Redefining Non-Operative Sports, Spine, & Regenerative Medicine With Cutting-Edge Technology

Generally, it is recommended to wait at least 3 months before getting another injection. Most people shouldn’t get more than 3 shots per year.

Every patient responds differently but generally injections last between a few weeks and a few months.

Risks of repeated steroid injections include tendon weakening or rupture, damage to cartilage, weakening of surrounding bone, thinning of skin around injection site.

Ultrasound is an imaging modality that utilizes high-frequency sound wave to produce real-time dynamic images of the body. Ultrasound examinations do not involve ionizing radiation and are painless. Ultrasound evaluation is an extension of the physical exam and assists Sports Medicine physicians in obtaining real-time point of care information regarding injuries to muscles, tendons, ligaments, joints, or nerve. Ultrasound can give a clear picture of soft tissue injuries that may not show up on x-ray. They may assist in assessing injuries on the date of appointment, sometimes in place of an MRI. For example, ultrasound can give a clear picture of rotator cuff tears. Its use is especially beneficial for patients who cannot undergo an MRI. Ultrasound is also utilized for needle guidance to ensure accurate placement of injections. MRI is still the imaging modality of choice with many conditions but Ultrasound is an excellent alternative in many cases.

Ultrasound guidance is useful in needle placement during injections. Ultrasound allows real-time visualization of the needle in guidance to the target tissue such as joint, tendon, ligament, or nerve.

Generally, PRP takes a minimum of 3 months to take effect with some benefits still being seen at 1 year.

Generally, it is recommended to decrease activity for approximately 10 days following PRP injection, depending on type of injury being treated. We will provide you with a detailed rehabilitation and return to activity program.

A lumbar RFA is a procedure that uses radio waves to stop the lumbar medial branch nerve from transmitting pain signals from the injured facet joint to the brain. The procedure calls for a needle to be inserted through the skin and guided with X-ray to the correct site overlying the medial branch nerve.

It can take up to 8 weeks to start seeing the pain relieving benefits of RFA.

80% of patients get 60% pain relief and 60% of patients get 80% pain relief.

Minimal recovery time of 24-48 hours.

TENEX™ is a minimally invasive procedure that removes scar tissue from your tendon. It utilizes ultrasonic energy precisely treats only the damaged tendon tissue, the surrounding healthy tissue is left unharmed, allowing patient recovery to be in the 4-6 week range. A small incision is made and the Tenex device is guided under ultrasound to the area of diseased tendon to remove damaged tissue. Its most frequent applications include tennis elbow (lateral epicondylitis), golfers elbow (medial epicondylitis), patellar tendinitis, achilles tendinitis, plantar fasciitis, rotator cuff tendinits, calcific tendinitis.

4-6 weeks

Tenex (tenotomy or percutaneous needle tenotomy) is a minimally invasive procedure used to treat chronic tendon pain, commonly associated with conditions like tendinopathy or tendinosis. The procedure involves using a needle-like device to break down damaged tissue within the tendon, promoting healing and reducing pain.

Studies on the efficacy of Tenex have shown promising results for certain conditions, particularly in the treatment of chronic tendon pain in areas such as the elbow (tennis elbow), shoulder (rotator cuff tendinopathy), and knee (patellar tendinopathy). Research suggests that Tenex may provide significant pain relief and functional improvement in patients who have not responded to conservative treatments like rest, physical therapy, or corticosteroid injections.

However, it’s essential to note that the efficacy of Tenex can vary depending on factors such as the specific tendon being treated, the severity of the condition, and individual patient factors. Additionally, like any medical procedure, Tenex carries potential risks and complications, including infection, nerve damage, or incomplete resolution of symptoms.

The SPRINT^® PNS system offers a minimally-invasive 60-day implant specifically designed to deliver significant and sustained pain relief while offering a system that is easy to use. The SPRINT^® PNS System has been used extensively for low back pain, shoulder pain, head and neck pain, post-amputation pain, and chronic and acute post-operative pain.

