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Injection under diagnosis ultrasound guidance (also called ultrasound-guided injection or injection under fluoroscopy) allows the detailed evaluation of a wide range of musculoskeletal system injuries: muscle and ligament lesions, tendinosis (tendinitis), bursitis, peripheral nerve lesions and more.
By using a probe over sterile gel applied on the skin, this device uses safe ultrasounds to reproduce on a screen images of the musculoskeletal system. A Doctor can interpret the images and detect the presence of problems, for instance a torn tendon in the shoulder. During injection under ultrasound guidance, the anatomical area targeted can be reached safely and precisely.
This type of equipment has been used for many years to view fetuses in pregnant women. At our Clinic, we provide ultrasounds to analyze various musculoskeletal injuries and lesions.
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Injection techniques under fluoroscopy are used for high-precision injections to ensure that medication is injected in a targeted site.
During an injection under fluoroscopic guidance procedure, a source of radiation is directed at a patient in a radiology room with X-ray control. Internal elements to be examined are coloured with a radio-opaque material. The material will absorb more radiations and generate simple- or double-contrast images to better analyze affected structures. The position of an injection needle is pinpointed under radiography. A small quantity of contrast agent (iodine) is injected right before injection of medication to confirm that the tip of the needle is in the right place and aimed at the location or source of a patient’s pain.
A multitude of pathologies cause chronic pain that may benefit from local treatment using various high-precision means. Douleur MD specializes in injection treatment.
For more information about the procedures offered at out clinic or to make an appointment, contact us.
The following injections under fluoroscopy are performed at our clinic :
Facet joint injections
Medial branch blocks
Facet joint thermolesion
Peripheral joint injection
Sacro joint thermolesion
For musculoskeletal pain (knees, ankles, shoulders, wrists, etc.), healing starts with appropriate diagnosis! Musculoskeletal ultrasound is a non-invasive, radiation-free radiological examination used to generate images for diagnosis. Linked to a powerful computer, a probe produces images of the human body’s anatomical structures. It is among the best examinations to diagnose certain musculoskeletal disorders affecting tendons, muscles, ligaments, bursae, fascias and nerves.
This examination helps individuals afflicted by pain or joint limitations and for which X-ray examinations are non-specific.
Musculoskeletal ultrasound is an accurate and dynamic examination, during which several musculoskeletal structures likely to be the source of a patient’s pain are examined.
The ultrasound does not involve any X-rays; instead, ultrasounds are emitted by a probe in the form of short impulses. They help in making or confirming a diagnosis and, more precisely, identifying the type and extent of a lesion. When required, high-precision injections can also be performed during such examination by directly observing the lesion and the injection needle used to inject medication right where the problem is located.
Discal stimulation is a diagnostic procedure performed to determine if a patient’s symptoms are the result of a disc affliction (disc tear, herniated disc). To do so, a needle is inserted in the intervertebral disc under fluoroscopic guidance. Then a contrast medium is injected to increase pressure inside the disc.
The purpose of this procedure is to confirm that a disc is the source (discogenic) of pain by recreating the patient’s usual symptoms. A scan can then be performed to ensure a better discal disease diagnosis. This procedure is indicated when an intra-discal percutaneous (thermal annuloplasty, PRP injection) procedure or surgery is considered after conservative treatment failed on a patient.
An epidural injection (commonly referred to as an epidural) is an injection made in the epidural area near the nerve roots in the spine. A combination of anti-inflammatory (cortisone) and anaesthetic (Xylocaine) agents are used during the injection to reduce pain caused by the inflammation of nerve roots.
In simpler terms, the purpose of an epidural injection is to reduce inflammation and pain caused by one or more nerve roots located inside the spine. This procedure is the most precise method to administer anti-inflammatory agents specifically to an area with inflammation likely to be caused by a herniated disc, foraminal stenosis or spinal stenosis.
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BOTOX is a purified neurotoxin complex protein produced from the bacterium Clostridium botulinum.
