Stem Cell and Biologic Treatments

Ultrasound Guided Injections

Ultrasound is a common imaging technique that employs high frequency sound waves to create images of the organs and other internal structures of the body. These images provide the doctor valuable information which assists in diagnosis and treatment of a wide range of tendon, muscle and joint disorders affecting the body. It is also an excellent tool for guiding the placement of needles for both diagnostic as well as therapeutic purposes. Injection of a pain medication in combination with a local anesthetic directly to the site of injury helps relieve pain. Ultrasound-guided injection provides improved accuracy for injection site location.

Advantages

The advantages of ultrasound imaging compared to other imaging techniques includes the following:

  • No patient exposure to ionizing radiation
  • Able to assess tendons, ligaments and muscles under high resolution
  • Provides direct visualization of the area being treated
  • Ensures accurate placement of the needle to targeted areas

Indications

The indications for diagnostic ultrasound imaging technique include the following:

  • Diagnose conditions such as tendon/ligament tears, inflamed bursa, compressed nerves, joint fluid and cysts
  • Assess painful pops and snaps that occur during movement
  • Deliver diagnostic injections to specific targets including joints and tendon sheaths or around nerves
  • Help guide needle placement during needle aspirations or injections for patients with challenging anatomical variations or people taking blood-thinning medications
  • Aspiration of a ganglion cyst
  • Injection into a tendon sheath or a bursa
  • Administer a nerve block (diagnostic or therapeutic)
  • Guide needles in percutaneous therapy for the treatment of calcific tendonitis

Procedure

During an ultrasound guided injection, you will be asked to lie or sit down on a table depending on the injection location. A clear water based conducting gel is applied to your skin to assist the transmission of sound waves. Your doctor moves a hand-held probe, called a transducer, over the target area. The doctor then inserts the needle into the skin under ultrasound guidance to the specified location. The transducer emits sound waves and detects the rebound echoes from the tissue. Images are created from these sound waves which are viewed on the video display screen attached to the scanner.

Risks

Ultrasound guided injection is a relatively safe and painless procedure. Some of the associated complications include bleeding at the site of insertion, and injury to adjacent structures. You can resume your normal activities immediately after the procedure.

Ultrasound Guided Hip Injections

Introduction

The hip joint is a ball and socket joint and is the largest weight-bearing joint in the human body. The head of the thigh bone or femur forms the "ball" and the acetabulum of the pelvis is the "socket". These bones come together to form the hip joint.

The hip joint is made up of:

  • Bones and joints
  • Ligaments
  • Muscles and tendons
  • Nerves and blood vessels

The hip joint may become painful and inflamed due to various conditions.

Hip joint injections can help diagnose the source of pain as well as alleviate the discomfort. A hip joint injection is a mixture of an anaesthetic which blocks pain impulses and a steroid which reduces inflammation to the area. Hip joint injections are a conservative treatment approach to relieve hip pain.

Disease Overview

The hip joint helps to bear your body's weight while standing, walking and running. The joint may become painful and inflamed due to overuse, trauma or certain medical conditions such as osteoarthritis, leading to pain in the hip, low back, buttock or leg. The pain may increase with certain activities and movements.

Indications

Hip joint injections are usually indicated to treat hip joint pain not relieved by other conservative treatment options. Conditions treated with hip joint injections include:

  • Arthritis (inflammation of the joints)
  • Bursitis (inflammation of fluid-filled sacs that act as a cushion between bones and soft tissue present in the joint)
  • Synovitis (inflammation of the joint lining)
  • Defects of the hip labrum (the raised rim of cartilage that borders the lining of the acetabulum)
  • Trauma or post-surgical pain

Surgical procedure

Hip joint injections are usually performed by a radiologist. You are requested to bring any previous scans or X-rays of your hip.

  • For the procedure, you will lie on your back and with the help of an ultrasound scan, the injection site is identified and marked on your hip.
  • The site is then cleansed and anesthetised.
  • A needle is inserted through the site and guided into the hip joint with the help of live ultrasound imaging.
  • An injection of anaesthetic and steroid medicine is then administered.
  • Once completed, the needle is removed and the injection site covered with a small dressing.
  • The entire procedure takes approximately 15 to 30 minutes
  • You are observed for a while and if stable may return home.

Post-Procedural Care

Your doctor will prescribe medication and ice pack applications to help relieve any pain and soreness at the injection site.

You are advised not to drive, bathe or shower immediately after the procedure. The anaesthetic in the injection usually has an immediate effect. The steroid component will start to show effects in 2-3 days.

Risks and complications

Risks and complications with this procedure are rare and include

  • Bruising at the injection site
  • Allergic reaction
  • Infection
  • Leg problems or weakness

Ultrasound Guided Shoulder Injections

Shoulder joint injections are commonly used for certain conditions such as osteoarthritis, frozen shoulder, or tendonitis. The administration of the injection to the shoulder joint depends upon the condition to be treated. The approach for application of the injection may be anterior, posterior, superior or inferior aspect of the joint.

During an ultrasound guided injection, the patient will be asked to lie or sit down on a table depending on the site of the injection. A clear water based conducting gel is applied over the skin to assist with transmission of the sound waves. The doctor moves a hand-held probe, called a transducer, over the targeted area. The transducer emits sound waves and detects the rebound echoes from the tissue. Images are created from these sound waves and can be viewed on the video display screen attached to the scanner. The waves provide a clear view of the targeted area and helps the doctor locate the correct site for injection.

Ultrasound Guided Knee Injections

Knee joint injections are frequently used for knee conditions such as osteoarthritis, baker's cyst or knee bursitis.

During the administration of the injection the patient will be positioned lying down and a clear water based conducting gel is applied over the targeted site. The gel is used for transmission of the sound waves to deeper structures. The doctor moves the hand-held transducer over the targeted area to provide images of internal structures. Under the guidance of ultrasound, the doctor inserts the needle into the skin to reach the targeted location. The procedure can be used for injecting medications or to aspirate fluid from the affected tissue.

Please note for any PRP, amniotic or stem cell injection we do not recommend the use of NSAIDs (i.e. ibuprofen) for 5 days after the injection but patients can use acetaminophen. This allows for an inflammatory/healing response to occur.