Treatments & Services For Active Adults
Orthopaedic & Sports Medicine in Chicago, IL
Musculoskeletal Ultrasound
Musculoskeletal ultrasound is a tool that utilizes high-frequency sound waves to image soft tissue and bony surfaces. It can be thought of as a camera that allows visualization of tendons, muscles, nerves, ligaments, and parts of joints.
Ultrasound-Guided Injections
Dr. Verma utilizes ultrasound for precise placement of injections to treat pain and improve function. Injections may include platelet-rich plasma, hyaluronic acid, corticosteroid, or local anesthetic.
Hyaluronic Acid Injections
Hyaluronic acid (more commonly known as “gel”) injections are used to treat knee osteoarthritis.
Platelet-Rich Plasma
Platelet-rich plasma is a minimally-invasive non-surgical procedure for various types of osteoarthritis and chronic tendon problems.
Tenex
Tenex is an evidence-based, minimally-invasive procedure for chronic tendon pain that may serve as an alternative to more invasive surgery.
Diagnostic Musculoskeletal Ultrasound
Musculoskeletal ultrasound is a tool that utilizes high-frequency sound waves to image soft tissue and bony surfaces. It can be thought of as a camera that allows visualization of tendons, muscles, nerves, ligaments, and parts of joints.
During the evaluation, the ultrasound probe is placed gently over the skin to evaluate the area of symptoms. The relevant anatomy can be assessed to determine if it is normal or abnormal. Dr. Verma can then determine how the ultrasound findings correlate with a patient’s history and physical examination, and subsequently develop a specific treatment plan.
A benefit of diagnostic musculoskeletal ultrasound is dynamic evaluation. Compared to MRI in which the patient is laying still, dynamic musculoskeletal ultrasound allows the patient to reproduce painful movements while Dr. Verma images the painful area while it is in motion, which is highly valuable in establishing a diagnosis.
Other benefits of diagnostic musculoskeletal ultrasound include:
Excellent image clarity for structures close to the skin surface
In-office evaluations
Enhanced patient education via patient-physician interaction during the exam
Lower cost compared to MRI
No radiation
No specific contraindications
While musculoskeletal ultrasound has some limitations, such as inability to see through bone, studies have shown it is comparable to and in some cases even superior to MRI.
Dr. Verma is certified in musculoskeletal ultrasound by the Alliance for Physician Certification and Advancement. He also teaches musculoskeletal ultrasound as the Associate Program Director of the University of Chicago / Endeavor Health Primary Care Sports Medicine Fellowship.
For more information regarding the evidence-basis for the use of musculoskeletal ultrasound, please refer to Dr. Verma’s blog post.
Ultrasound-Guided Injections
Dr. Verma utilizes ultrasound for precise placement of injections to treat pain and improve function. Injections may include platelet-rich plasma, hyaluronic acid, corticosteroid, or local anesthetic.
Diagnostic ultrasound enables direct visualization of the target area for an injection. The ultrasound imaging is then used to visualize and guide the needle to the target area, ensuring the injection is delivered to the correct location.
From a therapeutic perspective, numerous studies have shown ultrasound-guided injections are more accurate, more effective, and less painful than traditional injections guided by palpation or feel.
Furthermore, precise placement of the injection via ultrasound guidance helps determine whether the area injected is the source of symptoms by comparing painful movements before and after the injection.
For more information regarding the evidence-basis for ultrasound-guided injections, please refer to Dr. Verma’s blog post.
Gel Injections (Hyaluronic Acid Injections)
Hyaluronic acid (more commonly known as “gel”) injections are used to treat knee osteoarthritis and have been approved for use by the United States Food and Drug Administration (FDA) since 1997.
The knee joint naturally makes hyaluronic acid which functions to lubricate the joint and has an anti-inflammatory effect. In knee osteoarthritis, the amount and quality of the naturally-occurring hyaluronic acid decreases, which is why supplementing the knee joint with hyaluronic acid can be beneficial.
There is evidence that hyaluronic acid injections may result in improvement of pain and function lasting 3-6 months. Furthermore, several studies have shown hyaluronic acid injections to delay treatment with knee replacement surgery. Individual results may vary.
