Plantar Fasciitis

(PF) is a painful inflammatory process of the plantar fascia, the connective tissue on the bottom of your foot that causes foot, heel and ankle pain. It is often caused by overuse of the plantar fascia or arch tendon of the foot. It is a very common condition and can be treated effectively in most cases. Another common term for the affliction is “policeman’s heel”.

The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is an increased probability of knee pain, especially among runners.

How Is Ankle Pain Diagnosed?

History and Examination:

A history of your complaints including duration, what makes it better and worse is very important. Previous treatments and outcomes, as well as orthopedic examination of the muscles, joint, movement and strength are also used for diagnosis.

X-rays:

Plain X-rays can reveal narrowing of the space in the two joints of the ankle, revealing wear and tear on the cartilage from arthritis like diseases and bone spurs that can interfere with movement.

MRI (Magnetic Resonance Imaging):

Is a noninvasive procedure that can reveal the detail of the joints, ligaments and tendons.

Myelography/CT scanning:

Sometimes used as an alternative to MRI

Diagnostic ultrasound Imaging:

Unlike an x-ray, which emits radiation and shows only bone, diagnostic ultrasound is non-invasive and allows for viewing the causes of your ankle pain with great accuracy. With musculoskeletal ultrasound imaging (MSUS), the muscles, tendons, ligaments, cartilage and joint can be accurately examined at the time of your visit. This provides immediate information about the health of your joint and what factors are contributing to your pain. With this information in hand, specific treatment options can be established immediately!

Treatment

Cortisone Injection:

Painful arthritic joints, chronic tendinitis, bursitis and inflammation respond quickly to cortisone. In many cases this is the head start patients need to allow for gains with more conservative care and no further treatment is required. Many patients think that cortisone is bad for you. Too much of anything is not good. Using cortisone infrequently, as much as several times per year will not do any harm. If the pain continues to return, other treatment options should be considered.

Cortisone is injected using continuous live ultrasound guidance exactly where it is needed to quickly reduce inflammation and pain.

Lubrication for Arthritis:

Why Hyalgan?

A squeaky gear needs the most oil!

The joints of the body are normally surrounded by a lubricant and shock absorber called Synovial fluid. Patients with osteoarthritis experience pain and inflammation because arthritic damage in theankle causes the Synovial fluid to break down over time.

This process causes increased friction and excess wear and tear on the cartilage cushioning movement that becomes rough and jagged causing the joint further deteriorate. Range of motion, walking, getting up from a seated position, climbing and descending steps and weight bearing is often painful. Pain is often increased during or after activity.

What is Hyalgan?

Hyalgan is a naturally derived lubricant that instantly cushions and lubricates painful arthritic joints. By restoring lubrication and cushion, your joints move more freely again with less friction and most importantly, less pain. Hyalgan is injected using continuous live ultrasound guidance ensuring pin-point accuracy exactly where it is needed.

The joints of the body are normally surrounded by a fluid that acts as a lubricant and shock absorber. This fluid is lacking in patients with osteoarthritis, and leads to pain and inflammation in the joints.

Platelet Rich Plasma Therapy (PRP): Jump starting the healing signals:

Why use PRP?

When there is damage, tissue tears or arthritis, this exciting new procedure (made popular by professional athletes) that heals damaged structures in a joint such as the labrum, tendons, muscle, ligament or cartilage is showing exciting results!

How does PRP work?

When you cut your skin and it bleeds, platelets collect and gather at the wound site. Once there, platelets act like a conductor in an orchestra. They release growth factors that signal the healing activities to begin, resulting in a cascade of events that restore the damaged tissue.

Joints, however, do not have a direct blood supply. Therefore, when a joint structure is damaged or torn, platelets do not gather and orchestrate the necessary events for that damage to be restored. Joint damage either heals slowly or not at all. That is where Platelet Rich Plasma Therapy (PRP) proves valuable!

How is the procedure performed?

By taking a small sample of your blood, a special centrifuge concentrates and separates the platelets, growth factors and specialized white blood cells from the other components of the blood. This super concentrated PRP is then injected using continuous ultrasound guidance into the cracks and crevices of the damaged area. The orchestra of events is stimulated and the tissue begins to heal. The result is reduced inflammation and pain.

AmnioFix: Healing Damage – Tears and Chronic Tendinitis:

Why use AmnioFix?

When there is damage, tissue tears or arthritis this exciting new treatment can be used to heal the structures in a joint such as the labrum, tendons, muscle, ligament or cartilage.

What is AmnioFix?

AmnioFix is a new treatment that harnesses the power of 13 growth factors in a pre-packaged application. AmnioFix is hydrolyzed micronized amniotic membrane allograft containing 13 powerful growth factors. That’s a mouth full! Amniotic Membrane has been used in wound healing for many years. By placing the allograft over wounds that aren’t healing, as with burn victims, new tissue grows. Just recently, the allograft has been processed into a form that is dehydrated and micronized.

As with the explanation above regarding platelets, damage in the body is healed by an orchestrated cascade of events guided by the release of specific growth factors in the areas where damage occurs. Because joints and surrounding tendons lack a direct blood supply, damage heals slowly or often not at all.

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increase local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

When to see a doctor:

You should see your doctor if:

  • You’re experiencing severe ankle pain
  • You have swelling
  • You have ankle pain that’s lasted more than a week
  • If you have difficulty walking or weight bearing

Pain is increasing

 


 

Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.

 

Ankle Pain

Strong enough to bear your body weight, the ankle joint can be prone to injury and pain.Your ankle, the joint where your foot and leg meet, is an intricate network of bones, ligaments, tendons and muscles. Injury to any of these structures can cause pain.

Most ankle pain is the result of a sprain, which occurs when your ankle rolls over your foot, causing a ligament to stretch or tear. Though sprains are often sports-related, they can also occur when you walk on an uneven surface or simply take a misstep.You may feel pain on the inside or outside of your ankle or along the Achilles tendon, which connects the muscles in your lower leg to your heel bone. Because ankle pain can sometimes indicate a serious problem, severe ankle pain should be evaluated by your doctor, especially if it follows an injury. Though mild ankle pain often responds well to home treatments, it can take time to go away. See your doctor when any ankle pain does not improve in a few weeks.

Optimum Joint is currently one of a few practices authorized to conduct IRB (Institutional Review Board) clinical studies using Lipogems. Lipogems are fat clusters taken from the same patient they are used to treat, by use of a local anesthetic, with no sedation required in one single office visit.

The study is titled: Clinical Evaluation of Autologous Micro-Fragmented Adipose Tissue as a Treatment Option for Ankle Pain from Osteoarthritis and/or Tendon Tears.

The study is a non-randomized study to evaluate the effects of non-digested micro-fragmented adipose tissue (fat = Lipogems) on patients with complex joint pain from osteoarthritis and/or concurrent ankle joint abnormalities. Patients will be treated with by intra articular injection under ultrasound guidance and evaluated using follow up imaging, range of motion, pain, and functional scores for up to two years.

The early results are showing significant gains in the vast majority of cases treated.

Achilles Tendinitis

Your Achilles tendon is a large band of tissue connecting the muscles in the back of your lower leg to your heel bone. Also called the heel cord, the Achilles tendon is used when you walk, run, jump or push up on your toes.

Achilles tendinitis, a common cause of ankle pain, is inflammation of the Achilles tendoncaused by repetitive or intense strain on the tendon. It is often a running or other sport-related injury resulting from overuse, intense exercise, jumping, or other activities that strain the tendon and calf muscles.

The most common sign of Achilles tendinitis is pain that develops gradually and worsens over time.

Other signs and symptoms include:

  • Mild ache or pain at the back of the leg and above the heel after running or other sports activity
  • Episodes of more severe pain associated with prolonged running, stair climbing or intense exercise, such as sprinting
  • Tenderness or stiffness, especially in the morning, that usually improves with mild activity
  • Mild swelling or a “bump” on your Achilles tendon
  • A crackling or creaking sound when you touch or move your Achilles tendon
  • Weakness or sluggishness in your lower leg

Bursitis is a painful condition that affects the back of the heel. Small fluid-filled padscalled bursaact as cushionsas they lie between a tendon and a bone to prevent excess friction. Bursitis occurs when a bursa becomes inflamed.

If you have bursitis, the affected joint may:

  • Feel achy or stiff
  • Hurt more when you move it or press on it
  • Look swollen and red
  • Prevent you from weight bearing

Ligament injuries occurs when one of the ligaments most commonly on the outside of your ankle become strained or sprained by a slip, fall or rolling your ankle over. The area on the outside or inside of your ankle becomes painful.

If you have a ligament injury, the affected joint may have:

  • Pain and tenderness in your ankle, especially with certain ranges of motion
  • Swelling or redness at you ankle
  • Loss of range of motion
  • Pain with weight bearing

Osteoarthritis

Osteoarthritis occurs when the surfaces in the joint begin wear down.

What Is Osteoarthritis?

The joints of the body are normally surrounded by a fluid that acts as a lubricant and shock absorber. This fluid is lacking in patients with osteoarthritis, and leads to pain and inflammation in the joints.

Osteoarthritis, also known as degenerative joint disease, is the most common form of arthritis. It occurs when the cartilage that covers the tops of bones, known as articular cartilage, degenerates or wears down. The roughened and jagged bone surfaces become inflamed causing swelling, pain, and sometimes the development of osteophytes or bone spurs when the ends of the two bones rub together.

What Is Osteoarthritis of the Ankle?

The ankle is made up of several joints on the top and sides of your ankle. Osteoarthritis can affect any of these joints causing chronic pain.

What Are the Symptoms of Ankle Osteoarthritis?

As with most osteoarthritis, pain is aprimary symptom. A person is likely to have pain with activity, certain ranges of motion and at rest due to inflammation-causing difficulty sleeping. Range of motion generally decreases over time.

Tarsal tunnel syndrome(TTS), also known as posterior tibial neuralgia, is a compression neuropathy and painful foot condition in which the tibial nerve is compressed as it travels through the tarsal tunnel on the inside of the ankle joint.

Patients with TTS typically complain of numbness in the foot radiating to the big toe and the first 3 toes, pain, burning, electrical sensations, and tingling over the base of the foot and the heel.

Some of the symptoms are:

  • Pain and tingling in and around ankles and sometimes the toes
  • Swelling of the feet
  • Painful burning, tingling, or numb sensations in the lower legs—pain worsens and spreads after standing for long periods and/or pain is worse with activity and is relieved by rest
  • Electric shock sensations
  • Pain radiating up into the leg, and down into the arch, heel, and toes
  • Hot and cold sensations in the feet
  • A feeling as though the feet do not have enough padding
  • Pain while operating automobiles
  • Pain along the Posterior Tibial nerve path
  • Burning sensation on the bottom of foot that radiates upward reaching the knee
  • “Pins and needles”-type feeling and increased sensation on the feet

Plantar fasciitis(PF) is a painful inflammatory process of the plantar fascia, the connective tissue on the bottom of your foot that causes foot, heel and ankle pain. It is often caused by overuse of the plantar fascia or arch tendon of the foot. It is a very common condition and can be treated effectively in most cases. Another common term for the affliction is “policeman’s heel”.

The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is an increased probability of knee pain, especially among runners.

How Is Ankle Pain Diagnosed?

History and Examination: A history of your complaints including duration, what makes it better and worse is very important. Previous treatments and outcomes, as well as orthopedic examination of the muscles, joint, movement and strength are also used for diagnosis.

X-rays: Plain X-rays can reveal narrowing of the space in the two joints of the ankle, revealing wear and tear on the cartilage from arthritis like diseases and bone spurs that can interfere with movement.

MRI (Magnetic Resonance Imaging): Is a noninvasive procedure that can reveal the detail of the joints, ligaments and tendons.

Myelography/CT scanning: Sometimes used as an alternative to MRI

Diagnostic ultrasound Imaging: Unlike an x-ray, which emits radiation and shows only bone, diagnostic ultrasound is non-invasive and allows for viewing the causes of your ankle pain with great accuracy. With musculoskeletal ultrasound imaging (MSUS), the muscles, tendons, ligaments, cartilage and joint can be accurately examined at the time of your visit. This provides immediate information about the health of your joint and what factors are contributing to your pain. With this information in hand, specific treatment options can be established immediately!

New Treatment Using LIPOGEMS® Could Be the Answer for Arthritis Pain

LIPOGEMS® is a new treatment option for arthritis pain now offered by Dr. Norma Bilbool, M.D., a double board certified physician specializing in Physical Medicine and Rehabilitation and Pain Medicine and Richard D. Striano D.C., RMSK Registered in Diagnostic Medical Musculoskeletal Sonography. The combination of advanced imaging techniques with ultrasound to diagnose and precisely guide treatment, and physician experience with treating all joints with minimally invasiveLIPOGEMS® has led to the majority of patients treated having significant improvement with less pan, improved function and quality of life.

