Cross sectional (MRI and CT) arthrography is a great diagnostic tool from the evaluation of a multitude of acute and chronic joint conditions. Contrast material is injected directly into the joint by a radiologist. This causes distention of the joint enhancing the internal architecture. This technique leads to improved evaluation of the pathology or anatomic variation which may be leading to your symptoms.

Musculoskeletal radiologists use imaging guidance to precisely locate bones, muscles, nerves, and tendons and deliver the contrast to the appropriate joint space. At Casper Medical Imaging our radiologists have years of experience performing and interpreting MRI and CT arthrography of a multitude of peripheral joints to include the shoulder, elbow, wrist, hip, knee, and ankle.

What should I expect from an arthrogram injection?

An image guided contrast injection allows the radiologist to accurately and safely watch the needle position real-time. Image guidance also allows the radiologist to see the critical nearby anatomic structures allowing for a more successful and safer injection. Depending on the source of your pain you may experience immediate relief from the pain numbing anesthetic medications also placed into the joint at the time of the procedure. This immediate pain relief can also provide critical information to the ordering physician about your source of pain.

Your physician should discuss which medications you need to withhold for your procedure.

What should I expect the day of the procedure?

After you arrive at Casper Medical Imaging / Outpatient Radiology and check in, our technologists will escort you to the procedure room. We will discuss the procedure with you further and answer any questions you may have left. Once we are ready to begin the procedure, we will position you on the procedure table. We will clean and prep the area of skin for the procedure using sterile technique. We will then numb the skin with local anesthetic. Then utilizing imaging guidance with either ultrasound, fluoroscopy (X-ray), or computed tomography (CT) we will numb the deeper soft tissues with a combination of anesthetic medication up to and into the joint. You may feel some pressure in joint or soft tissues from the anesthetic medication and injected contrast material. Following removal of the needle we will place a small bandage over the area. We will then escort you to the MRI or CT suite to undergo further imaging.

What to expect after procedure?

Shortly following the procedure, you may experience some pain and swelling around the injection site. The effects of the anesthetic can last up to a few hours depending on whether the joint/area injected is the main source of your pain. You may feel numb or experience mild weakness in the limb for a few hours after the injection. If you experience discomfort over the first few days after injection apply an ice pack to the area. We recommend over the counter Tylenol (acetaminophen) if any pain medication is needed.

Our recommendation is to avoid strenuous activity the day of the treatment. And since you know your body better than anyone else, you may begin to resume normal activity when you feel ready.

What are the risks?

The risks associated with arthrography injections are very small. Most patients experience no significant or lasting complications.

A multitude of chronic joint conditions can lead to years of pain, to include osteoarthritis, inflammatory arthritis such as rheumatoid arthritis and ankylosing spondylitis, gout and pseudogout, as well as tendonitis and bursitis,

Musculoskeletal radiologists use imaging guidance to precisely locate bones, muscles, nerves, and tendons and deliver treatments directly.  Successful treatment can sometimes avoid the need for open surgery and long recoveries. At Casper Medical Imaging our radiologists have years of experience providing diagnostic and therapeutic steroid injections to peripheral joints, tendons, bursa and other locations to successfully diagnose and treat your source of pain.

What should I expect from an image guided pain injection?

An image guided pain injection allows the radiologist to accurately and safely watch the needle position real-time. Image guidance also allows the radiologist to see the critical nearby anatomic structures allowing for a more successful and safer injection. Depending on the source of your pain you may experience immediate relief from the pain numbing anesthetic medications.  The addition of a corticosteroid can help reduce chronic inflammation and lead to days, weeks, and even months of pain relief.

Your physician should discuss which medications you need to withhold for your procedure. And depending on which type of injection you receive you may need to arrange transportation on the day of your procedure. 

What should I expect the day of the procedure?

After you arrive at Casper Medical Imaging / Outpatient Radiology and check in, our technologists will escort you to the procedure room. We will discuss the procedure with you further and answer any questions you may have left. Once we are ready to begin the procedure, we will position you on the procedure table. We will clean and prep the area of skin for the procedure using sterile technique. We will then numb the skin with local anesthetic. Then utilizing imaging guidance with either ultrasound, fluoroscopy (X-ray), or computed tomography (CT) we will numb the deeper soft tissues with a combination of anesthetic medication up to and into the joint or other area of interest. You may feel some pressure in joint or soft tissues from the medication. Following removal of the needle we will place a small bandage over the area. We will keep you for a short period of observation to make sure you are ready to head home after the procedure.

