Procedures

Cervical Medial Branch Blocks

When a person’s cervical facet (zygapophysial) joints are emanating pain, the cervical medial branch nerves will sense this pain signal and transmit it along a pathway to the spinal cord and up to the brain where we interpret, perceive, and “feel” that painful sensation. As such, cervical medial branch nerve blocks can be used as a diagnostic procedure to help determine whether or not the cervical facet joints are the primary source of one’s neck pain. Using x-ray (fluoroscopic) guidance, needles are safely guided to and placed near the cervical medial branch nerves which are then anesthetized (“numbed up”), thus temporarily blocking the pain coming from the targeted cervical facet joints. Patients are then asked to monitor their typical pain during the period that the local anesthetic (“numbing medication”) is blocking the cervical facet joint pain. In patients who experience a significant improvement in their pain, it increases the likelihood that the cervical facet joints are the main source of neck pain and therapeutic procedures can then be performed to provide long lasting improvement in the pain. In patients who do not experience much improvement in their pain during the anesthetic phase, it can be determined with much more certainty that the cervical facet joints are not the main source of neck pain and the diagnostic focus can shift to other potential pain generating structures.

Cervical Facet Joint Injections

Once the diagnosis of cervical facet joint pain has been established, cervical facet joint injections can be performed to treat the issue. Using x-ray (fluoroscopic) guidance, needles are safely guided to the symptomatic cervical facet joints. Once the facet joints have been accessed, a corticosteroid (“cortisone”) solution is instilled through the needles and into the target joints. This helps to decrease inflammation and pain with subsequent improvements in function.

Cervical Facet Joint Injections with Platelet Rich Plasma (PRP)

Once the diagnosis of cervical facet joint pain has been established, cervical facet joint injections with platelet rich plasma (PRP) can be performed to treat the issue. PRP is an all-natural injectate option that has been shown to provide clinical improvements in pain without the potential concerns or risks that can occur with corticosteroids (“cortisone”). Using x-ray (fluoroscopic) guidance, needles are safely guided to the symptomatic cervical facet joints. Once the facet joints have been accessed, the PRP is instilled through the needles and into the target joints. This helps to decrease inflammation while improving signaling of cells that contribute to tissue healing, both of which contribute to improvements in pain and function.

Smith, A et al. (2022). Cervical facet joint platelet-rich plasma in people with chronic whiplash-associated disorders: A prospective case series of short-term outcomes. Interventional Pain Medicine, 1(2), Article 100078.

Allison, D et al. (2024). Intra-articular corticosteroid injections versus platelet-rich plasma as a treatment for cervical facetogenic pain: A randomized clinical trial. Regional Anesthesia & Pain Medicine. Advance online publication.

Manchikanti, L et al. (2025). A systematic review of regenerative medicine therapies for axial spine pain of facet joint origin. Current Pain and Headache Reports, 29(1), 61.

Cervical Medical Branch Nerve Radiofrequency Ablation

Once the diagnosis of cervical facet joint pain has been established, cervical medial branch nerve radiofrequency ablation (CMBN RFA) can be performed to treat the issue. Using x-ray (fluoroscopic) guidance, needles are placed in close proximity to the medial branch nerves supplying the symptomatic cervical facet joints. After testing, the needle tips are then warmed up to a temperature that causes coagulation or “cauterization” of the medial branch nerves. This disrupts the nerves that sense the pain coming from the symptomatic cervical facet joints and, consequently, disrupts the pathway for that pain to be sensed and transmitted to the brain. Thus, much less of the cervical facet joint pain is perceived or “felt” by the patient allowing for significant and long lasting improvements cervical facet joint pain. In the end, CMBN RFA can provide long lasting improvement in cervical facet joint pain, typically 9-18 months at a time, and repeat CMBN RFA procedures can be performed time and again to allow for ongoing pain relief for patients.

Cervical Epidural Steroid Injection

When patients with cervical radiculopathy/radiculitis, cervical disc herniation, or cervical discogenic pain have not significantly improved with conservative treatments such as medications, physical therapy, or chiropractic care or are unable to tolerate their rehabilitation due to severe pain, an epidural steroid injection (ESI) can be considered. Using x-ray (fluoroscopic), a needle is carefully and precisely guided to the epidural space. Once the epidural space has been accessed, a corticosteroid (“cortisone”) solution is instilled through the needle and coats the inflamed and painful disc herniation and nerve(s). This helps to decrease pain and inflammation with resultant improvements function.

Thoracic Medial Branch Blocks

When a person’s thoracic facet (zygapophysial) joints are emanating pain, the thoracic medial branch nerves will sense this pain signal and transmit it along a pathway to the spinal cord and up to the brain where we interpret, perceive, and “feel” that painful sensation. As such, thoracic medial branch nerve blocks can be used as a diagnostic procedure to help determine whether or not the thoracic facet joints are the primary source of one’s mid back pain. Using x-ray (fluoroscopic) guidance, needles are safely guided to and placed near the thoracic medial branch nerves which are then anesthetized (“numbed up”), thus temporarily blocking the pain coming from the targeted thoracic facet joints. Patients are then asked to monitor their typical pain during the period that the local anesthetic (“numbing medication”) is blocking the thoracic facet joint pain. In patients who experience a significant improvement in their pain, it increases the likelihood that the thoracic facet joints are the main source of mid back pain and therapeutic procedures can then be performed to provide long lasting improvement in the pain. In patients who do not experience much improvement in their pain during the anesthetic phase, it can be determined with much more certainty that the thoracic facet joints are not the main source of mid back pain and the diagnostic focus can shift to other potential pain generating structures.

