PAIN AND FUNCTIONALITY

We provide the latest mininvasive diagnostic and therapeutic interventions, utilizing a multi-disciplinary approach to treat many types of pain syndromes.

The following range of Pain and Functional Disabilities are sensitive to our selection of treatments.

Regenerative Injection TherapyRegenerative Injection Therapy is a new approach, utilizing minimally invasive interventions to induce and accelerate tissue healing, previously damaged by a disease process or trauma. In some circumstances, tissue regeneration can be accomplished, eliminating the need for more invasive surgical interventions.

 
 
 
Why is Regenerative Therapy Necessary?

Regenerative Injection Therapy Certain tissues in your body are prone to wear and tear. Regenerative Injection TherapyThis may happen from trauma, occupational exposure or overuse. Specific tissues such as ligaments (tissue bands that connect bones with bones) and tendons (tissue bands than connect muscles with bones) are essential in preserving your skeletal stability, joints and range of motion. When affected by chronic degeneration and trauma, the good collagen and cartilage is replaced by a faulty one; creating painful and sometimes incapacitating conditions. Common conditions such as sprains, strains, tennis elbow, joint pain, heel pain, rotator cuff tears and trochanteric bursitis (inflammation of the bursa) are associated with chronic degenerative changes. Commonly prescribed anti-inflammatory medications, although effective sometimes in controlling the pain, do not heal or regenarate tissues. Regenerative therapy is used in cases in which other modalities such a medication, therapy and neuromuscular training have failed.

Which Types of Regenerative Therapies Are Offered?

ProlotherapyProlotherapy. Consists of injecting a solution of a local anesthetic (numbing agent) along with medical grade glucose, into a specific tissue: usually a tendon, ligament or a joint using sonography (unltrasound) guidance. This triggers a more intense healing reaction in the tissues, thus allowing faster healing. Numerous studies have shown ligament strength increase up to 40 %. Platelet Rich Plasma Grafting (PRP)Platelet Rich Plasma Grafting (PRP).An advanced type of therapy, in which the patient’s blood is drawn from a vein and concentrated by a special centrifuge device, ultimately creating a concentrate of platelets in plasma. This concentrate contains up to 500% of bioactive proteins, along with multiple growth factors, which are essential in inducing and accelerating tissue repair and regeneration. Platelet Rich Plasma Grafting (PRP) The PRP is injected into specific tissues by using the most advanced tissue guidance with ultrasound. Most of the benefit is seen in the connective tissues, bone, hyaline cartilages and development of new blood vessels necessary for tissue healing.Platelet Rich Plasma Grafting (PRP)Bone Marrow Aspirate Concentrate (BMAC).This procedure is a more advanced form of regenerative therapy, in which blood is withdrawn from the patient’s bone marrow (Iliac crest) and concentrated in a special device. The concentrate contains a significant amount of stem cells and platelets, which are capable of regenerating tissues to a greater degree than the PRP. The technique is more invasive and costly. It is usually reserved for cases in which there is significant tissue damage, or in patients who have failed other types of regenerative therapy. Sometimes, these grafts are enhanced with fibrin products necessary to create a tissue scaffold, in order to provide a tissue blueprint for regeneration. This new and exciting field is constantly evolving and is at the forefront of regenerative medicine.

Why Not Use Steroid Shots?

Why Not Use Steroid Shots?Although steroids are frequently injected to treat inflammatory conditions with success, they are not usually effective for chronic tissue damage or degenerative tissues. They can potentially cause tissue damage and significant side effects if performed habitually.

 
Which Type of Regenerative Therapy is Best for Me?

Upon reviewing your medical records and undergoing a complete evaluation, your physician will determine which specific therapy is best for you. For simple cases with minimal tissue damage or degeneration, Prolotherapy may be recommended. When the condition is more advanced, then Platelet Rich Plasma Grafting (PRP) or Bone Marrow Aspirate Concentrate (BMAC) may be a more suitable alternative.

How Many Treatments are Usually Necessary?

The amount of treatments is dependent on several factors: type and severity of the damaged tissue, location, nutritional state of the patient, age and genetic factors. Usually with Prolotherapy or PRP, several treatments (usually 3-6), four to six weeks apart, are usually necessary to achieve the desired outcome. With BMAC usually one therapy is performed and if necessary, followed by PRP or Prolotherapy.