Physical Medicine and Rehabilitation (PM&R) physicians, also known as physiatrists, treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons.

Nerve hydrodissection involves placing a needle near an impinged nerve under ultrasound guidance and injecting normal saline to free up tissue entrapping the nerve.

PRP stands for Platelet-Rich Plasma, which is a regenerative medicine treatment that has gained popularity in various medical fields, including orthopedics, sports medicine, dermatology, and aesthetic medicine.

PRP therapy involves extracting a small amount of the patient’s blood and processing it to isolate the platelets and plasma, which contain a concentrated source of growth factors and other bioactive proteins. These platelets are then re-injected into the target area of the body, where they are believed to stimulate tissue repair, reduce inflammation, and promote healing.

The rationale behind PRP therapy is that the growth factors and other bioactive proteins present in platelets can enhance the body’s natural healing processes. By delivering a high concentration of these substances directly to the site of injury or tissue damage, PRP therapy aims to accelerate healing, improve tissue regeneration, and relieve pain.

PRP therapy has been used to treat a variety of conditions, including:

1. Orthopedic injuries: Such as tendonitis, ligament sprains, muscle strains, osteoarthritis, and tendon or ligament tears.
2. Sports injuries: Such as tennis elbow, golfer’s elbow, jumper’s knee, and Achilles tendonitis.
3. Musculoskeletal conditions: Such as rotator cuff tears, plantar fasciitis, and degenerative joint diseases.
4. Dermatological conditions: Such as hair loss (androgenetic alopecia), acne scars, and aging skin.

PRP therapy is typically performed as an outpatient procedure and is considered minimally invasive. While research on the effectiveness of PRP therapy is ongoing, some studies have shown promising results, particularly for certain conditions such as tendonitis and osteoarthritis. However, the efficacy of PRP therapy can vary depending on factors such as the specific condition being treated, the patient’s overall health, and individual response to treatment.

As with any medical procedure, it’s essential to consult with a qualified healthcare professional to determine if PRP therapy is appropriate for your specific condition and to discuss potential risks, benefits, and alternatives.

Currently, there is no solid human studies indicating cartilage regeneration with PRP or BMAC (Bone Marrow Aspirate Concentrate).

The efficacy of Platelet-Rich Plasma (PRP) therapy in treating rotator cuff tears is a subject of ongoing research and clinical debate. While some studies have shown promising results, others have reported more modest outcomes.

Several factors may influence the effectiveness of PRP therapy for rotator cuff tears, including the size and severity of the tear, the patient’s age and overall health, and the specific PRP preparation and injection technique used.

Research on PRP therapy for rotator cuff tears has produced mixed findings:

1. Some studies have suggested that PRP therapy may promote healing and improve clinical outcomes in patients with rotator cuff tears. These studies have reported reductions in pain, improvements in shoulder function, and evidence of tendon healing on imaging studies following PRP treatment.
2. However, other studies have found no significant differences between PRP therapy and placebo or other treatments, such as corticosteroid injections or physical therapy, in terms of pain relief, functional improvement, or tendon healing.
3. The variability in study outcomes may be attributed to differences in study design, patient selection, PRP preparation methods, injection techniques, and outcome measures used.

Overall, while there is some evidence to suggest that PRP therapy may have a beneficial effect on rotator cuff tears, further research is needed to better understand its efficacy, optimal treatment protocols, and long-term outcomes. It’s also essential to consider PRP therapy as part of a comprehensive treatment plan that may include physical therapy, activity modification, and, in some cases, surgical intervention.

