Services

Physical Medicine & Rehabilitation


Comprehensive Sports & Orthopedic Evaluations

We are innovative medical doctors work together to treat all varieties of acute,sub acute and chronic neurologic and musculoskeletal injuries and conditions. Our approach is uniquely one-on-one giving our patients undivided attention during their visit

Platelet Rich Plasma (PRP) & STEM Cell Therapy

PRP is platelet rich plasma, also known as, autologous blood concentrate (APC). Platelets are special blood cells that are involved in injury healing. Platelets are naturally rich in tissue growth factors that can be extracted from one’s own blood and then concentrated. Injecting these concentrated growth factors into injured ligaments, tendons and joints stimulate and accelerate the natural repair process. 

PRP treatments can be used to treat ligament and tendon injuries that have failed other conservative treatments, including: Rotator cuff injuries, hamstring tendon injuries, tennis elbow, muscle strains, knee sprains, plantar fasciitis and ankle sprains. Many professional athletes and performing artists have used this treatment to speed recovery from musculoskeletal injuries.

PRP can be performed in the office with or without ultrasound or x-ray guidance, depending on the area being treated. Blood is drawn from the patient and placed in a special centrifuge that separates the platelets from the red blood cells. The concentrated platelets are then used for treatment. The injured area is first anesthetized with an anesthetic before the actual injection is performed. Typically 1-3 treatments are necessary. The success rates are reported to be in the 80-85% range depending on the condition being treated. Some patients experience complete, permanent relief. To maximize the benefits of treatment and to help prevent re-injury, a specially-designed exercise program is incorporated into your treatment. This also helps newly developed connective tissue mature into healthy and strong tendons or ligaments.

Proper FDA cleared devices are used to ensure proper platelet harvesting. The platelets are collected in a sterile, anti-coagulated state with the proper concentrate and pH (acidity level). Therefore the PRP sample is viable and will aid in tissue healing. Ultrasound guided techniques are used.

Trigger Points Injections (Ultrasound and EMG Guided)

Trigger Points are fibrous bands or “knots” of scar tissue that are felt over a muscle. When the layer of tissue overlying our muscles called the myofascia becomes injured or over used, the resulting scar tissue can be painful and refer pain to nearby areas of the body. An effective way to treat these trigger points is by receiving either ultrasound guided or EMG guided injections into the trigger point in order to break up the adhesions and relive the pain.

The injection contains a local anesthetic or saline, and may include a corticosteroid. With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment will result in sustained relief. Injections are given in the office and usually take just a few minutes. Several sites may be injected in one visit. If a patient has an allergy to a certain drug, a dry-needle technique (involving no medications) can be used.

Joint Injections (Ultrasound Guided)

One way to try to increase the chance of getting the injection into the right spot is to use an imaging device to allow you to “see” inside the body as the injection is being given. The most commonly used device is an ultrasound machine. Ultrasound guided injections are administered in a similar fashion to traditional injections. The needle and syringe are the same. When ultrasound is used, a small probe attached to a video monitor is pressed against the skin. The probe is placed next to the body part to be injected–commonly a joint or tendon sheath. Once your doctor has identified the anatomic landmarks, the injection is administered while watching the needle with the ultrasound. Ultrasound is an excellent way to visualize and ensure the injection is performed in the proper location. 

There are a number of studies that demonstrate improved accuracy of the ultrasound guided injections. This is especially important with injections that may be in a more anatomically difficult location, such as a hip joint or deep tendon, rather than a superficial, easily felt joint or tendon.

Visco Supplementation

Osteoarthritis is one of the leading causes of disability in the United States. It develops slowly and the pain it causes worsens over time. Although there is no cure for osteoarthritis, there are many treatment options available to help people manage pain and stay active. 

In its early stages, arthritis of the knee is treated with nonsurgical methods. Your doctor may recommend a range of treatments, including: 

  • Changes in activity level
  • Weight loss
  • Pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs
  • Physical Therapy
  • Corticosteroid Injections
Another treatment option is a procedure called viscosupplementation. If you have
tried all other nonsurgical treatment methods and your pain continues to limit
your activities, viscosupplementation may be an option.
In this procedure, a gel-like fluid called hyaluronate is injected into the knee joint.
Hyaluronate is a naturally occurring substance found in the synovial fluid
surrounding joints. It acts as a lubricant to enable joint surfaces to move
smoothly over each other and as a shock absorber for joint loads. People with
osteoarthritis have a lower-than-normal concentration of hyaluronate in their
joints. The theory is that adding hyaluronate to the arthritic joint will facilitate
movement and reduce pain.

 

PROCEDURE

You will receive three shots one to two weeks apart.

During the procedure, if there is significant swelling in your joint, the excess fluids may be removed before injecting hyaluronate. Usually, the aspiration and the injection are done using only one needle injected into the joint.

For the first 48 hours after the shot, you should avoid excessive weight bearing on the leg, such as jogging or heavy lifting.

 

Electrodiagnostic Testing

Did you know that your body is an electrical generator? Nerves and muscles create electrical signals that deliver messages to and from your brain. Sensory nerves deliver information about your surroundings to the brain. Motor nerves deliver signals from the brain to activate your muscles. Injuries or diseases that affect nerves and muscles can slow or halt the movement of these electrical signals. If you have pain, weakness or numbness in your back, neck, legs, feet, or hands, measuring the speed and degree of electrical activity in your muscles and nerves can help make a proper diagnosis.This process is called electrodiagnostic testing.

Two tests are commonly used:

  • Nerve conduction studies(NCS)
  • Electromyography (EMG)
Generally, these tests can accurately determine injuries to the nerves or nerve roots as well as diseases of the nerves and muscles. In some conditions, however, it may take several weeks for changes to become apparent.

Medical Marijuana Program Registration

Medical marijuana has been used to provide controlled levels of THC and CBD. Our bodies have a regulatory sstem called the endocannabinoid system. The two primary receptors of the endocannabinoid system are the CB1 and CB2 receptors. The two receptors are located throughtout much of the body including the central nervous system, gastrointestinal system, urinary system and immune system. THC and CBD bind to these receptors in different ways working together to give effects like pain relief and muscle relaxation. 

What to expect a initial consultation for medical marijuana  program? 

  • A Review of your medical record or  documents.
  • A comprehensive physical examination.
  • Certification with NYS department of health for NYS medical marijuana program.
  • Registration into the medical marijuana program, if qualified.

*If accepted, you will receive a copy of the signed certification and a prescription/recommendation for medical Marijuana and a copy of your temporary ID from the department of health online.

Telemedicine

Telemedicine allows these patients to access medical expertise quickly, efficiently and without travel. 

Telemedicine is used for a number of different services include:

  • Medication management.
  • Management of chronic health conditions.
  • Consultations-to evaluate,diagnose and treat.
  • Follow-up visits.

These services are conducted via secure video and audio connections