diagnosis of frozen shoulder can be made with physical examination and also an ultrasound to detect the thickness of the capsular structures of the shoulder that are thickened.

Treatments

Treatment for frozen shoulder is highly successful in the office utilizing a Brisement procedure. Under local anesthesia with ultrasound guidance, the shoulder is effectively anesthetized, and with appropriate ROM and isometric techniques, shoulder motion can be improved dramatically with minimal to no pain.

A rotator cuff tear is extremely common. Approximately 50% of all 50 year olds sustain a rotator cuff tear during that decade and 60% of 60 year olds do.

A rotator cuff tear can occur instantaneously with a violent strain, or progressively over time, with wear and tear caused by pinching of the rotator cuff.

Diagnosis

Diagnosis of rotator cuff tears is very efficiently performed with ultrasound technique. Partial tears in the rotator cuff can be diagnosed, measured and appropriate treatment directed from there.

Treatment

Treatment of rotator cuff tears first involve mobilization of the joint, strengthening of the joint and, in partial tears, multiple trephination technique with ultrasound guidance and platelet rich plasma injections can be employed.

Degenerative arthritis is the wear and tear of the shoulder that occurs either traumatically or with age. Frequently the joint next to the shoulder, called the acromioclavicular joint has degenerative arthritis also.

Diagnosis

Diagnosis is easily made with a plain x-ray or ultrasound, demonstrating joint fluid and decreased thickness of the cartilage at the end of the bones.

Treatment

Initial treatment to degenerative arthritis is strengthening and stretching; and, in more advanced cases, ultrasound guided injections into the shoulder joint, or the AC joint.

Bicipital tendonitis into the anterior aspect of the shoulder from inflammation or dislocation of the bicipital tendon. This produces pain with lifting or doing such things as curling weights.

Diagnosis

Diagnosis of bicipital tendonitis is accurately performed with ultrasound technique. The biceps tendon can be seen actively moving in and out of its specific location if it is dislocating, or fluid around the tendon or partial tearing of the tendon can be accurately diagnosed.

Instability of the Shoulder

Instability of the shoulder occurs when there is frequent dislocation or partial dislocations of the shoulder. The diagnosis of this condition is performed with physical examination and careful attention to the patient’s history.

In complex dislocations that cannot be treated with exercise and stretching, MRI scans are employed to see if a portion of the shoulder complex has been torn.

Treatment

Treatment to shoulder instability is exercise with appropriate muscle strengthening; and, in severe cases, surgical stabilization is required.

Degenerative arthritis is essentially wear and tear that occurs in the knee joint either from an injury or from aging. People that are heavy or have had injuries in the past are much more susceptible to degenerative arthritis.

Diagnosis

Degenerative arthritis is diagnosed with plain x-rays and ultrasound technique, which can show the thickness of the swelling in the soft tissues of the knee and the amount of cartilage damage present in the knee.

Nonsurgical Treatments

Nonsurgical treatments involve specific stretches, exercises, injections of either cortisone or knee lubrication solutions are possibilities. Of course, having strong muscles and flexible joints along with appropriate body weight are very beneficial to the knee.

There are four main ligaments to the knee, the cruciate ligaments, and the medial and lateral collateral ligaments. These ligaments are frequently injured in slip, fall and athletic activities. If a ligament is completely ruptured, possible surgery is indicated. Partial tears can be treated with conservative care including bracing and exercises.

Diagnosis

Diagnosis of ligament injuries can be made with ultrasound technique, x-ray or MRI scans.

Menisci are frequently injured during twisting, torquing injuries to the knee. Frequently the tears are partial and will heal on their own, but if displaced, will require repair or partial removal of the meniscal tissue.

Diagnosis

Diagnosis can be performed with ultrasound technique or MRI scans to the knee

A Baker’s cyst is a collection of fluid that communicates with the knee joint or a tendon in the back part of the knee. Baker’s cyst can be large and contain similar fluid to that which is in a normal knee.

Diagnosis

Baker’s cyst can be diagnosed with an MRI scan or an MRI scan.

Treatment

Treatment of a Baker’s cyst in the early phases is aspiration, which can be accomplished with ultrasound guidance with high specificity. If the origin of the Baker’s cyst can be found, a trephination procedure can be performed to stop the Baker’s cyst from reoccurring. In rare instances, a Baker’s cyst may need to be surgically removed.

Patella tendonitis is pain below the kneecap, which hurts more with activities such as getting out of a chair, jumping or walking. The pathology is tearing of the internal fibers of the patella tendon, which has a very poor blood supply. Frequently, patella tendonitis forms scar tissue and is extremely difficult to treat without some intervention.

Diagnosis

Patella tendonitis is most accurately diagnosed with ultrasound. The exact location of the torn fibers can be found and treatment directed appropriately from there.