Mesenchymal stem cells (MSCs) are a type of adult stem cell found in various tissues throughout the body, including bone marrow, adipose (fat) tissue, and umbilical cord blood. These cells have garnered significant interest in orthopedic medicine due to their remarkable regenerative and immunomodulatory properties. Here’s how MSCs relate to orthopedic conditions:

1. Regenerative Potential: MSCs have the ability to differentiate into various cell types, including bone, cartilage, and tendon cells. This means they can contribute to the repair and regeneration of damaged tissues in orthopedic conditions such as osteoarthritis, tendon injuries, ligament tears, and bone fractures.
2. Anti-inflammatory Effects: In addition to their regenerative capabilities, MSCs possess potent anti-inflammatory properties. They can modulate the immune response by releasing factors that suppress inflammation and promote tissue healing. This makes them particularly valuable in conditions characterized by chronic inflammation, such as osteoarthritis and tendonitis.
3. Tissue Engineering: MSCs play a crucial role in tissue engineering and regenerative medicine approaches for orthopedic conditions. Researchers are exploring methods to harness MSCs in combination with biomaterials and growth factors to create tissue-engineered constructs for repairing or replacing damaged bone, cartilage, and other musculoskeletal tissues.
4. Clinical Applications: MSC-based therapies, including bone marrow aspirate concentrate (BMAC) and adipose-derived stem cell injections, are being increasingly used in clinical practice for orthopedic conditions. These treatments aim to promote tissue repair, reduce pain, improve function, and potentially delay or eliminate the need for surgical intervention.
5. Challenges and Considerations: While MSC-based therapies hold immense promise, several challenges remain, including optimizing the isolation and expansion of MSCs, ensuring their safety and efficacy in clinical use, and addressing regulatory considerations. Research is ongoing to address these challenges and further refine MSC-based treatments for orthopedic conditions.

In summary, MSCs represent a promising avenue for the development of novel therapies in orthopedic medicine, offering the potential to harness the body’s own regenerative mechanisms to treat a wide range of musculoskeletal disorders.

BMAC stands for Bone Marrow Aspirate Concentrate, a cutting-edge treatment in orthopedics. Here’s a breakdown:

1. Bone Marrow Aspirate: This is the process of extracting bone marrow from a patient’s body, usually from the hip bone (iliac crest). Bone marrow is a rich source of stem cells, growth factors, and other healing elements.
2. Concentration: Once the bone marrow is aspirated, it undergoes a process to concentrate the beneficial components. This can involve centrifugation or filtration techniques to isolate the most potent elements, including mesenchymal stem cells (MSCs) and growth factors.
3. Injection: The concentrated bone marrow, now enriched with healing factors, is injected into the site of injury or damage. This could be in joints affected by osteoarthritis, fractures, tendon or ligament injuries, or other orthopedic conditions.
4. Healing and Regeneration: Once injected, the concentrated bone marrow works to promote healing and tissue regeneration. MSCs have the remarkable ability to differentiate into various cell types, aiding in the repair of damaged tissues. Growth factors also play a crucial role in stimulating cellular activity and tissue regeneration.
5. Benefits: BMAC therapy offers several advantages in orthopedics. It’s minimally invasive, utilizing the patient’s own cells, which reduces the risk of rejection or adverse reactions. It can potentially accelerate healing, reduce pain, improve function, and in some cases, even delay or eliminate the need for surgery.
6. Clinical Applications: BMAC has been used in various orthopedic conditions, including osteoarthritis, tendon injuries (such as Achilles tendonitis), ligament injuries (like anterior cruciate ligament tears), non-union fractures, and spinal fusion procedures, among others.
7. Research and Development: While BMAC has shown promising results in many studies and clinical applications, ongoing research aims to further optimize techniques, improve outcomes, and explore new avenues for its use in orthopedic care.

Overall, BMAC represents a significant advancement in orthopedic treatment, harnessing the body’s own healing mechanisms to promote tissue repair and regeneration.

Repeated steroid injections have the potential to promote cartilage degeneration, tendon weakening or rupture, and surrounding bone loss.

• Gender
• Age
• Genetics
• Race
• Occupation
• Obesity
• History of Joint Trauma

Hip OA

The incidence of hip osteoarthritis tends to increase with age, with older adults being at higher risk. However, similar to knee osteoarthritis, hip OA can also affect younger individuals, especially those with risk factors such as a history of hip injuries, repetitive stress on the hips (e.g., from certain occupations or activities), or genetic predisposition.