LIPOGEMS® could be the solution to those who suffer from pain in the shoulder, lower back, hip, knee, ankle and other joints including the rotator. Optimum Joint, is equipped and has been performing ongoing clinical studies on the shoulder, rotator cuff, lower back, hip and ankle pain where a patient’s own fat is used to alleviate arthritis related conditions many of which have failed to respond to other treatment methods including bone-on-bone joints. Optimum was among the first practices in the USA trained in the state-of-the-art treatment through LIPOGEMS® technology that is a minimally invasive same day procedure, performed in about an hour, using local anesthetic with no sedation required and no down time. This could be the answer for many of those looking to avoid surgery.

The Autologous (fat from you and put back into you) Micro-Fragmented Adipose Tissue (LIPOGEMS®) is a NEW technology where fat is taken from the patient, using a local anesthetic, washed, and micro-fragmented, using the LIPOGEMS® system. Micro-fragmented fat using the LIPOGEMS® system mechanically supports and cushions joints, and holds regenerative capabilities and when re-injected can decrease inflammation, cushion, repair or replace defects in damaged tendons and cartilage, or other tissue.

The fat is injected using continuous ultrasound guidance to ensure pin point accuracy in treating the joint and surrounding damaged tendons to repair and restructure damaged tissue with pin-point accuracy. Research has shown non-guided “blind” injections are accurate 36% – 60% of the time while ultrasound guided injections are 100% accurate. Accuracy in delivering regenerative treatments is essential. We are evaluating the LIPOGEMS®, made with an FDA cleared device, for their ability to cushion, repair, or replace damaged tissue and the regenerative effects of the fat it contains, to jump-start repair and decrease inflammation.

“This is an extraordinary study because of its use of micro-fragmented fat tissue, which makes it more bioavailable to the area we inject, and by using the precision of ultrasound guidance the treatment is visualized being delivered to each area of the joint and tissues in need of repair. This combination of support and regenerative regenerative elements with the precision of advanced ultrasound guidance is contributing to the long term impressive results.

 NEW STUDY: Adipose tissue contains Adipose Derived Stem Cells “ADSC’s” and more than 600 secreted proteins and included key molecules involved in tissue regeneration. Stem Cell Res Ther. 2015; 6: 221.

NEW STUDY: Lipogems Product Treatment Increases the Proliferation Rate of Human Tendon Stem Cells without Affecting Their Stemness and Differentiation Capability. Results showed that the Lipogems product significantly increases the proliferation rate of hTSCs (human tendon stem cells). Moreover, treated cells increase the expression of VEGF, which is crucial for tissue healing. Stem Cells International Volume 2016 (2016), Article ID 4373410, 11 pages

Dr’s Bilbool and Striano are among few doctors in the country offering IRB- approved regenerative treatment options, with a focus on minimally invasive alternatives to surgery. Their work has been recognized and new studies are being published this year.

Treatment Cortisone Injection:

Painful arthritic joints, chronic tendinitis, bursitis and inflammation respond quickly to cortisone. In many cases this is the head start patients need to allow for gains with more conservative care and no further treatment is required. Many patients think that cortisone is bad for you. Too much of anything is not good. Using cortisone infrequently, as much as several times per year will not do any harm. If the pain continues to return, other treatment options should be considered.

Cortisone is injected using continuous live ultrasound guidance exactly where it is needed to quickly reduce inflammation and pain.

Lubrication for Arthritis:

Why Hyalgan?

A squeaky gear needs the most oil!

The joints of the body are normally surrounded by a lubricant and shock absorber called Synovial fluid. Patients with osteoarthritis experience pain and inflammation because arthritic damage in theankle causes the Synovial fluid to break down over time.

This process causes increased friction and excess wear and tear on the cartilage cushioning movement that becomes rough and jagged causing the joint further deteriorate. Range of motion, walking, getting up from a seated position, climbing and descending steps and weight bearing is often painful. Pain is often increased during or after activity.

What is Hyalgan?

Hyalgan is a naturally derived lubricant that instantly cushions and lubricates painful arthritic joints. By restoring lubrication and cushion, your joints move more freely again with less friction and most importantly, less pain. Hyalgan is injected using continuous live ultrasound guidance ensuring pin-point accuracy exactly where it is needed.

The joints of the body are normally surrounded by a fluid that acts as a lubricant and shock absorber. This fluid is lacking in patients with osteoarthritis, and leads to pain and inflammation in the joints.

Platelet Rich Plasma Therapy (PRP): Jump starting the healing signals:

Why use PRP?

When there is damage, tissue tears or arthritis, this exciting new procedure (made popular by professional athletes) that heals damaged structures in a joint such as the labrum, tendons, muscle, ligament or cartilage is showing exciting results!

How does PRP work?

When you cut your skin and it bleeds, platelets collect and gather at the wound site. Once there, platelets act like a conductor in an orchestra. They release growth factors that signal the healing activities to begin, resulting in a cascade of events that restore the damaged tissue.

Joints, however, do not have a direct blood supply. Therefore, when a joint structure is damaged or torn, platelets do not gather and orchestrate the necessary events for that damage to be restored. Joint damage either heals slowly or not at all. That is where Platelet Rich Plasma Therapy (PRP) proves valuable!

How is the procedure performed?

By taking a small sample of your blood, a special centrifuge concentrates and separates the platelets, growth factors and specialized white blood cells from the other components of the blood. This super concentrated PRP is then injected using continuous ultrasound guidance into the cracks and crevices of the damaged area. The orchestra of events is stimulated and the tissue begins to heal. The result is reduced inflammation and pain.

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increase local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

When to see a doctor:

You should see your doctor if:

  • You’re experiencing severe ankle pain
  • You have swelling
  • You have ankle pain that’s lasted more than a week
  • If you have difficulty walking or weight bearing
  • Pain is increasing

 


 

Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.

 

Knee Pain

In the simplest terms, a joint occurs wherever two bones come together; however, that definition does not begin to convey the complexity of joints, which provide your body with flexibility, support and a wide range of motion.

You have four types of joints: fixed, pivot, ball-and-socket and hinge. Your knees are hinge joints. As the name suggests, they work much like the hinge of a door, allowing the joint to move backward and forward. Your knees are the largest and heaviest hinge joints in your body, and the most complex. In addition to bending and straightening, they twist and rotate. This makes them especially vulnerable to damage, which is why they sustain more injuries on average than do other joints.

A Closer Look at Your Knees

Your knee joint is essentially four bones held together by ligaments. Your thighbone (femur) makes up the top part of the joint, and two lower leg bones, the tibia and the fibula, comprise the lower part. The fourth bone, the patella, slides in a groove on the end of the femur.

Other structures in your knee include:

  • Ligaments: These are large bands of tissue that connect bones to one another. In the knee joint, four main ligaments link the femur to the tibia and help stabilize your knee as it moves through its arc of motion.
  • Tendons: These fibrous bands of tissue connect muscles to bones. Your knee has two important tendons, which make it possible for you to straighten or extend your leg: the quadriceps tendon, which connects the long quadriceps muscle on the front of your thigh to the patella, and the patellar tendon, which connects the patella to the tibia.
  • Meniscus: This C-shaped cartilage curves around the inside and outside of your knee, cushioning your knee joint.
  • Bursae: A number of these fluid-filled sacs surround your kneeand help cushion your knee joint, so that ligaments and tendons slide across it smoothly.

Normally, all of these structures work together efficiently, but injury and disease can disrupt this balance, resulting in pain, muscle weakness and decreased function.

Some common causes of knee pain and injuries include:

  • A ruptured ligament or torn cartilage, resulting from forceful contact during sports, a fall or a car accident
  • Repeated stress or overuse, which may occur from playing sports or if your work or hobby requires repetition of the same activity
  • Sudden turning, pivoting, stopping, or cutting from side to side, which happens frequently during certain sports
  • Awkward landings from a fall or jumping during sports, such as basketball
  • Rapidly growing bones, which are especially prone to injury during sports
  • Degeneration from aging or medical conditions, including arthritis, gout and infection

If you’re suffering from knee pain, you are not alone. Almost one in three Americans older than age 45 reportssome type of knee pain. It is a common cause for doctor and emergency room visits.

Some of the more common knee injuries and their signs and symptoms include the following:

Ligament Injuries: Your knee contains four ligaments — tough bands of tissue that connect your thighbone (femur) to your lower leg bones (tibia and fibula). You have two collateral ligaments — one on the inside (medial collateral ligament) and one on the outside (lateral collateral ligament) of each knee. The other two ligaments are inside your knee and cross each other as they stretch diagonally from the bottom of your thighbone to the top of your shinbone (tibia). The posterior cruciate ligament (PCL) connects to the back of your shinbone, and the anterior cruciate ligament (ACL) connects near the front of your shinbone. A tear in one of these ligaments, which may be caused by a fall or contact trauma, is likely to cause:

  • Immediate pain that worsens when you try to walk or bend your knee
  • A popping sound
  • An inability to bear weight on the injured knee
  • A feeling that the knee might buckle or give way

Tendon Injuries (tendinitis): Tendinitis is irritation and inflammation of one or more tendons — the thick, fibrous cords that attach muscles to bones. Athletes, especially runners, skiers and cyclists, are prone to develop inflammation in the patellar tendon, which connects the quadriceps muscle on the front of the thigh to the larger lower leg bone (tibia). If your knee pain is caused by tendinitis, some of the signs and symptoms include:

  • Pain, in one or both knees
  • Swelling in the front of the knee or just below the kneecap
  • Worsening pain when you jump, run, squat or climb stairs
  • An inability to completely extend or straighten your knee

Meniscus injuries: The meniscus is a C-shaped piece of cartilage that curves within your knee joint. Meniscus injuries involve tears in the cartilage, which can occur in various places and configurations. Signs and symptoms of this type of injury include:

  • Pain
  • Mild to moderate swelling that occurs slowly, around 24 to 36 hours after the injury
  • An inability to straighten the knee completely; the knee may feel locked in place

Bursitis: Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint so that tendons and ligaments glide smoothly over the joint. Bursitis can lead to:

  • Warmth
  • Swelling
  • Redness
  • Pain, even at rest
  • Aching or stiffness when you walk
  • Considerable pain when you kneel or go up and down stairs
  • Fever, pain and swelling if the bursa located over your kneecap bone (prepatellar bursa) becomes infected

Loose body: Sometimes a piece of bone or cartilage will break off and float in the joint space because it has degenerated or sustained injury. This may not create any problems unless the loose body interferes with knee joint movement. The effect is similar to a pencil caught in a door hinge — leading to pain and a locked joint.

Iliotibial band syndrome: This occurs when the ligament that extends from the outside of your pelvic bone to the outside of your tibia (iliotibial band) becomes so tight that it rubs against the outer portion of your femur. Distance runners are especially susceptible to iliotibial band syndrome, which generally causes:

  • A sharp, burning pain on the outer side of the knee that usually begins after longer distance runs
  • Pain that initially goes away with rest from running, but in time, may persist when you walk or go up and down stairs

With this type of knee injury, there usually isn’t swelling and you’ll likely have normal range of motion.

Rheumatoid arthritis: The most debilitating of the more than 100 types of arthritis, rheumatoid arthritis can affect almost any joint in your body, including your knees. Common signs and symptoms include:

  • Pain
  • Swelling
  • Aching and stiffness, especially when you get up in the morning or after periods of inactivity
  • Loss of motion in your knees and eventually deformity of the knee joints
  • Sometimes, a low-grade fever and a general sense of not feeling well (malaise)

Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go. Periods of increased disease activity — called flare-ups or flares, often alternate with periods of remission.
Osteoarthritis: Sometimes called degenerative arthritis, this is the most common type of arthritis. It’s a wear-and-tear condition that occurs when the cartilage in your knee deteriorates with use and age. Osteoarthritis usually develops gradually and tends to cause:

  • Varying degrees of pain, especially when you stand or walk
  • Swelling
  • Stiffness, especially in the morning and after you’ve been active
  • Creaking or popping sounds
  • A loss of flexibility in your knee joints

Chondromalacia of the patella, or patellofemoral pain: These are general terms that refer to pain arising between your patella and the underlying thighbone (femur). It is common in young adults ( especially those who have a slight misalignment of the kneecap), in athletes and in older adults who usually develop the condition as a result of arthritis of the kneecap. Chondromalacia of the patella causes:

  • Pain and tenderness in the front of your knee that worsens when you sit for long periods, get up from a chair, and climb or descend stairs
  • A grating or grinding sensation may be present when you extend your knee

How Is Knee Pain Diagnosed?

History and Examination: A history of your complaints including duration, what makes it better and worse is very important. Previous treatments and outcomes, as well as orthopedic examination of the muscles, joint, movement and strength are also used for diagnosis

X-rays: Plain X-rays can show narrowing of the space in the two joints of the knee —revealing wear and tear on the cartilage from arthritis like diseases and bone spurs that can interfere with movement.