Thoracic Facet Joint Injections

Once the diagnosis of thoracic facet joint pain has been established, thoracic facet joint injections can be performed to treat the issue. Using x-ray (fluoroscopic) guidance, needles are safely guided to the symptomatic thoracic facet joints. Once the facet joints have been accessed, a corticosteroid (“cortisone”) solution is instilled through the needles and into the target joints. This helps to decrease inflammation and pain with subsequent improvements in function.

Thoracic Facet Joint Injections with Platelet Rich Plasma (PRP)

Once the diagnosis of thoracic facet joint pain has been established, thoracic facet joint injections with platelet rich plasma (PRP) can be performed to treat the issue. PRP is an all-natural injectate option that has been shown to provide clinical improvements in pain without the potential concerns or risks that can occur with corticosteroids (“cortisone”). Using x-ray (fluoroscopic) guidance, needles are safely guided to the symptomatic thoracic facet joints. Once the facet joints have been accessed, the PRP is instilled through the needles and into the target joints. This helps to decrease inflammation while improving signaling of cells that contribute to tissue healing, both of which contribute to improvements in pain and function.

Thoracic Medical Branch Nerve Radiofrequency Ablation

Once the diagnosis of thoracic facet joint pain has been established, thoracic medial branch nerve radiofrequency ablation (TMBN RFA) can be performed to treat the issue. Using x-ray (fluoroscopic) guidance, needles are placed in close proximity to the medial branch nerves supplying the symptomatic thoracic facet joints. After testing, the needle tips are then warmed up to a temperature that causes coagulation or “cauterization” of the medial branch nerves. This disrupts the nerves that sense the pain coming from the symptomatic thoracic facet joints and, consequently, disrupts the pathway for that pain to be sensed and transmitted to the brain. Thus, much less of the thoracic facet joint pain is perceived or “felt” by the patient allowing for significant and long lasting improvements thoracic facet joint pain. In the end, TMBN RFA can provide long lasting improvement in thoracic facet joint pain and repeat TMBN RFA procedures can be performed time and again to allow for ongoing pain relief for patients.

Thoracic Epidural Steroid Injection

When patients with thoracic radiculopathy/radiculitis, thoracic disc herniation, or thoracic discogenic pain have not significantly improved with conservative treatments such as medications, physical therapy, or chiropractic care or are unable to tolerate their rehabilitation due to severe pain, an epidural steroid injection (ESI) can be considered. Using x-ray (fluoroscopic), a needle is carefully and precisely guided to the epidural space. Once the epidural space has been accessed, a corticosteroid (“cortisone”) solution is instilled through the needle and coats the inflamed and painful disc herniation and nerve(s). This helps to decrease pain and inflammation with resultant improvements function.

Thoracic Selective Nerve Root Block

Thoracic selective nerve root blocks (SNRB) can be utilized to help determine if a particular nerve root is the primary source of a patient’s thoracic radicular pain. Using x-ray (fluoroscopic) guidance, a needle is placed near the suspected symptomatic nerve root. Then, a small volume of local anesthetic (“numbing medication”) is administered to temporarily block the pain coming from the target nerve. If a significant decrease in pain is noted during the time period the local anesthetic is acting on the nerve, it can then be determined with increased certainty that the targeted nerve is the primary source of pain.

Lumbar Medial Branch Blocks

When a person’s lumbar facet (zygapophysial) joints are emanating pain, the lumbar medial branch nerves will sense this pain signal and transmit it along a pathway to the spinal cord and up to the brain where we interpret, perceive, and “feel” that painful sensation. As such, lumbar medial branch nerve blocks can be used as a diagnostic procedure to help determine whether or not the lumbar facet joints are the primary source of one’s low back pain. Using x-ray (fluoroscopic) guidance, needles are safely guided to and placed near the lumbar medial branch nerves which are then anesthetized (“numbed up”), thus temporarily blocking the pain coming from the targeted lumbar facet joints. Patients are then asked to monitor their typical pain during the period that the local anesthetic (“numbing medication”) is blocking the lumbar facet joint pain. In patients who experience a significant improvement in their pain, it increases the likelihood that the lumbar facet joints are the main source of low back pain and therapeutic procedures can then be performed to provide long lasting improvement in the pain. In patients who do not experience much improvement in their pain during the anesthetic phase, it can be determined with much more certainty that the lumbar facet joints are not the main source of low back pain and the diagnostic focus can shift to other potential pain generating structures.

Lumbar Facet Joint Injections

Once the diagnosis of lumbar facet joint pain has been established, lumbar facet joint injections can be performed to treat the issue. Using x-ray (fluoroscopic) guidance, needles are safely guided to the symptomatic lumbar facet joints. Once the facet joints have been accessed, a corticosteroid (“cortisone”) solution is instilled through the needles and into the target joints. This helps to decrease inflammation and pain with subsequent improvements in function.

Lumbar Facet Joint Injections with Platelet Rich Plasma (PRP)

Once the diagnosis of lumbar facet joint pain has been established, lumbar facet joint injections with platelet rich plasma (PRP) can be performed to treat the issue. PRP is an all-natural injectate option that has been shown to provide clinical improvements in pain without the potential concerns or risks that can occur with corticosteroids (“cortisone”). Using x-ray (fluoroscopic) guidance, needles are safely guided to the symptomatic lumbar facet joints. Once the facet joints have been accessed, the PRP is instilled through the needles and into the target joints. This helps to decrease inflammation while improving signaling of cells that contribute to tissue healing, both of which contribute to improvements in pain and function.

Manchikanti, L et al. (2025). A systematic review of regenerative medicine therapies for axial spine pain of facet joint origin. Current Pain and Headache Reports, 29(1), 61.

