Interventional & Pain Management Exams

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At Pureform Radiology, we offer a wide range of Interventional services such as Pain Management Injections, Breast Biopsies, Thyroid Biopsies, Fine Needle Aspirations, as well as Tenotomy. Our Airdrie location now offers Fluoroscopic guided injections.

We have a team of Radiologists who are passionate about providing the best Interventional Services to all of our patients.

We require a requisition to book an appointment. Please have your doctor fax your requisition to us and we will do the rest.

Most of our interventional procedures require that you have work up imaging done before your exam is booked. If you have completed this imaging within Alberta in the past year we don’t need to repeat it. However if you have not, we will schedule you accordingly. Once we review your work up imaging, our Interventional Radiologist will determine the best procedure for your needs and our Pain Management Coordinator will contact you to schedule an appointment.

Very rarely, a Radiologist will recommend that a procedure not be completed. If this is the case, we will contact your referring doctor with the rationale behind that decision.

Please select your exam from the below options to find out more about the procedure and the preparation required for your exam.

Platelet-Rich Plasma (PRP) therapy amplifies the natural growth factors your body uses to heal damaged tissue. PRP therapy uses injection of a concentration of a patient’s own platelets to accelerate the healing of injured soft tissue (Muscle, Tendons and Ligaments). PRP therapy may be beneficial in treating Joint disease such as Osteoarthritis.

PRP injections are prepared by taking the patient’s own blood and running it through a centrifuge to obtain a high platelet concentrate. The platelet concentrate is then injected directly into the injured or diseased body tissue. This releases growth factors that stimulate and increase the number of reparative cells your body produces to promote healing.

PRP therapy could be beneficial in the management of the following conditions: Tennis Elbow (Common Extensor Tendinosis); Golfer’s Elbow (Common Flexor Tendinosis); Rotator Cuff Tendon disease; Gluteal Tendon disease; Hamstring Muscle/Tendon disease; Patellar Tendon disease (Osgood Schlatter’s/Jumper’s Knee); Achilles Tendon disease; Plantar Fasciitis and Joint disease.

We advise that you discuss with your doctor or specialist if PRP therapy is appropriate for you.

Commonly Asked Questions

How long do I have to wait in between injections?

Healing response will take time, this can be varied based on the individual, we recommend that you follow up with your referring physician to discuss. Procedure may be repeated 8 weeks if needed.

How soon can I get back to exercise or start physiotherapy?

Normal daily activity is recommended, though the avoidance of strenuous activities is advised for 14 days post injection, especially if platelet rich plasma is injected in the vicinity of a tendon or into a weight bearing joint. You can begin to resume physical therapy 2weeks (or longer if needed) after the procedure.

How much does the procedure cost?

Platelet Rich Plasma therapy is not covered by Alberta Health Care and is a Fee-For-Service. You may check with any supplemental insurance to see if it is covered under your benefit plan. One site injection (1 vial) costs $400, and two site injection (2 vials) costs $650 without supplemental insurance.

Physical examination or diagnostic imaging will often detect soft tissue abnormalities. An FNA is performed to:

1) Remove some cells and to examine them under a microscope to determine a diagnosis, and/or

2) Remove fluid to alleviate patient discomfort. A fine needle aspiration may be done on various areas or sites of the body.

Ultrasound guided FNA is performed when the area of concern can be seen with ultrasound imaging.

Pureform Procedure

Image guided FNA procedures are performed by a specially trained radiologist. The entire procedure is usually completed within one hour. FNA's are performed on an outpatient basis.

The skin is cleansed with a sterile solution. Local anesthetic (“freezing”) may be injected into the skin and tissue to numb it. You may be asked to remain still and not cough, talk, or swallow during the procedure.

The radiologist, constantly monitoring the lesion site with the ultrasound probe, will insert the needle and advance it directly into the mass. Tissue samples or fluid are removed using an aspiration needle. The needle will be reinserted if additional samples are required.

Once the FNA is complete, pressure will be applied to stop any bleeding, a bandage may be placed if necessary. No sutures are needed.