MRI: Magnetic Resonance Imaging: Is a noninvasive procedure that can reveal the detail of knee ligaments, tendons and cartilage including tears in the meniscus.

Myelography/CT scanning: Sometimes used as an alternative to MRI

Diagnostic ultrasound Imaging: Unlike an x-ray, which emits radiation and shows only bone, diagnostic ultrasound is non-invasive and allows for viewing the causes of your knee joint pain with great accuracy. With musculoskeletal ultrasound imaging (MSUS), the muscles, tendons, ligaments, cartilage and joint can be accurately examined at the time of your visit. This provides immediate information about the health of your joint and what factors are contributing to your pain. With this information in hand, specific treatment options can be established immediately!

Treatment

When the joint is painful or damaged there are a variety of successful treatment options.

Why are ultrasound-guided injections better and more accurate?

When using an injection to deliver treatment into painful joints, it is necessary to be exact and precise.

Dr. Isidro and his team are highly trained in ultrasound-guided injections. These procedures are performed in the office, at the time of your visit. Some of the common structures involved in joint pain may be as little as 2-3mm wide and therefore require a high level of precision to be accurate. In addition, when performing an injection, there are also structures that you want to avoid so you don’t knick or damage them on your way into the joint. The ultrasound machine provides live imaging in real time, to safely place injectable medications or treatments into or around the joint with laser-like precision.

Consider trying to hit a target blindfolded¾you may know the general direction but would not be certain if you have actually hit your target. With live ultrasound imaging, the targeted areas of pain are viewed in real time while the injection is taking place, guiding the needle with pin-point accuracy!

Cortisone Injection: Painful arthritic joints, chronic tendinitis, bursitis and inflammation respond quickly to cortisone. In many cases this is the head start patients need to allow for gains with more conservative care and no further treatment is required. Many patients think that cortisone is bad for you. Too much of anything is not good. Using cortisone infrequently, as much as several times per year will not do any harm. If the pain continues to return, other treatment options should be considered.Cortisone is injected using continuous live ultrasound guidance exactly where it is needed to quickly reduce inflammation and pain.

New Treatment Using LIPOGEMS® Could Be the Answer for Arthritis Pain

LIPOGEMS® is a new treatment option for arthritis pain now offered by Dr. Norma Bilbool, M.D., a double board certified physician specializing in Physical Medicine and Rehabilitation and Pain Medicine and Richard D. Striano D.C., RMSK Registered in Diagnostic Medical Musculoskeletal Sonography. The combination of advanced imaging techniques with ultrasound to diagnose and precisely guide treatment, and physician experience with treating all joints with minimally invasiveLIPOGEMS® has led to the majority of patients treated having significant improvement with less pan, improved function and quality of life.

LIPOGEMS® could be the solution to those who suffer from pain in the shoulder, lower back, hip, knee, ankle and other joints including the rotator. Optimum Joint, is equipped and has been performing ongoing clinical studies on the shoulder, rotator cuff, lower back, hip and ankle pain where a patient’s own fat is used to alleviate arthritis related conditions many of which have failed to respond to other treatment methods including bone-on-bone joints. Optimum was among the first practices in the USA trained in the state-of-the-art treatment through LIPOGEMS® technology that is a minimally invasive same day procedure, performed in about an hour, using local anesthetic with no sedation required and no down time. This could be the answer for many of those looking to avoid surgery.

The Autologous (fat from you and put back into you) Micro-Fragmented Adipose Tissue (LIPOGEMS®) is a NEW technology where fat is taken from the patient, using a local anesthetic, washed, and micro-fragmented, using the LIPOGEMS® system. Micro-fragmented fat using the LIPOGEMS® system mechanically supports and cushions joints, and holds regenerative capabilities and when re-injected can decrease inflammation, cushion, repair or replace defects in damaged tendons and cartilage, or other tissue.

The fat is injected using continuous ultrasound guidance to ensure pin point accuracy in treating the joint and surrounding damaged tendons to repair and restructure damaged tissue with pin-point accuracy. Research has shown non-guided “blind” injections are accurate 36% – 60% of the time while ultrasound guided injections are 100% accurate. Accuracy in delivering regenerative treatments is essential. We are evaluating the LIPOGEMS®, made with an FDA cleared device, for their ability to cushion, repair, or replace damaged tissue and the regenerative effects of the fat it contains, to jump-start repair and decrease inflammation.

“This is an extraordinary study because of its use of micro-fragmented fat tissue, which makes it more bioavailable to the area we inject, and by using the precision of ultrasound guidance the treatment is visualized being delivered to each area of the joint and tissues in need of repair. This combination of support and regenerative regenerative elements with the precision of advanced ultrasound guidance is contributing to the long term impressive results.

 NEW STUDY: Adipose tissue contains Adipose Derived Stem Cells “ADSC’s” and more than 600 secreted proteins and included key molecules involved in tissue regeneration. Stem Cell Res Ther. 2015; 6: 221.

NEW STUDY: Lipogems Product Treatment Increases the Proliferation Rate of Human Tendon Stem Cells without Affecting Their Stemness and Differentiation Capability. Results showed that the Lipogems product significantly increases the proliferation rate of hTSCs (human tendon stem cells). Moreover, treated cells increase the expression of VEGF, which is crucial for tissue healing. Stem Cells International Volume 2016 (2016), Article ID 4373410, 11 pages

Dr’s Bilbool and Striano are among few doctors in the country offering IRB- approved regenerative treatment options, with a focus on minimally invasive alternatives to surgery. Their work has been recognized and new studies are being published this year.

Lubrication for Arthritis:

Why Hyalgan?

A squeaky gear needs the most oil!

The joints of the body are normally surrounded by a lubricant and shock absorber called Synovial fluid. Patients with osteoarthritis experience pain and inflammation because arthritic damage in thejoint causes the Synovial fluid to break down over time.

This process causes increased friction and excess wear and tear on the cartilage cushioning movement that becomes rough and jagged causing the joint further deteriorate. Range of motion, walking, getting up from a seated position, climbing and descending steps and weight bearing is often painful. Pain is often increased during or after activity.

What is Hyalgan?

Hyalgan is a naturally derived lubricant that instantly cushions and lubricates painful arthritic joints. By restoring lubrication and cushion, your joints move more freely again with less friction and most importantly, less pain. Hyalgan is injected using continuous live ultrasound guidance ensuring pin-point accuracy exactly where it is needed.

Platelet Rich Plasma Therapy (PRP): Jump starting the healing signals:

Why use PRP?

When there is damage, tissue tears or arthritis, this exciting new procedure (made popular by professional athletes) that heals damaged structures in a joint such as the labrum, tendons, muscle, ligament or cartilage is showing exciting results!

How does PRP work?

When you cut your skin and it bleeds, platelets collect and gather at the wound site. Once there, platelets act like a conductor in an orchestra. They release growth factors that signal the healing activities to begin, resulting in a cascade of events that restore the damaged tissue.

Joints, however, do not have a direct blood supply. Therefore, when a joint structure is damaged or torn, platelets do not gather and orchestrate the necessary events for that damage to be restored. Joint damage either heals slowly or not at all. That is where Platelet Rich Plasma Therapy (PRP) proves valuable!

How is the procedure performed?

By taking a small sample of your blood, a special centrifuge concentrates and separates the platelets, growth factors and specialized white blood cells from the other components of the blood. This super concentrated PRP is then injected using continuous ultrasound guidance into the cracks and crevices of the damaged area. The orchestra of events is stimulated and the tissue begins to heal. The result is reduced inflammation and pain.

Lipogems Regenerative Medicine: Healing Damage – Tears and Chronic Tendinitis:

As with the explanation above regarding platelets, damage in the body is healed by an orchestrated cascade of events guided by the release of specific growth factors in the areas where damage occurs. Because joints and surrounding tendons lack a direct blood supply, damage heals slowly or often not at all.

Lipogems Regenerative Medicine is hydrolyzed micronized amniotic membrane allograft. Lipogems Regenerative Medicine contains 13 powerful growth factors. That’s a mouth full! Amniotic Membrane has been used in wound healing for many years. By placing the allograft over wounds that aren’t healing, as with burn victims, new tissue grows. Just recently, the allograft has been processed into a form that is dehydrated and micronized.

Lipogems Regenerative Medicine is pre-packaged and injected using continuous, live ultrasound guidance exactly where the damage is. This begins to jump start and boost the healing response so joints function better with less inflammation and less pain.

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increase local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

When to see a doctor 

You should see your doctor if:

  • You’re experiencing severe knee pain
  • You’re activities are becoming restricted
  • You have increased pain with activity
  • You have pain that is gradually increasing over time
  • You’ve been told you have arthritis
  • You have pain lasting more than two weeks

 


 

Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.

 

Hip Pain

Hip pain is a general term that can stem from pain on the side of your leg, buttock pain radiating into the thigh and/or pain in the front of your leg by the groin. The area of the hip is surrounded in the front, back and sides by muscles and small pads that cushion the tendons of these muscles called Bursa. Any or all of these structures can become inflamed, injured or torn and lead to hip and leg pain.

What Causes Hip and Leg Pain?

Bursitis is a painful condition that affects the small fluid-filled pads called bursathat act as cushions among your bones, tendons and muscles near your joints. Bursitis occurs when a bursa becomes inflamed.

If you have bursitis, the affected joint may:

  • Feel achy or stiff
  • Hurt more when you move it or press on it
  • Look swollen and red   

Osteoarthritis sometimes called degenerative joint disease is the most common form of arthritis and occurs when cartilage in your joints wears down over time. This causes the normal smooth surfaces of the joint that glide over each other as you move to become rough and jagged. The normal fluid inside the joint is called Synovial fluid and functions to lubricate and cushion movement. With arthritis, the amount of Synovial fluid decreases and breaks down, causing increased wear and tear on the joint.

Osteoarthritis gradually worsens with time and no cure exists, but osteoarthritis treatments can help you relieve pain, increase mobility, slow down the wear and tear and help you remain active. The earlier you treat osteoarthritis the better!

Osteoarthritis symptoms include:

  • Pain: Your joint(s) may hurt during or after movement. Pain is often felt arising from a seated position, using stairs, and/ or crossing your leg.
  • Tenderness: Your joint may feel tender when you apply light pressure to it
  • Stiffness: Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity
  • Loss of flexibility: You may not be able to move your joint through its full range of motion
  • Grating sensation: You may hear or feel a grating sensation when you use the joint
  • Bone spurs: These extra bits of bone, which feel like hard lumps, may form around the affected joint

Piriformis Syndrome is a common neuromuscular disorder that is caused when the piriformis musclelocated in the buttock area behind your hip tightens. This can cause hip and buttock pain, as well as compression of the sciatic nerve. This muscle is important in lower body movement because it stabilizes the hip joint and lifts and rotates the thigh away from the body. This enables us to walk, shift our weight from one foot to another, and maintain balance. It is also used in sports that involve lifting and rotating the thighs.

Piriformis symptoms include:

  • Pain that can be triggered climbing steps, applyingfirm pressure in the buttock area and extended sitting.
  • Numbness or tingling into the leg
  • Sciatica pain or tingling radiating down the leg

How Is Hip Pain Diagnosed?

History and Examination: A history of your complaints including duration, what makes it better and worse is very important. Previous treatments and outcomes, as well as orthopedic examination of the muscles, joint, movement and strength are also used for diagnosis.

X-rays: Plain X-rays can reveal narrowing of the space in the joint, arthritis like diseases and bone spurs that can interfere with movement.

MRI: Magnetic Resonance Imaging is a noninvasive procedure that can reveal the detail of joint including an important fibro-cartilaginous cup or rim that supports the hip joint called the Labrum.

Myelography/CT scanning: Sometimes used as an alternative to MRI

Diagnostic Ultrasound Imaging: Unlike an x-ray, diagnostic ultrasound allows us to view the most common causes of yourhip pain with great accuracy. The bundles muscles, tendons, bursa, joint capsule and the front portion of the labrum can be examined for signs of swelling or inflammation. If the symptoms are only on one side, the symptomatic side can be compared with the non-symptomatic side. With musculoskeletal ultrasound imaging (MSUS), the joint can be accurately examined at the time of your visit.

Treatment Options We Offer

Why are ultrasound-guided injections better and more accurate?

When using an injection to deliver treatment into painful joints, it is necessary to be exact and precise.

Dr. Bilbool and her team are highly trained in ultrasound-guided injections. These procedures are performed in the office, at the time of your visit. Some of the common structures involved in joint pain may be as little as 2-3mm wide and therefore require a high level of precision to be accurate. In addition, when performing an injection, there are also structures that you want to avoid so you don’t knick or damage them on your way into the joint. The ultrasound machine provides live imaging in real time, to safely place injectable medications or treatments into or around the joint with laser-like precision.

Consider trying to hit a target blindfolded¾you may know the general direction but would not be certain if you have actually hit your target. With live ultrasound imaging, the targeted areas of pain are viewed in real time while the injection is taking place, guiding the needle with pin-point accuracy!