Wu, J et al. (2017). A prospective study comparing platelet-rich plasma and local anesthetic (LA)/corticosteroid in intra-articular injection for the treatment of lumbar facet joint syndrome. Pain Practice, 17(7), 914-924.

Singh, C et al. (2023). Comparison of intra-articular lumbar facet joint injection of platelet-rich plasma and steroid in the treatment of chronic low back pain: A prospective study. Journal of Orthopaedics, Trauma and Rehabilitation, 30.

Lumbar Medical Branch Nerve Radiofrequency Ablation

Once the diagnosis of lumbar facet joint pain has been established, lumbar medial branch nerve radiofrequency ablation (LMBN RFA) can be performed to treat the issue. Using x-ray (fluoroscopic) guidance, needles are placed in close proximity to the medial branch nerves supplying the symptomatic lumbar facet joints. After testing, the needle tips are then warmed up to a temperature that causes coagulation or “cauterization” of the medial branch nerves. This disrupts the nerves that sense the pain coming from the symptomatic lumbar facet joints and, consequently, disrupts the pathway for that pain to be sensed and transmitted to the brain. Thus, much less of the lumbar facet joint pain is perceived or “felt” by the patient allowing for significant and long lasting improvements lumbar facet joint pain. In the end, LMBN RFA can provide long lasting improvement in lumbar facet joint pain and repeat LMBN RFA procedures can be performed time and again to allow for ongoing pain relief for patients.

Lumbar Epidural Steroid Injection

When patients with lumbar radiculopathy/radiculitis (“sciatica”), lumbar disc herniation, or lumbar discogenic pain have not significantly improved with conservative treatments such as medications, physical therapy, or chiropractic care or are unable to tolerate their rehabilitation due to severe pain, an epidural steroid injection (ESI) can be considered. Using x-ray (fluoroscopic), a needle is carefully and precisely guided to the epidural space. Once the epidural space has been accessed, a corticosteroid (“cortisone”) solution is instilled through the needle and coats the inflamed and painful disc herniation and nerve(s). This helps to decrease pain and inflammation with resultant improvements function.

Lumbar Selective Nerve Root Block

Lumbar selective nerve root blocks (SNRB) can be utilized to help determine if a particular nerve root is the primary source of a patient’s lumbar radicular pain. Using x-ray (fluoroscopic) guidance, a needle is placed near the suspected symptomatic nerve root. Then, a small volume of local anesthetic (“numbing medication”) is administered to temporarily block the pain coming from the target nerve. If a significant decrease in pain is noted during the time period the local anesthetic is acting on the nerve, it can then be determined with increased certainty that the targeted nerve is the primary source of pain.

Pulsed Radiofrequency Ablation of Lumbar Dorsal Root Ganglion

When patients with lumbar radiculopathy/radiculitis (sciatica) have not significantly improved with conservative treatments such as medications, physical therapy, or chiropractic care or are unable to tolerate their rehabilitation due to severe pain, pulsed radiofrequency of lumbar dorsal root ganglion (PRF of LDRG) can be considered. Using x-ray (fluoroscopic), a specialized needle is used to access the epidural space and placed in close proximity to the causative nerve root.  After testing is completed to ensure proper nerve root identification, a signal via a generator to the specialized needle tip is produced to “stun” the component of the nerve root that manages and transmits sensory information, the DRG, which can help reduce lumbar radicular pain (sciatica).

Provocative Lumbar Discography

Provocative lumbar discography is the gold standard diagnostic test to precisely confirm or exclude a lumbar intervertebral disc as a source of chronic low back pain. Using fluoroscopic (x-ray) guidance, needles are placed within two or more discs and pressurized using contrast dye. Based on patient response (i.e. whether the patient’s typical low back pain is reproduced or not) and imaging findings such as fissures (tears) within the disc(s), a diagnosis of lumbar discogenic pain (discogenic low back pain) can be confirmed or ruled out as a source of chronic low back pain. Candidates for provocative lumbar discography are patients who have been experiencing low back pain for greater than three months, have not responded to conservative management (medications, physical therapy, chiropractic), and for whom non-invasive diagnostic tests (x-ray, MRI) have failed to precisely diagnose the source of low back pain. Despite concerns raised by some physicians that lumbar discography contributes to higher rates of disc degeneration, a recent review of the safety and overall diagnostic value of provocative lumbar discography concluded that it is a safe and helpful diagnostic test when performed by properly trained physicians using strict procedural guidelines as outlined by the International Pain & Spine Intervention Society.

McCormick, Z et al. Low-pressure lumbar provocation discography according to Spine Intervention Society/International Association for the Study of Pain standards does not cause acceleration of disc degeneration in patients with symptomatic low back pain: A 7-Year Matched Cohort Study. Spine 44(19):p E1161-E1168, October 1, 2019

McCormick Z et al. on behalf of the Standards Division of the Spine Intervention Society. Diagnostic value, prognostic value, and safety of provocation discography. Pain Medicine, Volume 19, Issue 1, January 2018, Pages 3–8.

Pulsed Radiofrequency of Lumbar Sinuvertebral Nerves

When patients with lumbar discogenic pain have not significantly improved with conservative treatments such as medications, physical therapy, or chiropractic care or are unable to tolerate their rehabilitation due to severe pain, pulsed radiofrequency of lumbar sinuvertebral nerves (PRF of LSVNs) can be considered. Using fluoroscopic (x-ray) guidance for procedural target identification and precise needle guidance, specialized needles are placed in close proximity to the SVNs of the symptomatic disc.  After testing is completed, a signal is produced by a generator and transmitted to the tip of the specialized needle to “stun” the nerves that sense and transmit sensory information from the posterior 2/3 of the affected disc which can help reduce lumbar discogenic pain.

