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A rationale for intra articular dextrose grimes
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 +/- SM
DILUTED 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 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.
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.
9.
10. ROBERT G
• 42 y/o male injured shoulder while
working on automobile
• Presented with classic impingement signs