New Treatment Using LIPOGEMS® Could Be the Answer for Arthritis Pain

LIPOGEMS® is a new treatment option for arthritis pain now offered by Dr. Norma Bilbool, M.D., a double board certified physician specializing in Physical Medicine and Rehabilitation and Pain Medicine and Richard D. Striano D.C., RMSK Registered in Diagnostic Medical Musculoskeletal Sonography. The combination of advanced imaging techniques with ultrasound to diagnose and precisely guide treatment, and physician experience with treating all joints with minimally invasiveLIPOGEMS® has led to the majority of patients treated having significant improvement with less pan, improved function and quality of life.

LIPOGEMS® could be the solution to those who suffer from pain in the shoulder, lower back, hip, knee, ankle and other joints including the rotator. Optimum Joint, is equipped and has been performing ongoing clinical studies on the shoulder, rotator cuff, lower back, hip and ankle pain where a patient’s own fat is used to alleviate arthritis related conditions many of which have failed to respond to other treatment methods including bone-on-bone joints. Optimum was among the first practices in the USA trained in the state-of-the-art treatment through LIPOGEMS® technology that is a minimally invasive same day procedure, performed in about an hour, using local anesthetic with no sedation required and no down time. This could be the answer for many of those looking to avoid surgery.

The Autologous (fat from you and put back into you) Micro-Fragmented Adipose Tissue (LIPOGEMS®) is a NEW technology where fat is taken from the patient, using a local anesthetic, washed, and micro-fragmented, using the LIPOGEMS® system. Micro-fragmented fat using the LIPOGEMS® system mechanically supports and cushions joints, and holds regenerative capabilities and when re-injected can decrease inflammation, cushion, repair or replace defects in damaged tendons and cartilage, or other tissue.

The fat is injected using continuous ultrasound guidance to ensure pin point accuracy in treating the joint and surrounding damaged tendons to repair and restructure damaged tissue with pin-point accuracy. Research has shown non-guided “blind” injections are accurate 36% – 60% of the time while ultrasound guided injections are 100% accurate. Accuracy in delivering regenerative treatments is essential. We are evaluating the LIPOGEMS®, made with an FDA cleared device, for their ability to cushion, repair, or replace damaged tissue and the regenerative effects of the fat it contains, to jump-start repair and decrease inflammation.

“This is an extraordinary study because of its use of micro-fragmented fat tissue, which makes it more bioavailable to the area we inject, and by using the precision of ultrasound guidance the treatment is visualized being delivered to each area of the joint and tissues in need of repair. This combination of support and regenerative regenerative elements with the precision of advanced ultrasound guidance is contributing to the long term impressive results.

 NEW STUDY: Adipose tissue contains Adipose Derived Stem Cells “ADSC’s” and more than 600 secreted proteins and included key molecules involved in tissue regeneration. Stem Cell Res Ther. 2015; 6: 221.

NEW STUDY: Lipogems Product Treatment Increases the Proliferation Rate of Human Tendon Stem Cells without Affecting Their Stemness and Differentiation Capability. Results showed that the Lipogems product significantly increases the proliferation rate of hTSCs (human tendon stem cells). Moreover, treated cells increase the expression of VEGF, which is crucial for tissue healing. Stem Cells International Volume 2016 (2016), Article ID 4373410, 11 pages

Dr’s Bilbool and Striano are among few doctors in the country offering IRB- approved regenerative treatment options, with a focus on minimally invasive alternatives to surgery. Their work has been recognized and new studies are being published this year.

Cortisone Injection:

Painful arthritic joints, chronic tendinitis, bursitis and inflammation respond quickly to cortisone. In many cases this is the head start patients need to allow for gains with more conservative care and no further treatment is required. Many patients think that cortisone is bad for you. Too much of anything is not good. Using cortisone infrequently, as much as several times per year will not do any harm. If the pain continues to return, other treatment options should be considered.

Cortisone is injected using continuous live ultrasound guidance exactly where it is needed to quickly reduce inflammation and pain.

Lubrication for Arthritis:

Why Hyalgan?

A squeaky gear needs the most oil!

The joints of the body are normally surrounded by a lubricant and shock absorber called Synovial fluid. Patients with osteoarthritis experience pain and inflammation because arthritic damage in thejoint causes the Synovial fluid to break down over time.

This process causes increased friction and excess wear and tear on the cartilage cushioning movement that becomes rough and jagged causing the joint further deteriorate. Range of motion, walking, getting up from a seated position, climbing and descending steps and weight bearing is often painful. Pain is often increased during or after activity.

What is Hyalgan?

Hyalgan is a naturally derived lubricant that instantly cushions and lubricates painful arthritic joints. By restoring lubrication and cushion, your joints move more freely again with less friction and most importantly, less pain. Hyalgan is injected using continuous live ultrasound guidance ensuring pin-point accuracy exactly where it is needed.

Platelet Rich Plasma Therapy (PRP): Jump starting the healing signals:

Why use PRP?

When there is damage, tissue tears or arthritis, this exciting new procedure (made popular by professional athletes) that heals damaged structures in a joint such as the labrum, tendons, muscle, ligament or cartilage is showing exciting results!

How does PRP work?

When you cut your skin and it bleeds, platelets collect and gather at the wound site. Once there, platelets act like a conductor in an orchestra. They release growth factors that signal the healing activities to begin, resulting in a cascade of events that restore the damaged tissue.

Joints, however, do not have a direct blood supply. Therefore, when a joint structure is damaged or torn, platelets do not gather and orchestrate the necessary events for that damage to be restored. Joint damage either heals slowly or not at all. That is where Platelet Rich Plasma Therapy (PRP) proves valuable!

How is the procedure performed?

By taking a small sample of your blood, a special centrifuge concentrates and separates the platelets, growth factors and specialized white blood cells from the other components of the blood. This super concentrated PRP is then injected using continuous ultrasound guidance into the cracks and crevices of the damaged area. The orchestra of events is stimulated and the tissue begins to heal. The result is reduced inflammation and pain.

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increases local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

When to see a doctor

  • Your activity is being restricted by pain
  • Before you pain becomes severe
  • Pain is getting worse or not improving in two weeks
  • Sharp or shooting pain, especially when you exercise or exert yourself
  • A fever
  • Swelling or stiffness in your joints that lasts for more than two weeks

 


 

Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.

 

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a condition whereby the median nerve in the wrist is compressed. A group of tendons travel through the carpal tunnel along with the nerve. Swelling or inflammation of the tendons or nerve causes pressure and compression of the median nerve (shown in blue in the image above). The median nerve is a mixed nerve, meaning it has a sensory function (provides feeling) and also provides nerve signals to move your muscles (motor function). The median nerve provides sensation to your thumb, index finger, middle finger and the middle-finger side of the ring finger. Problem with the nerve causes numbness (often worse at night or upon awakening in the morning), tingling, pain and weakness of the grip.

Common causes of Carpal Tunnel Syndrome

Although it might seem that carpal tunnel syndrome is a condition born from long hours spent working on a computer keyboard, it actually has numerous causes.

Bound by bones and ligaments, the carpal tunnel is a narrow passageway — about as big around as your thumb — located on the palm side of your wrist. This tunnel protects a main nerve to your hand and nine tendons that bend your fingers. Pressure placed on the nerve produces the numbness, tingling, pain and, eventually, hand weakness that characterize carpal tunnel syndrome. Carpal tunnel syndrome typically starts gradually with a vague aching in your wrist that can extend to your hand or forearm.

Common Symptoms include:

  • Numbness or tingling, pins and needles in the first three fingers and part of the ring finger
  • Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers, especially after forceful or repetitive use. This usually occurs on the palm side of your forearm.
  • A sense of weakness in your hands and a tendency to drop objects.
  • Waking at night or during the day having to shake your hands out to wake them up
  • Hands falling asleep when you keep them in one position.

Why is diagnostic ultrasound important when examining the Carpal Tunnel and Wrist?

Unlike an x-ray, which emits radiation and shows only bone, diagnostic ultrasound is non-invasive, allowing us to view the causes of your wrist and hand pain with great accuracy. The bundles of tendons and the sheath that surround them can be examined for signs of swelling or inflammation. The nerve can be measured within the Carpal Tunnel and compared with normal values to obtain a preliminary diagnosis. If the symptoms are only on one side, the symptomatic side can be compared with the non-symptomatic side.

With musculoskeletal ultrasound imaging (MSUS), the muscles, tendons, ligaments, cartilage and nerves can be accurately examined at the time of your visit. No referrals are needed and there is no waiting for the test results!

Patent with right hand symptoms: Left wrist and right wrist side-by-side on the same film for comparison showing an enlarged right median nerve and swollen tendons consistent with Carpal Tunnel Syndrome.

 

 

 

 

 

 

 

 

 

Below is a different viewing angle of the same patient as above.

Left wrist and right wrist side-by-side on the same film for comparison showing an enlarged right median nerve and swollen tendons in a different viewing angle consistent with Carpal Tunnel Syndrome.

 

 

 

 

 

Nerve testing

EMG/NCV nerve testing is also done in some cases and measures the degree and severity of changes in nerve function. The nerve test measures the speed at which the nerve signal travels as it passes through the carpal tunnel. With Carpal Tunnel Syndrome the speed of the nerve impulse is slowed down due to compression of the nerve.

Treatment

Most patients we see are told there is no treatment other than surgery. That is not true in many cases we care for.

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increases local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

Injections:Why are ultrasound-guided injections better and more accurate?

When using an injection to deliver treatment into the Carpal Tunnel, it is necessary to be exact and precise. Consider trying to hit a target blindfolded¾you may know the general direction but would not be certain if you have actually hit your target. With live ultrasound imaging, the targeted areas of pain are viewed in real time while the injection is taking place, guiding the needle with pin-point accuracy!

Dr. Isidro and his team are highly trained in ultrasound-guided injections. These procedures are performed in the office, at the time of your visit. Some of the common structures involved in joint pain may be as little as 2-3mm wide and therefore require a high level of precision to be accurate. In addition, when performing an injection, there are also structures that you want to avoid so you don’t knick or damage them on your way into the joint. The ultrasound machine provides live imaging in real time, to safely place a specialized combination of saline and cortisone directed above and below the nerve to “lift off” the ligament and medicate the tendons with anti-inflammatory treatment to reduce swelling. The result is a rapid reduction in symptoms.

When should you see a doctor?

  • If you have pain in the wrist or forearm for more than two weeks
  • If your symptoms are getting worse
  • If you shake your hands out to wake them up during the day or in the morning
  • If you have numbness or tingling in your hands
  • If your grip is weak or you drop things

 


 

Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.

 

Back Pain

Middle and Lower Back Pain, Disc Herniation, Pinched Nerves and Spinal Stenosis

Middle and lower back pain is a common complaint. Back pain can become chronic and worsen over time if left untreated. In general, symptoms lasting more than two weeks or symptoms that are getting worse should be checked by a doctor. If the pain begins to radiate to the hip, buttock or down the leg you should see a doctor. The history, precise location and severity of your back pain provide important clues in determining what might be causing it. It is also common for middle back pain to radiate to the shoulder blades or rib cage.

What Causes Middle and Lower Back Pain?

  • Strains between the shoulders or ribs
  • Abnormalities in the bone or joints
  • Trauma
  • Poor posture
  • Arthritis – Degenerative diseases
  • Tumors
  • Muscle strain
  • Herniated disc
  • Pinched nerves
  • Joint inflammation

How Is Back Pain Diagnosed?

History and Examination: A history of your complaints including duration, what makes it better and worse is very important. Previous treatments and outcomes, as well as orthopedic examination of the muscles, joint, movement and strength are also used for diagnosis.

X-rays: Plain X-rays can reveal narrowing of the space between two spinal bones, arthritis like diseases, tumors, slipped discs, narrowing of the spinal canal, fractures and instability of the spinal column.

MRI: Magnetic Resonance Imaging is a noninvasive procedure that can reveal the detail of neural (nerve-related) elements.

Myelography/CT scanning: Sometimes used as an alternative to MRI

Electrodiagnosticstudies: Nerve Testing: Electromyography (EMG) and nerve conduction velocity (NCV) are sometimes used to diagnosis neck pain, arm pain, numbness and tingling.

What Treatments Do We Offer To Help Back Pain?

Our multi-specialty team is medically supervised and treatments can include one or a combination of prescription medication, physical therapy, chiropractic manipulation, trigger point injections, epidural nerve blocks or facet joint injections.

New Treatment Using LIPOGEMS® Could Be the Answer for Arthritis Pain

LIPOGEMS® is a new treatment option for arthritis pain now offered by Dr. Norma Bilbool, M.D., a double board certified physician specializing in Physical Medicine and Rehabilitation and Pain Medicine and Richard D. Striano D.C., RMSK Registered in Diagnostic Medical Musculoskeletal Sonography. The combination of advanced imaging techniques with ultrasound to diagnose and precisely guide treatment, and physician experience with treating all joints with minimally invasiveLIPOGEMS® has led to the majority of patients treated having significant improvement with less pan, improved function and quality of life.