What to expect after procedure?

Shortly following the procedure, you may experience some pain and swelling around the injection site. The effects of the anesthetic can last up to a few hours depending on whether the joint/area injected is the main source of your pain. You may feel numb or experience mild weakness in the limb for a few hours after the injection. Also, your pain may mildly increase for a few days as the anesthetic wears off and the anti-inflammatory effects of the steroid kick in. If you experience discomfort over the first few days after injection apply an ice pack to the area. We recommend over the counter Tylenol (acetaminophen) if any pain medication is needed. It may take up to 10 days for the full anti-inflammatory effects of the steroid to provide the greatest pain relief.

Our recommendation is to avoid strenuous activity the day of the treatment. And since you know your body better than anyone else, you may begin to resume normal activity when you feel ready.

What are the risks?

The risks associated with pain injections are very small. Since the treatment is localized to the area of pain most patients experience no significant or lasting complications.

A multitude of chronic joint conditions can lead to accumulation of fluid in the joints or surrounding joint spaces. These include osteoarthritis, inflammatory arthritis such as rheumatoid arthritis and ankylosing spondylitis, gout and pseudogout, as well as infection. Common causes for fluid filled cysts include ganglion cysts, synovial cysts, versus resolving hematomas and seromas.

Musculoskeletal radiologists use imaging guidance to precisely locate the joint space and accumulated fluid.   Casper Medical Imaging our radiologists have years of experience accessing peripheral joints to successfully aspirate the fluid and often provide pain relief or answers as to the source of the fluid.

What should I expect from an image guided aspiration?

An image guided aspiration allows the radiologist to accurately and safely watch the needle position real-time. Image guidance also allows the radiologist to see the critical nearby anatomic structures allowing for a more successful and safer aspiration. Depending on the source of your pain you may experience immediate relief from the aspiration.  The addition of a corticosteroid can sometimes help with pain the reaccumulating of fluid.

Your physician should discuss which medications you need to withhold for your procedure. And depending on which type of injection you receive you may need to arrange transportation on the day of your procedure. 

What should I expect the day of the procedure?

After you arrive at Casper Medical Imaging / Outpatient Radiology and check in, our technologists will escort you to the procedure room. We will discuss the procedure with you further and answer any questions you may have left. Once we are ready to begin the procedure, we will position you on the procedure table. We will clean and prep the area of skin for the procedure using sterile technique. We will then numb the skin with local anesthetic. Then utilizing imaging guidance with either ultrasound, fluoroscopy (X-ray), or computed tomography (CT) we will numb the deeper soft tissues with a combination of anesthetic medication up to and into the joint or other area of interest. You may feel some pressure in joint or soft tissues from the medication. Following removal of the needle we will place a small bandage over the area. We will keep you for a short period of observation to make sure you are ready to head home after the procedure.

What to expect after procedure?

Shortly following the procedure, you may experience some pain and swelling around the procedural site. You may feel numb or experience mild weakness in the limb for a few hours after the injection. Also, your pain may mildly increase for a few days as the anesthetic wears off. If you experience discomfort over the first few days after injection apply an ice pack to the area. We recommend over the counter Tylenol (acetaminophen) if any pain medication is needed.

Our recommendation is to avoid strenuous activity the day of the treatment. And since you know your body better than anyone else, you may begin to resume your usual physical activity when you feel ready.

What are the risks?

The risks associated with this procedure are exceedingly rare. Most patients experience no significant or lasting complications.

Hydroxyapatite crystal deposition disease (HADD) is a process where calcium crystals become deposited in tendons most commonly around the shoulder and hip. These deposited crystals can cause irritation to the tendons and significant pain. The cause for this process is unknown. The disease process can commonly be diagnosed by x-ray. Barbotage is a procedure where anesthetics and saline are used to lavage (washout) the tendon crystals. This can lead to a significant reduction in the crystal burden of the tendon and significantly improve and sometime eliminate the pain caused by this process. Steroids can also be injected into the area to help reduce the inflammation and pain.