Intradiscal Steroid Injection

When patients with lumbar discogenic pain have not significantly improved with conservative treatments such as medications, physical therapy, or chiropractic care or are unable to tolerate their rehabilitation due to severe pain, intradiscal steroid injection can be considered. Using fluoroscopic (x-ray) guidance for procedural target identification and precise needle guidance, a needle is placed at the centre of the symptomatic disc followed by instillation of corticosteroid (“cortisone”) solution.  Corticosteroid helps to manage pain by decreasing inflammation.

Miller S et al. The effectiveness of intradiscal corticosteroid injection for the treatment of chronic discovertebral low back pain: a systematic review. Pain Med. 2024 Jan 4;25(1):33-46.

Riegger, M et al. (2023). Intradiscal glucocorticoid injection in discogenic back pain and influence on Modic changes: A systematic review and meta-analysis of RCTs. Pain Physician, 26(5), E449-E465.

Intradiscal Platelet Rich Plasma (PRP) Injection

When patients with lumbar discogenic pain have not significantly improved with conservative treatments such as medications, physical therapy, or chiropractic care or are unable to tolerate their rehabilitation due to severe pain, intradiscal platelet rich plasma (PRP) injection can be considered. Using fluoroscopic (x-ray) guidance for procedural target identification and precise needle guidance, a needle is placed at the centre of the symptomatic disc followed by instillation of the PRP solution. This helps to decrease inflammation while improving signaling of cells that contribute to tissue healing, both of which contribute to improvements in pain and function.

Navani A et al. The safety and effectiveness of orthobiologic injections for discogenic chronic low back pain: a multicenter prospective, crossover, randomized controlled trial with 12-months follow-up. Pain Physician. 2024;27(1):E65-E77.

Sacral Lateral Branch Blocks

When a person’s sacroiliac (SI) joints are emanating pain, the sacral lateral branch nerves will sense this pain signal and transmit it along a pathway to the spinal cord and up to the brain where we interpret, perceive, and “feel” that painful sensation. As such, sacral lateral branch nerve blocks can be used as a diagnostic procedure to help determine whether or not the SI joints are the primary source of one’s low back pain. Using x-ray (fluoroscopic) guidance, needles are safely guided to and placed near the sacral lateral branch nerves which are then anesthetized (“numbed up”), thus temporarily blocking the pain coming from the targeted SI joints. Patients are then asked to monitor their typical pain during the period that the local anesthetic (“numbing medication”) is blocking the SI joint pain. In patients who experience a significant improvement in their pain, it increases the likelihood that the SI joints are the main source of low back pain and therapeutic procedures can then be performed to provide long lasting improvement in the pain. In patients who do not experience much improvement in their pain during the anesthetic phase, it can be determined with much more certainty that the SI joints are not the main source of low back pain and the diagnostic focus can shift to other potential pain generating structures.

Sacroiliac Joint Injections

Once the diagnosis of sacroiliac (SI) joint pain has been established, SI joint injections can be performed to treat the issue. Using x-ray (fluoroscopic) guidance, needles are safely guided to the symptomatic SI joints. Once the SI joints have been accessed, a corticosteroid (“cortisone”) solution is instilled through the needles and into the target joints. This helps to decrease inflammation and pain with subsequent improvements in function.

Sacroiliac Joint Injections with Platelet Rich Plasma (PRP)

Once the diagnosis of sacroiliac (SI) joint pain has been established, SI joint injections with platelet rich plasma (PRP) can be performed to treat the issue. PRP is an all-natural injectate option that has been shown to provide clinical improvements in pain without the potential concerns or risks that can occur with corticosteroids (“cortisone”). Using x-ray (fluoroscopic) guidance, needles are safely guided to the symptomatic SI joints. Once the SI joints have been accessed, the PRP is instilled through the needles and into the target joints. This helps to decrease inflammation while improving signaling of cells that contribute to tissue healing, both of which contribute to improvements in pain and function.

Burnham, T et al. (2020). The effectiveness of platelet-rich plasma injection for the treatment of suspected sacroiliac joint complex pain: A systematic review. Pain Medicine, 21, 2518-2528.

Manchikanti, L et al. (2025). A systematic review of sacroiliac joint injections of platelet-rich plasma (PRP) and stem cells. Current Pain and Headache Reports, 29(1), 63.

Sacral Lateral Branch Nerve Radiofrequency Ablation

Once the diagnosis of sacroiliac (SI) joint pain has been established, sacral lateral branch nerve radiofrequency ablation (SLBN RFA) can be performed to treat the issue. Using x-ray (fluoroscopic) guidance, needles are placed in close proximity to the sacral lateral branch nerves supplying the symptomatic SI joints. After testing, the needle tips are then warmed up to a temperature that causes coagulation or “cauterization” of the sacral lateral branch nerves. This disrupts the nerves that sense the pain coming from the symptomatic SI joints and, consequently, disrupts the pathway for that pain to be sensed and transmitted to the brain. Thus, much less of the SI joint pain is perceived or “felt” by the patient allowing for significant and long lasting improvements SI joint pain. In the end, SLBN RFA can provide long lasting improvement in SI joint pain and repeat SLBN RFA procedures can be performed time and again to allow for ongoing pain relief for patients.

Spinal Cord Stimulator Trial

Spinal cord stimulation (SCS) may be used for patients who have chronic pain conditions despite trials of treatment options such as medications, physical therapy, chiropractic, injections, and even surgery. Indications for use of SCS include chronic low back with or without limb pain such as failed back surgery syndrome (post-laminectomy pain syndrome). It may also be used for patients with chronic nerve pain conditions such as complex regional pain syndrome (CRPS) or painful peripheral polyneuropathy including painful diabetic neuropathy. Finally, SCS may be used for those patients with chronic pain who may not be surgical candidates or those who wish to avoid surgery altogether.

