headaches or pain in other areas of the body. Trigger point injections can be performed with a little anesthetic, another injection medium, or without any injection substance at all (dry needling). It is minimally invasive, affordable, performed with or without pharmaceutical drugs and is administered intramuscularly. Many times, you will feel the muscle twitch during treatment and relief can be felt immediately or within 24-hours after treatment. Repeat treatments are usually not necessary unless your lifestyle continues to cause these knots in your muscles.

Used to treat: acute or traumatic injuries resulting in trigger points, chronic pain points, headaches due to trigger point, myofascial pain syndrome, fibromyalgia trigger points

Sources for Trigger Point:

1. Hammi C, Schroeder JD, Yeung B. Trigger Point Injection. [Updated 2022 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542196/

This minimally invasive, drug-free injection is administered just below the skin and offers an effective pain management option for a wide range of neurological pain. A small isotonic (neutral) amount of dextrose (plant-based sugar) in water is injected around superficial, inflamed nerves, which could be leading to neuralgias or neuropathic pain patterns. It is incredibly safe, even for diabetic patients experiencing diabetic neuropathy symptoms. This differs from prolotherapy, which is delivered much deeper under the skin and with higher amounts of dextrose. You can expect pain-relief to last 4 hours to 4 days initially, occasionally up to 2 weeks. Occasionally it is permanent after one visit though this is not a realistic expectation for most people. Most people need 6-8 visits to be substantially or completely better. Individual results vary and you can discuss these more thoroughly with Dr. Lorna.

Used to treat: frozen shoulder, migraines, sciatica, carpal tunnel, plantar fasciitis, neuralgia, fibromyalgia, nerve impingement, neuropathy, low back pain

Sources for PIT: 

1. Güzel İ, Gül D, Akpancar S, Lyftogt J. Effectiveness of Perineural Injections Combined with Standard Postoperative Total Knee Arthroplasty Protocols in the Management of Chronic Postsurgical Pain After Total Knee Arthroplasty. Med Sci Monit. 2021 Feb 6;27:e928759. doi: 10.12659/MSM.928759. PMID: 33547269; PMCID: PMC7874529.

Hailing from the word “proliferation,” prolotherapy is all about proliferating new, healthy collagen fibers and is considered a regenerative therapy. This injection targets weak tendons and ligaments by stimulating the body’s innate healing response. This happens when dextrose (plant-based sugar) at a particular concentration is delivered directly to a weak tendon or ligament and causes an inflammatory response. This inflammatory response is what calls the body to action, and jumpstarts the healing process. More nutrients are delivered to the area allowing for new collagen formation and healing. This minimally invasive, drug-free injection is administered via ultrasound guidance by Dr. Lorna to ensure accurate delivery. It’s incredibly safe, well-researched (used since the 1950’s), and affordable. Pain relief with prolotherapy has been shown to last up to a year for musculoskeletal injuries and according to some research is similar to steroids and PRP one month after injection. You can expect to need 2-8 sessions to help you reach maximum relief if this injection is right for you, but is based on your particular injury and needs. 

Used to treat: ligament and tendon injuries, cartilage damage, muscle damage, trauma or overuse injuries

Sources for Prolotherapy:

1. Bae G, Kim S, Lee S, Lee WY, Lim Y. Prolotherapy for the patients with chronic musculoskeletal pain: systematic review and meta-analysis. Anesth Pain Med (Seoul). 2021 Jan;16(1):81-95. doi: 10.17085/apm.20078. Epub 2020 Dec 16. PMID: 33348947; PMCID: PMC7861898.

This ultrasound-guided injection can be used in peripheral nerve entrapments to help decompress the nerve and to release soft tissue adhesions causing entrapment and subsequently pain. This minimally invasive injection is performed by inserting a needle near the entrapped nerve and a medium is injected such as saline, anesthetic, steroid, or dextrose. Once the injection has been performed, a perineural fluid plane between the nerve and surrounding tissue is created and consequently improves the nerve mobility. Results from this injection are very promising and while duration of benefit is unknown, depending on your condition, this may be a safe and useful injection.

Used to treat: nerve entrapment, carpal tunnel syndrome

Sources for hydrodissection:

1. Evers S, Thoreson AR, Smith J, Zhao C, Geske JR, Amadio PC. Ultrasound-guided hydrodissection decreases gliding resistance of the median nerve within the carpal tunnel. Muscle Nerve. 2018 Jan;57(1):25-32. doi: 10.1002/mus.25723. Epub 2017 Jul 6. PMID: 28622409; PMCID: PMC5722677.

