Back pain 2

Specialist Orthopaedic Doctors

Back pain 1

Back Pain Injections

Back pain 6

Fluoroscopically Guided Digital X-Ray Injections

Back pain 4

Spinal Manipulation

Back pain 3

Exercise & Rehabilitation Programmes for the Young...

Back pain 5

...and the Not So Young

PRP - Platelet Rich Plasma

PRP or Platelet-Rich Plasma is derived from a blood sample taken from a vein in your arm. It is spun down in a centrifuge and the portion with the most platelets (small cells responsible for clotting) is drawn off. This has been shown to contain a high concentration of growth factors – proteins that boost healing. PRP has been used in many parts of the body and for many different injuries with varying success. It has been used in tendinosis (degeneration of tendons such as Achilles tendons) and in tennis elbow. The area in which the evidence of success is most convincing is in the treatment of osteo-arthritis – wear and tear of joints, especially in the knee. An injection of PRP has been shown to be at least as effective as cortico-steroids (cortisone) and visco-supplementation - joint lubricants such as Ostenil. It can also last longer.
The effects often allows greater movement and less pain and so allows an exercise programme supervised by one of our physiotherapists to be more effective. The improvement can be longer term – 6-12 months or longer. It is probable that it works by supplying increased levels of the growth factors that promote healing of the joint surface.

The Procedure

You will be asked if you agree to the treatment after it has been explained to you by the doctor. A small amount of blood is taken from a vein in the non-painful arm. The identified area on the painful arm will then be injected with your own blood. For platelet rich plasma (PRP) injections the plasma will be separated in a centrifuge first before the injection.

The procedure will take place in the theatre or consulting room. Everything will be explained to you as it is happening. A fluoroscope or ultrasound scanner may be used to aid in the placement of the injection. A fluoroscope is a special x-ray machine which allows the doctor to be very accurate in the placement of the needle. The x-rays used are to guide the injection and are a much smaller dose than normal x-rays.

Local anaesthetic is used so it is not an excessively painful procedure but you may experience some pain. If you do it is important to tell the doctor and/or nurses so they can administer extra pain relief if appropriate.

What to expect after your injection

You might not feel any benefit for the first day or two and some people feel worse temporarily for a few days. This may be due to bruising or soreness near to the injection site. Your pain may worsen significantly for 1-3 days, but should begin to settle within one week.

The pain relief should allow you to gradually increase your activities. It is important that you do not immediately take up unaccustomed exercise until your muscles have had time to adapt. You should book in to see your physiotherapist at Blackberry Clinic one week after your injection so they can monitor your progress and give you a graduated exercise program to follow.

Maintaining regular contact with your physiotherapist will help to maintain the improvement gained.

Follow up

We routinely perform one injection initially and there may occasionally be a requirement of a second injection four weeks later. Most pain relief occurs within the first 4-6 weeks. Please contact the clinic if you need advice as to whether you need a second injection for the best outcome.

Aftercare advice

Pain relief – discomfort can be treated by application of a cold pack to the painful area. Suitable cold packs include bought gel packs but can be as simple as a bag of frozen peas or some crushed ice in a plastic bag. Wrap the cold pack in a damp tea towel and apply for 10 minutes at a time, repeat hourly if necessary. Do not apply ice directly to the skin. In addition, you can take medication such as Paracetamol. Please avoid anti-inflammatories such as Ibuprofen (Nurofen).

Wound dressing - remove the dressing after 24hrs. Keep the area dry in that time.

Complete Rest - if possible, it is best to refrain from pain provoking activities for 2 days.

Relative Rest - avoid very strenuous activity on the joint/area, such as heavy lifting, for up to 2 weeks. Scientific studies have shown this period of rest may improve the effect of the injection.

Possible complications

Reaction - shortness of breath, dizziness or severe headache are rare reactions following the injection and could occur within 24 hours. An allergic reaction is rare but could present as a rash, shortness of breath, facial swelling or a wheeze. If you experience any of these symptoms, you should call the Blackberry Clinic, your doctor (or Out of Hours service), go immediately to A&E or call the emergency services, as appropriate.