LIPOGEMS® could be the solution to those who suffer from pain in the shoulder, lower back, hip, knee, ankle and other joints including the rotator. Optimum Joint, is equipped and has been performing ongoing clinical studies on the shoulder, rotator cuff, lower back, hip and ankle pain where a patient’s own fat is used to alleviate arthritis related conditions many of which have failed to respond to other treatment methods including bone-on-bone joints. Optimum was among the first practices in the USA trained in the state-of-the-art treatment through LIPOGEMS® technology that is a minimally invasive same day procedure, performed in about an hour, using local anesthetic with no sedation required and no down time. This could be the answer for many of those looking to avoid surgery.

The Autologous (fat from you and put back into you) Micro-Fragmented Adipose Tissue (LIPOGEMS®) is a NEW technology where fat is taken from the patient, using a local anesthetic, washed, and micro-fragmented, using the LIPOGEMS® system. Micro-fragmented fat using the LIPOGEMS® system mechanically supports and cushions joints, and holds regenerative capabilities and when re-injected can decrease inflammation, cushion, repair or replace defects in damaged tendons and cartilage, or other tissue.

The fat is injected using continuous ultrasound guidance to ensure pin point accuracy in treating the joint and surrounding damaged tendons to repair and restructure damaged tissue with pin-point accuracy. Research has shown non-guided “blind” injections are accurate 36% – 60% of the time while ultrasound guided injections are 100% accurate. Accuracy in delivering regenerative treatments is essential. We are evaluating the LIPOGEMS®, made with an FDA cleared device, for their ability to cushion, repair, or replace damaged tissue and the regenerative effects of the fat it contains, to jump-start repair and decrease inflammation.

“This is an extraordinary study because of its use of micro-fragmented fat tissue, which makes it more bioavailable to the area we inject, and by using the precision of ultrasound guidance the treatment is visualized being delivered to each area of the joint and tissues in need of repair. This combination of support and regenerative regenerative elements with the precision of advanced ultrasound guidance is contributing to the long term impressive results.

 NEW STUDY: Adipose tissue contains Adipose Derived Stem Cells “ADSC’s” and more than 600 secreted proteins and included key molecules involved in tissue regeneration. Stem Cell Res Ther. 2015; 6: 221.

NEW STUDY: Lipogems Product Treatment Increases the Proliferation Rate of Human Tendon Stem Cells without Affecting Their Stemness and Differentiation Capability. Results showed that the Lipogems product significantly increases the proliferation rate of hTSCs (human tendon stem cells). Moreover, treated cells increase the expression of VEGF, which is crucial for tissue healing. Stem Cells International Volume 2016 (2016), Article ID 4373410, 11 pages

Dr’s Bilbool and Striano are among few doctors in the country offering IRB- approved regenerative treatment options, with a focus on minimally invasive alternatives to surgery. Their work has been recognized and new studies are being published this year.

Pain Medicine

Because back pain arises from a variety of sources, many patients require pain management with prescription medication when over the counter medications likeAleve, Motrin, Tylenol or Advil do not provide relief.

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increase local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

Chiropractic Care

Doctors of Chiropractic are experts in detecting areas in the spine where there is a loss of movement and local inflammation that causes irritation to delicate spinal nerves, muscles, ligaments and tendons.

Dr. Striano is an expert in gentle manipulation techniques to ease pressure in the joints of your spine. By gently stretching the muscles, using pressure applied in areas of spasm and tenderness and mobilizing the vertebra or spinal bones, painful inflammation and irritation is resolved.

Dr. Striano’s skillful chiropractic care is gentle, safe and effective in managing spinal pain. He is also skilled in manually relieving trigger point pain in tender muscles and tendons.

Dr. Striano is board eligible through the American Registry for Diagnostic Medical Sonography (ARDMS) to be one of the first doctors in the USA to become certified in Diagnostic Musculoskeletal Ultrasound Imaging (RMSK).

Dr. Striano regularly attends several conferences per year on ultrasound diagnosis and ultrasound guided medical procedures in interventional medicine taught by leading doctors and radiologists from all over the world at various national locations including The Mayo Clinic.

Dr. Striano has spent the past 15 years in the multi-specialty field workinghand in hand as a team with the physicians and physical therapists at Optimum Joint to provide the leading edge in cooperative care for the joints and spine. His vast experience and knowledge is applied on a daily basis in pain management.

Trigger Point Injections:

Arthritis and Trigger Point Injections: Trigger point injection (TPI) may be an option in treating pain for some patients. TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body. Local corticosteroid injection is often helpful for trigger points and arthritis.
Injections adjacent to the spine, called para-vertebral injections are administered using continuous live ultrasound guidance ensuring pin point accuracy exactly where the injection is needed.

What Happens During a Trigger Point Injection?
In the TPI procedure, a small needle is guided under continuous ultrasound imaging into the painful trigger point. The injection contains a local anesthetic that sometimes includes a steroid. With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment that can include weekly injections over the course of several weeks is required to alleviate all of the pain resulting in sustained relief. The injections are not painful, as the skin is first coated with a freezing spray and a local anesthetic is used. Injections take just a few minutes and you’re on your way. Several sites may be injected in one visit. If there are allergies to a certain drug, a dry-needle technique (involving no medications) can be used.

When Are Trigger Point Injections Used?
TPI is used to treat many muscle groups, especially those in the arms, legs, lower back, and neck. In addition, TPI can be used to treat fibromyalgia and tension headaches. The techniques are also used to treat myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) when unresponsive to other treatments.

Epidural Spinal Injection: Using local anesthetics

Patients with known diagnoses of herniated discs or pinched nerves in their neck have complaints that include numbness and tingling, as well as weakness in the arms or hands. Patient may feel weakness in the grip, holding or squeezing objects.

What is the epidural space?

The membrane that covers the spine and nerve roots in the neck is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to the neck, shoulder and arms. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contact with the bony structure of the spine in some way.

What is an epidural and why is it helpful?

An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, reducing the pain in the neck, shoulders and arms, as well as numbness and tingling into the arms. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or a period of pain relief for several months while the injury or cause of pain is healing.

Will I be “put out” for this procedure?

No. This procedure is done under local anesthesia. This makes the visit quick and convenient where patients are able to pick up and go right after their visit.

What happens during the procedure?

The patient is placed on the injection table with stomach facing downward.The injected area is cleaned and sterilized and a local anesthetic is administered to numb the area of the injection site. After the numbing medicine has been given time to be effective, we direct a small needle, using x-ray guidance called fluoroscopy into the epidural space. A small amount of contrast (dye) is injected to insure the needle is properly positioned in the epidural space. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected.

Patients are able to get up and drive home after the procedure, as we do not use any general anesthesia. The procedure is performed in the office and takes approximately 30 minutes.

Facet Joint Injection

The small joints in your neck that guide movement back and forth, up and down and around arecalled facet joints. They are small circular joints that are surrounded by a joint capsule. Facet joints are commonly affected by arthritis and inflammation of the capsule called capsulitis. This type of condition results in stiffness and pain with ranges of motion and physical activity, in addition to the constant need to change sleep positions.

When the facet joints and capsules are the primary problem, pain is most often localized to the neck on either side, and usually does not include numbness or tingling into the arms or hands.

What is a Facet Joint Injection?

Facet Joint Injection is an injection of long lasting steroid (“cortisone”) in the facet joints, which are those that guide movement in your neck. These are actual joints with joint capsule that contains lubricating fluids.

What is the purpose of a Facet Joint Injection?

The injected steroid reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation and irritation of the joint and surrounding structures.

How long does the injection take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a mixture of local anesthetic (like Lidocaine or bupivacaine) and the steroid medication (methylprednisolone – Depomedrol).

Will I be “put out” for this procedure?

No. This procedure is done under local anesthesia. This makes the visit quick and convenient, allowing patients to get up and go right after.

How is the injection performed?

It is done lying on the stomach. The skin on the back of the neck is cleaned and sterilized, and local anesthetics injected to numb the injection site. Using x-ray guidance (called fluoroscopy) a small needle is guided to the facet joint. A small amount of contrast (dye) is injected to insure the needle is properly positioned in the facet joint capsule. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected. In some cases where the arthritis covers several locations, more than one joint can be injected during the same visit.

Patients are able to get up and drive home after the procedure, as we do not use any general anesthesia. The procedure is performed in the office and takes approximately 30 minutes.

Our Mission Statement

We want to make a difference. We are dedicated to providing our patients with updated and current treatment alternatives for adults suffering with joint and spine pain. Our staff regularly attends several conferences per year on ultrasound guided interventional medicine with new and innovative, as well as traditional techniques in treating joint pain. This allows us to utilize and implement the practices and techniques of leaders in diagnostic ultrasound imaging and ultrasound guided treatment from Europe, Asia, Canada and the United States at prestigious institutions including the Mayo Clinic. We remain on the cutting edge of treatment objectives to help our patients feel better!

 


 

Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.

 

Wrist Pain

Wrist pain is a common complaint and many types are caused by sudden injuries that result in sprains or fractures as well as more long-term problems, such as repetitive stress, arthritis and carpal tunnel syndrome.

Your wrist is a complex joint made up of eight small bones arranged in two rows between the bones in your forearm and the bones in your hand. Tough bands of ligament connect your wrist bones to each other, to your forearm bones and hand bones. Tendons attach muscles to the bone. Damage to any of the wrist structures can cause pain and affect your ability to use your wrist and hand.

Wrist pain may vary, depending on the cause. For example, osteoarthritis pain is often described as being similar to a dull toothache, while tendinitis usually causes a sharp, stabbing pain. The precise location of your wrist pain can also give your doctor clues as to what might be causing your symptoms.

Injuries

  • Sudden impacts:

    The most common method of injuring your wrist is when you fall forward onto your outstretched hand. This can cause sprains, strains and even fractures.

  • Repetitive stress:

    Any activity that involves repetitive wrist motion such as hitting a tennis ball, bowing a cello, or driving cross-countrycan inflame the tissues around joints or cause stress fractures, especially when you perform the movement for hours without a break.

  • De Quervain’s

    disease is a repetitive stress injury that causes pain at the base of the thumb.

Arthritis

  • Osteoarthritis:

    In general, osteoarthritis in the wrist is uncommon, usually occurring only in people who have injured that wrist in the past. Osteoarthritis is caused by wear and tear on the cartilage that cushions the ends of your bones. Pain that occurs at the base of the thumb may be caused by osteoarthritis.

  • Rheumatoid arthritis.

    A disorder in which the body’s immune system attacks its own tissues, rheumatoid arthritis is common in the wrist. Usually both wrists become affected.

Other diseases and conditions

  • Carpal tunnel syndrome:

    Carpal tunnel syndrome develops when there’s increased pressure on the median nerve, which passes through the carpal tunnel, a passageway in the palm side of your wrist.

  • Ganglion cysts:

    These soft tissue cysts occur most often on the top of your wrist opposite your palm. Smaller ganglion cysts seem to cause more pain than larger ones.

How Is Wrist Pain Diagnosed?

History and Examination:

A history of your complaints including duration, what makes it better and worse is very important. Previous treatments and outcomes, as well as orthopedic examination of the muscles, joint, movement and strength are also used for diagnosis.

X-rays:

Plain X-rays can reveal changes in and around the joint as it relates to the bone. X-ray will reveal the extent and severity of arthritis in the joint. X-ray does not show soft tissue such as ligaments, tendons, cartilage, muscle or nerve.

MRI (Magnetic Resonance Imaging):

Is a noninvasive procedure that can reveal the detail of joints structures such as the bone, ligaments, tendons, cartilage, muscle and nerve.

Myelography/CT scanning:

Sometimes used as an alternative to MRI

Diagnostic ultrasound Imaging:

Unlike an x-ray, which emits radiation and shows only bone, diagnostic ultrasound is non-invasive and allows for viewing the causes of your wrist pain with great accuracy. With musculoskeletal ultrasound imaging (MSUS), the muscles, tendons, ligaments, cartilage and joint can be accurately examined at the time of your visit. This provides immediate information about the health of your joint and what factors that is contributing to your pain. With this information in hand, specific treatment options can be established immediately!

Treatment

Cortisone Injection:

Painful arthritic joints, chronic tendinitis, bursitis and inflammation respond quickly to cortisone. In many cases this is the head start patients need to allow for gains with more conservative care and no further treatment is required. Many patients think that cortisone is bad for you. Too much of anything is not good. Using cortisone infrequently, as much as several times per year will not do any harm. If the pain continues to return, other treatment options should be considered.

Cortisone is injected using continuous live ultrasound guidance exactly where it is needed to quickly reduce inflammation and pain.

Lubrication for Arthritis in the Wrist and Hand:

Why Hyalgan?

A squeaky gear needs the most oil!