Treatment

Patella Tendonitis is amenable to a multiple trephination technique with ultrasound guidance and also plasma rich protein injections are very beneficial.

Quadriceps tendonitis is pain on the top portion of the kneecap where the tendon that inserts in this region has partially pulled off and caused scar tissue. This type of pain hurts most from getting up from a chair, jumping, or climbing hills

Diagnosis

Quadriceps tendonitis is accurately diagnosed with ultrasound technique and is not visualized on plain x-rays.

Treatment

Treatment for quadriceps tendonitis can be done with multiple trephination technique under local anesthesia in the office. In this area, with resistant cases, platelet rich plasma protein injections can also be performed.

Medial epicondylitis is caused by ripping the tendon that inserts on the inside portion of the elbow. This is frequently called “golfers elbow” and can be a persistent problem. With chronic tearing of the tendon insertion on the medial epicondyle, scar tissue develops which in many cases does not go away with conservative treatment.

Diagnosis

Diagnosis of medial epicondylitis is made with physical exam, and ultrasound is helpful in demonstrating the exact area and size of scarring in the tendon.

Treatments

Treatment to medial epicondylitis, at first is exercise and stretching, but frequently, will come down to ultrasound guided multiple trephination technique to revascularize the medial epicondyle, and possible use of platelet rich plasma.

Lateral epicondylitis is tearing of the extensor tendon from the lateral epicondyle of the elbow. Scar tissue develops in this region and frequently is not amenable to conservative treatment.

Diagnosis

Diagnosis of lateral epicondylitis is conveniently done by ultrasound technique. The amount of scar tissue present, size and location is easily documented.

Treatment

Treatment of chronic lateral epicondylitis is multiple trephination technique with ultrasound guidance, cortisone injections, and possible use of platelet rich plasma.

Degenerative arthritis is common in older age, resulting in decreased ROM of the elbow.

Diagnosis

Diagnosis is made with physical examination, plain x-rays and ultrasound is useful in determining the amount of tissue thickening and cartilage destruction present.

Treatment

Initial treatment to elbow arthritis is exercise with stretching and strengthening, anti-inflammatories, and possible cortisone injections. In rare instances, surgical procedures may need to be performed.

Tardy ulnar nerve is essentially having a pain in your elbow that travels down to your little and ring finger like an electric shock. It is very similar to hitting your funny bone, but the tingling continues.

Diagnosis

Diagnosis of tardy ulnar nerve is performed by physical examination and ultrasound technique, which can see the swelling or contractures around the ulnar nerve.

Treatment

Treatment is generally conservative, but in rare incidences, surgery may need be employed to release the pressure on the nerve. Ultra sound guided release of the Ulnar Nerve with hydrodisection is also useful.

Carpal Tunnel Syndrome is essentially squeezing of the median nerve at the wrist caused by overgrowth of the lining of the tendons that go through the same compartment. As the nerve is progressively squeezed, weakness and tingling occurs in one’s hands. People are frequently awakened at night, or bothered with such things as driving or blow-drying their hair.

Diagnosis

Diagnosis is made with physical examination, an EMG or an ultrasound is useful to see the amount of compression on the median nerve.

Treatments

Initial treatment is stretching and strengthening. Specific maneuvers can be avoided and performed to help lessen the amount of swelling in the carpal canal. Frequently, patients will benefit from a steroid injection placed in the carpal canal, and it is not uncommon to undergo carpal release.

Ganglion cysts are frequent and they on the top part of the wrist, most commonly in the center of the wrist. These are caused by irritation of a ligament in the wrist, which has allowed part of the wrist fluid to leak into a pouch called a ganglion cyst.

Diagnosis

Diagnosis of a ganglion cyst is generally performed by physical examination.

Treatment

Treatment of a ganglion cyst can involve aspiration and multiple trephine technique at the origin of the ganglion cyst. Steroid injections are also frequently employed. If the ganglion cyst becomes recurrent and bothersome, surgery is indicated.

Trigger fingers occur in the thumb as well as the fingers of the hand where, after the hand is clenched, it is hard to straighten one’s finger out without noting a popping sensation. In severe instances, the finger will not straighten out, even after attempts to physically do it.

Diagnosis

Diagnosis of trigger finger is on physical examination and direct visualization with ultrasound.

Treatment

Treatment of a trigger finger is a well-guided injection into the area where the tendon is getting caught, called the A-1 pulley. With an appropriately placed injection into this region, 60% of trigger fingers can be relieved. If trigger fingers injections do not work, a release of the tissue catching on the finger is performed through surgery.

de Quervain’s Tenosynovitis is pain near the base of the thumb. This area in particular has multiple tendons crossing one point where pain is frequent, and doesn’t resolve with conservative treatments.

Diagnosis

Diagnosis of de Quervain’s tenosynovitis is made with physical evaluation.

