Joint Injections
Cobblestone Medicine and Rehab

Performed by our Trusted Physician – Dr. Raza Khan M.D

jointclinic1The Joint Clinic is a precision therapeutic joint injection service performed by our professionally trained physicians. These are primary care physicians who are highly experienced injectors who inject a wide variety of joints, tendons and ligaments using the latest technological therapeutic interventions. Where indicated, highly precise injections are performed under ultrasound guidance with real-time doppler imaging allowing direct visual feedback to the physician and the patient showing the product being injected precisely where it is needed.

Precision Therapeutic Joint Injections
Ultrasound-guided injection of steroids, hyaluronic acid, and autologous Platelet-Rich Plasma (PRP) for injured or damaged joints and tendons. (All ultrasound guided injections will be performed at separate location. Non Ultrasound guided will be performed in clinic location)**

Private, Third-Party Insurance Coverage
Most treatments are covered by OHIP, private pay, as well as third-party insurance plans.

Types of Injections We Offer

Platelet-Rich Plasma Injections
What is Autologous Platelet-Rich Plasma (A-PRP)? Autologous Platelet-Rich Plasma (A-PRP) was first developed in the 1970s and has gained popularity since the 1990s being applied to many different medical fields including cosmetic surgery, dentistry, sports medicine and pain management. It is defined by a limited volume of plasma (blood minus the red blood cells and granulocytes), and contains concentrated platelets, a large pool of growth factors, and proteins that have been found to enhance wound healing and repair in injured tendons, ligaments and joints. These structures, when injured, take a very long time to heal due to limited blood supply and low cell density.

The growth factors contained in A-PRP are released from granules in the platelets and when activated, stimulate repair of injured tissues through a variety of physiological mechanisms. Sports medicine physicians, primary care physicians and orthopedic surgeons throughout Europe, the United States and Canada are increasingly using A-PRP as a means to enhance the healing of injured tendons and ligaments, and to delay artificial joint replacement by years.

Corticosteroid Injections

Steroid injections into injured or degenerated joints, or around injured tendons can provide anywhere from several weeks to up to six months of relief. This procedure can be done using surface anatomoical features recognizable by an experienced injecting physician, but also using ultrasound guidance to significantly increase precision of the injection to the injured or degenerated site. Usually xylocaine (an injectable local anesthetic) is mixed with the steroid to act as a “tracer”, to verify that the steroid was injected at the correct location, but also to increase the comfort of the injection.

SynVisc Injections

Synvisc® injections (elastoviscous fluid containing hyaluronic acid) are done commonly for Osteoarthritis of the hip or knee. Injections are done weekly for a total of three injections, and repeated every six months. This restores and rejuvenates the joint fluid and nourishes the damaged joint cartilage. These injections will help to delay joint replacement by several years and can be performed in patients with mild to moderate disease. For advanced osteoarthritis of the joint, this option is not recommended.

Barbotage Procedure – Calcific Tendonosis

We do this procedure primarily for calcific tendonosis of the shoulder. This is where a painful calcium stone forms at the site of a tendon. Commonly this occurs at the supraspinatus tendon in the shoulder.  Barbotage makes it possible to avoid painful, complicated surgery which may result in prolonged down time.

After injecting local anesthetic for your comfort, saline solution is injected around the location of the calcium stone. This is followed by manipulation of the stone with a needle to break it into pieces, causing the stone to dissolve into solution.

Once the stone is gone, we aspirate (suck up) the saline with the dissolved calcium stone.  You should continue aggressive physiotherapy after this procedure.

Bakers Cyst Drainage Technique

(Before)

(After)

We do this procedure for Baker’s cysts which can occur in the back of the knee.

These can cause pain, reduced range of motion and pressure. They can also rupture causing significant knee pain and inflammation.

Because of the major blood vessels and nerves that pass through this area, it is highly recommended to do this procedure under ultrasound guidance to ensure your safety.

After injection local anesthetic for your comfort, a needle is passed into the Baker’s Cyst under ultrasound guidance for your safety, and the fluid is aspirated (sucked) out, causing the cyst to be completely drained. To prevent the cyst from re-forming, steroids are injected into the remaining cystic tissue.  You should continue aggressive physiotherapy after this procedure.

Fees for Services:

Your joint assessment is performed by an experienced and qualified primary care physician. There is no consultation fee and this fee is covered by OHIP, provided you have a valid health card. While referrals from your family doctor are recommended, they are not necessary.

The following is a list of our fees for non-OHIP insurable services:

  • Steroid injection into joint under ultrasound guidance: $200 first joint/site, +$50 for each additional joint/site.
  • Synvisc® injection into joint (knee): $50 per injection
    Synvisc® injection into hip joint under ultrasound guidance: $200 per injection

Platelet-Rich Plasma injection:

  • Ultrasound-Guided (per session): $600 – injection of one site, $200 each additional site
  • Non-Utrasound-Guided (per session): $500-first joint, $150 each additional site

There is no HST on these fees as it is a therapeutic service.