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Infiltrations

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Our therapeutic arsenal is varied but we mainly intervene via a range of therapeutic injections (infiltrations) to promote optimal functional recovery of the majority of common musculoskeletal injuries. Since 2010, most if not all the injections we do are done under ultrasound guidance. Multiple clinical studies have confirmed the clear advantages obtained with ultrasound guided injections

MEDICAL MSK INDICATIONS FOR THERAPEUTIC INJECTIONS

  • Tendonitis
  • Capsulitis (Frozen shoulder)
  • Arthritis
  • Synovitis
  • Osteoarthritis,
  • Myofascial Syndrome
  • Sprains and strains
  • Old painful fractured bones
  • Painful scars
  • Sciatic neuralgia
  • Occipital Neuralgia
  • Morton’s Neuroma
  • Heel Spur
  • Plantar Fasciitis
  • Carpal Tunnel Syndrome
  • Chronic Spinal Sprains
  • Facet Syndrome
  • Disc hernia ( operated or not )
  • Surgery sequels
  • Etc…

INFILTRATABLE AREAS AND REGIONS

EVERY SKELETAL JOINTS

  • Shoulder
  • Elbow
  • Wrist
  • Hand
  • Fingers
  • Hip
  • Knee
  • Ankle
  • Foot
  • Toes

  • Myofascial Trigger Points

SPINAL AREAS

  • Greater and Lesser Occipital Nerves Blocks GON, LON
  • Third Occipital Nerve Block TON
  • Superficial Cervical Plexus Block
  • Trigeminal Nerve Block
  • Facet Blocks
  • Peri-Radicular Spinal Blocks
  • Paravertebral Thoracic Blocks
  • Caudal Block
  • Articulating infiltration. sacro-iliaque
  • Articulating infiltration. sacro-coccygien
  • Impar Block (Warther’s Sacro-coccygeal Plexus)

PERIPHERAL NERVES

  • Median Nerve
  • Ulna Nerve
  • Radial Nerve
  • P.I.N. Posterior Interosseous Nerve
  • Suprascapular Nerve
  • Sciatic Nerve
  • Lateral Femoro-Cutaneous Nerve
  • Pudendal Nerve
  • Common Peroneal Nerve
  • Geniculate Nerves
  • Posterior Tibial Nerve
  • Sural Nerve
  • Saphenous Nerve
  • Deep and Superficial Peroneal Nerve
  • Morton’s Neuroma

THORACIC INJECTIONS

  • Intercostal Nerve Block
  • Paravertebral Thoracic Blocks
  • NDS nerf dorsal scapulaire
  • NSA nerf spinal accessoire
  • Sterno-clavicular and costo-sternal joint injection
  • Articulating infiltration. costo-transverse
  • Myosfascial Trigger Points injections

Pelvis

  • Hip joint injection
  • Hip Trochanter injection ( tendon and bursa )
  • Ischial injection ( tendon and bursa )
  • Pubic joint injection
  • Piriformis and Obturator internus injections
  • Pudendal Nerve block
  • Ilio-Hypogastric Nerve block
  • Genito-Femoral Nerve block
  • Impar Nerve block (Warther’s plexus)

Others

  • Shoulder calcification lavage
  • Frozen Shoulder distensive capsular injection
  • TMJ injection (Jaw)

TYPES OF INJECTIONS

CORTISONE INJECTIONS

Cortisone injections have been used since the 1950’s to treat injuries and inflammatory issues of the musculo-skeletal system. Generally speaking, cortisone injections are still very useful even in very low dosages. They remain quite a safe procedure as long as we don’t treat the same parts over 3-4 times yearly. Most if not all cortisone injections should be done under ultrasound guidance for matters of efficacy and safety. Most cortisone injections are mixed with a local anesthetic ( lidocaine, marcaine, etc…) so the procedure is almost painless.

VISCOSUPPLEMENTATION INFILTRATION

Purified Hyaluronic Acid injections act as joints lubricants for treating worn out joints. In a majority of patients, 1 or 2 yearly injections give adequate relief so most joint replacement surgery can be postponed indefinetely (Monovisc, Durolane, Néovisc, Euflexxa, etc…)

CELLULAR MATRIX : TO IMPROVE STEM CELLS MIGRATION

Combining PRP into a hyaluronic acid viscosupplement can significantly increase the bio-active time of PRP inside the targeted joints Actually, platelets trapped in a liquid cartilage injection tend to prolong the migration attracting effect over neighboring stem cells.
This procedure, named CELLULAR MATRIX, aims to optimise PRP healing properties in joints.

PRP injections : Platelet Rich Plasma injections

Since 2010, PRP (Platelet Rich Plasma)injections are well established medical procedures to increase the healing and repair of most musculo-skeletal tissus:

Thousand of physicians all over the world are using these injections daily. This therapy uses our own plasma and platelets to activate healing processes in tissus that resist common treatment modalities: cortisone injections, physiotherapy, anti-inflammatory medications, etc…

PRP is first prepared by drawing a small quantity of blood from the patient’s arm vein. This sample is spinned in a centrifuge with specific tubes to extract plasma and platelets while removing white and red blood cells.

This is the PRP that will be injected under ultrasound guidance in the targeted injuries and lesions. When injected, platelets release a multitude of biochemical substances (growth factors) that induce the various stages of lesion repair while activating the migration and transformation of stem cells, which play a key role in tissue regeneration.

