Pain Management


Ultrasound NYC

In a 2007 study presented at the American Academy of Orthopaedic Surgeons and published in Foot & Ankle International, Dr. Reach and his colleagues at Duke demonstrated 100 percent accuracy with ultrasound guided injections in the small joints and tendon sheaths of the foot and ankle.

Blind unguided local anesthetic and steroid shots are far less accurate—studies have shown blind injections to be only 80 percent accurate in the knee, which is a very large joint, and only 30 percent in the shoulder.

Below are the percentage of correct injection placement using unguided and Ultrasound guided injections using meta-analysis.

Dr.Kulick uses ultrasound guidance, when indicated. for injections of PRP, Prolotherapy and Synvisc, thus markedly increasing the accurate placement of the substance.

One extremely exciting technique, that ultrasound allows is called Hydrodissection. In this technique an ultrasound guided needle is placed at the site of nerve entrapment, and normal saline, water and salt in the identical concentration found in the body) is injected  between the nerve and the ligaments trapping and thereby causing pain , and the force of the saline injected frees the nerve .the recovery from pain is almost immediate. The only other option is surgery, where the muscle layers need to be separated and or cut, and the ligaments cut. Nerve hydrodissecton is a new technique performed by injecting small amounts of fluid around the affected nerve by using a needle under careful ultrasound guidance. Nerves may become scarred and adhere to the surrounding tissue after surgery or trauma, causing pain, numbness, tingling or weakness. This procedure will release the nerve and allow it to glide easier within its surrounding structures. Many times the nerve hydrodissection has the same effect in relieving symptoms as a surgical release. This is an in-office procedure that takes about 30 to 40 minutes and leaves no significant scar.

What conditions benefit from a nerve hydrodissection?

Carpal Tunnel Syndrome
Cubital Tunnel Syndrome
Sural nerve entrapment (after foot surgery)
Saphenous nerve entrapment
Peroneal nerve entrapment
Lateral femoral cutaneous nerve entrapment (Meralgia Paresthetica)
pelvic  floor pain(pudendal nerve neralgia)