Physiotherapy treatment

Inflammatory Arthritis

Rheumatoid arthritis is an autoimmune disorder and happens when the immune system attacks the joints. This causes inflammation, pain and swelling around the joint. Women are much more likely to be affected by rheumatoid arthritis than men.

Rheumatoid arthritis affects the lining of the joints and can result in bone erosion and joint deformity.

Michael spent several years working in a community-based Rheumatology service managing his own caseload of patients with Rheumatic disease under the supervision of a Rheumatology Consultant. As an independent prescriber, Michael has experience managing Rheumatoid Arthritis, Psoriatic Arthritis, Osteoarthritis, Sjogren’s disease, Gout and Pseudogout, Axial Spondyloarthritis, and seronegative Inflammatory Arthritis.

The Arthritis clinic offers a holistic approach to the management of Rheumatic disease offering both Rehabilitation and exercise advice and guidance as well as Prescriptions if required and ultrasound-guided interventions.

Michael has a close relationship with a Rheumatology consultant and specialists in all fields of medicine including Orthopaedic surgeons, spinal consultants, Neurologists, Periodontists, and Specialist Anaesthetists. If we can’t offer you the treatment you need at the Arthritis Clinic we will refer you to colleagues and friends who we trust to look after you on your road to recovery.

Tendinopathy

A tendon is a strong, flexible fibrous tissue that attaches muscle to bone and transfers force. Tendon injuries are often multi-factorial and can be tendonitis which is characterised by inflammation and tendinosis characterised by degenerative changes in tendon structure. A tendinopathy is a broader term including the characteristics of pain, weakness, and reduced function. Tendinopathy can occur in most tendons around the body and the cause is usually multi-factorial relating to abnormal joint mechanics or stiffness. The onset is often gradual causing a dull ache and worsened by repetitive loading and strain of the joint leading to micro-tears which can become chronic over time.

Carpal and Cubital Tunnel

Carpal tunnel syndrome and cubital tunnel syndrome are nerve entrapment syndromes of the median nerve at the wrist and the ulnar nerve at the elbow respectively. Ultrasound can be used to diagnose these problems in some cases, however, sometimes nerve conduction studies are required. At The Arthritis Clinic, we use ultrasound to guide a steroid injection into the carpal tunnel or cubital tunnel to give you much-needed relief from nerve pain in these syndromes, we also perform a procedure called hydro dissection where we use 5% Dextrose and gently under ultrasound guidance separate the nerve from the surrounding tissues relieving the compression. Unfortunately sometimes despite these interventions, we may still recommend a surgical referral for decompression.

Hydrodilation for Frozen Shoulder

Hydrodilatation is a very effective treatment for frozen shoulder. A mixture of steroids (also called cortisone), fluid (saline) and local anesthetic is injected into your shoulder. Michael uses ultrasound to ensure that the needle is correctly placed in your shoulder joint.

Once the needle is placed into your shoulder joint, the fluid is gently injected into your shoulder until it starts to stretch your joint. You can imagine that this is a bit like inflating a balloon, gently stretching the joint lining that has gone tight and prevents your shoulder from moving. The combination of steroids and local anesthetic is also effective for pain relief because often the inside of your shoulder is quite inflamed and angry early on in frozen shoulder.

The whole procedure takes around 10-15 minutes to complete.

Barbotage for Calcific Tendinitis

Ultrasound-guided barbotage therapy is an outpatient treatment. A diagnostic ultrasound scan is performed first. The skin is then marked and sterilized and local anaesthetic is given.

Using the ultrasound image, the needle is guided into the calcification under direct vision. The calcification will then be attempted to be aspirated/withdrawn. To encourage healing the calcification is punctured several times under local anaesthetic. Finally, the tendon is bathed in some more local anaesthetic.

Tendon stripping for Achilles Tendinopathy

This is a novel injection technique which involves injecting a large volume of saline (sterile water) mixed with local anaesthetic, with or without steroid, to ‘strip’ the surrounding fat and vessels (known as neovascularisation) away from the Achilles. This procedure must be carried out with ultrasound guidance and can be an affective remedy.

When a tendon becomes tendinopathic the internal structure of the tendon is altered. The tendon becomes thickened and a process called neovascularisation occurs. Neovascularisation is the growth of new blood vessels in response to an injury to the tendon. These new vessels bring with them small nerves, which have been shown to be one of the causes of the pain in Achilles tendon problems.

Prolotherapy for Temporamandibular Joint Dysfuntion

Prolotherapy is used at the Arthritis clinic when prescribed by your Periodontist or Specialist Dental Surgeon and is indicated for TMJ Disorders.

The procedure involves the injection of Dextrose into the joint under direct ultrasound guidance. The High Concentration sterile sugar water (Dextrose) is a irritant and causes low grade inflammation in the joint, this results in thickening of the connective tissue i.e. ligaments in the joint providing stability and preventing the subluxation of the disc.

The course of treatment generally consists of three injections monthly over a 3 month period. Currently this Procedure is offered only in the Channel Islands on request of your Periodontist or Dental Specialist.