Various studies have estimated the incidence of hip osteoarthritis in different populations. For example, a study published in the journal Osteoarthritis and Cartilage in 2017 estimated that the incidence rate of hip osteoarthritis was approximately 100 to 300 cases per 100,000 person-years in the general population. However, this rate may vary based on factors such as geographic location, ethnicity, and socioeconomic status.

Knee OA

While precise figures may vary slightly across different studies and populations, knee osteoarthritis is generally considered to be a common condition, particularly among older adults. According to the Centers for Disease Control and Prevention (CDC), osteoarthritis affects over 32.5 million adults in the United States alone, with the knee being one of the most commonly affected joints.

Research indicates that the incidence of knee osteoarthritis tends to increase with age, with older adults being at a higher risk. However, knee OA can also affect younger individuals, especially those with risk factors such as a history of joint injuries, repetitive stress on the knees (e.g., from certain occupations or sports), or genetic predisposition.

Various studies have estimated the incidence of knee osteoarthritis in different populations. For example, a systematic review published in the journal Arthritis & Rheumatology in 2014 estimated that the overall incidence rate of symptomatic knee osteoarthritis ranged from 240 to 295 cases per 100,000 person-years in the general population.

Rotator Cuff Tears

Research suggests that the prevalence of rotator cuff tears tends to increase with age, with older adults being at higher risk. However, rotator cuff tears can also occur in younger individuals, especially those involved in activities or occupations that place repetitive stress on the shoulder joint, such as athletes, manual laborers, or individuals with certain hobbies.

While specific figures may vary across studies and populations, rotator cuff tears are estimated to affect a significant portion of the population. For example, a systematic review published in the Journal of Shoulder and Elbow Surgery in 2019 estimated that the prevalence of rotator cuff tears ranged from 17% to 39% in the general population, with higher rates observed among older age groups.

Additionally, the incidence of rotator cuff tears may be influenced by factors such as gender, with some studies suggesting that men may be more predisposed to developing rotator cuff tears compared to women. Occupational factors, such as repetitive overhead activities or heavy lifting, can also contribute to the development of rotator cuff tears.

It’s essential to note that not all rotator cuff tears cause symptoms, and the severity of symptoms can vary widely among affected individuals. While some rotator cuff tears may respond well to conservative treatments such as rest, physical therapy, platelet rich plasma injections, and others may require surgical intervention, particularly if they are large or causing significant pain and functional impairment.

Achilles Tendinopathy

Research suggests that Achilles tendinopathy is more prevalent in certain populations, such as runners, basketball players, volleyball players, and individuals involved in jumping or sprinting sports. Additionally, factors such as age, biomechanical abnormalities, improper footwear, training errors, and systemic conditions like obesity or diabetes can increase the risk of developing Achilles tendinopathy.

Estimates of the incidence of Achilles tendinopathy vary across studies. For example, a systematic review published in the Journal of Foot and Ankle Research in 2019 reported that the incidence of Achilles tendinopathy ranged from 0.9% to 2.1% per year among runners and athletes participating in jumping or pivoting sports. However, the overall incidence may be higher when considering the general population and other contributing factors.

It’s important to note that while Achilles tendinopathy can be a challenging and sometimes debilitating condition, many cases can be effectively managed with conservative treatments such as rest, physical therapy, stretching exercises, orthotics, and eccentric strengthening exercises. In some cases, more advanced treatments such as extracorporeal shockwave therapy (ESWT), platelet-rich plasma (PRP) injections, or surgery may be considered, particularly for chronic or severe cases that do not respond to conservative measures.

Plantar Fasciitis

The incidence of plantar fasciitis varies across different populations and studies but is generally considered to be relatively common. Several factors contribute to the development of plantar fasciitis, including age, activity level, foot structure, biomechanical issues, obesity, and certain occupations or activities that involve prolonged standing, walking, or running on hard surfaces.