2. Lee JY, Park Y, Park KD, Lee JK, Lim OK. Effectiveness of ultrasound-guided carpal tunnel injection using in-plane ulnar approach: a prospective, randomized, single-blinded study. Medicine (Baltimore). 2014 Dec;93(29):e350. doi: 10.1097/MD.0000000000000350. PMID: 25546691; PMCID: PMC4602597.

Corticosteroids are delivered to an area of pain and work almost immediately by reducing inflammation. When used carefully, they can serve to provide near immediate pain relief so that appropriate strengthening and mobility can be performed. They can also serve as a quick fix while you determine what other tools you may need to help you treat the root cause of your pain. These injections are used sparingly to reduce the chance of side effects, and pain relief can last for months.

Used to treat:  arthritis, shoulder bursitis, trigger finger, plantar fasciitis

Sources for Corticosteroid: 

1. Jennings JW. The Safety and Potential Harm of Intraarticular Steroid Injections: The Debate Continues. Radiology. 2022 Aug;304(2):370-371. doi: 10.1148/radiol.220700. Epub 2022 May 10. PMID: 35536140.

2. Gaujoux-Viala C, Dougados M, Gossec L. Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomised controlled trials. Ann Rheum Dis. 2009 Dec;68(12):1843-9. doi: 10.1136/ard.2008.099572. Epub 2008 Dec 3. PMID: 19054817; PMCID: PMC2770107.

Viscosupplementation is the injection of hyaluronic acid into painful joints with osteoarthritis with the intention of restoring the slippery and elastic qualities to the synovial fluid. Synovial fluid is normally found inside the joint space and serves the role of minimizing friction when the bones glide over one another. Hyaluronic acid is a natural component found in synovial fluid and is found to naturally decrease as part of the aging process. When it’s injected into the knee joint, data shows that pain relief can last up to a year with a single injection for some people. Since it is naturally produced by the body, side effects are minimal. Repeat injections are safe and provide longer lasting pain relief than steroids. Find out if this injection is right for you by consulting with Dr. Lorna.

Used to treat: osteoarthritis, knee arthritis, hip arthritis, tennis elbow, non-surgical candidates, people with NSAID allergies 

Sources for VIscosupplementation: 

1. Peck J, Slovek A, Miro P, Vij N, Traube B, Lee C, Berger AA, Kassem H, Kaye AD, Sherman WF, Abd-Elsayed A. A Comprehensive Review of Viscosupplementation in Osteoarthritis of the Knee. Orthop Rev (Pavia). 2021 Jul 10;13(2):25549. doi: 10.52965/001c.25549. PMID: 34745480; PMCID: PMC8567800.

2. Leighton R, Åkermark C, Therrien R, et al. NASHA hyaluronic acid vs. methylprednisolone for knee osteoarthritis: a prospective, multi-center, randomized, non-inferiority trial. Osteoarthritis Cartilage. 2014;22(1):17-25. doi:10.1016/j.joca.2013.10.009.

This minimally invasive, regenerative injection consists of using platelets from your own blood and injecting them back into a problem area. At the beginning of the treatment, your blood is drawn and then spun in a machine that separates out the platelets. Platelets can be injected into tendons, ligaments, muscles and joint spaces, which are thought to jumpstart your body’s healing process by releasing growth factors into the area. Some data and people report that after 2-3 injections spaced a month a part, an individual can become pain-free. 

Used to treat: osteoarthritis, tennis elbow, shoulder pain, wrist pain, ankle pain, unstable ACL/PCL, Achilles tendonitis, rotator cuff tears, meniscal tears 

Sources for PRP:

1. Xu J, Du W, Xue X, Chen M, Zhou W, Luo X. Global research trends on platelet-rich plasma for tendon and ligament injuries from the past two decades: A bibliometric and visualized study. Front Surg. 2023 Feb 10;10:1113491. doi: 10.3389/fsurg.2023.1113491. PMID: 36843990; PMCID: PMC9950278.

2. Zhang J, Li F, Augi T, Williamson KM, Onishi K, Hogan MV, Neal MD, Wang JH. Platelet HMGB1 in Platelet-Rich Plasma (PRP) promotes tendon wound healing. PLoS One. 2021 Sep 16;16(9):e0251166. doi: 10.1371/journal.pone.0251166. PMID: 34529657; PMCID: PMC8445483.