A rationale for intra articular dextrose grimes

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Nomienredes

Health & Medicine Technology

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

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

HOW WE DO PROLO
History-Physical Exam
Diagnostic then Therapeutic Injections

P2G +/- SM
DILUTED WITH CARBOCAINE/MARCAINE

FLUOROSCOPIC GUIDANCE

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!

• 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

WHY IS TREATING THE CAPSULE
IMPORTANT ?
• 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.

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.

ROBERT G

• 42 y/o male injured shoulder while
working on automobile
• Presented with classic impingement signs

JAMES N

• 63 y/o male injured shoulder while skiing,
weight lifting
• Classic impingement

GREGORY R

• 45 y/o male with injury secondary to
rugby, skiing
• Classic impingement

Shannon R

• 33 y/o triathelte with L ankle pain, h/o
twisting ankle multiple times
• Failed cortisone, refused ankle fusion

Patrick P
• 50 y/o M
• R toe pain, s/p fusion

R HIP PROLO

• 76 Y/O Female with R hip pain s/p R SIJ
prolo

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