Osteoarthritis and Joint Pain

What is Osteoarthritis?

Osteoarthritis is the most common form of arthritis sometimes referred to as degenerative joint disease or “wear-and-tear.” It can occur in any joint of the body though commonly in the shoulders, knees, and hips as a result of the gradual breakdown of cartilage and slow change of bone over time. Generally it develops slowly and worsens with time. Often causes pain isolated to the affected joint with stiffness and swelling on occasion. An xray can help assist in the diagnosis of arthritis.

Treatment options for arthritis include physical therapy, medications, procedure options, and possible joint replacement surgery. Coastal Spine and Pain Center offers a variety of non-surgical options to assist in your pain needs: 1) Steroid Injection 2) Viscosupplementation 3) Radiofrequency ablation (pre or post surgical)

Frequently asked questions about treatments

What is an Intra-articular Steroid Injection?

Pain in joints can originate from arthritis and inflammation as noted above. An intra-articular injection uses low dose x-ray to guide a small needle into the joint space. Following needle placement, a small dose of contrast confirms the proper location and spread. Nex, a combination of local anesthetic and steroids are administered into the joint space. The local anesthetic as numbing medication for immediate relief and the steroid being a potent anti-inflammatory medication to provide long lasting relief.

What is Viscosupplementation?

Unlike steroids where the goal is to decreased inflammation to stop pain, viscosupplementation is a similar procedure technique though hyaluronic acid is given. The goal of this therapy is to increase the lubrication within the joint space to decrease pain symptoms.

What is Radiofrequency Ablation Therapy?

This therapy takes a different approach compared to steroids and viscosupplementation though targeting the nerves that send pain signals. It is most commonly completed for knee joint pain and can be even be completed after joint replacement surgery if pain persists. This technique places three small needles adjacent to nerves external to the knee that send pain signals. The goal is to first preform a diagnostic test block(s) with local anesthetic only to see if numbing the nerve stops pain signals. If successful in pain relief, the following procedure uses radiofrequency energy to generate heat and provide more long lasting pain relief. The latter step is only completed if the diagnostic(s) blocks were beneficial.

How long is the pain relief and what if it returns?

It is difficult to predict the response for someone's joint injection and can vary depending on the type of procedure that is completed. In general, a steroid injection can offer a response of 3-6 months of relief following the injection. There are some that have a shorter or no response and others that have a more prolonged response. If pain returns, we can repeat the procedure pending the duration of relief that was achieved.

What are the risks?

As with any procedure it is not without risks. With placement of a needle through the skin, there is always concern for infection or bleeding. Notify your doctor if you are taking any blood thinners/aspirin/plavix or have an active infection. Patients with diabetes should monitor their blood sugar closely as steroids can cause it to increase. Generally, the biggest risk is some mild post procedure soreness which typically resolves in 24 hours. Stretching, ice/heat, and anti-inflammatory medications (if medically able) can help with this. Risk that the procedure makes things worse or does not offer improvement is possible.

Iovera

An alternative knee pain treatment option

Coastal Pain & Spine Center strives to remain at the forefront, offering the latest treatment options for our patients. Our team is proud to offer an alternative option to aid with knee pain regardless if you are trying to avoid knee replacement surgery, are not a surgical candidate, or are considering a knee replacement. Iovera treatment utilizes ultrasound guided placement of liquid nitrogen to freeze the nerves offering rapid relief of knee pain while avoiding any steroids or damage to the surrounding structures. By freezing the nerves, patients can experience pain relief up to three months or longer.

More recently, we have been working with our local orthopedic surgeons to complete this treatment just prior to knee replacement surgery. Doing so decreases post operative pain reducing the need for pain medications and ideally speeding and improving recovery during physical therapy and rehabilitation.

To our knowledge, Coastal Pain & Spine Center, is presently the only practice in Bluffton and Hilton Head Island offering this therapy.

Learn More

Please follow the link below if you would like to learn more about this treatment option.

Iovera.com

Myofascial Pain

What is Myofascial Pain?

The optimal way to understand this is to look at the etymology of the diagnosis. Myofascial comes from "myo" meaning muscle and "Fascia" which is the strong connective tissue surrounding the muscles. There are a variety or reasons this can cause pain. Overuse or strain can be a contributing factor as can posture and mechanical damage. Generalized symptoms can sometimes be the result of fibromyalgia. Treatment often consists of R.I.C.E. (rest, ice, compression, elevation) for the initial acute injury symptoms. Then transition to physical therapy and rehab to improve strength and flexibility/mobility of the affected muscle or muscle groups. There are a variety of medication options that can assist in these pain symptoms with benefits and drawbacks to each. You should discuss with your treating provider.

Further care can consist of myofascial release through deep tissue massage or interventional options of acupuncture, dry needling, or trigger point injections. When the needle hits a trigger point it can cause a twitch response which will release the tension built up within the muscle. This can result in relaxation of muscles, reduced referral pain, and an increase in range of motion.

Trigger Point Injection: Your physician will identify the painful areas of the muscles through palpation. Then after cleaning the skin, will use a small needle to administer local anesthetic and/or steroid medication into the area to relieve symptoms.

Dry Needling: This commonly completed by licensed and trained physical therapists and is similar to trigger point injections though medication is NOT administered into the muscle. Coastal Spine and Pain can assist with a referral.

Acupuncture: Small needles are placed and different points in the skin, but are not placed deeper into the actual muscle groups. Coastal Spine and Pain can assist with a referral.

Treatment of myofascial or muscle pain with trigger point injections, dry needling, and acupuncture