Musculoskeletal radiologists use imaging guidance to precisely locate bones, muscles, nerves, and tendons and deliver treatments directly.  Successful treatment can sometimes avoid the need for open surgery and long recoveries. At Casper Medical Imaging our radiologists have years of experience with barbotage and can hopefully help you with your pain associated with calcific tendonitis.

What should I expect from an image guided barbotage?

An image guided pain injection allows the radiologist to accurately and safely watch the needle position real-time. Image guidance also allows the radiologist to see the critical nearby anatomic structures allowing for a more successful and safer injection. Depending on the source of your pain you may experience immediate relief from the pain numbing anesthetic medications.  The addition of a corticosteroid can help reduce chronic inflammation and lead to days, weeks, and even months of pain relief.

Your physician should discuss which medications you need to withhold for your procedure. And depending on which type of injection you receive you may need to arrange transportation on the day of your procedure. 

What should I expect the day of the procedure?

After you arrive at Casper Medical Imaging / Outpatient Radiology and check in, our technologists will escort you to the procedure room. We will discuss the procedure with you further and answer any questions you may have left. Once we are ready to begin the procedure, we will position you on the procedure table. We will clean and prep the area of skin for the procedure using sterile technique. We will then numb the skin with local anesthetic. Then utilizing imaging guidance with ultrasound, we will numb the deeper soft tissues with a combination of anesthetic medication and saline into the affected tendon. You may feel some pressure in joint or soft tissues from the medication. Following removal of the needle we will place a small bandage over the area. We will keep you for a short period of observation to make sure you are ready to head home after the procedure.

What to expect after procedure?

Shortly following the procedure, you may experience some pain and swelling around the injection site. The effects of the anesthetic can last up to a few hours depending on if the area injected is the main source of your pain. You may feel numb or experience mild weakness in the limb or area for a few hours after the injection. Also, your pain may mildly increase for a few days as the anesthetic wears off and the anti-inflammatory effects of the steroid kick in. If you experience discomfort over the first few days after injection apply an ice pack to the area. We recommend over the counter Tylenol (acetaminophen) if any pain medication is needed. It may take up to 10 days for the full anti-inflammatory effects of the steroid to provide the greatest pain relief.

Our recommendation is to avoid strenuous activity the day of the treatment. And since you know your body better than anyone else, you may begin to resume normal activity when you feel ready.

What are the risks?

The risks associated with barbotage are very small. Since the treatment is localized to the area of pain most patients experience no significant or lasting complications.

Tendonitis is caused by inflammation and low-grade swelling of tendons associated with muscles about the joints of the body. Chronic tendonitis can lead to degeneration of the collagen fibers which make up tendons leading to a chronic process called tendinosis. A needle tenotomy or fasciotomy, also called tendon fenestration) is a procedure where a radiologist directs a needle under ultrasound guidance into the affected tendon making multiple micro punctures of the tendon. This process causes the body to respond by upregulating or accelerating the bodies healing process. This process can also be helpful in treating low grade partial small tendon or ligament tears or chronic muscle fascia inflammation.

Musculoskeletal radiologists use imaging guidance to precisely locate bones, muscles, nerves, and tendons and deliver treatments directly.  Successful treatment can sometimes avoid the need for open surgery and long recoveries. At Casper Medical Imaging our radiologists have years of experience performing tenotomy to help treat your source of pain.

What should I expect from a needle tenotomy?

An image guided pain injection allows the radiologist to accurately and safely watch the needle position real-time. Image guidance also allows the radiologist to see the critical nearby anatomic structures allowing for a more successful and safer procedure. Depending on the source of your pain you may experience immediate relief from the pain numbing anesthetic medications.

Your physician should discuss which medications you need to withhold for your procedure. And depending on which type of injection you receive you may need to arrange transportation on the day of your procedure. 

What should I expect the day of the procedure?

After you arrive at Casper Medical Imaging / Outpatient Radiology and check in, our technologists will escort you to the procedure room. We will discuss the procedure with you further and answer any questions you may have left. Once we are ready to begin the procedure, we will position you on the procedure table. We will clean and prep the area of skin for the procedure using sterile technique. We will then numb the skin with local anesthetic. Then utilizing imaging guidance with ultrasound, we will numb the deeper soft tissues with a combination of anesthetic medication. Continuing with ultrasound guidance a needle is the utilized to create many tiny fenestrations to the affected tendon, ligament of fascia. You may feel some pressure in joint or soft tissues from the anesthetic medications. Following removal of the needle we will place a small bandage over the area. We will keep you for a short period of observation to make sure you are ready to head home after the procedure.