While specific figures may vary, epidemiological studies have provided estimates of the incidence of plantar fasciitis in various populations. For example:

1. A study published in the Journal of Bone and Joint Surgery in 2003 estimated the annual incidence of plantar fasciitis to be approximately 8 to 10 cases per 1000 people in the general population.
2. Another study published in the Journal of Foot and Ankle Research in 2008 reported an incidence rate of approximately 1.3 cases per 1000 person-years in a large population-based cohort study.
3. Research suggests that plantar fasciitis is more prevalent among certain groups, such as athletes, runners, military personnel, and individuals with occupations that require prolonged weight-bearing activities.

It’s essential to note that while plantar fasciitis is common, not everyone with risk factors will develop the condition, and the severity of symptoms can vary among affected individuals. Additionally, plantar fasciitis can be a challenging condition to manage, requiring a combination of conservative treatments such as rest, stretching exercises, orthotics, footwear modifications, physical therapy, and in some cases, PRP injections, extracorporeal shockwave therapy (ESWT), or Tenex needle tenotomy.

Patellar Tendinitis/Jumpers Knee

The incidence of patellar tendonitis can vary depending on factors such as age, gender, activity level, and participation in sports or activities that involve repetitive jumping, running, or squatting movements. While precise figures may vary across studies and populations, patellar tendonitis is considered relatively common, particularly among athletes and individuals engaged in activities that place repetitive stress on the patellar tendon.

Several studies have provided estimates of the incidence of patellar tendonitis in various populations:

1. A study published in the American Journal of Sports Medicine in 2012 estimated the incidence of patellar tendonitis to be approximately 14% among basketball players and 12% among volleyball players.
2. Another study published in the Scandinavian Journal of Medicine & Science in Sports in 2015 reported an incidence rate of approximately 1.5 to 4.5 cases per 1000 hours of exposure in elite male volleyball players.
3. Research suggests that patellar tendonitis is more prevalent among certain sports populations, such as basketball, volleyball, soccer, track and field, and other sports that involve jumping and explosive movements.

It’s important to note that while patellar tendonitis is common, not everyone with risk factors will develop the condition, and the severity of symptoms can vary among affected individuals. Additionally, patellar tendonitis can be a challenging condition to manage, requiring a combination of conservative treatments such as rest, activity modification, physical therapy, eccentric strengthening exercises, orthotics, and in some cases, PRP injections, extracorporeal shockwave therapy (ESWT), or Tenex needle tenotomy.

Disc Herniations

While precise figures may vary across studies and populations, disc herniations are relatively common, particularly among adults. Research suggests that the incidence of disc herniations tends to increase with age, with older adults being at higher risk. However, disc herniations can also occur in younger individuals, especially those with risk factors such as heavy lifting, repetitive bending, twisting motions, or occupations that involve prolonged sitting or standing.

Several studies have provided estimates of the incidence of disc herniations in various populations:

1. A systematic review and meta-analysis published in the European Spine Journal in 2016 estimated the prevalence of lumbar disc herniations to be approximately 1.9% in the general population, with higher rates observed among older age groups.
2. Another study published in the journal Spine in 2015 reported an annual incidence rate of symptomatic lumbar disc herniations of approximately 5 per 1000 adults.
3. Research suggests that lumbar disc herniations are more common than cervical disc herniations, with the lower back being the most frequently affected area of the spine.

It’s important to note that while disc herniations are common, not all herniated discs cause symptoms, and the severity of symptoms can vary among affected individuals. Additionally, the management of disc herniations typically involves a combination of conservative treatments such as rest, physical therapy, pain management, and in some cases, surgical intervention for severe or refractory cases.

• Diagnostic Ultrasound
• Ultrasound guided joint injections
• Fluoroscopic guided lumbar epidural injections
• Fluoroscopic guided Sacroiliac joint injections
• Ultrasound guided tendon sheath injections
• Tenex needle tenotomy
• Platelet Rich Plasma injections
• Radiofrequency Ablation
• Sprint Peripheral Nerve Stimulator
• Basivertebral Nerve Ablation