Where is the Regenerative Therapy Done?

Regenerative Therapy is mostly performed on ligaments, tendon, joints (major and minor), and sometimes nerves. Usually the treatment of multiple sites are the most efficacious and yield the best outcome. The following are commonly treated conditions:

  • Spine: Sacroiliac joint, Ilio-lumbar ligaments, facet joints. Regenerative Injection Therapy
  • Regenerative Injection TherapyShoulder: Rotator cuff-partial tears, Biceps tendinosis, chronic Glenohumeral ligament sprains, Acromio-clavicular joint dysfunction and pain, Levatorscapula tendinosis.
  • Elbow: Tennis and Golfer's elbow, Ulnar collateral ligament injury, distal biceps tendon partial tear
  • Wrist & Hand: Chronic joint sprain and arthritis.
  • Hip/Pelvis/SI Joints: Pyriformis syndrome, Greater trochanteric bursitis, Sacroiliac joint dysfunction, hamstring strain, bursitis, hip joint arthritis
  • Knee: Patellar tendinitis/tendinopathy, Osgood-Schlatter's disease, quadriceps strain or partial tear, degenerative arthritis, rheumatoid arthritis, Chondromalacia patella, Enthesopathy
  • Ankle & Foot: Chronic ligament strain, chronic Achilles tendinitis, chronic partial tendon tear, plantar fasciitis, arthritic joints.
When Can I Return to Work or Resume My Usual Activities?

Since the procedure is minimally invasive, in 24 hours the patient usually returns to same activity level prior to the procedure. However, every patient is unique and requires specific recommendations. The decision is usually made according to the progress, lack of symptoms and response to therapy. Remember, the regenerative process takes time and usually requires several interventions to achieve the desired goal.

Are There Any Specific Instructions Before or After the Procedure?

With PRP and BMAC, all non-steroidal anti-inflammatory medications (aleve, motrin, ibuprofen, anaprox, etc.) should be stopped for one week prior to and one month after the procedure. According to which specific tissue is treated, certain restrictions will apply. Usually there is localized soreness and discomfort lasting for 24-48 hours. Medications will be prescribed if necessary to alleviate the symptoms. Other instructions will be given which pertains to the specific type of intervention to be performed.

Is the Procedure Covered by My Insurance Plan?

Most insurance plans cover the specific types of procedure. However, the cost of the supplies for PRP and BMAC are frequently excluded. Separate financial arrangements are sometimes necessary.

What Is the Sacroiliac Joint?

Sacroiliac Joint PainSacroiliac Joint Pain The sacroiliac joint (SIJ) is a large joint in the region of the low back are and buttock. It connects the pelvis with the spine (sacrum). It acts as a shock absorber from forces transmitted from the upper body to the legs. As a joint, it has limited motion.

What Is a Sacroiliac Joint Injection?

It is a procedure in which a local anesthetic (numbing medication) and a steroid (long acting anti inflammatory) is injected in the SIJ for the purpose of diagnose or exclude the source of pain and to treat persistent inflammation in the SIJ.

What Are the Indications for Sacroiliac Joint Injections?

Patients with known sacroiliac joint pain, due to conditions such as traumatic, inflammatory and occupational, who have failed conservative therapy. This injection often allows the physical therapist or chiropractor to more effectively restore function and stability. In a significant number of patient with persistent buttock, low back and leg pain, in which an accurate diagnosis have not been obtained, a SIJ injection can determine or exclude the source of pain. With this information, a more specific and accurate treatment can be prescribed.

The Procedure

Usually the procedure is performed under local anesthetic alone. Some patients that are apprehensive may benefit from intravenous sedation. This decision will be made based on individual preference and medical necessity. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, place in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied. Next, your sacroiliac area will be scrub and cleansed in a sterile fashion. With the aid of an X-ray machine, which provides constant imaging (called fluoroscopy), the specific area to be injected will be identified. The physician will then inject a small amount of local anesthetic in the skin and deeper tissues to numb the area. This may be associated with a mild and brief stinging sensation. Once the area is numb, your doctor will insert a small needle into the appropriate sacroiliac joint, under x-ray guidance. A small amount of contrast (X-ray dye) will be injected to confirm proper needle placement. Following this, a solution of local anesthetic and steroid (long acting anti-inflammatory) will be injected in the joint.