What to expect after procedure?

Shortly following the procedure, you may experience some pain and swelling around the procedure site. The effects of the anesthetic can last up to a few hours depending on if the area injected is the main source of your pain. You may feel numb or experience mild weakness in the limb or area for a few hours after the injection. If you experience discomfort over the first few days after injection apply an ice pack to the area. We recommend over the counter Tylenol (acetaminophen) if any pain medication is needed.

Our recommendation is to avoid strenuous activity the day of the treatment. And since you know your body better than anyone else, you may begin to resume normal activity when you feel ready.

What are the risks?

The risks associated with needle tenotomy are very small. Since the treatment is localized to the area of pain most patients experience no significant or lasting complications.

Musculoskeletal radiologists use imaging guidance to precisely locate bones, muscles, nerves, and tendons and deliver treatments directly. Successful treatment can sometimes avoid the need for open surgery and long recoveries. At Casper Medical Imaging our radiologists have years of experience performing tenotomy to help treat your source of pain.
What should I expect from a needle tenotomy?
An image guided pain injection allows the radiologist to accurately and safely watch the needle position real-time. Image guidance also allows the radiologist to see the critical nearby anatomic structures allowing for a more successful and safer procedure. Depending on the source of your pain you may experience immediate relief from the pain numbing anesthetic medications.
Your physician should discuss which medications you need to withhold for your procedure. And depending on which type of injection you receive you may need to arrange transportation on the day of your procedure.
What should I expect the day of the procedure?
After you arrive at Casper Medical Imaging / Outpatient Radiology and check in, our technologists will escort you to the procedure room. We will discuss the procedure with you further and answer any questions you may have left. Once we are ready to begin the procedure, we will position you on the procedure table. We will clean and prep the area of skin for the procedure using sterile technique. We will then numb the skin with local anesthetic. Then utilizing imaging guidance with ultrasound, we will numb the deeper soft tissues with a combination of anesthetic medication. Continuing with ultrasound guidance a needle is the utilized to create many tiny fenestrations to the affected tendon, ligament of fascia. You may feel some pressure in joint or soft tissues from the anesthetic medications. Following removal of the needle we will place a small bandage over the area. We will keep you for a short period of observation to make sure you are ready to head home after the procedure.
What to expect after procedure?
Shortly following the procedure, you may experience some pain and swelling around the procedure site. The effects of the anesthetic can last up to a few hours depending on if the area injected is the main source of your pain. You may feel numb or experience mild weakness in the limb or area for a few hours after the injection. If you experience discomfort over the first few days after injection apply an ice pack to the area. We recommend over the counter Tylenol (acetaminophen) if any pain medication is needed.
Our recommendation is to avoid strenuous activity the day of the treatment. And since you know your body better than anyone else, you may begin to resume normal activity when you feel ready.
What are the risks?
The risks associated with needle tenotomy are very small. Since the treatment is localized to the area of pain most patients experience no significant or lasting complications.

Thoracic Outlet Syndrome (anterior scalene injection)

Thoracic outlet syndrome is a condition caused narrowing or compression of a passage in the lower neck the allows nerves, arteries and veins to exit the lower neck. Symptoms can include arm swelling, numbness, neurogenic pain, and decreased circulation. The thoracic outlet is created by borders of the first rib, possible cervical ribs (an anatomic variant), the clavicle and the scalene muscle. Often surgical intervention is needed to relieve the compression. Our radiologists are trained to utilize CT guidance to injection Botox into the scalene musculature to provide some atrophy of the injected muscles and relieve the compression of the thoracic outlet.

Piriformis Syndrome Injection/Sciatic Nerve Block

Piriformis syndrome is a painful condition affecting the hip, buttocks, and legs. It is usually caused by irritation of the piriformis muscle and/or the adjacent sciatic nerve. Sciatica or sciatic nerve pain can be caused by inflammation or spasm of the piriformis muscle. This can be aggravated by physical activity, sitting for long periods of time, or history or injury. Your health care provider may recommend a regimen of NSAIDS, physical therapy, or pain injection to help alleviate this syndrome. Our radiologists our trained to provide fluoroscopic injection of numbing medications and steroid to this area to help diagnose and treat this syndrome.                           

