Ultrasound-Guided Injections

Recent advances in high-resolution Ultrasound (US) imaging present new opportunities in improving the care of patients with pain due to musculoskeletal and nerve injuries. US uses sound waves to provide real-time, high resolution images of tendons, ligaments, muscles, and nerves throughout the body. US allows us to deliver treatments precisely and safely to the effected tissue. During ultrasound-guided injections, Dr Binegar and his trained staff can directly visualize the needle passing...

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Joint Injections

Orthovisc or Synvisc may be  used to treat knee osteoarthritis to prevent or delay needing a total knee replacement surgery.  When the synovial fluid becomes thinner and loses its elasticity and viscosity (ability to lubricate), the osteoarthritic, synovial fluid cannot provide "cushioning" in your knee joint. A lubricant such as Orthovisc is injected into the joint cavity to replace the lost synovial joint fluid. Corticosteroid injections are used to treat...

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X-ray/Fluoroscopy/C-arm

Some procedures will require use of an x-ray/fluoroscopy machine referred to as a C-arm. Our C-arm is equipped with the most advanced, state-of-the-art technology providing us, you, and your referring doctor with beautiful digital pictures. The pulsed technology and collimator allows decreased exposure to you and our staff. The digital subtraction technology not only give us better pictures but allows us play back, decreasing your risks. The "super C-arm" allows...

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Spinal Cord Stimulation (SCS)

SCS uses similar technology to a pacemaker with the end result being an electrode placed in the epidural space which is connected to a pulsed generator placed under your skin (typically upper abdomen or buttocks). This technology is usually reserved for patients with refractory extremity pain not responsive to other conservative treatments. Turning on the electrode causes a "tingling" sensation which helps to decrease the perceived pain of the involved...

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Kyphoplasty/Vertebroplasty

Kyphoplasty and/or Vertebroplasty are new procedures sometimes done for patients with lower thoracic and lumbar vertebral compression fractures. However, typically vertebral compression fractures do heal over time and can be treated with pain medications, bracing, and/or facet/epidural steroid injections. If these more conservative measures fail, then one can consider doing a kyphoplasty or vertebroplasty. This requires careful placement of one to two needles into the vertebral body. With a kyphoplasty...

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Discograms

Discograms are done to help diagnose your pain and not to treat your pain. Although dye is injected into your disc and x-ray pictures (and sometimes a CT scan) are taken, the pictures are not as important as your response to the dye being injected (see below). Discography is most commonly done at the lumbar level for people who have failed extensive conservative treatments yet continue to have disabling low...

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Radiofrequency Ablation

Radiofrequency (RF) techniques require a special machine allowing interruption of the nerve conduction on a semi-permanent basis. With the "classic" RF technology, RF waves pass down a needle causing an increased temperature and partial destruction of the nerve it is near. This is most commonly done for people with neck or back pain due to facet arthritis, who have had a very good response (but unfortunately only for a short...

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Peripheral Nerve Injections

The most common peripheral nerve blocks are of the intercostal nerves (between the ribs), ilioinguinal and/or genitofemoral nerves for groin pain, the lateral femoral cutaneous nerve for upper thigh pain, and greater and lesser occipital nerve injections for headaches in the back of the head. However, chronic nerve irritation may occur with any nerve post surgery. As examples, intercostal injections may be required for post thoracotomy pain, and ilioinguinal and/or...

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Trigger Point Injections

Trigger point injections are done for people with myofascial pain syndrome. When your muscles are chronically sensitive to touch and painful with movement, you may have inflamed areas of muscles or trigger points. Injecting the muscle with a local anesthetic/steroid may reduce the inflammation and allow better range of motion. Typically, stretching and exercise, especially with physical therapy, will assist with this process. Also may require electrical stimulation with a...

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Superior Hypogastric Plexus Block

The superior hypogastric plexus innervates the lower sigmoid colon, bladder, ureters, testes, and ovaries. Therefore, by blocking the superior hypogastric plexus, you can interrupt the pain fibers from these pelvic organs. The superior hypogastric plexus is actually a series of ganglia just in front of the fifth lumbar and first sacral vertebra. A diagnostic block is done first with local anesthetic only. If the patient has a good response, we...

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