The joints of the body are normally surrounded by a lubricant and shock absorber called Synovial fluid. Patients with osteoarthritis experience pain and inflammation because arthritic damage in thewrist causes the Synovial fluid to break down over time.

This process causes increased friction and excess wear and tear on the cartilage cushioning movement that becomes rough and jagged causing the joint further deteriorate. Range of motion, squeezing, holding objects, fine movement of the fingers and hand, lifting and carrying are often painful. Pain is often increased during or after activity.

What is Hyalgan?

The joints of the body are normally surrounded by a fluid that acts as a lubricant and shock absorber. This fluid is lacking in patients with osteoarthritis, and leads to pain and inflammation in the joints.

Hyalgan is a naturally derived lubricant that is FDA approved, safe and effective atinstantly cushioning and lubricating painful arthritic joints.

By restoring lubrication and cushion, your joints move more freely again with less friction and most importantly, less pain. Hyalgan is injected using continuous ultrasound guidance ensuring pin-point accuracy exactly where it is needed.

Platelet Rich Plasma Therapy (PRP): Jump starting the healing signals:

Why use PRP?

When there is damage, tissue tears or arthritis, this exciting new procedure (made popular by professional athletes) that heals damaged structures in a joint such as the labrum, tendons, muscle, ligament or cartilage is showing exciting results!

How does PRP work?

When you cut your skin and it bleeds, platelets collect and gather at the wound site. Once there, platelets act like a conductor in an orchestra. They release growth factors that signal the healing activities to begin, resulting in a cascade of events that restore the damaged tissue.

Joints, however, do not have a direct blood supply. Therefore, when a joint structure is damaged or torn, platelets do not gather and orchestrate the necessary events for that damage to be restored. Joint damage either heals slowly or not at all. That is where Platelet Rich Plasma Therapy (PRP) proves valuable!

How is the procedure performed?

By taking a small sample of your blood, a special centrifuge concentrates and separates the platelets, growth factors and specialized white blood cells from the other components of the blood. This super concentrated PRP is then injected using continuous ultrasound guidance into the cracks and crevices of the damaged area. The orchestra of events is stimulated and the tissue begins to heal. The result is reduced inflammation and pain.

Lipogems Regenerative Medicine: Healing Damage – Tears and Chronic Tendinitis:

New Treatment Using LIPOGEMS® Could Be the Answer for Arthritis Pain

LIPOGEMS® is a new treatment option for arthritis pain now offered by Dr. Norma Bilbool, M.D., a double board certified physician specializing in Physical Medicine and Rehabilitation and Pain Medicine and Richard D. Striano D.C., RMSK Registered in Diagnostic Medical Musculoskeletal Sonography. The combination of advanced imaging techniques with ultrasound to diagnose and precisely guide treatment, and physician experience with treating all joints with minimally invasiveLIPOGEMS® has led to the majority of patients treated having significant improvement with less pan, improved function and quality of life.

LIPOGEMS® could be the solution to those who suffer from pain in the shoulder, lower back, hip, knee, ankle and other joints including the rotator. Optimum Joint, is equipped and has been performing ongoing clinical studies on the shoulder, rotator cuff, lower back, hip and ankle pain where a patient’s own fat is used to alleviate arthritis related conditions many of which have failed to respond to other treatment methods including bone-on-bone joints. Optimum was among the first practices in the USA trained in the state-of-the-art treatment through LIPOGEMS® technology that is a minimally invasive same day procedure, performed in about an hour, using local anesthetic with no sedation required and no down time. This could be the answer for many of those looking to avoid surgery.

The Autologous (fat from you and put back into you) Micro-Fragmented Adipose Tissue (LIPOGEMS®) is a NEW technology where fat is taken from the patient, using a local anesthetic, washed, and micro-fragmented, using the LIPOGEMS® system. Micro-fragmented fat using the LIPOGEMS® system mechanically supports and cushions joints, and holds regenerative capabilities and when re-injected can decrease inflammation, cushion, repair or replace defects in damaged tendons and cartilage, or other tissue.

The fat is injected using continuous ultrasound guidance to ensure pin point accuracy in treating the joint and surrounding damaged tendons to repair and restructure damaged tissue with pin-point accuracy. Research has shown non-guided “blind” injections are accurate 36% – 60% of the time while ultrasound guided injections are 100% accurate. Accuracy in delivering regenerative treatments is essential. We are evaluating the LIPOGEMS®, made with an FDA cleared device, for their ability to cushion, repair, or replace damaged tissue and the regenerative effects of the fat it contains, to jump-start repair and decrease inflammation.

“This is an extraordinary study because of its use of micro-fragmented fat tissue, which makes it more bioavailable to the area we inject, and by using the precision of ultrasound guidance the treatment is visualized being delivered to each area of the joint and tissues in need of repair. This combination of support and regenerative regenerative elements with the precision of advanced ultrasound guidance is contributing to the long term impressive results.

 NEW STUDY: Adipose tissue contains Adipose Derived Stem Cells “ADSC’s” and more than 600 secreted proteins and included key molecules involved in tissue regeneration. Stem Cell Res Ther. 2015; 6: 221.

NEW STUDY: Lipogems Product Treatment Increases the Proliferation Rate of Human Tendon Stem Cells without Affecting Their Stemness and Differentiation Capability. Results showed that the Lipogems product significantly increases the proliferation rate of hTSCs (human tendon stem cells). Moreover, treated cells increase the expression of VEGF, which is crucial for tissue healing. Stem Cells International Volume 2016 (2016), Article ID 4373410, 11 pages

Dr’s Bilbool and Striano are among few doctors in the country offering IRB- approved regenerative treatment options, with a focus on minimally invasive alternatives to surgery. Their work has been recognized and new studies are being published this year.

– See more at: https://optimumjointmd.com/index.php/2015/12/10/shoulder-pain/#sthash.rfJRy7sh.dpuf

 

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

    Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increase local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

    Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

    Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

    Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

    The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

When to see a doctor:

 You should see your doctor if:

  • Your wrist pain continues for more than three weeks
  • The pain is restricting use of your hand
  • The pain is getting worse
  • There is swelling of the wrist and hand
  • Your experience numbness or tingling into the fingers
  • Your grip is getting weaker
  • You are dropping objects within your grip
  • You awaken in the morning with your hands feeling numb

Our Mission Statement

We want to make a difference. We are dedicated to providing our patients with updated and current treatment alternatives for adults suffering with joint and spine pain. Our staff regularly attends several conferences per year on ultrasound guided interventional medicine addressing new and innovative, as well as traditional techniques in treating joint pain. This allows us to utilize and implement the practices and techniques of leaders in diagnostic ultrasound imaging and ultrasound guided treatment from Europe, Asia, Canada and the United States at prestigious institutions including the Mayo Clinic.

We remain on the cutting edge of treatment objectives to help our patients feel better!

 


 

Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.

 

Elbow Pain

Your elbow is a complex joint formed by three long bones in your arm. Four sets of muscles help to move the joint and are attached to the bones by thick tendons. Damage to any of these structures or to the joint’s network of nerves, blood vessels and ligaments can lead to elbow pain.

Elbow pain can definitely affect your life since your elbow is used in so many ways. Most elbow pain results from over-use injuries. These may be sports-related or the result of activities and professions requiring repetitive hand, wrist or arm movements. Elbow pain can be due to arthritis, but in general, your elbow joint is much less prone to wear-and-tear damage than other joints. Although elbow conditions may be named after sports such as Golfer’s and Tennis elbow, they are very common whether one is engaged in sports or not.

Common causes of elbow pain include:

Golfer’s elbow: Also known as medial Epicondylitis,is similar to tennis elbow.Golfer’s elbow is pain and inflammation on the inner side of your elbow where the tendons of your forearm muscles attach to the bony bump on the inside of your elbow. The pain may spread into your forearm and wrist.

Tennis elbow: Also known as lateral Epicondylitis (see sonogram image) is on the outside of the elbow and is also associated with forearm pain. You feel the tenderness in the meat of the muscles above and below the elbow joint.

Bursitis: The bursa is a slippery sac between the loose skin and the bones of the elbow. It is located at the tip of the elbow. The bursa allows the skin to move freely over the underlying bone. Normally, the bursa is flat. If it becomes irritated or inflamed, a condition known as bursitis develops. Swelling is often the first symptom. The skin on the back of the elbow is loose, which means that a small amount of swelling may not be noticed right away. As the swelling continues, the bursa grows,causing pain as it is stretched, since it contains nerve endings. The swelling may grow large enough to restrict motion of the elbow.

Tendon and ligament tears: Tendons are the attachment of a muscle to a bone, and ligaments connect two bones together. When a ligament or tendon becomes overstretched due to an activity or overuse, the fibers that make up the tissues can fray and tear. The result can be chronicinstability in the joint.

Ulnar neuropathy: A disorder involving the ulnar nerve. Ulnar neuropathy may be caused by entrapment of the ulnar nerve as it passes through a tunnel on the inside of your elbow where your “funny bone” is located. The feeling you get when you hit your funny bone radiating into your ring and little finger is from the ulnar nerve.

The pain from elbow conditions does not have to keep you off the course or away from your favorite activities. With a proper diagnosis, rest and appropriate treatment, you can get back into the swing of things in no time!

Elbow symptoms include:

  • Pain and tenderness: On the inner or outer side of your elbow, and sometimes along your forearm.
  • StiffnessYour elbow may feel stiff, and it may hurt to make a fist.
  • Weakness: You may have weakness in your hands and wrists.
  • Numbness or tingling: Many people with golfer’s elbow experience numbness or a tingling sensation that radiates into one or more fingers — usually the ring and little fingers.

Pain can be increased when you:

  • Swing a golf club or racket
  • Squeeze or pitch a ball
  • Shake hands
  • Turn a doorknob
  • Pick up something with your palm down
  • Flex your wrist toward your forearm

How Is Elbow Pain Diagnosed?

History and Examination: A history of your complaints including duration, and what makes it better and worse is very important. Previous treatments and outcomes as well as an orthopedic examination to assess the muscles, joint, movement, strength and nerves are also used for diagnosis.

X-rays: X-rays can reveal arthritis and any abnormalities of the bone. In most cases an x-ray is not necessary.

Diagnostic Ultrasound Imaging: Unlike an x-ray, diagnostic ultrasound allows us to view the most common causes of your elbow pain with great accuracy. The bundles muscles and the tendons related to Golfer and Tennis Elbow, the bursa, joint capsule and the tunnel through which the ulnar nerve passes in the elbow can be readily examined for signs of swelling or inflammation. If the symptoms are only on one side, the symptomatic side can be compared with the non-symptomatic side.

With musculoskeletal ultrasound imaging (MSUS), the joint can be accurately examined at the time of your visit.

Treatment Options We Offer

Why are ultrasound-guided injections better and more accurate?

When using an injection to deliver treatment into painful joints, it is necessary to be exact and precise. Dr. Isidro and his team are highly trained in ultrasound-guided injections. These procedures are performed in the office, at the time of your visit. Some of the common structures involved in joint pain may be as little as 2-3mm wide and therefore require a high level of precision to be accurate. In addition, when performing an injection, there are also structures that you want to avoid so you don’t knick or damage them on your way into the joint. The ultrasound machine provides live imaging in real time, to safely place injectable medications or treatments into or around the joint with laser-like precision.

Consider trying to hit a target blindfolded¾you may know the general direction but would not be certain if you have actually hit your target. With live ultrasound imaging, the targeted areas of pain are viewed in real time while the injection is taking place, guiding the needle with pin-point accuracy!

Cortisone Injection:

Painful arthritic joints, chronic tendinitis, bursitis and inflammation respond quickly to cortisone. In many cases this is the head start patients need to allow for gains with more conservative care and no further treatment is required. Many patients think that cortisone is bad for you. Too much of anything is not good. Using cortisone infrequently, as much as several times per year will not do any harm. If the pain continues to return, other treatment options should be considered.

Cortisone is injected using continuous live ultrasound guidance exactly where it is needed to quickly reduce inflammation and pain.

Platelet Rich Plasma Therapy (PRP): Jump starting the healing signals:

Why use PRP?

When there is damage, tissue tears or arthritis, this exciting new procedure (made popular by professional athletes) that heals damaged structures in a joint such as the labrum, tendons, muscle, ligament or cartilage is showing exciting results!

How does PRP work?

When you cut your skin and it bleeds, platelets collect and gather at the wound site. Once there, platelets act like a conductor in an orchestra. They release growth factors that signal the healing activities to begin, resulting in a cascade of events that restore the damaged tissue.

Joints, however, do not have a direct blood supply. Therefore, when a joint structure is damaged or torn, platelets do not gather and orchestrate the necessary events for that damage to be restored. Joint damage either heals slowly or not at all. That is where Platelet Rich Plasma Therapy (PRP) proves valuable!