Sciatic Nerve Block

Genicular Never Block

Lateral Femoral Cutaneous Nerve Block

A neuroma is a benign mass which forms along the underside of the foot or between the metatarsals of the foot. This mass when present commonly causes pain and irritation of the adjacent structures. If clinical evaluation is unclear a diagnostic ultrasound may be needed to diagnose this mass. Musculoskeletal radiologists use imaging guidance to precisely locate bones, muscles, nerves, and tendons and deliver treatments directly.  Successful treatment can sometimes avoid the need for open surgery and long recoveries. At Casper Medical Imaging our radiologists have years of experience providing diagnostic and therapeutic anesthetic and steroid injections to the Morton’s neuroma and surrounding soft tissues to help successfully diagnose and commonly treat your source of pain.

What should I expect from a Morton’s neuroma injection?

An image guided pain injection allows the radiologist to accurately and safely watch the needle position real-time. Image guidance also allows the radiologist to see the critical nearby anatomic structures allowing for a more successful and safer injection. Depending on the source of your pain you may experience immediate relief from the pain numbing anesthetic medications.  The addition of a corticosteroid can help reduce chronic inflammation and lead to days, weeks, and even months of pain relief.

Your physician should discuss which medications you need to withhold for your procedure. And depending on which type of injection you receive you may need to arrange transportation on the day of your procedure. 

What should I expect the day of the procedure?

After you arrive at Casper Medical Imaging / Outpatient Radiology and check in, our technologists will escort you to the procedure room. We will discuss the procedure with you further and answer any questions you may have left. Once we are ready to begin the procedure, we will position you on the procedure table. We will clean and prep the area of skin for the procedure using sterile technique. We will then numb the skin with local anesthetic. Then utilizing imaging guidance with ultrasound, we will numb the deeper soft tissues with a combination of anesthetic medication about this neuroma. You may feel some pressure in joint or soft tissues from the medication. Following removal of the needle we will place a small bandage over the area. We will keep you for a short period of observation to make sure you are ready to head home after the procedure.

What to expect after procedure?

Shortly following the procedure, you may experience some pain and swelling around the injection site. The effects of the anesthetic can last up to a few hours depending on if the area injected is the main source of your pain. You may feel numb or experience mild weakness in the limb or area for a few hours after the injection. Also, your pain may mildly increase for a few days as the anesthetic wears off and the anti-inflammatory effects of the steroid kick in. If you experience discomfort over the first few days after injection apply an ice pack to the area. We recommend over the counter Tylenol (acetaminophen) if any pain medication is needed. It may take up to 10 days for the full anti-inflammatory effects of the steroid to provide the greatest pain relief.

Our recommendation is to avoid strenuous activity the day of the treatment. And since you know your body better than anyone else, you may begin to resume normal activity when you feel ready.

What are the risks?

The risks associated with Morton’s neuroma injections are very small. Since the treatment is localized to the area of pain most patients experience no significant or lasting complications.

Physicians use many different tests to help diagnose cancer, including imaging and tissue sampling. Most cancer diagnoses also require a biopsy, which is a sample of tissue from the area of concern. This sample is then evaluated by a pathologist to determine if it is cancer or not, and what type of cancer, and what is the best treatment.

At Casper Medical Imaging our radiologists perform several different image guided biopsies. Often musculoskeletal type masses can be sampled by ultrasound guidance on an outpatient basis.

What should I expect from an image guided soft tissue biopsy?

An image guided biopsy allows the radiologist to accurately and safely watch the needle position real-time. Image guidance also allows the radiologist to see the critical nearby anatomic structures allowing for a more successful and safer biopsy.

Your physician should discuss which medications you need to withhold for your procedure. And depending on which type of injection you receive you may need to arrange transportation on the day of your procedure. 

What should I expect the day of the procedure?