After the Procedure

You will go back to the post anesthesia care unit (if you received intravenous sedation), where you will be monitored for 30-60 minutes according to your response. If no sedation was used, according to your specific condition, you may proceed to the post procedure observation area. Immediately after the procedure, you will be evaluated to assess for specific response. A post procedure evaluation form to assess the effectiveness of the injections will be given to the patient prior to discharge. Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for follow up and to determine if a repeat injection may be necessary. Frequently, according to your specific response, more injections may be indicated. It is not advisable that you drive the day of the procedure.

General Pre and Post Procedure Instructions

If no intravenous sedation is planned, you continue with your usual dietary habits the day of the procedure. If intravenous sedation is planned, avoid eating any king of solid foods prior to the procedure and you may have clear liquids up to 4 hours prior to the procedure. If you are taking Coumadin, Heparin, Plavix or non-steroidal anti-inflamatories (such as aspirin, ketoprofen, naproxen or others), stop taking them at least one week prior to the procedure. If you are diabetic and planning on having IV sedation, our office will give you specific instructions. You will be at the facility or hospital for approximately 1-2 hours for your procedure. It is important that you bring a driver with you, since you will not be allowed to drive the day of the procedure. You may return to your usual pre injection activities in 24 hours. The decision to return to work after the procedure will be made on an individual basis considering medical necessity and your specific condition.

What Are Trigger Points?

Trigger Point InjectionsA trigger points are commonly defined areas of taut muscle bands or palpable knots in the muscle, which are painful. Often, these trigger points can cause localized pain or even referred pain to other areas of your body, which can mimic conditions such as a pinch nerve in your neck or back. They can occur from direct muscle injuries, poor posture, repetitive strain, or secondarily from spine conditions such as a herniated disc. Although most of the time they respond to conservative measures such as massage, muscle relaxants and physical therapy, sometimes trigger point injections are required.

What Are Trigger Point Injections?

Trigger point injections are specific types of local muscle injections use to treat the painful taut bands responsible for pain and spasm. Common medications use in trigger point injections is local anesthetics, saline, glucose and small doses of steroids. Also a technique known as dry needling has shown significant improvement without injecting a medication, just inserting the needle in the muscle. The purpose of the injection is not only to decrease pain, but also to improve function and break the pain cycle.

The Procedure

The injection is performed in the examination room or the procedure suite (if you are having a different procedure). You will be examined and the trigger points will be identified and marked. The skin area will be sterilized with alcohol and numb with a local anesthetic. A small needle is then inserted into the specific site and a specific volume of the medication is injected. The procedure is repeated in the remaining trigger points. Trigger point injections are sometimes repeated, depending on the results and degree of improvement.

After the Procedure

Ice will be applied to the involve area and you will be observed for approximately 15 minutes. Afterwards, you will be discharged and given instructions about the post procedure care.

General Pre and Post Procedure Instructions.

The day of the procedure you should eat and drink routinely. Take your routine medications (blood pressure, diabetes, etc) as prescribed by your doctor. There may be certain medications (blood thinners such as Plavix, Coumadin, others) that, at the discretion of your physician, may have to be discontinue for several days prior to the procedure.At home continue usual medication and therapeutic exercises as prescribe. During the first 24 hours, apply a cold compress to the injected area for 20 minutes, three times a day. Some soreness and localized swelling is expected. Occasional, a small bruise may develop. If severe pain, swelling and bleeding develop, contact our office as soon as possible.

What Are Intervertebral Discs?

DiscographyDiscography The discs are gel like pads that separate the vertebral bodies of your spine. If provides stability, range of motion and most importantly, they act as shock absorbers. Certain conditions can create changes in the internal structure of the disc creating a painful condition. The source of the pain can be the disc itself, ligaments surrounding the spinal canal or nerves (being irritated by a herniated disc or a tear on the disc). Pain can be referred to your arms, legs, and neck and back, hips, abdomen and chest wall. Other structures such as muscles, joints and ligaments in your spine, along with internal organs, can produce similar symptoms.

