Tel: 415.408.3500
Text: 415.729.3539
Fax: 415.408.3365
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Pain Management and Rehabilitation
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Qualified Medical Evaluation
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EMG NCS Diagnostics
Areas of Expertise
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PM & R
What is a PM&R specialist?
Physical medicine and rehabilitation (PM&R) specialists are physiatrists who promote healing and rehabilitation of patients who have experienced an injury or undergone surgery. They also diagnose and treat acute and/or chronic pain and musculoskeletal conditions.
PM&R specialists treat the patient as a whole, by addressing not only physical needs, but emotional and social needs as well, such as pain induced depression.
What does a PM&R specialist do?
PM&R physicians treat patients of all ages, focus treatment on function, have a broad medical expertise that allows them to treat disabling conditions, diagnose and treat pain as a result of an injury/illness/disabling condition, determine and lead a treatment/prevention plan, lead a team of medical professionals such as, physical therapists, occupational therapists, and physician extender to optimize patient care.
PM&R physicians also work with other physician, which may include primary care physicians, neurologist, orthopedic surgeons, and many others, with a goal to treat the whole person or accepted body parts.
Depending on the type of injury/illness/disabling condition, some specialists may treat their patients using EMG/nerve conduction studies, nerve stimulators, blocks and ablation procedures, manual medicine osteopathic treatment, prosthetics and orthotics, complementary-alternative medicine, disability/impairment assessment, medical-legal consulting, and injections to the spine, joints, or muscles.
What should I expect from my office visit?
PM&R physicians plan treatment based on a thorough evaluation of the patient's medical history, and/or neurological reports, X-rays, and laboratory tests. PM&R treatment may include any combination of the following: medication, physical therapy, occupational therapy, massage, exercise, spinal injections, and more.
QME
What are Qualified Medical Evaluations?
Qualified medical evaluators (QMEs) are qualified physicians who are certified by the Division of Workers' Compensation - Medical Unit to examine injured workers to evaluate disability and write medical-legal reports. The reports are used to determine an injured worker's eligibility for workers' compensation benefits. QMEs include medical doctors, doctors of osteopathy, doctors of chiropractic, dentists, optometrists, podiatrists, psychologists and acupuncturists.
What should I expect from my Qualified Medical Evaluation?
When your appointment is approved with your QME, you will receive an evaluation form either through email or standard mail. Although lengthy, these forms allow the physician better analyze the body parts affected by your injury, how your injury impacts activities of daily living, what treatment has helped in the past, level of pain induced depression, and severity of body parts affected.
What should I expect on the day of my Qualified Medical Evaluation?
On the day of your appointment, an assistant to the physician will make sure all proper documentation is filled prior to starting the evaluation.
During your appointment, the physician will begin by asking questions on how your injury occurred, how your symptoms have progressed, what treatment you have received from other physicians, and details of your medical history that may have contributed to the injury.
In addition to asking questions, the physician will perform a detailed physical examination to evaluate the severity of your condition.
Will I get a copy of the report?
Yes. The QME has 30 calendar days from the date of the commencement of the exam to mail a copy of the report.
EMG/NCS
What is an EMG?
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An EMG test measures muscle response or electrical activity in response to a nerve's stimulation of the muscle. The test is used to help detect neuromuscular abnormalities. During the test, one or more small needles (also called electrodes) are inserted through the skin into the muscle to measure the electrical activity of the targeted muscle.
What is a NCS?
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A NCS is used to assess nerve damage and dysfunction by measuring the strength and speed of electrical signals moving through your peripheral nerves.
What should I expect?
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The procedure will start with a NCS by placing sticky electrodes over the targeted nerve(s). The targeted nerve(s) will be electrically stimulated and recorded. After we have finished evaluating all the nerves of interest, we will complete the study with an EMG by recording muscle responses or electrical activity with a needle electrode.
Please refrain from wearing any lotions or oils as it will delay the procedure.
Please wear clothing that will allow you to be examined easily i.e., tank tops, stretchy shirts, loose pants, or shorts.
Trigger Point Injections
What is a TPI?
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A Trigger point injection (TPI) is a procedure used to treat painful areas of muscle that contain trigger points, which are knots of muscle that form when muscles do not relax.
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A TPI involves the use of a small and thin needle to inject a local anesthetic (lidocaine) to reduce pain of multiple trigger point locations.
The goal of TPIs is to relieve pain, tightness, and tenderness of taught bands at myofascial trigger points with twitch responses in the affected muscles and to increase activities of daily living such as stretching, exercises, physical therapy, function, activities of daily living, and work.
TPI without a local anesthetic
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If you have any allergies or do not wish to use a local anesthetic, TPI’s can be performed without the injection of the solution, by inserting a small needle to the trigger point region, similar to acupuncture or dry needling.