Treatment

Initial treatment of de quervain’s tenosynovitis is a cortisone injection. This is effective 75% of the time. Cases that become chronic and fail repeated injections can require surgery to release the tendon.

Pain localized in the back portion of the hip, accentuated by sitting or getting out of a chair. A chronic bursitis and tendonitis can occur which is difficult to treat without accurate diagnosis and appropriate measures.

Diagnosis

Diagnosis of greater trochanteric bursitis can be made with either ultrasound technique or an MRI scan.

Treatment of Greater Trochanteric Bursitis

Treatment to greater trochanteric bursitis is highly successful with multiple trephination technique under local anesthesia in the office. Cortisone injections are also frequently employed in this region.

Degenerative arthritis of the hip is diagnosed by physical exam. The patient loses range of motion and usually has pain even at rest. An x-ray is most commonly utilized to diagnose this condition.

Treatment

Treatment of degenerative arthritis in this hip in the early stages can be performed with ultrasound-guided injections into the hip joint. In some cases, arthroscopic surgery can be employed or actual replacement of the hip joint.

Musculoskeletal strain to the back is a very common condition. It can be associated with tearing or rupturing of a disc, or just degenerative arthritis of the spine and degenerative arthritis of the disc space. In most cases, musculoskeletal strains of the back can be treated conservatively. It is very common for one to have a backache either in the upper back, mid back or low back.

Diagnosis

Diagnosis of musculoskeletal strains does not require imaging such as x-ray or MRI’s unless more pronounced problems are evident. Any evidence of a pinched nerve or problems with ones bowel or bladder do require immediate attention, which would result in an MRI being employed. Short of these problems, an x-ray can be performed if the backache is prolonged, just to demonstrate the amount of degenerative arthritis present, or in rare cases, determination of a fracture or growth.

Treatments

Treatments for musculoskeletal strain to the spine are frequently affectively performed through osteopathic manipulation. With good osteopathic technique, the portion of the back which is sore can be remobilized, allowing the blood to return to the region to affect a cure.

Trigger point injections may be utilized for resistant cases of back pain.

Sacroiliitis is a common problem in the low back and has a very specific pain with any pressure applied to the sacroiliac joint. This pain can come about either from an injury or progressive activities resulting in inflammation of the sacroiliac joint.

Diagnosis

Diagnosis of sacroiliitis does not require x-rays in the early stages.

Treatment

Treatment can be effectively applied to the sacroiliac joint with osteopathic manipulation, and in some cases, an injection performed with local anesthesia and cortisone into the effected sacroiliac joint.

In chronic cases, PRP injections can/may be utilized.

Ankle sprains are very common and, most commonly involve the lateral (outside part of the ankle).

Frequently a person steps in a hole or steps down a stair inappropriately causing the ligaments on the outside part of the foot to stretch.

Ankle sprains are classified in three different categories. A

1st degree is common and can be treated conservatively. It doesn’t have any laxity of the ankle.

In a 2nd degree, there is laxity of the ankle and some bleeding of the tissue, which occurs causing discoloration.

A 3rd degree is the most severe and usually represents a complete rupture of the lateral ligaments of the ankle.

Treatment

Treatment of ankle sprain is generally some form of immobilization and, most importantly, neuromuscular reeducation exercises to help prevent further ankle sprains in the future.

In resistant cases, PRP ( Platelet Rich Plasma) can/may be utilized.

Achilles tendonitis is a common problem, which causes pain where the Achilles tendon inserts into the heel bone or further up the tendon. Most people complain of this while performing activities and do not have pain while at rest.

The pathology of Achilles tendonitis is partial rupturing of the internal fibers of the internal tendon. These fibers are very vascular, have a very poor blood supply, and take a very long time to heal.

In many cases, Achilles tendonitis can progress to a point where the Achilles tendon itself becomes weak and with moderate athletic activities can, in fact, rupture.

Diagnosis of Achilles Tendonitis

Diagnosis of Achilles tendonitis can accurately be performed with an ultrasound. The exact location of the Achilles tendon fibers, which are ruptured, can be found and quantified making accurate treatment possible without surgery.

Treatment

Utilizing ultrasound technology, an ultrasound guided technique (revascularization of the Achilles tendon) can be performed with a multiple trephination technique, and in many instances, platelet rich plasma injections can be performed.

Plantar fasciitis is a common problem, which causes pain in the patient’s heel. The pain is persistent and classically most sore first thing in the morning.

The plantar fascia is a fibrous band of tissue that attaches on the heel bone and fans forward toward the toes.

The problem that occurs is that part of the plantar fascia tears off the heel bone and creates a scar. Scar tissue, in that area of your body takes a long time to heel and frequently doesn’t heel, therefore continues to tear causing the person a great deal of disability.

