Dr. Chris Bowman, MB, BChir, MLCOM, DMS Med
Consultant in Orthopaedic and Musculo-skeletal medicine

           Specialising in musculo-skeletal conditions from back pain and sciatica to shoulder, elbow and knee problems and in patients ranging from elite sports men and women to those who just want to keep as active as possible.

Some patients need the cause of their condition identified and others need medical treatment for conditions that have not responded to osteopathy or physiotherapy or pain killers.

Treatments include:

             Epidural injections

For sciatica, spinal stenosis and lumbar spondylosis. Cortisone mixed with normal saline is injected into the base of the spine into the epidural space. The actual injection takes about five minutes. The cortisone passes up the spine and removes inflammation from joints in the spine, around discs and trapped nerves. Its effects last about 2 to 4 weeks during which time it is hoped that natural healing is able to occur due to the removal of inflammation. About one third of patients report a very good result, one third report worthwhile improvement while the final third report only temporary or no lasting benefit.

            Steroid injections

for shoulder impingement and tendonitis, tennis and golfer's elbows, tendonitis of the wrist, knees and feet, bursitis of the hip. Injection into trigger areas.

            Hyaluronate (Ostenil) injections

These are indicated for pain and restricted mobility in degenerate and traumatic conditions affecting the knees, shoulders and other synovial joints.

Synovial fluid lubricates and nourishes most joints in the body. In degenerative joint disorders such as osteoarthritis, the viscoelasticity of sign over your fluid is markedly reduced thereby decreased think it's lubricating, shock absorbing and probably nutritional functions. This increases mechanical loading of the joint and cartilage destruction which ultimately results in paiin and restricted mobility of the affected joint. Supplementing this synovial fluid with intra-articular injections of highly purified hyaluronic acid can ameliorate the viscoelastic properties of synovial fluid. This improves it's lubricating and shock absorbing functions and reduces mechanical overload of the joint. As a rule this results in a decrease in pain and an improvement in joint mobility which may last several months after a treatment cycle of five injections.

            Prolotherapy

Ligaments help to provide stability in the joints. They prevent the joint from moving more than the normal range. Some people have lax ligaments that allow more than normal movement, often spoken of as being double jointed. In the spine there is a complex arrangement of ligaments which allow flexibility in some directions and produce restraint in others. Sometimes ligaments can be overstretched or even torn (as in a sprained ankle). The ligaments may then not control the joint adequately leading to instability which may put abnormal stress on the joints and discs in the spine.

Prolotherapy works by stimulating the body to make new fibres which are laid down within the substance of ligaments, thickening and strengthening them. The solution phenol 2%, dextrose 30% and glycerol 30% is mixed with local anaesthetic and a small amount injected into the ends of the ligaments close to their attachment to the bone. This initially provokes inflammation that attracts cells that make collagen fibres in the area. Over the ensuing weeks these fibres are incorporated into the existing ligaments. Each ligament has to be stimulated three or four times at intervals of a week in order to produce sound fibrous development. This solution is also used for injection in other treatments such as varicose veins so it is know to be safe.

            Injections

Injections are commonly given in the lumbar region, sacroilliac region thoracic and cervical spines. They are also useful in the ankle and shoulder region. When receiving these injections, Entonox (nitrous oxide and oxygen as used in labour) is offered to relieve the discomfort of the injection.

Injection of autologous blood. Sometimes ligamentous injuries are slow to heal or remain painful. A patient's blood is taken from a vein and injected into the painful or damaged ligament. The blood causes a bruise that often seems to speed healing.

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