Platelets and stem cells are always interacting in healing tissues. First, platelets initiate tissues repair by forming a blood clot at the injection site. PRP. Secondly, platelets release chemotactic molecules that attracts neighbouring stem cells to migrate at the injection site PRP. Thirdly, platelets induce the stem cells to transforms in the types of mains cells needed for the healing and repair of the injured part.

PRP: a novel and safe therapy available at our Pain clinicsince 2010

1 to 4 sessions are usually effective in about 80% of treated lesions.

PRP: SAMPLING OF BLOOD

On the day of treatment, 2 to 4 tablespoons of blood is simply drawn from a vein from the patient elbow crease. After the centrifuging process, the PRP injection is done under ultrasound guidance

REST PERIOD

Complete relative rest of the treated area is required for the first week of two after the PRP injection Light mobilisation and light exercices are allowed after a few days when the initial post-injection pain is wearing off. Usually from the third or fourth week after the PRP injection, more regular activities and gentle strenghting Then we can start a gradual return to regular activities. Gradual return to normal activities is allowed in the coming weeks and month to match the functionnal capacities that should improve in the coming months

AUTORIZED MEDICATIONS

During the first few days after a PRP injection, local pain can increase. It should be treated with Acetaminophne (Tylenol) as needed, 500 mg 1-2 caplets 2-4 times daily. If the pain is more intense, a more potent pain killer may be used for a day or two. One should avoid applying ice at the injected area because this might reduce the healing potency of PRP

MEDICATIONS TO AVOID:

Anti-inflamatory medications should be avoided for the 4 weeks period following a PRP treatment: Aspirine, Motrin, Advil, Ibuprofène, Voltaren, Naprosyn, Arthrotec, Aleve, Celebrex Prednisone, cortisone. Like ice applications , these medications may reduce the healing potency of PRP injections

COUNTER-INDICATIONS TO HAVING A PRP INJECTIONS

PRP injections should be avoided for any of the following reasons:

  • Allergies to local anesthetic ( Xylocaine )
  • Ongoing treatment with blood thinners ( anti-coagulants )
  • Recent cortisone injection ( < )
  • Pregnancy and breast feeding
  • Unstable blood coagulation issues
  • AIDS or other immuno-deficient issues
  • Active untreated infections
  • Active untreated anemia
  • Active cancer

MEDICAL INDICATIONS FOR PRP INJECTIONS

  • Injuries : Tendons
  • Ligaments
  • Bursa
  • Cartilage and labrum
  • Meniscuc tears
  • Sprains and strains
  • Osteo-arthritis
  • Arthritis
  • Occipital neuralgia
  • Morton’s neuroma
  • Carpal tunnel syndrome
  • Trigger fingers
  • Sciatic Nerve
  • Spinal pains
  • Residual fracture pains
  • Plantar Fasciitis
  • Myofascial Syndrome
  • Capsulitis (Frozen shoulder)

OTHER INDICATIONS FOR PRP INJECTIONS

  • Alopecia, hair loss
  • Hypertrophic scars , cheloids
  • Acnea scars
  • Vitiligo
  • Localised skin atrophy
  • Stretch marks

3-4 sessions required 2-4 weeks apart

Advanced Prp Protocol

For more complex musculoskeletal issues with chronic pains. improved centrifuging and extraction procedures enables the preparation of specific platelets and stem cells concentrations and growth factors (LPCGF) the medifuge mf200 unit process the blood through 4 consecutive spin cycles of different speeds and different time length in order to obtain and optimized PRP (LPCGF)

* LPCGF : Liquid phase concentrated growth factors

INDICATIONS :

  • Chronic muscle pain,
  • Chronic spinal pain,
  • Generalized arthrosis and arthritis,
  • Post-traumatic stress disorder,
  • Fibromyalgia syndrome,
  • Etc…

PROGRAM :

  • Includes 3 medical visits.
  • collection of 20-60 ml of venous blood at the initial visit
  • automated centrifugation and extraction with medifuge centrifuge mf200
  • multiple echo-guided Intra- and peri-lesional injections
  • 2nd and 3rd visits (inclusive) in the weeks following the initial visit.

Fees: $2000

Other types of injections procedures

LAVAGE AND ASPIRATION OF CALCIFICATIONS

Ultrasound guided procedure wherein a painful calcium depot ( usually in the shoulder ) is broken up in smaller fragment to either be needle-aspirated of taken up by nearby scavenger cells ( macrophages )

JOINT DISTENTIVE INJECTION

Injection procedure almost exclusively dedicated to treatment of Frozen shoulder The shoulder joint is flooded with 12-15 cc of local anesthetics and cortisone in order to breakdown the joint adhesive tissues that restrict motion

TRIGGER FINGER RELEASE

Ultrasound guided micro-surgery procedure wherein section of the incroaching tendon sleeve is achieved under local anesthesia Technique performed under local anesthesia and ultrasound guidance

INJECTABLE MEDICATIONS

  • Lidocaine, Marcaine (local anaesthetic)
  • CORTICOSTEROIDS: Triamcinolone, Dexamethasone
  • ANTI-INFLAMMATORY : Ketorolac
  • Visco-supplementation (Monovisc, Durolane, etc.)