Diagnosis of chronic plantar fasciitis

The diagnosis is most accurately performed utilizing an ultrasound, which will show the exact location of the plantar fasciitis and the amount of tearing and scar tissue present. This is as specific as an MRI scan, at a much lower cost.

Treatment

Treatment of plantar fasciitis is first stretching, trying to get the calf muscles relaxed and also, trying to stretch out the forefoot. If that does not work, anti-inflammatory medications are worth a try, but if the symptoms persist, other treatment options are available.

In our office, treatment of confirmed plantar fasciitis is an ultrasound guided multiple trephination procedure, utilizing a local anesthetic with specific techniques, revascularizing the scar tissue effects a cure. The procedure generally takes 10 minutes and is effective 85% of the time.

In chronic cases, PRP injections can/may be utilized.

Neuromas occur toward the base of the toes from nerves that are pinched and become enlarged. Pain is noted in the forefoot with weight bearing, and there is usually no pain at rest. Occasionally the toes become numb secondary to the inflammation of the nerves as it goes through the neuroma.

Diagnosis of Neuromas

Diagnosis can be performed accurately with an ultrasound and physical examination.

Treatment of Neuromas

Neuromas can be treated with injections and direct visualization with an ultrasound. A cortisone injection is attempted and if this is unsuccessful, either a surgical removal of the neuroma or an alcohol block can be performed to treat the neuroma.
Ankle sprains are very common and, most commonly involve the lateral (outside part of the ankle).

Frequently a person steps in a hole or steps down a stair inappropriately causing the ligaments on the outside part of the foot to stretch.

Ankle sprains are classified in three different categories. A

1st degree is common and can be treated conservatively. It doesn’t have any laxity of the ankle.

In a 2nd degree, there is laxity of the ankle and some bleeding of the tissue, which occurs causing discoloration.

A 3rd degree is the most severe and usually represents a complete rupture of the lateral ligaments of the ankle.

Treatment

Treatment of ankle sprain is generally some form of immobilization and, most importantly, neuromuscular reeducation exercises to help prevent further ankle sprains in the future.

In resistant cases, PRP ( Platelet Rich Plasma) can/may be utilized.

Achilles tendonitis is a common problem, which causes pain where the Achilles tendon inserts into the heel bone or further up the tendon. Most people complain of this while performing activities and do not have pain while at rest.

The pathology of Achilles tendonitis is partial rupturing of the internal fibers of the internal tendon. These fibers are very vascular, have a very poor blood supply, and take a very long time to heal.

In many cases, Achilles tendonitis can progress to a point where the Achilles tendon itself becomes weak and with moderate athletic activities can, in fact, rupture.

Diagnosis of Achilles Tendonitis

Diagnosis of Achilles tendonitis can accurately be performed with an ultrasound. The exact location of the Achilles tendon fibers, which are ruptured, can be found and quantified making accurate treatment possible without surgery.

Treatment

Utilizing ultrasound technology, an ultrasound guided technique (revascularization of the Achilles tendon) can be performed with a multiple trephination technique, and in many instances, platelet rich plasma injections can be performed.

Plantar fasciitis is a common problem, which causes pain in the patient’s heel. The pain is persistent and classically most sore first thing in the morning.

The plantar fascia is a fibrous band of tissue that attaches on the heel bone and fans forward toward the toes.

The problem that occurs is that part of the plantar fascia tears off the heel bone and creates a scar. Scar tissue, in that area of your body takes a long time to heel and frequently doesn’t heel, therefore continues to tear causing the person a great deal of disability.

Diagnosis of chronic plantar fasciitis

The diagnosis is most accurately performed utilizing an ultrasound, which will show the exact location of the plantar fasciitis and the amount of tearing and scar tissue present. This is as specific as an MRI scan, at a much lower cost.

Treatment

Treatment of plantar fasciitis is first stretching, trying to get the calf muscles relaxed and also, trying to stretch out the forefoot. If that does not work, anti-inflammatory medications are worth a try, but if the symptoms persist, other treatment options are available.

In our office, treatment of confirmed plantar fasciitis is an ultrasound guided multiple trephination procedure, utilizing a local anesthetic with specific techniques, revascularizing the scar tissue effects a cure. The procedure generally takes 10 minutes and is effective 85% of the time.

In chronic cases, PRP injections can/may be utilized.

Neuromas occur toward the base of the toes from nerves that are pinched and become enlarged. Pain is noted in the forefoot with weight bearing, and there is usually no pain at rest. Occasionally the toes become numb secondary to the inflammation of the nerves as it goes through the neuroma.

Diagnosis of Neuromas

Diagnosis can be performed accurately with an ultrasound and physical examination.

Treatment of Neuromas

Neuromas can be treated with injections and direct visualization with an ultrasound. A cortisone injection is attempted and if this is unsuccessful, either a surgical removal of the neuroma or an alcohol block can be performed to treat the neuroma.