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How do I get in to see Dr. Hui? If you are a BC resident with MSP coverage (or from another province with equivalent coverage), contact your primary / family medicine provider to ask for a referral to see Dr. Jason Hui (MSP 37911). Due to long wait times, Dr. Hui's North Vancouver office is currently restricted to North Shore/Sunshine Coast residents or patients who are referred from providers in our catchment area only. Referrals are limited to the shoulder, knee, and hips. Current referral wait times are around 4-6 months. Dr. Hui's Coquitlam office has no geographical or referral restrictions, current referral wait times are around 1-2 months. If you are from out of country and would like to be seen by Dr. Hui for private consult, please contact either clinic directly.

How long is the waiting time to see Dr. Hui for a follow up visit? Previously established patients of Dr. Hui's should anticipate about 3-4 weeks of wait time to see him for a follow up visit in office. If it has been an extended time since your previous visit with Dr. Hui, you may need a re-referral from your referring provider - however you do not need to line up within the new referral waiting list again.

What are the benefits of ultrasound guided injections? Ultrasound guided injections allows for safer, more accurate injections, avoiding critical nearby structures such as nerves and blood vessels, and ensuring the medication is injected in the desired anatomical location. Advanced procedures, viscosupplement injections, and PRP injections are done under ultrasound guidance at Dr. Hui's clinics.

Tell me more about Viscosupplementation Injections Injections of hyaluronic acid, also known as viscosupplementation are aimed at reducing joint pain and improving the functional condition of the osteoarthritic joint, in particular, the knee. Hyaluronic acid is a viscous and elastic substance that is normally produced by the joint and that makes up joint fluid(or "synovial fluid"). The latter is rich in hyaluronic acid in its normal state, and its viscous properties lubricate the cartilage surfaces while its elastic properties protect them from shocks. In osteoarthritis the synovial fluid is depleted in hyaluronic acid making the cartilage more vulnerable to forces of friction and compression. Some patients will not be helped by viscosupplementation. For those who report pain relief with the procedure, it may take several weeks to notice an improvement. How long the effects last varies. Some patients report pain relieving effects for several months following the injections. If the injections are effective they may be repeated after a period of time, usually 6 months. Although some patients report relief of arthritis symptoms with viscosupplementation, the procedure has never been shown to reverse the arthritic process or re-grow cartilage. The effectiveness of viscosupplementation in treating arthritis is not clear. It has been proposed that viscosupplementation is most effective if the arthritis is in its early stages (mild to moderate). Please note that while MSP covers the cost of your visit and injection, the cost of viscosupplementation medication is separate, check with your extended insurance provider to see if you are covered for your condition.

Tell me more about Cortisone injections Corticosteroids are a class of medications that are synthetic forms of cortisone, a naturally occurring hormone in the body. Cortisone plays a role in reducing inflammation. When corticosteroids are injected directly into a joint, they can help to reduce swelling, redness, and pain at that site. Most cortisone injections typically take full effect in 24 to 48 hours. The goal of each injection is that it would last 3-4 months.

Tell me more about Platelet Rich Plasma Injections Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets). The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors that are very important in the healing of injuries. PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual. To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased by spinning the blood down during a process called centrifugation. These platelets are then injected into the injured site. Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP may potentially speed up the healing process. Patients typically report improvement 2-4 weeks following their PRP procedure. The duration of effects can vary but some have reported 6-12 months or relief. PRP does appear to be effective in the treatment of certain chronic tendon injuries and low- to moderate-grade knee osteoarthritis, the medical community needs more scientific evidence before it can determine whether PRP therapy is truly effective in other conditions. Please note that while MSP covers the cost of your visit and injection, the cost of PRP preparation is separate.

What are some risks of injections? The primary risk of ALL injections are bleeding and infection. Using a sterile preparation and image guidance can help minimize these risks but do not reduce this to zero. Cortisone specific risks include but are not limited to cortisone flare, hot flashes, transient increased blood pressure and blood sugar readings, loss of skin pigmentation around the injection site. There have been some concerns that repeat cortisone injections can lead to damage of surrounding cartilage tissues. The jury is still out on this as most studies related to this topic have been replicated in a lab setting but not in a human body. The main risk for viscosupplementation is development of a local allergy-like reaction in the knee due to the body's response to the preservatives. PRP injection procedure is fairly safe as the injectate is simply a concentrated blood product. However, an increased inflammatory response is often seen in the next few days following the procedure, so patients often report they see a brief deterioration of their symptoms before noticing improvement a couple weeks after. If the PRP procedure is done with needle fenestration and/or tenotomy, then there are specific risks of tendon injuries / damage based on the procedure being performed.

What is the Vancouver Hip Institute? The Vancouver Hip Institute (VHI) is a clinic devoted to the management of NON-ARTHRITIC musculoskeletal hip pain. Access to timely assessment and treatment of conditions such as femoroacetabular impingement (FAI), acetabular labral tears, and tendinopathies and overuse injuries around the hip is limited in British Columbia. The primary goal is to have patients appropriately investigated and referred for consideration of hip arthroscopy or other surgical intervention in an efficient manner and at the same time provide expert advice to direct non-operative care for those patients who may not require surgical management. The secondary goal is to encourage judicious use of investigations, such as MR arthrograms, to be mindful of finite health care resources and reduce patient anxiety and confusion. Dr. Hui is one of the non-surgical sports medicine specialists working with the VHI group, and helps triage patients in the North Shore district as well as the Fraser Valley Area.