New Treatment Using LIPOGEMS® Could Be the Answer for Arthritis Pain

LIPOGEMS® is a new treatment option for arthritis pain now offered by Dr. Norma Bilbool, M.D., a double board certified physician specializing in Physical Medicine and Rehabilitation and Pain Medicine and Richard D. Striano D.C., RMSK Registered in Diagnostic Medical Musculoskeletal Sonography. The combination of advanced imaging techniques with ultrasound to diagnose and precisely guide treatment, and physician experience with treating all joints with minimally invasiveLIPOGEMS® has led to the majority of patients treated having significant improvement with less pan, improved function and quality of life.

LIPOGEMS® could be the solution to those who suffer from pain in the shoulder, lower back, hip, knee, ankle and other joints including the rotator. Optimum Joint, is equipped and has been performing ongoing clinical studies on the shoulder, rotator cuff, lower back, hip and ankle pain where a patient’s own fat is used to alleviate arthritis related conditions many of which have failed to respond to other treatment methods including bone-on-bone joints. Optimum was among the first practices in the USA trained in the state-of-the-art treatment through LIPOGEMS® technology that is a minimally invasive same day procedure, performed in about an hour, using local anesthetic with no sedation required and no down time. This could be the answer for many of those looking to avoid surgery.

The Autologous (fat from you and put back into you) Micro-Fragmented Adipose Tissue (LIPOGEMS®) is a NEW technology where fat is taken from the patient, using a local anesthetic, washed, and micro-fragmented, using the LIPOGEMS® system. Micro-fragmented fat using the LIPOGEMS® system mechanically supports and cushions joints, and holds regenerative capabilities and when re-injected can decrease inflammation, cushion, repair or replace defects in damaged tendons and cartilage, or other tissue.

The fat is injected using continuous ultrasound guidance to ensure pin point accuracy in treating the joint and surrounding damaged tendons to repair and restructure damaged tissue with pin-point accuracy. Research has shown non-guided “blind” injections are accurate 36% – 60% of the time while ultrasound guided injections are 100% accurate. Accuracy in delivering regenerative treatments is essential. We are evaluating the LIPOGEMS®, made with an FDA cleared device, for their ability to cushion, repair, or replace damaged tissue and the regenerative effects of the fat it contains, to jump-start repair and decrease inflammation.

“This is an extraordinary study because of its use of micro-fragmented fat tissue, which makes it more bioavailable to the area we inject, and by using the precision of ultrasound guidance the treatment is visualized being delivered to each area of the joint and tissues in need of repair. This combination of support and regenerative regenerative elements with the precision of advanced ultrasound guidance is contributing to the long term impressive results.

 NEW STUDY: Adipose tissue contains Adipose Derived Stem Cells “ADSC’s” and more than 600 secreted proteins and included key molecules involved in tissue regeneration. Stem Cell Res Ther. 2015; 6: 221.

NEW STUDY: Lipogems Product Treatment Increases the Proliferation Rate of Human Tendon Stem Cells without Affecting Their Stemness and Differentiation Capability. Results showed that the Lipogems product significantly increases the proliferation rate of hTSCs (human tendon stem cells). Moreover, treated cells increase the expression of VEGF, which is crucial for tissue healing. Stem Cells International Volume 2016 (2016), Article ID 4373410, 11 pages

Dr’s Bilbool and Striano are among few doctors in the country offering IRB- approved regenerative treatment options, with a focus on minimally invasive alternatives to surgery. Their work has been recognized and new studies are being published this year.

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increases local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

When to see a doctor

  • Your activity is being restricted by pain
  • Before you pain becomes severe
  • Pain is getting worse or not improving in two weeks
  • Sharp or shooting pain, especially when you squeeze, grasp or twist your hand
  • Swelling around the elbow
  • Tingling into the ring and fifth finger
  • Weakness in your fingers

 


 

Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.

 

Shoulder Pain

The shoulder joint is supported by the rotator cuff and made up of the muscles and tendons in your shoulder. These muscles and tendons connect your upper arm bone with your shoulder blade and hold the ball of your upper arm bone firmly in your shoulder socket. This combination results in the greatest range of motion of any joint in your body. A shoulder condition or rotator cuff injury, which is very common, involves any type of irritation or damage to your rotator cuff muscles or tendons, including:

Bursitis

Bursitis is a painful condition that affects the small fluid-filled, cushion like pads called bursa. Bursa are cushions that lie between a tendon and a bone to prevent excess friction. Bursitis occurs when a bursa becomes inflamed.

If you have bursitis, the affected joint may:

  • Feel achy or stiff
  • Hurt more when you move it or press on it
  • Look swollen and red
  • Prevent you from elevating your arm or reaching behind

Rotator cuff injury

Rotator cuff injuries occur when one of the 4 main muscles or their tendons  that form the rotator cuff become injured, inflamed, worn down or torn.

If you have a rotator cuff injury, the affected joint may have:

  • Pain and tenderness in your shoulder, especially when reaching overhead, reaching behind your back, lifting, pulling or sleeping on the affected side
  • Shoulder weakness
  • Loss of shoulder range of motion
  • Inclination to keep your shoulder inactive
  • Inability to raise your arm from your side

Osteoarthritis

Osteoarthritis occurs when the surfaces in the joint begin to wear down.

What Is Osteoarthritis?

The joints of the body are normally surrounded by a fluid that acts as a lubricant and shock absorber. This fluid is lacking in patients with osteoarthritis, and leads to pain and inflammation in the joints.

Osteoarthritis, also known as degenerative joint disease, occurs when the cartilage that covers the tops of bones, known as articular cartilage, degenerates or wears down. The roughened and jagged bone surfaces become inflamedcausingswelling, pain, and sometimes the development of osteophytes (or bone spurs) when the ends of the two bones rub together.

What Is Osteoarthritis of the Shoulder?

The shoulder is made up of two joints, the acromio-clavicular (AC) joint and the glenohumeral joint. The AC joint is the point where the collarbone, or clavicle, meets the acromion, which is the tip of the shoulder blade. The glenohumeral joint is the point where the top of the arm bone, or humerus, meets the shoulder blade, or scapula. Osteoarthritis is more commonly found in the AC joint.

Who Gets Shoulder Osteoarthritis?

Osteoarthritis most often occurs in people who are over the age of 50. In younger people, osteoarthritis can result from an injury or trauma, such as a fractured or dislocated shoulder.Osteoarthritis may also be hereditary.

What Are the Symptoms of Shoulder Osteoarthritis?

As with most osteoarthritis, pain is aprimarysymptom. A person with shoulder arthritis is likely to have pain with activity, certain ranges of motion and at rest due to inflammation-causing difficulty sleeping. Range of motion generally decreases over time.

How Is Shoulder Pain Diagnosed?

History and Examination: A history of your complaints including duration, what makes it better and worse is very important. Previous treatments and outcomes, as well as orthopedic examination of the muscles, joint, movement and strength are also used for diagnosis.  

X-rays: Plain X-rays can reveal narrowing of the space in the two joints of the shoulder: the AC joint between the collar bone and the tip of the shoulder blade, and the glenohumeral joint between the humerous(the large bone of your arm and the shoulder blade).This reveals wear and tear on the cartilage from arthritis like diseases and bone spurs that can interfere with movement.X-ray reveals changes in the shape of the bones in the shoulder that may press upon tendons of the rotator cuff, restricting movement and causing pain.

MRI: Magnetic Resonance Imaging is a noninvasive procedure that can reveal details of the rotator cuff,the fibrocartilage ring around the head of the humerous called the labrum, show tears andchanges in the tendons called tendinosis, arthritis and bursitis.

Myelography/CT scanning: Sometimes used as an alternative to MRI.

Diagnostic ultrasound Imaging: Unlike an x-ray, which emits radiation and shows only bone, diagnostic ultrasound is non-invasive and allows for viewing the causes of your shoulder joint pain with great accuracy. With musculoskeletal ultrasound imaging (MSUS), the muscles, tendons, ligaments, cartilage and joint can be accurately examined at the time of your visit. This provides immediate information about the health of your joint and what factors are contributing to your pain. With this information at hand, specific treatment options can be established immediately!

Treatment

When the shoulder joint is painful or damaged there are successful treatment options.

Why are ultrasound-guided injections better and more accurate?

 When using an injection to deliver treatment into painful joints, it is necessary to be exact and precise.

The OptimumJoint Team are highly trained in ultrasound-guided injections. These procedures are performed in the office, at the time of your visit. Some of the common structures involved in joint pain may be as little as 2-3mm wide and therefore require a high level of precision to be accurate. In addition, when performing an injection, there are also structures that you want to avoid so you don’t knick or damage them on your way into the joint. The ultrasound machine provides live imaging in real time, to safely place injectable medications or treatments into or around the joint with laser-like precision.

Consider trying to hit a target blindfolded¾you may know the general direction but would not be certain if you have actually hit your target. With live ultrasound imaging, the targeted areas of pain are viewed in real time while the injection is taking place, guiding the needle with pin-point accuracy.

Cortisone Injection

Painful arthritic joints, chronic tendinitis, bursitis and inflammation respond quickly to cortisone. In many cases this is the head start patients need to allow for gains with more conservative care and no further treatment is required. Many patients think that cortisone is bad for you. Too much of anything is not good. Using cortisone infrequently, as much as several times per year will not do any harm. If the pain continues to return, other treatment options should be considered.

Cortisone is injected using continuous live ultrasound guidance exactly where it is needed to quickly reduce inflammation and pain.

Lubrication for Arthritis:

Why Hyalgan?

A squeaky gear needs the most oil!

The joints of the body are normally surrounded by a lubricant and shock absorber called Synovial fluid. Patients with osteoarthritis experience pain and inflammation because arthritic damage in thejoint causes the Synovial fluid to break down over time.

This process causes increased friction and excess wear and tear on the cartilage cushioning movement that becomes rough and jagged causing the joint further deteriorate. Range of motion, walking, getting up from a seated position, climbing and descending steps and weight bearing is often painful. Pain is often increased during or after activity.

What is Hyalgan?

Hyalgan is a naturally derived lubricant that instantly cushions and lubricates painful arthritic joints. By restoring lubrication and cushion, your joints move more freely again with less friction and most importantly, less pain. Hyalgan is injected using continuous live ultrasound guidance ensuring pin-point accuracy exactly where it is needed.

Platelet Rich Plasma Therapy (PRP): Jump starting the healing signals:

Why use PRP?

When there is shoulder joint damage, rotator cuff tear, tendinosis, chronic bursitis or arthritis this exciting new procedure (made popular by professional athletes) that heals damaged structures in a joint such as the labrum, tendons, muscle, ligament or cartilage is showing exciting results!

How does PRP work?

When you cut your skin and it bleeds, platelets collect and gather at the wound site. Once there, platelets act like a conductor in an orchestra. They release growth factors that signal the healing activities to begin, resulting in a cascade of events that restore the damaged tissue.

Joints, however, do not have a direct blood supply. Therefore, when a joint structure is damaged or torn, platelets do not gather and orchestrate the necessary events for that damage to be restored. Joint damage either heals slowly or not at all. That is where Platelet Rich Plasma Therapy (PRP) proves valuable!

 

New Treatment Using LIPOGEMS® Could Be the Answer for Arthritis Pain

LIPOGEMS® is a new treatment option for arthritis pain now offered by Dr. Norma Bilbool, M.D., a double board certified physician specializing in Physical Medicine and Rehabilitation and Pain Medicine and Richard D. Striano D.C., RMSK Registered in Diagnostic Medical Musculoskeletal Sonography. The combination of advanced imaging techniques with ultrasound to diagnose and precisely guide treatment, and physician experience with treating all joints with minimally invasive LIPOGEMS® has led to the majority of patients treated having significant improvement with less pan, improved function and quality of life.

LIPOGEMS® could be the solution to those who suffer from pain in the shoulder, lower back, hip, knee, ankle and other joints including the rotator. Optimum Joint, is equipped and has been performing ongoing clinical studies on the shoulder, rotator cuff, lower back, hip and ankle pain where a patient’s own fat is used to alleviate arthritis related conditions many of which have failed to respond to other treatment methods including bone-on-bone joints. Optimum was among the first practices in the USA trained in the state-of-the-art treatment through LIPOGEMS® technology that is a minimally invasive same day procedure, performed in about an hour, using local anesthetic with no sedation required and no down time. This could be the answer for many of those looking to avoid surgery.

The Autologous (fat from you and put back into you) Micro-Fragmented Adipose Tissue (LIPOGEMS®) is a NEW technology where fat is taken from the patient, using a local anesthetic, washed, and micro-fragmented, using the LIPOGEMS® system. Micro-fragmented fat using the LIPOGEMS® system mechanically supports and cushions joints, and holds regenerative capabilities and when re-injected can decrease inflammation, cushion, repair or replace defects in damaged tendons and cartilage, or other tissue.

