Dr. Eileen R. Slavin, DO, MPH

Both injection and aspiration are techniques that involve inserting a needle connected to a syringe directly into the joint. Aspiration involves the removal of excess fluid, and injection is the placement of medication directly into the joint space via the needle. Both procedures may be performed at the same time. In both cases a local anesthetic may be used, the skin will be cleaned and disinfected, and then the needle will be inserted. In some cases, especially if the injection or aspiration is in a large and deep joint such as the hip or spine, ultrasound may be used to guide the needle to the exact location desired.

In some cases, irritation to the joint can cause fluid to build up so significantly that the joint hurts and can no longer move well. Aspiration removes some of the excess fluid and relieves the pressure. In addition, aspiration can be used to provide a sample of joint fluid if it needs to be examined microscopically for the presence of white blood cells, bacteria, or crystal formations.

Certain injuries and diseases that affect joints are inflammatory in nature, such as rheumatoid arthritis, tendonitis or gout. These diseases may be helped by the local injection of anti-inflammatory medications directly into the affected joint. In this case, corticosteroids such as methylprednisone are usually used. Relief from the pain may be felt right away and may last for weeks or even months.

In some cases, such as with osteoarthritis, the cartilage buffer between the two bones wears down and pain comes from bones rubbing against each other. In this case, injection of a lubricating agent such as hyaluronic acid may be beneficial. It provides a slippery cushion between the bones to relieve pain that can last for months.

Osteopathic manipulation is similar but distinct from chiropractic care. It involves physical contact and pressure to treat disease and improve health. Treatments may include stretching, spinal traction, 'cracking' joints, or applying pressure to painful or stiff areas. It works particularly well for problems affecting the muscles and joints, such as back or neck pain, some kinds of headaches, and sports injuries.

In the case of more serious illnesses, some patients combine conventional treatments with osteopathic manipulation. Manipulation can increase blood flow, relax muscles, and increase movement, as well as make patients feel better. In this way, osteopathic manipulation can be effective for a wide variety of ailments.

Spinal cord injury medicine seeks to stabilize the spine and to alleviate the symptoms of spine damage. Practitioners of spinal cord injury medicine are called spinal cord injury specialists. Spinal cord injury medicine is an interdisciplinary field, meaning physicians of various specialties may be trained to treat spinal cord injuries.

Damage to the spinal cord may initially be diagnosed through X-ray, MRI, or CT scans. Patients can also undergo spinal exams to evaluate their sensory ability and strength. Injuries to the spinal cord can be complete (no feeling or sensation) or incomplete (some feeling or sensation remains). Conditions spinal cord injury medicine specialists may treat include:

• Paralysis, such as paraplegia (loss of function in the legs), or quadriplegia (loss of function from the neck down)
• Spine fracture or trauma, which can lead to impairment and/or significant pain
• Spinal infections
• Myelopathies, such as herniated disks, spinal tumors, and rheumatoid arthritis
• Inflammatory diseases such as ankylosing spondylosis, and degenerative conditions like Lou Gehrig's disease (ALS)

Treatment for spinal cord injuries often involves surgery, either directly after an injury occurs or at a later date. Surgery for spine injuries is intended to ease spinal compression and stabilize the spine. Surgical procedures can involve shifting vertebrae, removing bone, or altering spinal placement with implantable devices. Patients with significant spinal trauma may require urgent surgical intervention.

Surgical treatments can be complemented by rehabilitative physical therapy to improve mobility. Spinal cord injury specialists also treat complications arising from a spinal injury, such as respiratory or bladder conditions. Some patients with spinal cord injuries may require lifelong treatment. Spinal cord injury specialists aim to help these patients successfully adjust and lead an improved quality of life. An emerging treatment for spinal cord injuries is neural prosthetics, which replicate patients' lost nerve function. Neural prostheses may be used as artificial body parts or assistive devices that patients may cognitively control. Other assistive devices include wheelchairs and scooters.

Spinal cord injury specialists may collaborate with physical therapists, radiologists, neurologists, urologists, and orthopedists.