BOTOX is used in adults who have 15 or more migraine headaches per month lasting 4 or more hours per day.
Chronic Migraine is defined as:
BOTOX is injected by needle into several head and neck muscles that may be causing or contributing to your headaches. The radiologist determines the number of injections and the sites required to treat your specific condition.
It is recommended that you get your BOTOX injections every 12 weeks. You may continue this therapy, if deemed effective, after discussing with your practitioner.
Your practitioner will decide whether or not you are eligible for treatment if you are already receiving BOTOX for other conditions. It is very important that you inform your practitioner.
This procedure is also referred to as neurotomy, facet denervation, thermo-lesion or thermo-coagulation.
Facet rhizotomy involves “burning” with a radiofrequency device the nerve (the medial branch) innerving the joint facet responsible for the perception of chronic back pain. The procedure is performed once the source of a patient’s pain is identified as being of facet origin through medial branch blocks. The technique involves inactivating the medial branch that innerves a facet and transmits pain signals.
This procedure is indicated for patients suffering from chronic low back pain, who have responded positively to facet blocks but with a short duration or little improvement.
To become eligible for facet rhizotomy under radiofrequency, patients must respond positively to a double medial branch block with Xylocaine and Marcaine.
Rhizotomy can provide long-lasting, significant relief to patients suffering from chronic back pain originating in facet joints.
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Many patients with chronic headache report that their pain typically arises from the neck or, more specifically, the base of the skull. Often that pain arises on one side or the other and extends forward to involve the top of the head, the temple, the forehead, the eye or some combination thereof. These are termed cervicogenic (ie, “born of the neck”) headaches.
Residing in those areas of the skull base are the occipital nerves. Irritation/inflammation of those nerves may cause a specific type of “neuralgiform” pain: occipital neuralgia. More commonly, however, those nerves serve as major “on-ramps” to the “superhighway” upon which travel the pain signals that produce migraine and other types of headache. If one can block traffic on these busy on-ramps, then it may be possible to halt the flow of pain signal on the superhighway and thus—at least temporarily—halt head pain.
Such is the logic of occipital nerve blocks (ONBs) for suppression of chronic headache. The blocks themselves are relatively simple to perform. Your physician will use a small needle to inject a solution into the area around the nerves; the composition of that solution differs according to physician experience and preference but most often contains a long-acting local anesthetic and a steroid anti-inflammatory drug. Insertion of the needle is not especially painful, but infusion of the solution may cause temporary discomfort.
Occipital nerve blocks are not for everyone, but for selected patients they can prove a more effective means of suppressing chronic headache than any oral medication.
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Electromyography (EMG) is a medical examination during which peripheral nerve functions are assessed to pinpoint the nature and level of injury due to nerve lesion. To put it simply, the electrical activity in muscles at rest and during contraction is examined using an electromyogram. Analysis of the electrical activity of muscles and nerves is used to diagnose muscular diseases such as muscular dystrophy or nerve lesion. The procedure is recommended when a muscular, nerve or muscle-nerve junction disease is suspected.
This type of diagnostic test is quite useful in locating the exact origin of certain neurological disorders or muscle pain that may have more than one source, such as the following:
EMG has several applications. For example, when a back nerve is pinched or damaged due to a herniated disc, electromyography allows a physiatrist to identify the nerve involved and assess the severity of the injury. When a nerve is pinched in the wrist or in the case of any other peripheral nerve compression due to the impact of a carpal tunnel syndrome, the electromyogram is an excellent diagnostic tool. It is particularly recommended in the diagnosis of muscular pain and neurological injury.
At DouleurMD we specializes in electromyography (EMG) diagnosis. Our equipment is at the cutting edge of technology. The care that our physicians and all our administrative staff provide to our patients, combined with our experts’ qualifications make our clinic the place to go in Montréal for patients suffering from muscle pain, a herniated disc and other nerve-related problems.