Preparation

Take all prescribed medications as directed. If you are on anticoagulation drugs (Plavix, Coumadin, Warfarin) or if you are Diabetic and taking insulin, please let your booking coordinator know.

Please arrive 15 minutes prior to your appointment for there is paperwork to read over and a consent form to sign.

You may experience some discomfort, it is recommended to have someone accompany you for your exam and for moral support.

Post Procedure

Apply pressure immediately following the procedure and for 5 – 30 minutes depending on presence of bleeding. If sore or bruising, apply ice pack (wrapped in towel or Ziploc to keep skin dry) to area several times on the day of procedure. Use may use extra strength Tylenol 500 mg (1 tab) every 4-6 hours for pain as needed. Return to normal activity levels. If a bandage has been placed, you may remove it within a few hours. Bruising may occur but will usually clear in 5-7 days. If there is bleeding, drainage, excessive swelling, redness, or heat around the area, call your referring physician.

Results

Final results of your FNA are usually available in 7 working days (unless site was just drained to alleviate pressure and no sample given to the Lab).

Results will be forwarded to the referring physician that ordered the fine needle aspiration. If you have not received results within 7 days, please call your referring doctor.

Physical examination and ultrasound of the thyroid will often identify nodules or cysts in the thyroid gland. It is often difficult to determine if the findings are benign or cancerous.

A biopsy is performed to remove some cells and to examine them under a microscope to determine a diagnosis.

Pureform Procedure

Image guided biopsy procedures are performed by a specially trained radiologist. The entire procedure is usually completed within 30 minutes.

Thyroid biopsies are performed on an outpatient basis. You will be positioned lying face up on the examination table, with your neck extended slightly.

The skin is cleansed with a sterile solution. Local anesthetic (“freezing”) may be injected into the skin to numb it. You will be asked to remain still and not to cough, talk, or swallow during the procedure. The radiologist, constantly monitoring the lesion site with the ultrasound probe, will insert the needle and advance it directly into the mass. Tissue samples are removed using a 25 Gauge aspiration needle. The needle will be reinserted if additional samples are required.

Once the biopsy is complete, pressure will be applied to stop any bleeding. A bandage may be placed if necessary. No sutures are needed.

Preparation

Take all prescribed medications as directed. If you are on anticoagulation drugs (Plavix, Coumadin, Warfarin) or if you are Diabetic and taking insulin, please let your booking coordinator know.

Please arrive 15 minutes prior to your appointment for there is paperwork to read over and a consent form to sign.

You may experience some discomfort, it is recommended to have someone accompany you for your exam and for moral support.

Post Procedure

Apply pressure immediately following the procedure and for 5 – 30 minutes depending on presence of bleeding. Use Extra strength Tylenol 500 mg (1 tab) every 4-6 hours for pain as needed. Return to normal activity levels. If a bandage has been placed, you may remove it within a few hours. Bruising may occur but will usually clear in 5-7 days If there is bleeding, drainage, excessive swelling, redness, or heat around the biopsy area, call your referring physician. If swelling occurs and you feel short of breath, seek immediate medical attention.

Results

Final results of your biopsy are usually available in 7 working days. Results will be forwarded to the referring physician that ordered the biopsy. If you have not received results within 7 days, please call your referring doctor.

Physical examination, mammography, and ultrasound of the breast will often detect abnormalities that can appear as calcifications, masses, or distortion. It is often difficult to determine if the findings are benign or cancerous.

A biopsy is performed to remove some cells and to examine them under a microscope to determine a diagnosis.

Ultrasound guided biopsy is performed when the abnormal area cannot be seen with ultrasound imaging.

Pureform Procedure

Image guided biopsy procedures are performed by a specially trained Radiologist. The entire procedure is usually completed within one hour. Breast biopsies are performed on an outpatient basis.