If a patient is deemed to be a good candidate for SCS, Dr. Best will first discuss performing a spinal cord stimulator trial. During a SCS trial, the epidural space is accessed using an introducer needle and x-ray (fluoroscopic) guidance just like an interlaminar epidural steroid injection. However, rather than instilling steroid through the needle, a very small and thin wire (spinal cord stimulator lead) is inserted into the epidural space and gradually advanced to the mid thoracic spine region. The other end of the lead exits the skin at the site of introducer needle placement and is connected to the generator which will be secured to the patient’s flank area during the 5-7 day trial period. During this 5-7 day period, the patient has the opportunity to test out the SCS technology and get a sense of whether it helps to significantly decrease pain and improve function. The patient then returns to Dr. Best’s clinic to discuss the result of the SCS trial. During the follow up visit in clinic, the SCS trial leads are removed and, if successful, the patient may choose to have the spinal cord stimulator permanently placed. When a spinal cord stimulator is placed on a permanent basis, all components of the leads are once again placed in the epidural space and advanced to the mid thoracic region; however, they are then tunneled under the skin and connected to the generator which is sitting in a subcutaneous pocket created with a small incision. The goals when considering the use of SCS include significantly decreasing pain, reducing pain medication requirements and utilization, and improvements in overall function.

Subacromial Shoulder Injection

When patients with various types of shoulder pain (rotator cuff tendinopathy, subacromial/subdeltoid bursitis, labral tears, arthritis) have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology or are unable to tolerate their rehabilitation due to severe pain, a subacromial shoulder injection with corticosteroid can be considered. Using ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the subacromial/subdeltoid bursa and other injured structures followed by instillation of the corticosteroid solution. This helps to decrease inflammation leading to improvements in pain and function.

Subacromial Shoulder Injection with Platelet Rich Plasma (PRP)

When patients with various types of shoulder pain (rotator cuff tendinopathy, subacromial/subdeltoid bursitis, labral tears, arthritis) have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, are unable to tolerate their rehabilitation due to severe pain, or have not responded to conventional corticosteroid (cortisone) injections, a subacromial shoulder injection with platelet rich plasma (PRP) can be considered. Using ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the subacromial/subdeltoid bursa and other injured structures followed by instillation of the PRP solution. This helps to decrease inflammation while improving signaling of cells that contribute to tissue healing, both of which contribute to improvements in pain and function.

Rossi LA et al. Subacromial injection of platelet-rich plasma provides greater improvement in pain and functional outcomes compared to corticosteroids at 1‐year follow-up: A double-blinded randomized controlled trial. J Shoulder Elbow Surg. 2024;33(12):2563-2571.

Glenohumeral Shoulder Injection

When patients with various types of shoulder pain (labral tears, arthritis, frozen shoulder) have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, or are unable to tolerate their rehabilitation due to severe pain, a glenohumeral shoulder injection with corticosteroid can be considered. Using fluoroscopy- or ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the glenohumeral joint capsule followed by instillation of the corticosteroid solution. This helps to decrease inflammation leading to improvements in pain and function.

Glenohumeral Shoulder Injection with Hyaluronic Acid

When patients with various types of shoulder pain (labral tears, arthritis, frozen shoulder) have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, or are unable to tolerate their rehabilitation due to severe pain, a glenohumeral shoulder injection with hyaluronic acid can be considered. Using fluoroscopy- or ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the glenohumeral joint capsule followed by instillation of hyaluronic acid. Hyaluronic acid is a component of synovial (joint) fluid and provides viscosity and elasticity. It may also have anti-inflammatory properties. This allows for restoration of joint lubrication and shock absorbing capacity with subsequent reduction in pain and improve overall joint function.

Glenohumeral Shoulder Injection with Platelet Rich Plasma (PRP)

When patients with various types of shoulder pain (labral tears, arthritis, frozen shoulder) have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology or are unable to tolerate their rehabilitation due to severe pain, a subacromial shoulder injection with platelet rich plasma (PRP) injection can be considered. Using fluoroscopy- or ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the glenohumeral joint and other injured structures followed by instillation of the PRP solution. This helps to decrease inflammation while improving signaling of cells that contribute to tissue healing, both of which contribute to improvements in pain and function.

Lin, Ho-Wei, et al. “Efficacy of platelet-rich plasma injection on range of motion, pain, and disability in patients with adhesive capsulitis: a systematic review and meta-analysis.” Archives of Physical Medicine and Rehabilitation 104.12 (2023): 2109-2122.

Glenohumeral Joint Hydrodilatation

When patients with adhesive capsulitis (frozen shoulder) have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, are unable to tolerate their rehabilitation due to severe pain, or haven’t responded to conventional shoulder joint injections, hydrodilatation of the glenohumeral joint can be considered. Using fluoroscopy- or ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the glenohumeral joint followed by instillation of a local anesthetic (“numbing medication”) with corticosteroid (“cortisone”). This helps to stretch the thickened, scarred shoulder joint capsule while also reducing inflammation, allowing for improvements in pain and range of motion in those affected by adhesive capsulitis (frozen shoulder).

Catapano, Michael, et al. “Hydrodilatation with corticosteroid for the treatment of adhesive capsulitis: a systematic review.” PM&R 10.6 (2018): 623-635.

