TREATMENTS
Coolief Radiofrequency Ablation
Patients who suffer with chronic pain of their knees, hips, or shoulders, may be candidates for the Coolief Radiofrequency Ablation procedure. This involves using either x-ray or ultrasound to guide specialized needles that use heat at the tip to specifically damage joint sensory nerve branches. These procedures do not affect nerves that provide sensation to the skin, nor does it affect the nerves that control movement or strength. In damaging the sensory signal pathway, less pain in felt in that given joint. The nerves do tend to grow back, however, at a very slow rate. This can result in several months to a year of pain reduction, reducing the need or surgery or pain medicines. There is no recovery or downtime following these procedures and the procedure is FDA approved.
Tenex
Through the use of ultrasound, tendons in the body can be visualized very clearly. The Tenex procedure involves making a very small incision (no stitches needed) and inserting a special device that vibrates at the tip. This cuts the unhealthy tendon tissue and removes it through the tip. This leads to a quicker healing time as the body is able to fill in the area with healthier tissue. This procedure can be done for the rotator cuff of the shoulder, plantar fascia of the foot, achilles tendon, as well as tendons in the elbows, hips, and knees.
Injection Therapy
Ultrasound also is extremely helpful in guiding simple injections into the target locations more accurately, safely (avoiding surrounding nerves and blood vessels), and less painfully compared to traditional injections. Ultrasound is not only useful for common sites of injection such as the knee and shoulder, but also allows Dr. Goyeneche to inject hundreds of different locations throughout the body, safely and accurately right in the clinic room. The substances that are used to inject may include steroid, hyaluronic acid, platelet-rich plasma, stem cells, or may involve “needling” a target area to bring blood/nutrients to the area to stimulate a healing environment.
Regenerative Medicine
The use of one’s own cells for the healing and regeneration of tissue is an exciting and promising area for not only orthopedic and neurologic conditions, but all of medicine. Especially exciting is the use of cells to treat and reverse osteoarthritis, traditionally an incurable disease. While methods to best extract and use cellular therapies, like stem cells and platelet rich plasma (PRP), continue to evolve, these procedures are exceedingly safe, and showing great promise in terms of efficacy. Dr. Goyeneche has been treating patients with PRP and stem cell therapies since 2014, and is published in both medical journal and textbook formats on the subject. Most importantly, Dr. Goyeneche remains committed to offering the most cutting-edge techniques, without compromise of what is ethical and safe for his patients. As with any procedure, Dr. Goyeneche uses his expertise in ultrasound to direct and place the treatment precisely in the exact area that needs to be treated. The conditions that Dr. Goyeneche most commonly treats with biologic therapies include osteoarthritis and tendonitis, however these treatments have applications for a large number of orthopedic and sports medicine conditions. Not all patients are candidates for these types of treatments however. Consider making an appointment to discuss with Dr. Goyeneche if you are interested in any regenerative medicine procedures.
Musculoskeletal Ultrasound
While a valuable medical tool since the 1940’s, the use of ultrasound in orthopedic medicine did not blossom until recent years. As technology has produced machines capable of higher resolution and in smaller packages, applications for orthopedic medicine have been developed. Dr. Goyeneche received a rigorous foundation of ultrasound education during his fellowship year by field leader, Dr. Joshua Hackel of The Andrews Institute. Dr. Goyeneche uses ultrasound to look inside the body and diagnose orthopedic issues right in the clinic room, which results in a quicker time to treatment. He has also been able to use an ultra-portable probe to use during sports medicine sideline coverage to help diagnoses acute injuries. The use of ultrasound for diagnosis also has applications for patients that suffer with claustrophobia and/or have metal inside their body, which may reduce the feasibility of obtaining an MRI.
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He also uses ultrasound to guide injections or perform procedures through the skin with precision accuracy. Research shows that injections without ultrasound guidance can have very poor accuracy and effectiveness, thus potentially leading to unnecessary surgeries. The use of ultrasound is also leading to a growing number of minimally-invasive procedures, such as Tenex, that can speed healing and reduce complications compared to traditional open surgeries. Dr. Goyeneche is actively involved with teaching ultrasound to medical residents and has been honored to serve as an instructor of musculoskeletal ultrasound to other physicians at national conferences.
Concussion
Dr. Goyeneche trained under Dr. Aaron Karlin, a national leader in concussion management and author of medical textbook chapters on the subject. Dr. Goyeneche teams with Dr. Karlin and several other physiatrists and neurologists within the Ochsner system to form a comprehensive concussion management team. The Ochsner team utilizes the ImPACT test, which is a computerized neuropsychologic measure that helps diagnose and guide return to activity decisions. Dr. Goyeneche specializes in concussion management in the adolescent and athletic population.
