Melbourne Radiology Clinic specialises in the treatment of musculoskeletal pain syndromes and offers a broad range of tests to assist in obtaining an accurate diagnosis.
Melbourne Radiology Clinic can also use its modern imaging equipment to accurately guide a needle to deliver pain relieving medication precisely into the region that is the patient's source of pain, with minimal trauma to surrounding tissue. As such, these injections are useful in patients who have not responded adequately to rest, rehabilitation and medications. It is also of use in patients as a last resort prior to contemplating, or awaiting surgery.
Conditions treated on a daily basis include:
- Bursitis – The following are an example of the many bursae of the body which which routinely require injection: subacromial (shoulder), trochanteric (lateral hip), iliopsoas (anterior hip), ischial (buttock), intermetatarsal (forefoot), prepatellar and infrapatellar (knee), retrocalcaneal and retroachilles (Achilles tendon)
- Morton's neuroma injections
- Tenosynovitis/paratenonitis – deQuervain's (wrist), Achilles tendon paratenonitis
- Ganglion/cyst aspiration: such as ganglia arising from any joint, commonly around the wrist and cysts of the knee (Baker's or popliteal cyst)
- Dupuytren's Contracture
- Sciatic nerve release/neurolysis
- Plantar fasciitis
- Arthritis - Hyaluronan Injections
- Direct tendon injections - ABI, PRP & Polidocanol
A bursa is a fluid filled sac that surrounds joints and tendons and acts like a lubricant, allowing tendons and muscles to move bones with minimal friction. Wear and tear with excessive use or increasing age may damage a bursa, causing it to become inflamed and losing its lubricating ability. This then results in pain with certain movements
Most cases respond well to medication and rehabilitation, along with restriction or cessation of the activity that produced the symptoms in the first place.
Occasionally, symptoms may persist despite best efforts and a cortisone injection directly into the bursa is a frequently successful procedure. This is usually performed under ultrasound guidance, with the needle tip placed into the bursa under direct vision, guaranteeing precise delivery of the medication into the area where it is needed most.
A Morton's neuroma occurs when scar tissue builds upon a nerve in between the toes known as the interdigital nerve (nerve between the digits, or toes). This is most frequently seen in women and is and is attributed to high heeled shoes. The pain is often severe and has an electric shock character to it. A non-surgical option in treating this problem is to disrupt the nerve by using highly concentrated alcohol injected under ultrasound control. This is performed weekly until symptoms improve. Another form of treatment is to heat the nerve via radiofrequency ablation
- Gregg JM, Schneider T, Marks P. MR imaging and ultrasound of metatarsalgia--the lesser metatarsals. Radiol Clin North Am 46(6):1061-78, vi-vii, 2008
- Masala S, Fanucci E, Ronconi P, Sodani G, Taormina P, Romagnoli A, Simonetti G.Treatment of intermetatarsal neuromas with alcohol injection under US guidance.Radiol Med 102(5-6):370-3, 2001
- Hughes RJ, Ali K, Jones H, Kendall S, Connell DA. Treatment of Morton's neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. AJR Am J Roentgenol 188(6):1535-9, 2007
- Finney W, Wiener SN, Catanzariti F. Treatment of Morton's neuroma using percutaneous electrocoagulation. J Am Podiatr Med Assoc. 1989 Dec;79(12):615-8
- Genon MP, Chin TY, Bedi HS, Blackney MC. Radio-frequency ablation for the treatment of Morton's neuroma. ANZ J Surg. 80(9):583-5, 2010
Repetitive manual labour may result in increased friction between tendons of the wrist. Tendons are lined by a thin membrane (tendon sheath, or tenosynovium) which when irritated by repetitive motion becomes inflamed and produces fluid. This is called tenosynovitis and may occur in any tendon of the body which possesses this lining of tissue. When it occurs in the wrist, it is known as de Quervain's tenosynovitis, named after the person who first described the condition. Ultrasound can be used to deliver a dose of cortisone which is in many cases curative, provided that the patient also refrains from the offending activity.
Joints naturally produce fluid which acts as a natural lubricant. If this fluid production is excessive, such as seen in arthritis, or following excessive use, the fluid may protrude through a weakness in the joint capsule. When this occurs, it is known as a ganglion (or synovial cyst). Often it may simply be noticed as a firm lump. Occasionally these may be painful, or compress an important nearby structure, such as a nerve. Under local anaesthetic and using ultrasound guidance, the fluid can be removed and possibly avoid the need for surgery. This is a useful technique in conditions where the cyst is in a part of the body that is difficult to operate on, and as such, treatment options are limited. This is most commonly seen in a Baker's cyst, which occurs behind the knee.
In certain individuals, a build up of scar-like tissue, similar to that occurring in patients with a frozen shoulder, occurs in the palm of the hand, resulting in a firm and often painful nodule under the skin. If this progresses, contraction of the adjacent tissues occurs, including the tendons to the finger, which may make straightening the finger impossible. Ultrasound can be used to accurately deliver a dose of cortisone into the scar tissue with the aim of resolving symptoms. Best results are achieved when treated in the early stages.
- Ketchum LD, Donahue TK. The injection of nodules of Dupuytren's disease with triamcinolone acetonide. J Hand Surg [Am] 25(6):1157-62,2000
This procedure is performed in patients who suffer from leg pain thought to be due to entrapment of the sciatic nerve, however where the origin of the pain is not felt to be arising from the spine. The procedure may be performed under ultrasound or CT guidance and involves inserting a needle adjacent to the nerve. Saline is then injected, elevating the nerve from surrounding scar tissue and thus releases the entrapped sciatic nerve. This procedure has a high success rate in relieving patients from their sciatic pain and also improves flexibility (hamstring stretch). As such, this procedure is useful in athletes.
Also commonly referred to as "heel spurs", plantar fasciitis is a painful condition affecting the heel. This is due to wear and tear of the plantar fascia, a thick, cord like tissue which is similar to a tendon. Under ultrasound guidance, a needle can be introduced into the substance of the fascia and deliver either cortisone or blood.
Hyaluronan is an injectable lubricant that may be effective in alleviating the symptoms of arthritis and is known by several trade names, such as Synvisc, Euflexxa, Supartz and Orthovisc. This procedure is known as viscosupplementation and replaces the lubricating properties of joint fluid that is depleted during arthritis. Hyaluronan results in improved joint cushioning and potentially provides a protective effect for joint cartilage cells. Symptomatic improvement has been demonstrated for up to 6 months, often delaying the need for joint replacement surgery. Hyaluronan may be injected into any joint affected by arthritis, most commonly the knee and hip.
Other conditions include:
- Chronic shoulder and hip pain
- Myofascial pain syndromes and trigger points
- Hamstring pain
- Groin pain, including osteitis pubis and adductor syndrome, including Femoral, Ilioinguinal and Genitofemoral nerve blocks
- Iliotibial band friction syndrome
- Percutaneous trigger finger release
- Bone and soft tissue tumour biopsy.