Most insurances provide coverage for hyaluronic acid injections. Insurance coverage may vary based upon your policy. The injections may generally be repeated every 6 months.
Platelet-Rich Plasma (PRP)
Platelet-rich plasma is a minimally-invasive non-surgical procedure for osteoarthritis and chronic tendon problems.
Platelets play an important role in healing because they contain growth factors which create a signaling effect to initiate a healing response at the site of injury. In PRP treatment, the concentration of platelets injected at the site of injury is higher than that found in normal blood.
PRP is an office-based procedure that utilizes a patient’s own platelets. In this procedure, blood is drawn from the patient, similar to when routine bloodwork is obtained. The blood is then transferred to a machine called a centrifuge, which separates blood components and concentrates platelets to form PRP. At this point, PRP is isolated and ready for procedural purposes. Dr. Verma utilizes musculoskeletal ultrasound to identify the injured area and then guide the needle to the site of injury for precise localization and delivery of the PRP.
PRP is a treatment which has an evidence basis supporting its use for multiple orthopaedic conditions. PRP is commonly used in orthopaedics for the following:
Knee osteoarthritis
Elbow tendinitis (tennis elbow, golfer’s elbow)
Rotator cuff tendinitis
Partial-thickness rotator cuff tear
Hip (gluteal) tendonitis
Hamstring tendonitis
Patellar tendonitis
Achilles tendonitis
Plantar fasciitis
Patients who typically seek treatment with PRP have not responded to conservative treatment (such as physical therapy, home exercises, other injections) and would like to pursue an alternative to surgery or may not be a candidate for surgery due to other health conditions.
Despite growing evidence to support its use for numerous orthopaedic applications, PRP is still considered an experimental treatment and therefore is not covered by most insurance plans. The cost of a PRP treatment at Endeavor Health is $885.
If you are interested in treatment with PRP for your condition, please schedule a consultation with Dr. Verma to discuss the procedure and research pertaining to PRP.
Tenex (Ultrasound-Guided Percuteneous Needle Tenotomy with Vacuum Debridement)
Tenex is an evidence-based, minimally-invasive procedure for chronic tendon pain. The procedure has been approved by the United States Food and Drug Administration (FDA) since 2012 and is covered by most insurances.
Tenex is a minimally-invasive alternative to more invasive surgery and is suitable for patients with recurring symptoms or persistent ongoing pain. In this scenario, portions of the healthy tendon tissue have been replaced with damaged, degenerative, pain-producing tendon tissue.
Traditional treatment for chronic tendon disease involves an open surgical procedure to cut and remove the damaged tissue with a scalpel through a large incision. This could require general anesthesia and could mean several months of restricted activity.
Tenex was developed at the Mayo Clinic and has been shown to help tendon pain in over 85% of patients. Tenex is commonly used in orthopaedics for the following:
Elbow tendinitis (tennis elbow, golfer’s elbow)
Rotator cuff tendinitis or calcific tendonitis
Hip (gluteal) tendonitis
Patellar tendonitis
Achilles tendonitis
Plantar fasciitis
Dr. Verma uses ultrasound imaging during the procedure to visualize the damaged portion of the tendon, essentially degenerative or “scar” tissue, which produces pain and limits function.
Local anesthesia is applied to numb the area. General anesthesia or light sedation is typically not required. A tiny incision is made and the Tenex device is inserted to the area of tendon damage. A combination of ultrasonic energy, irrigation, and vacuum-function is used to break down and remove the damaged tendon tissue while leaving healthy tendon tissue alone. The process stimulates a natural healing response.
The procedure typically takes minutes to perform. Compared to traditional open surgery, the minimally invasive approach of Tenex provides less discomfort, typically no stitches, and a faster return to activity.
Most insurances provide coverage for Tenex procedures. Insurance coverage may vary based upon your policy.
If you are interested in treatment with Tenex for your condition, please schedule a consultation with Dr. Verma to discuss the procedure and research pertaining to Tenex.