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

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

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.

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.

Hip Joint Injections

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

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

What is injected?
A variety of different substances can be injected into the hip 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 hip 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?
Because the hip joint is quite deep and tight, a long thin needle is used and this is guided into the hip joint under X-ray control. One 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 hip joint. The local anaesthetic and steroid can then be injected into the hip joint.

Intra-articular injections into the hip 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.

Hip 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. Patients are normally able to fully weight bear pretty much straight away afterwards, although they may potentially need a crutch for assistance afterwards for a short period.

Does it work?
Intra-articular injection into the hip is not going to cure things such as arthritis within the joint. However, it can normally 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.