What Is Discography and What Are the Indications?

Sometimes, in spite of diagnostic tests such as MRI, CT Scan and Myelogram, the source of the pain remains unknown. Discography is a minimally invasive test, designed to confirm whether the intervertebral disc is the source of the pain. Studies have demonstrated that the presence or absence of a herniated or degenerative disc, do not correlate with pain in a significant number of patients. In these specific situations, discography is useful not only in identifying the source of pain, but it will help the surgeon or interventional pain medicine specialist plan the correct treatment.

The Procedure

The procedure can be performed as an outpatient, in the office, hospital or out patient surgical facility. Usually the procedure is performed under local anesthetic with intravenous sedation, in order to facilitate relaxation and assist in comfort. Also an intravenous antibiotic will be administered prior to the procedure. You will be taken to the procedure suite, place in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied. Next, the skin overlying the respective discs will be cleansed with special solutions, sterilizing the local. Then a solution of local anesthetic (numbing medication) is infiltrated in the skin and deeper tissues overlying the discs. Under fluoroscopic guidance (X-ray machine), a special needle is inserted into the respective disc. You may feel temporary discomfort during this time. Once the needle(s) are in the proper position, a small amount of contrast will be injected into the disc. Your doctor will ask you to describe what you feel as the dye is being injected. During this time, you will communicate as accurately as possible, your experience. If discomfort is reproduced at the usual location, your physician will then ask you to describe the intensity, in a scale from 1-10. The procedure usually takes around 20-30 minutes, according to the number of discs being evaluated. The procedure usually takes 30 minutes.

After the Procedure

You will go back to the post anesthesia care unit (if you received intravenous sedation), where you will be monitored for 30-60 minutes according to your response. Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for post procedure evaluation in approximately one week. Medications will be given post procedure to assist in managing any discomfort. The post procedure discomfort is usually minor and can be manage with ice packs and medications.

General Pre and Post Procedure Instructions

If no intravenous sedation is planned, you continue with your usual dietary habits the day of the procedure. If intravenous sedation is planned, avoid eating any king of solid foods prior to the procedure and you may have clear liquids up to 4 hours prior to the procedure. If you are taking Coumadin, Heparin, Plavix or non-steroidal anti-inflamatories (such as aspirin, ketoprofen, naproxen or others), stop taking them at least one week prior to the procedure. If you are diabetic and planning on having IV sedation, our office will give you specific instructions. The decision to return to work after the procedure will be made on an individual basis considering medical necessity and your specific condition.

What Is an IDET (Intra-Discal Electrothermal Therapy)

A relatively new treatment for back pain resulting from problems within the cushioning discs is intradiscal electrothermal annuloplasty, also called intradiscal electrothermal therapy (IDET). This outpatient procedure, applies high heat directly to the inside of the disc. Different mechanism of action, have been postulated to explain how the IDET works. It can destroy the small nerve endings in the posterior wall of the disc (annulus) responsible for pain transmission. The high heat can produce several changes in the protein matrix in the nucleus (gel inside the disc) decreasing the ongoing inflammatory process. Last, it can potentially help sealed the tears in the annulus (fibrous outer wall) of the disc. Intra-Discal Electrothermal Therapy-IDET

Who Is a Candidate for an IDET?

Patients suffering from mainly low back pain, due to a painful disc, which failed conservative therapy including but not limited to: physical therapy, chiropractic care, medication management and injections. The diagnosis and identification of a specific disc as the source of pain, is achieved by a diagnostic test called discography. If the patients symptoms are mainly low back pain, buttock and occasionally referred leg pain. Patients must have a significant amount of disc space present (at least 50 % or original level) and no evidence of neurological deficits.

The Procedure

Usually the procedure is performed under intravenous sedation with local anesthetic supplementation. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, place in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied. Next, your lower back area will be scrub and cleansed in a sterile fashion. With the aid of an X-ray guidance, which provides constant imaging (called fluoroscopy), the inter- vertebral discs are identified. The physician will then inject a small amount of local anesthetic in the skin and deeper tissues to numb the area. This may be associated with mild and brief stinging sensations. Once the area is numb, your doctor will insert a special needle into the appropriate disc nucleus, under x-ray guidance. A small amount of contrast (X-ray dye) will be injected to confirm proper needle placement. Then, the Electro-Thermal Catheter is inserted and positioned inside the disc in the back wall of the annulus. Proper position is confirmed by X-ray and of the posterior disc wall is performed for approximately 17 minutes, to a maximum of 90 degrees Centigrade. The procedure usually takes about 30 minutes and is associated with minimum post -operative discomfort.