Elsaman, Ahmed, Shrouk Abdelmageed, and Osama Sayed Daifallah. “Comparative efficacy of supra-scapular nerve block, posterior shoulder capsule hydro-dilatation, and shoulder interval hydro-dilatation in managing shoulder adhesive capsulitis.” Clinical Rheumatology (2025): 1-11.

Pulsed Radiofrequency of Suprascapular Nerve

When patients with various types of shoulder pain (arthritis, rotator cuff arthropathy) have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, are unable to tolerate their rehabilitation due to severe pain, or having responded to conventional shoulder joint injections, pulsed radiofrequency of the suprascapular nerve can be considered. Using fluoroscopy- or ultrasound-guidance for procedural target identification and precise needle guidance, a specialized needle is placed at the site of the suprascapular nerve. After testing is completed to ensure proper needle placement, a signal via a generator to the specialized needle tip is produced to “stun” the component of the suprascapular nerve which transmits sensory information including pain from certain aspects of the shoulder joint complex.

Gofeld, Michael, et al. “Pulsed radiofrequency of suprascapular nerve for chronic shoulder pain: a randomized double‐blind active placebo‐controlled study.” Pain Practice13.2 (2013): 96-103.

Acromioclavicular Joint Injection

When patients with acromioclavicular (AC) joint pain have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, or are unable to tolerate their rehabilitation due to severe pain, and AC joint injection with corticosteroid can be considered. Using ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the AC joint followed by instillation of the corticosteroid solution. This helps to decrease inflammation leading to improvements in pain and function.

Common Flexor Tendon Peritendinous Injection

When patients with elbow medial epicondylalgia (epicondylitis; golfer’s elbow) have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, or are unable to tolerate their rehabilitation due to severe pain, a common flexor tendon injection with corticosteroid (“cortisone”) can be considered. Using ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the common flexor tendon region followed by instillation of the corticosteroid solution. This helps to decrease inflammation leading to improvements in pain and function.

Common Flexor Tendon Injection with Platelet Rich Plasma (PRP)

When patients with elbow medial epicondylalgia (epicondylitis; golfer’s elbow) have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, or are unable to tolerate their rehabilitation due to severe pain, a common flexor tendon injection with platelet rich plasma (PRP) can be considered. Using ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the common flexor tendon region followed by instillation of the PRP solution. This helps to decrease inflammation while improving signaling of cells that contribute to tissue healing, both of which contribute to improvements in pain and function.

Alzahrani, Wael M. “Platelet-rich plasma injections as an alternative to surgery in treating patients with medial epicondylitis: a systematic review.” Cureus 14.8 (2022).

Bohlen, Hunter L., et al. “Platelet-rich plasma is an equal alternative to surgery in the treatment of type 1 medial epicondylitis.” Orthopaedic journal of sports medicine 8.3 (2020): 2325967120908952.

Common Extensor Tendon Peritendinous Injection

When patients with elbow lateral epicondylalgia (epicondylitis; tennis elbow) have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, or are unable to tolerate their rehabilitation due to severe pain, a common extensor tendon injection with corticosteroid (“cortisone”) can be considered. Using ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the common extensor tendon region followed by instillation of the corticosteroid solution. This helps to decrease inflammation leading to improvements in pain and function.

Common Extensor Tendon Injection with Platelet Rich Plasma (PRP)

When patients with elbow lateral epicondylalgia (epicondylitis; tennis elbow) have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology or are unable to tolerate their rehabilitation due to severe pain, a common flexor tendon injection with platelet rich plasma (PRP) injection can be considered. Using ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the injured common extensor tendon region followed by instillation of the PRP solution. This helps to decrease inflammation while improving signaling of cells that contribute to tissue healing, both of which contribute to improvements in pain and function.

Niemiec P et al. Effectiveness of Platelet-Rich Plasma for Lateral Epicondylitis: A Systematic Review and Meta-analysis Based on Achievement of Minimal Clinically Important Difference. Orthopaedic Journal of Sports Medicine. 2022;10(4).

Rodik, T and McDermott, B. “Platelet-rich plasma compared with other common injection therapies in the treatment of chronic lateral epicondylitis.” Journal of sport rehabilitation 25.1 (2016): 77-82.

Houck, D., et al. “Treatment of lateral epicondylitis with autologous blood, platelet-rich plasma, or corticosteroid injections: a systematic review of overlapping meta-analyses.” Orthopaedic journal of sports medicine 7.3 (2019): 2325967119831052.

Xu, Yang, et al. “Platelet-rich plasma has better results for long-term functional improvement and pain relief for lateral epicondylitis: a systematic review and meta-analysis of randomized controlled trials.” The American Journal of Sports Medicine 52.10 (2024): 2646-2656.

Hip Joint Injections

When patients with various types of hip pain (femoroacetabular impingement, labral tears, arthritis) have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, or are unable to tolerate their rehabilitation due to severe pain, a hip joint injection with corticosteroid (cortisone) can be considered. Using fluoroscopy- or ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the hip joint capsule followed by instillation of the corticosteroid solution. This helps to decrease inflammation leading to improvements in pain and function.

Hip Joint Injection with Hyaluronic Acid

When patients with various types of hip pain (femoroacetabular impingement, labral tears, arthritis) have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, or are unable to tolerate their rehabilitation due to severe pain, a hip joint injection with hyaluronic acid can be considered. Using fluoroscopy- or ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the hip joint capsule followed by instillation of the hyaluronic acid. Hyaluronic acid is a component of synovial (joint) fluid and provides viscosity and elasticity. It may also have anti-inflammatory properties. This allows for restoration of joint lubrication and shock absorbing capacity with subsequent reduction in pain and improve overall joint function.