Infection – an abscess or infection in other tissues is a very rare complication. Please monitor yourself for signs of fever, redness, swelling and increasing pain. Infections can be treated with antibiotics or surgery if necessary.

If you have any concerns following your procedure, please contact the clinic.
If the clinic is closed, please contact your GP or local out of hours service

Dr Simon Petrides, Registered Manager, Care Quality Commission

Fluoroscopy

The Blackberry Clinic is a leader in the field of spinal treatment and is the only multidisciplinary clinic of its kind in the UK to have two C-arm fluoroscopy theatres.

Fluoroscopy is an imaging technique commonly used by our physicians to obtain real-time static and moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed. However, modern fluoroscopes couple the screen to an image intensifier allowing the images to be recorded and played on a monitor.

Our physicians always use low dose rates during fluoroscopic procedures, the length of a typical procedure in the Blackberry Clinic results in only a minimal radiation dose.

We have used the C-arm fluoroscope at the Blackberry Clinic to assess the pattern of movement in the lumbar and cervical spine to analyse levels of possible instability leading to back and neck pain. The information gathered is often used to direct spinal injections to the right place in the safest and most effective manner. The injections are also carried out under direct guidance using one of our C-arm fluoroscopes. This innovative technique has been used here on many Olympic rowers and international footballers.

prolotherapy-4

Shoulder Injections

Injections of the shoulder are common treatments for numerous shoulder disorders. Shoulder injections can be used for diagnostic, as well as therapeutic purposes. Your doctor may recommend the injection of corticosteroids, local anaesthetic or hyaluronic acid in to or around your shoulder joint.

Corticosteroids are strong anti-inflammatory medications which reduce swelling and inflammation. These are often used in conjunction with physiotherapy rehabilitation and other medications for a more lasting cure of many conditions, such as shoulder arthritis, subacromial impingement syndrome, acromioclavicular joint pathology and inflammatory arthritides.

Hyaluronic acid also has anti-inflammatory benefits, as well as coating pain receptors, stimulating endogenous synovial fluid production and lubrication effects on the shoulder joint. They also have a role in the management of degenerative disease such as osteoarthritis where surgery is not indicated.

Injections are all undertaken with image guidance to allow accurate placement of the active treatment at the Blackberry Clinic. The more trained and skilled the clinician is, the more reliable and accurate the injection. Image guided injections are more accurate, but also require a skilled clinician who is familiar with the technique and equipment. The x-ray equipment that is used also allows the doctor to see damage to underlying structures and the deposit of calcium in tissues such as ligaments which can all help with your diagnosis and ongoing treatment.

Fluoroscopic Injection Courses

 

BLACKBERRY EDUCATION

In associatiion with the British Institute of Musculoskeletal Medicine

Fluoroscopic Injection course for MSK, SEM and trainee Pain Physicians

Thursday November 17th 2016

VENUE:  Blackberry Clinic, Milton Keynes

COST: £595

(£575 for BIMM and BASEM members)

IMPORTANT : Please contact  This e-mail address is being protected from spambots. You need JavaScript enabled to view it.  for an application form.

 

The course is provided by Blackberry Education with tutors from the fields of Sports and Musculoskeletal medicine. The course will be held at the Blackberry Clinic, Milton Keynes. The course is aimed at physicians working in Musculoskeletal, Pain and Sports and Exercise Medicine who would like to undertake practical skills training in fluoroscopically guided injections. To encourage this there is a discount to BIMM and BASEM members and trainees in any speciality.

Delegates are expected to be proficient in peripheral injections but would like to advance to fluoroscopically guided spinal and paraspinal injections. 

 

Testimonials from September 2015 delegates

 ‘Fantastic course. Perfect mix of lectures and clinical workshops. Great way to learn principles for fluoroscopic injections.’

 Dr Amit Pannu (Medical Officer Blackburn Rovers Football Club)

‘Stimulating and enjoyable in a positive learning environment.’