After the Procedure

You will go back to the post anesthesia care unit (if you received intravenous sedation), where you will be monitored for 30-60 minutes according to your response. Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for post procedure evaluation in approximately one week. Medications prescribed for the post -operative period may include: an antibiotic, a muscle relaxant and an analgesic/anti-inflammatory. The post procedure discomfort is usually minor and can be manage with ice packs and medications.

General Pre and Post Procedure Instructions

If intravenous sedation is planned, avoid eating any king of solid foods prior to the procedure and you may have clear liquids up to 4 hours prior to the procedure. If you are taking Coumadin, Heparin, Plavix or non-steroidal anti-inflamatories (such as aspirin, ketoprofen, naproxen or others), stop taking them at least one week prior to the procedure. If you are diabetic and planning on having IV sedation, our office will give you specific instructions. The decision to return to work after the procedure will be made on an individual basis considering medical necessity and your specific condition.

What Is a Nucleoplasty?

It is a minimally invasive procedure developed to treat patients with contained or small disc herniation, causing persistent leg or arm pain. Nucleoplasty means removal of the nucleus, which is the gel like substance in the center of the disc. The procedure is performed under X-ray guidance, inserting a special needle through the skin and into the nucleus. With a special device (spine wand) a portion of the nucleus is evaporated by a process called ablation and coblation. The end result is a decrease in the size of the herniated disc, relieving the pressure on the nerve or ligaments of the spine. Once the spine wand is removed, the small opening in the disc seals by itself.

Nucleoplasty
Who Is a Candidate for Nucleoplasty?

Nucleoplasty is reserved for patients with mainly persistent leg pain due to a small and contained disc herniations, not responding to conservative therapy such as: medications, chiropractic care, physical therapy and injections. A contained disc herniation or disc bulge occurs when the wall of the disc (annulus) weakens but does not break open; it still holds the nucleus pulposus. In other words, the gel in the center of the disc is "contained" within the wall of the disc. These patients do not have significant neurological deficits (leg weakness or inability to control their bowel or bladder functions). It is considered a minimally invasive procedure and performed as an outpatient. Multiple discs can be treated during the same procedure.

The Procedure

Usually the procedure is performed under intravenous sedation with local anesthetic supplementation. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, place in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied. Next, your upper or lower back area will be scrub and cleansed in a sterile fashion. With the aid of an X-ray guidance, which provides constant imaging (called fluoroscopy), the inter- vertebral discs are identified. The physician will then inject a small amount of local anesthetic in the skin and deeper tissues to numb the area. This may be associated with mild and brief stinging sensations. Once the area is numb, your doctor will insert a special needle into the appropriate disc nucleus, under x-ray guidance. A small amount of contrast (X-ray dye) will be injected to confirm proper needle placement. Then, part of the nucleus is removed by a process called coblation-ablation, which heats and evaporates a controlled amount of nucleus. The procedure usually takes about 20 minutes and is associated with minimum post -operative discomfort.

After the Procedure

You will go back to the post anesthesia care unit ( if you received intravenous sedation), where you will be monitored for 30-60 minutes according to your response.Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for post procedure evaluation in approximately one week. Medications will be given for the post -operative period which will include an antibiotic, a muscle relaxant and an analgesic/anti-inflammatory. The post procedure discomfort is usually minor and can be manage with ice packs and medications.

General Pre and Post Procedure Instructions

If no intravenous sedation is planned, you continue with your usual dietary habits the day of the procedure. If intravenous sedation is planned, avoid eating any king of solid foods prior to the procedure and you may have clear liquids up to 4 hours prior to the procedure. If you are taking Coumadin, Heparin, Plavix or non-steroidal anti-inflamatories (such as aspirin, ketoprofen, naproxen or others), stop taking them at least one week prior to the procedure. If you are diabetic and planning on having IV sedation, our office will give you specific instructions. The decision to return to work after the procedure will be made on an individual basis considering medical necessity and your specific condition.{slider=Musculoskeletal Diagnostic Test:}

X-ray

This test uses radiation to take a picture of structures inside the body, especially bones. Back x-rays may show signs of arthritis, degenerative disk disease, osteoporosis, or a tumor.