Piccirilli, Eleonora, et al. “Viscosupplementation with intra-articular hyaluronic acid for hip disorders. A systematic review and meta-analysis.” Muscles, ligaments and tendons journal6.3 (2016): 293.

Micu, Mihaela C., Alexandru Micu, and Sorana D. Bolboacă. “Ultrasound-guided injection with hyaluronic acid in hip osteoarthritis: efficacy and safety in a real-life setting.” Clinical Rheumatology 41.8 (2022): 2491-2498.

Hip Joint Injection with Platelet Rich Plasma (PRP)

When patients with various types of hip pain (femoroacetabular impingement, labral tears, arthritis) have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, or are unable to tolerate their rehabilitation due to severe pain, a hip joint injection with platelet rich plasma (PRP) can be considered. Using fluoroscopy- or ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the hip joint capsule and other injured structures followed by instillation of the PRP solution. This helps to decrease inflammation while improving signaling of cells that contribute to tissue healing, both of which contribute to improvements in pain and function.

Nouri, Farshad, et al. “Comparison between the effects of ultrasound guided intra-articular injections of platelet-rich plasma (PRP), high molecular weight hyaluronic acid, and their combination in hip osteoarthritis: a randomized clinical trial.” BMC Musculoskeletal Disorders 23.1 (2022): 856.

Berney, Mark, et al. “Platelet-rich plasma injections for hip osteoarthritis: a review of the evidence.” Irish Journal of Medical Science (1971-) 190.3 (2021): 1021-1025.

Zaffagnini, Marco, et al. “Orthobiologic injections for the treatment of hip osteoarthritis: a systematic review.” Journal of Clinical Medicine 11.22 (2022): 6663.

Piriformis Injection

When patients with piriformis syndrome have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, or are unable to tolerate their rehabilitation due to severe pain, a piriformis injection can be considered. Using fluoroscopy- or ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the piriformis muscle followed by instillation of corticosteroid (cortisone) and local anesthetic (numbing medication). This helps to decrease inflammation leading to improvements in pain and function.

Piriformis Injection with botulinum toxin (Botox)

When patients with piriformis syndrome have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, or are unable to tolerate their rehabilitation due to severe pain, a piriformis injection with a botulinum toxin (Botox) can be considered. Using fluoroscopy- or ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the piriformis muscle followed by instillation of Botox.  This blocks the release of acetylcholine at the neuromuscular junction, allowing for a hyperactive piriformis muscle to relax and reduce compression on the sciatic nerve.

Probst, Daniel, Alison Stout, and Devyani Hunt. “Piriformis syndrome: a narrative review of the anatomy, diagnosis, and treatment.” PM&R 11 (2019): S54-S63.

Greater Trochanteric Bursa/Hip Abductor (Gluteus Medius & Minimus) Tendon Peritendinous Injection

When patients with trochanteric bursitis and hip abductor (gluteus medius and minimus) tendinopathy, also known as greater trochanteric pain syndrome, have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, or are unable to tolerate their rehabilitation due to severe pain, a greater trochanteric bursa with hip abductor peritendinous injection with corticosteroid (cortisone) can be considered. Using fluoroscopy- or ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the greater trochanter and hip abductor peritendinous region followed by instillation of corticosteroid (cortisone) and local anesthetic (numbing medication). This helps to decrease inflammation leading to improvements in pain and function.

Hip Abductor (Gluteus Medius & Minimus) Tendon Injection with Platelet Rich Plasma (PRP)

When patients with trochanteric bursitis and hip abductor (gluteus medius and minimus) tendinopathy, also known as greater trochanteric pain syndrome, have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, are unable to tolerate their rehabilitation due to severe pain, or have not responded to conventional corticosteroid (cortisone) injections, a hip abductor tendon injection with platelet rich plasma (PRP) can be considered. Using fluoroscopy- or ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the hip abductor tendon region followed by instillation of instillation of the PRP solution. This helps to decrease inflammation while improving signaling of cells that contribute to tissue healing, both of which contribute to improvements in pain and function.

Ali, Mohammed, et al. “The use of platelet-rich plasma in the treatment of greater trochanteric pain syndrome: a systematic literature review.” Journal of hip preservation surgery 5.3 (2018): 209-219.

Jacobson, Jon A., et al. “Greater trochanteric pain syndrome: percutaneous tendon fenestration versus platelet‐rich plasma injection for treatment of gluteal Tendinosis.” Journal of Ultrasound in Medicine 35.11 (2016): 2413-2420.

Walker-Santiago, Rafael, et al. “Platelet-rich plasma versus surgery for the management of recalcitrant greater trochanteric pain syndrome: a systematic review.” Arthroscopy: The Journal of Arthroscopic & Related Surgery36.3 (2020): 875-888.

Migliorini, Filippo, et al. “Platelet-rich plasma versus steroids injections for greater trochanter pain syndrome: a systematic review and meta-analysis.” British Medical Bulletin 139.1 (2021): 86-99. 

Lateral Femoral Cutaneous Nerve Block

Lateral femoral cutaneous neuropathy, more commonly known as meralgia paresthetica, typically presents with anterolateral (front and outside) thigh pain, numbness, and or tingling without weakness.

Knee Joint Injections

When patients with knee pain due to conditions such as knee osteoarthritis or a meniscal tear have not significantly improved with conservative treatments such as medications, physical therapy, or chiropractic care or are unable to tolerate their rehabilitation due to severe pain, a knee joint injection can be considered. Using ultrasound guidance, a needle is carefully and precisely guided to the knee joint capsule. Once the knee joint has been accessed, a corticosteroid (“cortisone”) solution is instilled through the needle and into the joint capsule to coat or bathe the joint with anti-inflammatory medication. This helps to decrease inflammation and pain with subsequent improvements in function. For knee arthritis specifically, an alternative medication option used with knee injections is hyaluronic acid or viscosupplementation. Hyaluronic acid is a component of synovial (joint) fluid and provides viscosity and elasticity. It may also have anti-inflammatory properties. This allows for restoration of joint lubrication and shock absorbing capacity with subsequent reduction in pain and improved overall joint function.