After you arrive at Casper Medical Imaging / Outpatient Radiology and check in, our technologists will escort you to the procedure room. We will discuss the procedure with you further and answer any questions you may have left. Once we are ready to begin the procedure, we will position you on the procedure table. We will clean and prep the area of skin for the procedure using sterile technique. We will then numb the skin with local anesthetic. Then utilizing imaging guidance with either ultrasound, fluoroscopy (X-ray), or computed tomography (CT) we will numb the deeper soft tissues with a combination of anesthetic medication up to and around the mass or other area of interest. You may feel some pressure in joint or soft tissues from the anesthetic medication. A small skin incision is then made through which the biopsy needle is placed. Several small sample cores of tissue from the mass or area of interest will then retrieved. Following removal of the needle we will place a small bandage over the incision area. We will keep you for a short period of observation to make sure you are ready to head home after the procedure.

What to expect after procedure?

Shortly following the procedure, you may experience some pain and swelling around the injection site. The effects of the anesthetic can last up to a few hours. You may feel numb or experience mild weakness in the limb for a few hours after the injection. If you experience discomfort over the first few days after the procedure, we recommend applying an ice pack to the area. We also recommend over the counter Tylenol (acetaminophen) if any pain medication is needed.

Our recommendation is to avoid strenuous activity the day of the treatment. And since you know your body better than anyone else, you may begin to resume your usual physical activity when you feel ready.

What are the risks?

The risks associated with soft tissue biopsies are small. These include damage to adjacent structures, bleeding, infection, and allergic reaction. Most patients experience no significant or lasting complications from this procedure.

Trigger point injection (TPI) can be a success form of treatment for those with chronic musculoskeletal pain including fibromyalgia, chronic muscle spasms, or non-specific muscle pain. A trigger point injection is an image guided injection targeted at the areas of pain or muscle spasm or “knots” of muscle which do not seem to want to relax. A trigger point injection often is successful in relieving the muscle spasm as well as treating the pain.

Musculoskeletal radiologists use imaging guidance to precisely locate bones, muscles, nerves, and tendons and deliver treatments directly.  Successful treatment can sometimes avoid the need for open surgery and long recoveries. At Casper Medical Imaging our radiologists have years of experience providing diagnostic and therapeutic steroid injections to muscles, peripheral joints, tendons, bursa and other locations to successfully diagnose and treat your source of pain.

What should I expect from an image guided trigger point injection?

An image guided pain injection allows the radiologist to accurately and safely watch the needle position real-time. Image guidance also allows the radiologist to see the critical nearby anatomic structures allowing for a more successful and safer injection. Depending on the source of your pain you may experience immediate relief from the pain numbing anesthetic medications.  The addition of a corticosteroid can help reduce chronic inflammation and lead to days, weeks, and even months of pain relief.

Your physician should discuss which medications you need to withhold for your procedure. And depending on which type of injection you receive you may need to arrange transportation on the day of your procedure. 

What should I expect the day of the procedure?

After you arrive at Casper Medical Imaging / Outpatient Radiology and check in, our technologists will escort you to the procedure room. We will discuss the procedure with you further and answer any questions you may have left. Once we are ready to begin the procedure, we will position you on the procedure table. We will clean and prep the area of skin for the procedure using sterile technique. We will then numb the skin with local anesthetic. Then utilizing imaging guidance with ultrasound, we will numb the deeper soft tissues with a combination of anesthetic medication into the area of interest. You may feel some pressure in joint or soft tissues from the medication. Following removal of the needle we will place a small bandage over the area. We will keep you for a short period of observation to make sure you are ready to head home after the procedure.

What to expect after procedure?

Shortly following the procedure, you may experience some pain and swelling around the injection site. The effects of the anesthetic can last up to a few hours depending on if the area injected is the main source of your pain. You may feel numb or experience mild weakness in the limb or area for a few hours after the injection. Also, your pain may mildly increase for a few days as the anesthetic wears off and the anti-inflammatory effects of the steroid kick in. If you experience discomfort over the first few days after injection apply an ice pack to the area. We recommend over the counter Tylenol (acetaminophen) if any pain medication is needed. It may take up to 10 days for the full anti-inflammatory effects of the steroid to provide the greatest pain relief.

Our recommendation is to avoid strenuous activity the day of the treatment. And since you know your body better than anyone else, you may begin to resume normal activity when you feel ready.

What are the risks?

The risks associated with trigger point injections are very small. Since the treatment is localized to the area of pain most patients experience no significant or lasting complications.