Dr Greig Nicol (MSK physician)

 

THURSDAY November 17th 2016


 Please contact
This e-mail address is being protected from spambots. You need JavaScript enabled to view it.  for an application form.

 

 

 

08:15-08:45

 

 

Programme:  Transforaminals and Sacroiliac Joint Injections

Registration with tea, coffee and breakfast.

08:45-09:00

Welcome and housekeeping.

09:00-10:00

Transforaminal epidurals: Why, where and how? Anatomy of the lumbar spine. landmarks,

radiolology and pathology. An overview of practical process and techniques including consent, radiation, C-arm use and after care.

10:00-10:45

S1 Transforaminal epidural injection:  Instruction onpatient positioning, needle placement,

C-arm views, injectates and radiation safety, practical anatomy revision.

 

10:45-11:00

 

11:00-12:30

Tea and Coffee.

 

Injection Skills Lab 1: S1 Transforaminal epidural injection. Hands on workshop for specifics of S1 transforaminal injection and practice.

12.30-13.00

Lumbar Transforaminals L2-L5:  Patient positioning, needle placement, C-arm views,

 injectates and radiation safety. How to perform an L4 transforaminal injection.

13:00-13:45

  1. Lunch

13:45-15:00

Injection skills lab 2: Lumbar Transforaminal epidural injection L2-L5:

 Patient positioning, needle placement, C-arm views, needles and injectates.

15:00-15:45

Sacroiliac Joint injections. Diagnosis, treatment options, injectates, proof, needle placement and treatment protocols.

16.00-16:15

Tea/Coffee

16:15-17:30

Skills Lab 3: Sacroiliac joint injection techniques. Patient positioning and views for sacroiliac joint and posterior ligament injection, needle placement, C-arm views and injectates.

We hope to see you on our upcoming course. If you are not able to make the course on these dates but would like to be considered for further courses or have specific injections that you would like to see taught, please contact us as we will be having further courses covering different spinal and peripheral options.

Knee Joint Injections

Where patients either have suspected or proven pathology inside the knee joint, intra-articular injection of the knee may well prove beneficial.

What conditions can it be performed for?
Knee injection may provide symptom relief in cases of:

What is injected?
A variety of different substances can be injected into the knee joint. A mixture of local anaesthetic plus steroid is often injected into the joint. The local anaesthetic gives rapid pain relief, although this wears off quite quickly. This makes it more comfortable for the patient and lets your doctor know if all the pain is coming from the knee joint itself. Steroid (also sometime called cortisone) act as a very powerful anti-inflammatory, although it acts just locally, within the joint.

Patients do not get all the same side effects from a steroid injection as they do from having high dose i.v. steroids or prolonged courses of steroid tablets - this is because the steroid acts just locally, within the joint, to reduce inflammation. As well as steroid we are able to inject Hyaluronic Acid (e.g Ostenil, Synvisc or Duralane) into the joint. This acts as a synthetic synovial fluid(which helps lubricate the joint) reducing pain and improving movement. This treatment is especially beneficially in the case of arthritic(wear and tear) changes.

How is it done?
To guarantee the correct needle placement the needle is guided into the knee joint under X-ray control. Once the needle appears to be in the correct position, a dye is then injected to make sure that the tip of the needle is actually inside the joint. The local anaesthetic and steroid or hyaluronic acid can then be injected into the joint.

Intra-articular injections into the knee joint are done in our X-ray guided operating theatre with a small amount of local anaesthetic to the skin to make things more comfortable. This ensures the cleanest possible environment, to minimise the potential risks of introducing infection.

Knee injections are normally done as a quick day-case procedure with the patients awake and they are able to go home 30-60 minutes after the procedure.

Does it work?
Intra-articular injection into the knee is not going to cure things such as arthritis within the joint. However, it will settle down inflammation and offer good pain relief for a reasonable length of time, although this can range from anywhere between a few weeks up to several months or years depending on what pathology is present and how severe that pathology might actually be.