Ultrasound Guided

About Ultrasound Guided Procedures

Injections and needling therapies can be highly beneficial to patients suffering pain from a plethora of conditions. But pinpointing the exact site to be targeted can be difficult if you are going in “blind.”

Musculoskeletal ultrasound enables clinicians to view the structures within the human body in real time. Unlike other imaging methods where the patient is passive, the patient plays an important role in ultrasound imaging, as they can be repositioned or asked to move, to expose and pinpoint a targeted site.

Ultrasound enables an injection or needling procedure to be conducted with bulls-eye accuracy, taking the guesswork out of injections, and eliminating the need to repeat unsuccessful attempts.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Ultrasound Guided Specialist Dr. Lev Kalika

The expert professionals at NYDNR stay on top of the latest research on musculoskeletal conditions. We are always on the lookout for innovative therapies and procedures that can help our patients relieve pain, rehabilitate injuries and improve functional performance.

Our clinic features on-site real-time ultrasound imaging, operated by trained and certified professionals who understand every nuance of human anatomy. Ultrasound is an invaluable tool for injection and needling procedures, enabling us to provide treatment with pinpoint accuracy.

Needling and injection procedures are just some of the weapons in our arsenal to combat pain and rehabilitate injuries. Our cutting-edge technologies and innovative treatment approaches make NYDNR the very best clinic in NYC for pain management and injury rehab.


Injection and Needling Procedures at NYDNR


What it does: Prolotherapy promotes the healing of tendons and ligaments. Originally used in a primitive form by Hippocrates in Ancient Greece to heal dislocated joints, prolotherapy is making a modern-day resurgence as a minimally invasive procedure for joint repair.

How it works: Prolotherapy stimulates the production of new tissue in ligaments and tendons to repair tears and strengthen weakened tissue. Those structures have limited vascularity, which reduces their ability to heal.

What it treats: Prolotherapy has multiple applications, including:

What it treats: Prolotherapy has multiple applications, including:
  • Tendinitis
  • Ruptured ligaments
  • Degenerative discs
  • Arthritis
  • Cartilage repair
  • Backand neck pain
  • TMJ
  • Whiplash
  • Athletic Injuries

The procedure: Using a long slender needle guided by ultrasound, a harmless natural irritant is injected at the injury site, stimulating local tissues to self-repair. Commonly used irritants are sugar and sodium morrhuate, a purified derivative of cod liver oil. Prolotherapy treatment requires a series of injections (usually about 4 to 10) over the course of several weeks. The procedure is relatively painless, save for minor irritation and inflammation at the injection site.

Dry Needling

What it does: Dry needling guided by ultrasound enables us to treat myofascial pain by targeting specific trigger points. The approach was developed by renowned physiotherapist Dr. Karel Lewit, of Prague’s famed School of Rehabilitation. Our clinical director, Dr. Lev Kalika, was privileged to learn the technique directly from Dr. Lewit.

How it works: Dry needling targets trigger points, painful inflamed nodules that affect muscles throughout the body. Once the trigger point has been treated, the associated muscle is able to relax, pain is relieved, and function is restored

The procedure: After identifying the precise location of a trigger point, a thin needle is inserted through the skin, with the help of ultrasound imaging to accurately target the trigger point. The procedure reduces pain, relieves muscle spasm, increases range of motion and restores optimal muscle function.

Hydrodissection for Carpal Tunnel

What it does: The carpal tunnel of the wrist is a bony passage through which blood vessels and the median nerve travel to the hand and fingers. Inflammation, overuse or other factors can cause the median nerve to become entrapped, causing pain and interfering with hand function. Hydrodissection is a minimally invasive procedure that relieves carpal tunnel pain.

How it works: An entrapped median nerve can become scarred and adhere to surrounding tissue. Hydrodissection frees up the median nerve within the tunnel, allowing it to glide freely.

The procedure: Under ultrasound guidance, fluid is injected in small amounts around the median nerve, enabling it to glide freely, and eliminating numbness and pain.

Corticosteroid Injections

What it does: A corticosteroid is a powerful anti inflammatory drug used to target localized pain in joints and surrounding soft tissues.

How it works: When injected into the painful region, corticosteroids go to work to reduce pain and inflammation, enabling the patient to move more freely, and to participate in physical therapy.

The procedure: Under the guidance of ultrasound, an injection of corticosteroid solution is made through the skin, into the affected joint.

Hyaluronic Acid Injections

What it does: An injection of hyaluronic acid into an arthritic joint promotes fluid joint movement, reduces pain and prevents the progression of arthritis.

How it works: Hyaluronic acid is a natural component of joint synovial fluid, that acts to lubricate the joint and provides shock absorption. In arthritic patients, hyaluronic acid tends to break down, leading to pain and reduced mobility. Hyaluronic acid injections can help restore movement and relieve joint pain.

The procedure: Typically, the patient receives a series of three hyaluronic acid injections, performed over three consecutive weeks. The injections are guided by ultrasound to ensure that hyaluronic acid is released into the joint capsule. The procedure may be repeated every six to 12 months.

Corticosteroid Injections

What it does: A corticosteroid is a powerful anti inflammatory drug used to target localized pain in joints and surrounding soft tissues.

How it works: When injected into the painful region, corticosteroids go to work to reduce pain and inflammation, enabling the patient to move more freely, and to participate in physical therapy.

The procedure: Under the guidance of ultrasound, an injection of corticosteroid solution is made through the skin, into the affected joint.

Platelet Rich Plasma (PRP) Injections

What it does: PRP injections are used to treat chronic tendon and muscle injuries, and osteoarthritis.

How it works: Platelet rich plasma contains a high concentration of growth factors. When injected into damaged tissues, PRP promotes regeneration of cartilage and healing of damaged tissue.

The procedure: Under ultrasound guidance, PRP is injected directly into the joint or the targeted damaged tissue.

Joint Aspiration

What it does: Joint aspiration removes excess fluid from a joint, most commonly the knee, to reduce pan and promote healing.

How it works: Excess fluid can accumulate in a joint after a ligament tear, a fracture, trauma, or in relation to arthritis. Joint aspiration reduces pressure from fluid in the joint, relieving pain and stiffness.

The procedure: A sterile needle with a syringe are used to drain fluid from the affected joint. Ultrasound guidance helps ensure that the needle is correctly placed.


Are Ultrasound Guided
Procedures Safe?

High resolution ultrasound guidance during injections and needling procedures dramatically increases their safety, since the injections are accurately targeted to the treatment sight.

In fact, there is a plethora of evidence from research studies, along with numerous documented success stories, that ultrasound-guided needle procedures significantly enhance patient safety and quality of care. At the same time, ultrasound guided procedures eliminate complications that can arise from “blind” needling therapies and injections.

Clinical Case Studies

Case Study: Lateral Epicondylitis

Our Patient Our patient is a 56 year-old male jeweler who came to us with lateral elbow pain. The patient is a very athletic tennis player who works out at the gym on a regular basis. He stated that his pain initially started at the front of his elbow and eventually moved toward his lateral […]

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    In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

    Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

    The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

    Dynamic ultrasonography examination demonstrating
    the full thickness tear and already occurring muscle atrophy
    due to misdiagnosis and not referring the patient
    to proper diagnostic workup

    Demonstration of how very small muscle defect is made and revealed
    to be a complete tear with muscle contraction
    under diagnostic sonography (not possible with MRI)


    Complete tear of rectus femoris
    with large hematoma (blood)


    Separation of muscle ends due to tear elicited
    on dynamic sonography examination

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