MRI Scan

This test uses strong magnetic waves to take pictures of structures inside the body. An MRI can show disc herniations, disc degeneration, spinal cord or spinal nerve root compression, tumors, or infections in the spine. Patients who have had previous back surgery will need a contrast, Gadolinium, injected. This substance helps differentiate scar tissue resulting from previous surgery. Gadolinium enhances the images of structures and alters local magnetic field in tissues being examined. Normal and abnormal tissue responds differently to the alteration from the contrast allowing the radiologist to visualize tissue abnormalities and disease processes. There is slight risk of an allergic reaction to contrast material, however, most reactions are mild and can be controlled with medications.For some patients, MRI is not an option. An MRI cannot be done for patients who have:

  • Pacemakers - an MRI can cause malfunction
  • Shrapnel
  • Bone plates or pins
  • Aneurysm clips - an MRI may cause the clip to tear the artery it is trying to protect
  • Metal fragments in eye - can cause eye damage or blindness
  • Implanted spinal cord stimulators
  • Inner ear implants
  • Dental implants - some are magnetic
  • Metal heart valves
  • Tattooed eyeliner - iron pigments can cause irritation
  • Women who have intrauterine devices (IUD)
  • Pregnant women
Nerve Conduction Study- Neural Scan

In this test, an electrical current is passed through a nerve to determine the health or disease of that nerve. This test is used in combination with an EMG.

Electromyography (EMG)

This test measures the electrical activity of muscle by placing needle electrodes into the muscle.

Myelography

In this test, a special dye is injected into the spinal canal. X-rays are then taken to see how the dye lines the space in the spinal canal and see if there are disc herniations or pinched nerves in the spine. A CT scan is usually performed after a myelogram in order to help visualize structures in the spine.

Before the CT/Myelogram

You will be instructed about not eating or drinking before the test. You will need to remove all jewelry, hairpins, hearing aids, and dental work. You will lie on a moving table that slides into a scanner. The scanner moves around to change angles of x-rays. Advise the Radiology Department if:

  • You are pregnant
  • Allergic to iodine dye
  • Have kidney problems - the contrast can damage the kidneys
  • Have diabetes
  • Have had a barium enema within 4 days of the CT Myelogram
After CT/Myelogram

You will be instructed to keep your head elevated and not to bend over or lie flat. This helps keep the contrast material out of your head.

CT Scan

This type of x-ray uses a computer to generate images of structures inside the body. CT scans of the spine may show disc herniations, tumors, arthritis, vertebral fractures, or the stability of spinal fusions.

Bone Scan

A bone scan evaluates bones for infection, disease, fractures, tumors or other bone abnormalities. Bone scans examine the entire skeletal system. The scan can help diagnose the cause of unexplained bone pain, such as low back pain, detect damage to bones caused by infection or other disease, evaluate damage to bones, detect cancer that has metastasized to bones, and monitor conditions that can affect bones such as trauma or infection.A small amount of radioactive tracer is injected into the bloodstream and the bones will absorb it. It may take up to three hours for the tracer to be absorbed and the scan to begin. During the waiting period, patients may be asked to drink 5-8 cups of water to help eliminate any radioactive tracer that is not absorbed into the bones. You can eat and drink as normal before the scan.A Bone scan can take up to an hour. You will lie on your back while a scan camera moves slowly above and around your body. The camera will scan for the radioactive tracer and produce pictures of bones. The camera does not produce radiation. A normal bone scan will show the tracer evenly distributed throughout the bones. An abnormal bone scan shows the tracer accumulated in an area of the bone, indicating a "hot spot".Hot spots may be caused by a fracture that is healing, bone cancer, bone infection, arthritis, or a disease of a bone. Some bones lack the tracer indicating a "cold spot". Cold spots may be caused by a certain type of cancer or lack of blood supply to a bone. The body rids itself of the injected radioactive tracer thru urine or stool and is usually eliminated over a period of 24 hours

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