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Piriformis & SI Joint Injections
What is a Piriformis muscle/SI joint injection?
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A piriformis steroid injection is an injection of a steroid into the piriformis muscle of your buttock. Your sciatic nerve goes down the back of your leg and passes through or under this muscle. Tightness in the piriformis muscle can cause sciatica, which is pain down the back of the leg. There may also be pain symptoms in the hip and low back and even in the groin, genitals and rectum.
A sacroiliac joint injection is utilized to reduce back pain that is the result of an inflamed or injured sacroiliac joint.
The goal of this procedure is to reduce the inflammation and /or swelling around the nerves that pass near or through the piriformis muscle. This in turn may reduce your pain, numbness, tingling or other symptoms that may contribute to nerve inflammation, irritation or swelling.
Pain relief can last from days to years, allowing your condition to improve with physical therapy and an exercise program. You may need follow-up appointments for piriformis steroid injections until your home therapy is effective. Physical therapy and deep tissue massage may be recommended as adjunct treatment to assist setting up a home care program for you.
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Piriformis injection without a steroid
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If you have any allergies or do not wish to use a steroid, Piriformis injections can be performed by using a local anesthetic to numb the area and relax the targeted muscles.
Steroid Injections
What is a steroid joint injection?
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A steroid injection is a minimally invasive procedure that can temporarily relieve pain caused by an inflamed joint.
A steroid injection includes both a corticosteroid (methylprednisolone) and an anesthetic numbing agent (lidocaine). The drugs are delivered inside the joint capsule to reduce inflammation, which can be effective when delivered directly into the painful area.
The pain relief can last from days to years, allowing your condition to improve with physical therapy and an exercise program.
The goal of steroid injection is to relieve pain and help you increase activities such as stretching, exercises, physical therapy, function, activities of daily living, and work.
Shoulders
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Rotator Cuff-Partial
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Chronic Glenohumeral Ligament Sprain
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Acromio-Clavicular Joint Dysfunction
Elbows
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Ulnar Collateral Ligament injury
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Distal Biceps Tendon Partial Tear
Wrist & Hand
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Chronic Thumb Sprain
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Joint Arthritis
Hip
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Greater Trochanteric Bursitis
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Ischial Tuberosity Bursitis
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Hip Joint Arthritis
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Symphysis Pubis Pain
Knee
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Degenerative Arthritis
Ankle & Foot
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Chronic Ligament Strains
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Chronic Achilles Tendinosis
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Chronic Partial Tendon Tear
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Plantar Fasciitis
Hyaluronic Acid Injections
What is Hyaluronic Acid?
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Hyaluronic acid is produced naturally by your body. This fluid helps lubricate and cushion your joints and keeps them working smoothly.
What are Hyaluronic Acid injections?
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Hyaluronic acid injections, or viscosupplementation, is a fluid that acts as a lubricant or shock absorber, helping joints, specifically the knee, work properly.
People with arthritis experience a breakdown in hyaluronic acid or synovial fluid, for which an injection of hyaluronic acid can help to lessen joint pain and inflammation.
PRP Injections
What are Platelet Rich Plasma Injections?
Platelet Rich Plasma (PRP) injections can treat shoulder injuries, elbow injuries, knee injuries, and knee arthritis by using a patient’s own blood platelets to speed up the healing process of injured tendons, ligaments, muscles, and joints.
To extract the PRP, a vial of venous blood is drawn. The platelets and some white cells in your blood will be concentrated into PRP using a centrifuge.
Once the PRP is produced, a local anesthetic (Lidocaine) is injected to numb the targeted area. Once you are numb, your PRP is then injected directly into the injured area.
The goal of the procedure is for the PRP to release growth factors to stimulate the targeted area and increase the number of reparative cells your body produces, ultimately reducing symptoms and increasing your ability to move, stretch, and exercise.
Migraine Botox Injections
What are Migraines?
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Migraine is a common neurological disorder featuring recurrent headaches. Typical migraine attacks last for 4–72 hours and involve headaches of the following characteristics: pulsating quality, unilateral location, moderate or severe int ensity and aggravation by routine physical activity. Attacks can be accompanied with nausea, vomiting, visual auras, photophobia and phonophobia.
How is Botox used to treat migraine headaches?
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Botox blocks certain chemical signals from your nerves, causing temporary paralysis of your muscles and temporary relief of migraine symptoms.
After you receive Botox injections, it may take as long as 10 to 14 days for you to experience relief.
What should I expect from the procedure?
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After targeted areas are cleaned with an alcohol wipe, small amounts of Botox are injected using a very small needle into shallow muscles of the skin.
The following image represents the possible targeted muscles for the botox injections.