You will be positioned lying face up on the examination table. The skin is cleansed with a sterile solution and the area is covered in sterile drapes. Local anesthetic (“freezing”) is injected into the skin and breast to numb it. A small nick is made in the skin at the site where the biopsy needle is to be inserted. The Radiologist, constantly monitoring the lesion site with the ultrasound probe, will insert the needle and advance it directly into the mass. Tissue samples are removed using a 14 Gauge core needle. This needle has an automated mechanism that cuts small “cores” of breast tissue. The needle makes a clicking sound as it samples the tissue. This process will be repeated 3-6 times. After sampling, the needle will be removed. A small marker may be placed at the site so that it can be located in the future if necessary. This marker will cause no pain or harm Once the biopsy is complete, pressure will be applied to stop any bleeding and the opening in the skin will be covered with a dressing. No sutures are needed.

A mammogram may be performed to confirm that the marker is in proper position.

You will be sent home with a post biopsy instruction sheet. You should avoid strenuous activity for 24 hours after the biopsy, but then will be able to resume normal activities.

Preparation

Take all prescribed medications as directed. If you are on anticoagulation drugs (Plavix, Coumadin, Warfarin) or if you are Diabetic and taking insulin, please let your booking coordinator know.

Please arrive 15 minutes prior to your appointment for there is paperwork to read over and a consent form to sign.

You may experience some discomfort, it is recommended to have someone accompany you for your exam and for moral support.

Post Procedure

Some patients may experience mild side effects, which may include pain requiring non-prescription analgesics, swelling, or bruising. These symptoms usually resolve spontaneously over a few days. There is a small risk of bleeding and hematoma (1%) and a small risk of infection (0.1 %). If implants are present, there is a risk of rupture of the implants by the needle. Also, on rare occasions, the needle can pass through the chest wall and allow air into the space around the lung, resulting in collapse of the lung. This would require urgent medical care and placement of a chest tube. This is a very rare occurrence.

Results

A pathologist examines the removed tissue and makes a final diagnosis. The results are usually available within 7 days and will be forwarded to your referring physician.

Steroid injections are commonly used for the treatment of joint and soft tissue disorders. Steroids have been shown to be helpful for easing pain and reducing high levels of inflammation. Steroid injections are often used in conjunction with local anesthetic. There are several different formulations of both steroid and anesthetic which may be used. Like all medication, an individual’s response to a steroid injection cannot be predicted. Most patients experience an improvement in their symptoms within a few days. For some, the beneficial effect will persist for several months.

*Please note pre-work up imaging may be required.

Pureform Procedure

Your Technologist will escort you to your exam room, position you on the bed (positioning is specific to each exam) Some individuals are susceptible to fainting during medical procedures, due to a temporary fall in blood pressure. Please inform the Radiologist or Sonographer prior to the procedure.

The Technologist will ask you a few questions and then introduce you to the Radiologist.

The Radiologist will clean the skin and inject a local anaesthetic, similar to the freezing you would get at your dentist.

After the location is confirmed either with x-ray or ultrasound guidance, the steroid will be injected using a small sterile needle.

After being checked post-injection, you are free to leave with no recovery time required.

Preparation

Take all prescribed medications as directed. If you are on anticoagulation drugs (Plavix, Coumadin, Warfarin) or if you are Diabetic and taking insulin, please let your booking coordinator know.

Please arrive 15 minutes prior to your appointment for there is paperwork to read over and a consent form to sign.

You may experience some discomfort following your exam. It is recommended that you have someone accompany you for your exam. However, it is mandatory for you to have a driver if you’re having a bilateral procedure.

Post Procedure

Avoidance of strenuous activities is generally advised for a few days especially if steroid is injected in the vicinity of a tendon or into a weight bearing joint. Deterioration of symptoms for about 48 hours after the injection is seen in 5-10% of patients.

Rest and simple painkillers usually help. It is recommended to work with a physiotherapist post procedure to aid recovery process.

This is a procedure where a Radiologist injects local anesthetic (numbing medication) and then uses a needle to gently poke holes into the abnormal tendon under ultrasound guidance. This procedure is intended to break down scar tissue, cause bleeding in the tendon, and invoke the body's natural healing process to start healing the damaged tendon. The Radiologist will use an ultrasound machine during the procedure in order to see the needle to ensure accuracy and safety. Some patients may experience mild side effects. There is a small risk of bleeding or hematoma. There is a small risk of infection. Mild swelling may occur after the procedure. These symptoms usually resolve spontaneously over a few days.