Tell me more about osteoarthritis Osteoarthritis (OA) is the most common type of arthritis. It affects more Canadians than all other forms of arthritis combined. Osteoarthritis is a progressive disease of the whole joint that leads to the breakdown of joint cartilage and the underlying bone. (Cartilage is the tough elastic material that covers and protects the ends of bones). Joints require the body to regularly repair and replenish damaged tissues. Damage to joint tissues can occur through the normal function of a joint. When the body is not able to keep up with the repair process, or if there is too much tissue that requires repair to take place, osteoarthritis may begin to develop. For most people, this damage can occur when otherwise healthy joints are exposed to heavy workloads over a long period of time. However, for some people whose joints are formed differently or who have experienced a previous joint injury, even regular workloads can accelerate joint damage. Being overweight or obese is also a risk factor for developing osteoarthritis since additional body weight can cause significant stress on weight-bearing joints. There is currently no cure for osteoarthritis, however, there are ways to manage the symptoms and how you function in daily life. This can include a combination of self-management strategies, medications, treatment by healthcare professionals specializing in orthopedic care and, for severe osteoarthritis, possibly joint replacement surgery.

I would like to get a knee brace Many different form of knee braces exist in today's market. The most commonly see knee braces include compression brace, hinged knee brace, ligament support brace, offloading knee brace, arthritis brace etc. There's no textbook guidance on what type of brace works best for each individual. The main consideration should be on how the brace fits, and whether or not it is comfortable enough for long term use. Getting a fancy knee brace that doesn't fit your everyday life is not going to yield significant benefits. Custom knee braces can be very costly ($1800 CAD), it is best to speak with an expert and take a few options out for a "test drive" before making the commitment. Common knee brace manufacturers include Ossur, Breg, Donjoy, and Osskin. Dr. Hui's North Vancouver office provides fast access to be seen by a bracing specialist from Breg. Dr. Hui's Coquitlam office has fast access with a bracing specialist to be fitted for a custom 3D printed knee brace with Osskin.

What is a Barbotage Procedure? Barbotage is an effective treatment in which musculoskeletal specialists use ultrasound imaging to view the calcium deposits and break them up with a needle, allowing them to be absorbed into your body. It is done as an outpatient procedure using ultrasound guidance. There is no preparation required for this procedure. The procedure takes 30 minutes and will be performed at our office. It will help if you can wear clothing that will allow you to easily expose the shoulder in question. After an initial ultrasound examination, the barbotage is usually performed when you are lying on your side. With a thin needle the whole injection area is first numbed. The calcific deposit is then approached with one or two needles and multiple punctures are performed. The procedure is highly precise and the needle is continuously watched on the ultrasound. Care is taken to minimize injury to the tendon. Sometimes water pressure is used through the needle to break and suck the calcium deposits in the area. Following the barbotage, an injection of steroid and local anesthetic is administered. The injection site will be covered with a small dressing which can be removed after 24 hours. There are no specific restrictions after the procedure and once the discomfort from the procedure eases, usually 2-5 days, you could commence shoulder exercises.

What is a Hydrodilatation Procedure? This procedure is performed for adhesive capsulitis, otherwise known as frozen shoulder. The shoulder is a ball and socket joint, surrounded by a capsule. Usually the capsule allows movement, but when it becomes irritated, it starts to shrink and restrict movement. A hydrodilatation procedure can be thought of as expanding an empty balloon it with water. The procedure uses ultrasound guidance to access the shoulder joint. Three solutions are typically injected. - Local anesthetic for immediate, temporary relief - Steroid for later, lasting relief - Saline, to mechanically distend the joint ​​A systematic review with 2276 studies demonstrated that hydrodilatation combined with corticosteroid injection expedites pain-free movement, with the greatest benefit at 3 months (Catapano 2018). The goal of the procedure is to take advantage of the synergistic effect of hydrodilatation and the corticosteroid injection to relieve pain and improve function.

I have a pending injection w/ Dr. Hui, what do I need to know for before & after? - I do use a local anesthetic for each ultrasound guide procedure that is done. - This will be done in an outpatient clinic setting under sterile technique, the anticipated appointment time will be around 30 minutes. In preparation for your appointment with Dr. Hui, please ensure that you: - Do not have any signs of infection in the area we are planning on treating. (Injections around infected joints can be catastrophic) - If you are on a blood thinner, make sure you have already discussed this with Dr. Hui - Arrive to clinic with loose clothing to easily expose the targetted injection area Following the injection, depending on what procedure was done: - Resume regular activities for approximately the next 48 hours without increasing strenuous exercise. Exception would be any types of procedure involving a weight bearing tendon such as the achilles or plantar fascia - in which case Dr. Hui will go over this more in detail beforehand. - OK to shower, but please do not submerge the wound into any prolonged water exposure (to avoid risk of infection) such as a hot tub, swimming pool, or bath tub. - If the injection site involves the right lower extremity or involves the upper extremities, it would be best to bring a designated driver just in case. If you cannot arrange for a driver, anticipate that you will be asked to remain in the clinic for an additional 15-20 minutes after the procedure for monitoring.

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