Knee Joint Injection with Platelet Rich Plasma (PRP)

When patients with knee pain due to conditions such as knee osteoarthritis or a meniscal tear have not significantly improved with conservative treatments such as medications, physical therapy, or chiropractic care or are unable to tolerate their rehabilitation due to severe pain, a knee joint injection with platelet rich plasma (PRP) can be considered. PRP is an all-natural alternative to cortisone that is rich in growth factors and other cells that signal an increased healing response to injured tissue. Blood is drawn from a patient and then placed in a centrifuge for it to be “spun down.” This causes the different components of the blood to separate out in the vial. The PRP solution is then drawn up into a syringe and prepared to be injected at the site of the patient’s injury. Using ultrasound guidance, a needle is carefully and precisely guided to the knee joint capsule. Once the knee joint has been accessed, the PRP solution is instilled through the needle and into the joint which helps to decrease inflammation, signal other cells to aid in healing, and reduce pain with subsequent improvements in function.

Bagheri K et al. Platelet rich plasma compared to viscosupplementation in the treatment of knee osteoarthritis: a systematic review and meta‐analysis of randomised controlled trials with 6-month and 12-month follow‐up. J Exp Orthop. 2025;12(3):e70335.

Zhang R et al. Platelet-rich plasma is more effective than hyaluronic acid injections for osteoarthritis of the knee: a meta-analysis based on randomized, double-blinded, controlled clinical trials. Arthroscopy. 2025;41(1):209-220.

Patellar Tendon Injection with Platelet Rich Plasma (PRP)

When patients with patellar tendinopathy (tendinitis, tendinosis; jumper’s knee) have not significantly improved with conservative treatments such as medications, physical therapy, or kinesiology, or are unable to tolerate their rehabilitation due to severe pain, a patellar tendon injection with platelet rich plasma (PRP) injection can be considered. Using ultrasound-guidance for procedural target identification and precise needle guidance, a needle is placed to access the injured patellar tendon region followed by instillation of the PRP solution. This helps to decrease inflammation while improving signaling of cells that contribute to tissue healing, both of which contribute to improvements in pain and function.

van der Heijden, Rianne A., et al. “Platelet-rich plasma for patellar tendinopathy: A randomized controlled trial correlating clinical outcomes and quantitative imaging.” Radiology Advances 1.2 (2024): umae017.

Banerjee, Sumit, Ragulajay Balamarthandapuram Gopalakrishna, and Abhay Elhence. “Role of orthobiologics in managing patellar tendinopathy: A narrative review.” Journal of Experimental Orthopaedics 11.3 (2024): e12099.

Genicular Nerve Blocks

When a person’s knee joint is emanating pain, the genicular nerves will sense this pain signal and transmit it along a pathway to the spinal cord and up to the brain where we interpret, perceive, and “feel” that painful sensation. As such, genicular nerve blocks can be used as a diagnostic/prognostic injection to help determine whether or not a patient may be a candidate for treatment with genicular nerve radiofrequency ablation (GN RFA). Using x-ray (fluoroscopic) guidance, needles are safely guided to and placed near the genicular nerves which are then anesthetized (“numbed up”), thus temporarily blocking the pain coming from the knee joint. Patients are then asked to monitor their pain during the period that the local anesthetic (“numbing medication”) is blocking the knee joint pain. In patients who experience a significant improvement in their knee pain, GN RFA can then be performed as a treatment to provide long lasting improvement in the pain. In patients who do not experience much improvement in their pain during the anesthetic phase, it can be determined with much more certainty that they would be unlikely to benefit from GN RFA and other treatments options would then be considered, if available.

Genicular Nerve Radiofrequency Ablation

Once a patient has been deemed a good candidate via screening with genicular nerve blocks, genicular nerve radiofrequency ablation (GN RFA) can be performed to treat the knee arthritis pain or persistent pain despite undergoing knee replacement surgery. Using x-ray (fluoroscopic) guidance, needles are placed in close proximity to the genicular nerves supplying the affected knee joint. After testing, the needle tips are then warmed up to a temperature that causes coagulation or “cauterization” of the genicular nerves. This disrupts the nerves that sense the pain coming from the symptomatic knee joint and, consequently, disrupts the pathway for that pain to be sensed and transmitted to the brain. Thus, much less of the knee joint pain is perceived or “felt” by the patient allowing for significant and long lasting improvements in knee joint pain. In the end, GN RFA can provide long lasting improvement in knee joint pain and repeat GN RFA procedures can be performed time and again to allow for ongoing pain relief for patients.

Koshi, Edvin, et al. “Long-term clinical outcomes of genicular nerve radiofrequency ablation for chronic knee pain using a three-tined electrode for expanded nerve capture.” Interventional Pain Medicine 1.1 (2022): 100003.

Kanjanapanang, Napatpaphan, et al. “Effectiveness of Genicular Nerve Radiofrequency Ablation in Osteoarthritis and Post-surgical Knee Pain: Systematic Review.” Pain Medicine(2025): pnaf115.

Fogarty, Alexandra E., et al. “The effectiveness of fluoroscopically guided genicular nerve radiofrequency ablation for the treatment of chronic knee pain due to osteoarthritis: a systematic review.” American journal of physical medicine & rehabilitation 101.5 (2022): 482-492.