If you have any questions regarding this procedure, please speak with the Radiologist before beginning the procedure.

*Please note pre-work up imaging is always required.

Pureform Procedure

Your Technologist will escort you to your exam room and position you on the bed (positioning is specific to each exam).

The Technologist will ask you a few questions and then introduce you to the Radiologist.

The Radiologist will clean the skin and inject a local anesthetic (numbing medication) and then under ultrasound guidance, use a needle to gently poke holes into the abnormal tendon under ultrasound guidance.

Preparation

Take all prescribed medications as directed. If you are on anticoagulation drugs (Plavix, Coumadin, Warfarin) or if you are Diabetic and taking insulin, please let your booking coordinator know.

Please arrive 15 minutes prior to your appointment for there is paperwork to read over and a consent form to sign.

Please stop taking all anti-inflammatories 2 weeks prior to procedure date. (eg Advil, Motrin, Ibuprofen, Aleve, Naproxen, Celebrex,)

If this procedure is for Achilles Tenotomy, please bring the required walking boot. And use the walking boot for 2 weeks post procedure to reduce the risk of tendon rupture.

If this procedure is for Patellar Tenotomy, please bring the required hard knee brace. Please use the brace for 2 weeks post procedure to reduce risk of tendon rupture.

If you take insulin for diabetes, please let your booking coordinator know. You may have some juice and a small snack after taking your insulin.

You may experience some discomfort following your exam. It is recommended that you have someone accompany you for your exam. However, it is mandatory for you to have a driver for knee and ankle Tenotomy Treatments.

Post Procedure

After the numbing medication wears off (approx. 1-2 hours), the tissue that has been worked on will usually be quite sore. Although not typical, it can be so sore that some patients do not want to use that body part for some time. Sometimes a brace, splints, crutches, canes, or walkers can be used. Therefore, we recommend planning the procedure during a time that you will have at least a few days to recover.

Ice is generally recommended after the procedure. Anti-inflammatories such as Advil, Motrin, Ibuprofen, Aleve, Naproxen or Celebrex are discouraged for 2 weeks prior to the procedure, and 2 weeks following the procedure.

It is recommended to work with a physiotherapist post procedure to aid recovery process.

How long will the pain last after the procedure?

The acute “flare-up” of pain or increased pain usually lasts 3-7 days after the procedure but can rarely last for up to a month in some patients. There is a large amount of variability between patients and some patients hardly have ANY pain after the procedure. There are no restrictions given and patients are actually encouraged to use the treated body part as normally as possible.

In some cases, the Radiologist may recommend protecting the area in a brace or refraining from specific activities for up to 1-2 weeks post procedure, but there is usually no “down time” that would require patients to be off work or refrain from usual daily activities.

Lavage therapy is a technique used for the treatment of calcific tendinosis of the rotator cuff tendons. It has been proven to be much more effective than corticosteroid injections. Majority of patients notice significant improvement in their symptoms following the procedure.

Prior to lavage therapy you will have had a work up ultrasound and x-ray completed.

Pureform Procedure

Using the ultrasound machine, the Radiologist will guide the needle into the calcification. The calcification can be punctured several times under local anaesthetic. The Radiologist will attempt to break up and withdraw(lavage) the calcification. Once the calcium deposit is aspirated, you will then receive a corticosteroid injection into the subacromial subdeltoid bursa which helps with inflammation and pain relief.

Preparation

Take all prescribed medications as directed. If you are on anticoagulation drugs (Plavix, Coumadin, Warfarin) or if you are Diabetic and taking insulin, please let your booking coordinator know.

Please arrive 15 minutes prior to your appointment for there is paperwork to read over and a consent form to sign.

Post Procedure

Avoid strenuous activities for the first 24-48 hours. Depending on your pain tolerance you may want someone to accompany you as you may be in some discomfort after the procedure.

If you would like more information on the Interventional exams we do please refer to our Pain Management Requisition here.