The fat is injected using continuous ultrasound guidance to ensure pin point accuracy in treating the joint and surrounding damaged tendons to repair and restructure damaged tissue with pin-point accuracy. Research has shown non-guided “blind” injections are accurate 36% – 60% of the time while ultrasound guided injections are 100% accurate. Accuracy in delivering regenerative treatments is essential. We are evaluating the LIPOGEMS®, made with an FDA cleared device, for their ability to cushion, repair, or replace damaged tissue and the regenerative effects of the fat it contains, to jump-start repair and decrease inflammation.

“This is an extraordinary study because of its use of micro-fragmented fat tissue, which makes it more bioavailable to the area we inject, and by using the precision of ultrasound guidance the treatment is visualized being delivered to each area of the joint and tissues in need of repair. This combination of support and regenerative regenerative elements with the precision of advanced ultrasound guidance is contributing to the long term impressive results.

 NEW STUDY: Adipose tissue contains Adipose Derived Stem Cells “ADSC’s” and more than 600 secreted proteins and included key molecules involved in tissue regeneration. Stem Cell Res Ther. 2015; 6: 221.

NEW STUDY: Lipogems Product Treatment Increases the Proliferation Rate of Human Tendon Stem Cells without Affecting Their Stemness and Differentiation Capability. Results showed that the Lipogems product significantly increases the proliferation rate of hTSCs (human tendon stem cells). Moreover, treated cells increase the expression of VEGF, which is crucial for tissue healing. Stem Cells International Volume 2016 (2016), Article ID 4373410, 11 pages

Dr’s Bilbool and Striano are among few doctors in the country offering IRB- approved regenerative treatment options, with a focus on minimally invasive alternatives to surgery. Their work has been recognized and new studies are being published this year.

 

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped.Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increaselocal circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

When to see a doctor:

You should see your doctor if:

  • You’re experiencing severe shoulder pain
  • You’re unable to use your arm
  • You have shoulder pain that has lasted more than a week
  • You have difficulty raising your arm to or above 90 degrees
  • You experience pain reaching behind your neck or reaching around your back

 


 

Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.

 

Neck Pain

Neck pain is a common complaint and can become chronic and worsen over time if left untreated. Generally, symptoms lasting more than two weeks or symptoms that are getting worse should be checked by a doctor. The precise location and severity of your neck pain provides important clues in determining what might be causing it.

What Causes Neck Pain?

  • Abnormalities in the bone or joints
  • Trauma
  • Poor posture
  • Arthritis – Degenerative diseases
  • Tumors
  • Muscle strain
  • Herniated disc
  • Pinched nerves
  • Joint inflammation

 

How Is Neck Pain Diagnosed?

History and Examination: A history of your complaints including duration, what makes it better and worse is very important. Previous treatments and outcomes, as well as orthopedic examination of the muscles, joint, movement and strength are also used for diagnosis.

X-rays: Plain X-rays can reveal narrowing of the space between two spinal bones, arthritis like diseases, tumors, slipped discs, narrowing of the spinal canal, fractures and instability of the spinal column.

MRI: Magnetic Resonance Imaging is a noninvasive procedure that can reveal the detail of neural (nerve-related) elements.

Myelography/CT scanning: Sometimes used as an alternative to MRI.

Electrodiagnostic studies: Nerve Testing- Electromyography (EMG) and nerve conduction velocity (NCV) are sometimes used to diagnosis neck pain, arm pain, numbness and tingling.

What Treatments Do We Offer To Help Neck Pain?

Our multi-specialty team is medically supervised and treatments can include one or a combination of prescription medication, physical therapy, chiropractic manipulation, trigger point injections, epidural nerve blocks or facet joint injections.

New Treatment Using LIPOGEMS® Could Be the Answer for Arthritis Pain

LIPOGEMS® is a new treatment option for arthritis pain now offered by Dr. Norma Bilbool, M.D., a double board certified physician specializing in Physical Medicine and Rehabilitation and Pain Medicine and Richard D. Striano D.C., RMSK Registered in Diagnostic Medical Musculoskeletal Sonography. The combination of advanced imaging techniques with ultrasound to diagnose and precisely guide treatment, and physician experience with treating all joints with minimally invasiveLIPOGEMS® has led to the majority of patients treated having significant improvement with less pan, improved function and quality of life.

LIPOGEMS® could be the solution to those who suffer from pain in the shoulder, lower back, hip, knee, ankle and other joints including the rotator. Optimum Joint, is equipped and has been performing ongoing clinical studies on the shoulder, rotator cuff, lower back, hip and ankle pain where a patient’s own fat is used to alleviate arthritis related conditions many of which have failed to respond to other treatment methods including bone-on-bone joints. Optimum was among the first practices in the USA trained in the state-of-the-art treatment through LIPOGEMS® technology that is a minimally invasive same day procedure, performed in about an hour, using local anesthetic with no sedation required and no down time. This could be the answer for many of those looking to avoid surgery.

The Autologous (fat from you and put back into you) Micro-Fragmented Adipose Tissue (LIPOGEMS®) is a NEW technology where fat is taken from the patient, using a local anesthetic, washed, and micro-fragmented, using the LIPOGEMS® system. Micro-fragmented fat using the LIPOGEMS® system mechanically supports and cushions joints, and holds regenerative capabilities and when re-injected can decrease inflammation, cushion, repair or replace defects in damaged tendons and cartilage, or other tissue.

The fat is injected using continuous ultrasound guidance to ensure pin point accuracy in treating the joint and surrounding damaged tendons to repair and restructure damaged tissue with pin-point accuracy. Research has shown non-guided “blind” injections are accurate 36% – 60% of the time while ultrasound guided injections are 100% accurate. Accuracy in delivering regenerative treatments is essential. We are evaluating the LIPOGEMS®, made with an FDA cleared device, for their ability to cushion, repair, or replace damaged tissue and the regenerative effects of the fat it contains, to jump-start repair and decrease inflammation.

“This is an extraordinary study because of its use of micro-fragmented fat tissue, which makes it more bioavailable to the area we inject, and by using the precision of ultrasound guidance the treatment is visualized being delivered to each area of the joint and tissues in need of repair. This combination of support and regenerative regenerative elements with the precision of advanced ultrasound guidance is contributing to the long term impressive results.

 NEW STUDY: Adipose tissue contains Adipose Derived Stem Cells “ADSC’s” and more than 600 secreted proteins and included key molecules involved in tissue regeneration. Stem Cell Res Ther. 2015; 6: 221.

NEW STUDY: Lipogems Product Treatment Increases the Proliferation Rate of Human Tendon Stem Cells without Affecting Their Stemness and Differentiation Capability. Results showed that the Lipogems product significantly increases the proliferation rate of hTSCs (human tendon stem cells). Moreover, treated cells increase the expression of VEGF, which is crucial for tissue healing. Stem Cells International Volume 2016 (2016), Article ID 4373410, 11 pages

Dr’s Bilbool and Striano are among few doctors in the country offering IRB- approved regenerative treatment options, with a focus on minimally invasive alternatives to surgery. Their work has been recognized and new studies are being published this year.

Pain Medicine

Because neck pain arises from a variety of sources, many patients require pain management with prescription medication when over the counter medications like Aleve, Motrin, Tylenol or Advil do not provide relief.

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increase local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

Chiropractic Care

Doctors of Chiropractic are experts in detecting areas in the spine where there is a loss of movement and local inflammation that causes irritation to delicate spinal nerves, muscles, ligaments and tendons.

Dr. Striano is an expert in gentle manipulation techniques to ease pressure in the joints of your spine. By gently stretching the muscles, using pressure applied in areas of spasm and tenderness and mobilizing the vertebra or spinal bones, painful inflammation and irritation is resolved.

Dr. Striano’s skillful chiropractic care is gentle, safe and effective in managing spinal pain. He is also skilled in manually relieving trigger point pain in tender muscles and tendons.

Dr. Striano is board eligible through the American Registry for Diagnostic Medical Sonography (ARDMS) to be one of the first doctors in the USA to become certified in Diagnostic Musculoskeletal Ultrasound Imaging (RMSK).

Dr. Striano regularly attends several conferences per year on ultrasound diagnosis and ultrasound guided medical procedures in interventional medicine taught by leading doctors and radiologists from all over the world at various national locations including The Mayo Clinic.

Dr. Striano has spent the past 15 years in the multi-specialty field workinghand in hand as a team with the physicians and physical therapists at Optimum Joint to provide the leading edge in cooperative care for the joints and spine. His vast experience and knowledge is applied on a daily basis in pain management.

Trigger Point Injections:

Arthritis and Trigger Point Injections: Trigger point injection (TPI) may be an option in treating pain for some patients. TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body. Local corticosteroid injection is often helpful for trigger points and arthritis.

Injections adjacent to the spine, called para-vertebral injections are administered using continuous live ultrasound guidance ensuring pin point accuracy exactly where the injection is needed.

What Happens During a Trigger Point Injection?

In the TPI procedure, a small needle is guided under continuous ultrasound imaging into the painful trigger point. The injection contains a local anesthetic that sometimes includes a steroid. With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment that can include weekly injections over the course of several weeks isrequired to alleviate all of the pain resulting in sustained relief. The injections are not painful, as the skin is first coated with a freezing spray and a local anesthetic is used.  Injections take just a few minutes and you’re on your way. Several sites may be injected in one visit. If there are allergies to a certain drug, a dry-needle technique (involving no medications) can be used.

When Are Trigger Point Injections Used?

TPI is used to treat many muscle groups, especially those in the arms, legs, lower back, and neck. In addition, TPI can be used to treat fibromyalgia and tension headaches. The techniques are also used to treat myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) when unresponsive to other treatments.

Epidural Spinal Injection: Using local anesthetics

Patients with known diagnoses of herniateddiscs or pinched nerves in their neck have complaints that include numbness and tingling, as well as weakness in the arms or hands. Patient may feel weakness in the grip, holding or squeezing objects.

What is the epidural space?

The membrane that covers the spine and nerve roots in the neck is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to the neck, shoulder and arms. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contact with the bony structure of the spine in some way.

What is an epidural and why is it helpful?

An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, reducing the pain in the neck, shoulders and arms, as well as numbness and tingling into the arms. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or a period of pain relief for several months while the injury or cause of pain is healing.

Will I be “put out” for this procedure?

No. This procedure is done under local anesthesia. This makes the visit quick and convenient wherepatientsare able to pick up and go right after their visit.

What happens during the procedure?

The patient is placed on the injection table with stomach facing downward.The injected area is cleaned and sterilized and a local anesthetic is administered to numb the area of the injection site. After the numbing medicine has been given time to be effective, we direct a small needle, using x-ray guidance called fluoroscopyinto the epidural space. A small amount of contrast (dye) is injected to insure the needle is properly positioned in the epidural space. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected.

Patients are able to get up and drive home after the procedure, as we do not use any general anesthesia. The procedure is performed in the office and takes approximately 30 minutes.

Facet Joint Injection

The small joints in your neck that guide movement back and forth, up and down and around arecalled facet joints. They are small circular joints that are surrounded by a joint capsule. Facet joints are commonly affected by arthritis and inflammation of the capsule called capsulitis. This type of condition results in stiffness and pain with ranges of motion and physical activity, in addition to the constant need to change sleep positions.

When the facet joints and capsules are the primary problem, pain is most often localized to the neck on either side, and usually does not include numbness or tingling into the arms or hands.

What is a Facet Joint Injection?

Facet Joint Injection is an injection of long lasting steroid (“cortisone”) in the facet joints, which are those that guide movement in your neck. These are actual joints with joint capsule that contains lubricating fluids.

What is the purpose of a Facet Joint Injection?

The injected steroid reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation and irritation of the joint and surrounding structures.

How long does the injection take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a mixture of local anesthetic (like Lidocaine or bupivacaine) and the steroid medication (methylprednisolone – Depomedrol).  

Will I be “put out” for this procedure?

No. This procedure is done under local anesthesia. This makes the visit quick and convenient, allowingpatients to get up and go right after.

How is the injection performed?

It is donelying on the stomach. The skin on the back of the neck is cleaned and sterilized, and local anesthetics injected to numb the injection site. Using x-ray guidance (called fluoroscopy) a small needle is guided to the facet joint. A small amount of contrast (dye) is injected to insure the needle is properly positioned in the facet joint capsule. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected. In some cases where the arthritis covers several locations, more than one joint can be injected during the same visit.

Patients are able to get up and drive home after the procedure, as we do not use any general anesthesia. The procedure is performed in the office and takes approximately 30 minutes.

Our Mission Statement

We want to make a difference. We are dedicated to providing our patients with updated and current treatment alternatives for adults suffering with joint and spine pain. Our staff regularly attends several conferences per year on ultrasound guided interventional medicine with new and innovative, as well as traditional techniques in treating joint pain. This allows us to utilize and implement the practices and techniques of leaders in diagnostic ultrasound imaging and ultrasound guided treatment from Europe, Asia, Canada and the United States at prestigious institutions including the Mayo Clinic. We remain on the cutting edge of treatment objectives to help our patients feel better!

 


 

Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.