Physiatry

Procedures We Perform

The following is a partial list of procedures performed by physiatrists at HSS:

IntraDiscal Electrothermal Therapy (IDET) is a minimally invasive procedure performed by physiatrists at Hospital for Special Surgery (HSS) that offers an important treatment option to individuals with lower back pain caused by lumbar disc disease. The physician then passes a thermal catheter through the needle and into the injured disc in the specific area of the annulus tear. The catheter heats the collagen of the disc to shrink the protruded material and destroy the pain fibers 

Epidural steroid injection is an umbrella term applying to a variety of techniques performed to deliver a corticosteroid preparation around a nerve exiting the spinal cord in an epidural space. This procedure decreases inflammation of the nerve roots, thereby reducing pain for several months and hopefully aiding the healing process as well.

Nucleoplasty uses radiofrequency energy to treat patients with low back pain from contained, or mildly herniated, discs. Guided by x-ray imaging, a wand-like instrument is inserted through a needle into the disc to create a channel that allows inner disc material to be removed. The wand then heats and shrinks the tissue, sealing the disc wall. Several channels are made, depending on how much disc material needs to be removed.

Radiofrequency ablation/lesioning uses high-frequency alternating current flow to generate heat and destroy pain sensing nerves. A narrow electrode is introduced to the affected nerve. Precisely controlled generator heat is generated to destroy the nerve.

Nerve conduction/electromyography testing, or EMG testing, is a two-part electrodiagnostic test that is used to study nerve and muscle function, and it can provide your doctor with specific information about the extent of nerve and/or muscle injury.  The test consists of a nerve conduction study and a needle exam for muscle testing. The nerve conduction study entails stimulating the nerves at different points with small electric shocks, artificially activating them so their function can be measured. The needle exam involves inserting very fine needles into several muscles with determine normal and abnormal electrical signals given off by the muscles. EMG testing usually takes anywhere from 30 to 90 minutes, depending on the condition being tested and findings of the study.

Joint lavage procedures are arthroscopic techniques essentially meant to wash loose tissue debris and inflammatory agents away from the interior of a major joint, such as the knee. Although the lavage procedure is a short-term solution, it may assist in relieving the symptoms of those suffering from osteoarthritis for a number of years.
Joint injections are performed for diagnostic and therapeutic purposes, and they can be used in two ways - for aspiration, which involves removing fluid for testing or drainage, and fluid injection, whereby medications such as corticosteroids are injected into a joint to medicate areas affected by inflammatory arthritis.

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