A rationale for intra articular dextrose grimes

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  • 1. HEALING THE CAPSULE:THE SACROILIAC JOINT AND BEYOND Alfred H Grimes, MD Pinnacle Pain Medicine 550 W Washington St #2 Carson City, NV 89703 775-841-7246
  • 2. MY BACKGROUND• BOARD CERTIFIED IN ANESTHESIOLOGY-1984• PM&R RESIDENCY AT BAYLOR-BC IN 2001• PAIN FELLOWSHIP AT UCSF-SUBSPEC CERT IN 2001• AAOM-PROLO SINCE 2000
  • 3. HOW WE DO PROLO History-Physical Exam Diagnostic then Therapeutic Injections P2G +/- SMDILUTED WITH CARBOCAINE/MARCAINE FLUOROSCOPIC GUIDANCE
  • 4. WHY FLUOROSCOPY?• 1. INCREASED ACCURACY OF NEEDLE PLACEMENT. ESPECIALLY IN OBESE PATIENTS.• 2. ARTHROGRAMS SHOW INITIAL DAMAGE AS WELL AS SUBSEQUENT HEALING OF DAMAGED CAPSULES AND LIGAMENTS!• A PICTURE IS WORTH A THOUSAND WORDS!
  • 5. • CAPSULAR TEARS CORRESPOND TO PAINFUL AREAS• ARTHROGRAMS CAN LET YOU KNOW WHEN TREATMENT IS COMPLETE• THEY ARE HELPFUL IN CONVINCING PATIENTS OF THE NEED FOR FURTHER TREATMENT DESPITE BEING PAIN FREE
  • 6. WHY IS TREATING THE CAPSULEIMPORTANT ?• CAPSULE IS RICHLY INNERVATED, THEREFORE ANY STRETCHING OF CAPSULE OR INCOMPETENTENCY WILL CAUSE PAIN.• CAPSULE SHOULD BE INTACT TO PREVENT EXTRAVASATION OF JOINT FLUID• JOINT FLUID NOURISHES CARTILAGE• LACK OF JOINT FLUID LEADS TO IMPINGEMENT, PAIN, AND DEATH OF CARTILAGE.• CAPSULE INTEGRITY A MUST.• ONLY WITH ARTHROGRAMS CAN BE SURE HEALING IS COMPLETE.
  • 7. Gabrielle F• 44 y/o F• Complaint was abdominal (Low Pelvic) pain• GI/Surgical w/u nondiagnostic• Diagnostic SIJ injections eliminated pain for 24 hours.
  • 8. ROBERT G• 42 y/o male injured shoulder while working on automobile• Presented with classic impingement signs
  • 9. REINJURY
  • 10. JAMES N• 63 y/o male injured shoulder while skiing, weight lifting• Classic impingement
  • 11. GREGORY R• 45 y/o male with injury secondary to rugby, skiing• Classic impingement
  • 12. L Shoulder
  • 13. R Shoulder
  • 14. Shannon R• 33 y/o triathelte with L ankle pain, h/o twisting ankle multiple times• Failed cortisone, refused ankle fusion
  • 15. Patrick P• 50 y/o M• R toe pain, s/p fusion
  • 16. R HIP PROLO• 76 Y/O Female with R hip pain s/p R SIJ prolo
  • 17. QUESTIONS?