For many years, physicians have relied on their examination skills alone to provide injections for musculoskeletal pain. Some physicians acquire great skill in doing so. However, the complexity and precision required for the best outcomes often requires the use of advanced technology to "steer" the injection. Ultrasonic and fluoroscopic guidance have made procedures more safe, more comfortable, and more beneficial. CHARM physicians have trained for many years to provide precise, safe techniques that use hands-on examination skills, ultrasound guidance, and fluoroscopic guidance so that patients can benefit using whichever techniques are most appropriate.
Ultrasonic and Fluoroscopic Guidance
Ultrasound waves allow the physician to see the different layers in the body, such as tendons, nerves, ligaments, and joints. This allows for precise diagnosis of inflamed and damaged tissues, and also allows the physician to avoid direct nerve and blood vessel contact while guiding the needle to the target precisely for treatment. Ultrasound provides a "live" view of the needle and of the muscles, blood vessels, tendons, and other moving tissues. Ultrasound itself has no known side-effects. Ultrasound allows complex procedures to be performed safely. Carpal Tunnel Syndrome and other nerve compression syndromes can now be treated with a needle through the skin using ultrasound to release the constrictions around the nerve in a process called "hydro-dissection".
Fluoroscopy using X-Ray is also used for diagnosis and precision targeting of structures, providing a high-resolution image of bony structures allowing for placement of a needle into the spine and joints. Use of "contrast" allows the physician to determine whether the medication will reach the desired target, and avoid nearby structures. The images can be snapshots, or can be video "live" images, allowing the practitioner to identify the bony structures, the needle placement, and the flow patterns of contrast. State-of-the-art fluoroscopy machines and your experienced CHARM providers use low-dose settings and high-sensitivity detectors to minimize the risks of X-Ray radiation.