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The procedure takes about one hour. Patients were instructed to perform only light stretching for the first two weeks, strengthening exercises from weeks two through six, and then a gradual return to higher level activities.

While 65% of patients reported symptom relief in two to 12 weeks, Nazarian said 35% were unchanged. "But these patients still had all options open to them. Since we didn't treat with traditional surgery, no bridges were burned," he says. Moreover, even patients who didn't improve did not get worse.

Michael A. Sullivan, MD, associate chairman, department of radiology, Ochsner Clinic Foundation, New Orleans, says using ultrasound to guide needle therapy is a major advance. "For years people have been injecting joints blindly: If it hurts here, inject here. That can be successful, but it can also cause more harm than good. This is really a logical way to improve that approach." Sullivan was not involved in Nazarian's study.

Asked if the ultrasound-guided approach would be used to treat professional athletes, Nazarian says "we were at spring training with the Phillies last year and I can tell you that this was very effective for a minor league pitcher. You know if you operate on an athlete that often means missing all or most of a season. Using this approach he was back in the lineup in a short time. I don't know if he will ever make the major leagues, but I think this procedure helped him have a better chance."

Nazarian says that he also used the ultrasound-guided technique to treat an English soccer player who was frequently benched by injuries but after treatment the man went on "to be named an alternate to the Britain's World Cup Team."

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