Specialty Services

Musculoskeletal

Musculoskeletal Ultrasound (MSK US) 

Ultrasound (US) is a tool which can be used either to help diagnose a condition (such as rheumatoid arthritis or rotator cuff tear) or to help guide injections into a joint (such as a knee affected by arthritis).  It has the same resolution (that is the pictures are of equal quality) as MRI for many conditions, is less expensive, and can be performed by either Dr. David or Suneya Hogarty right in the office. 

When MSK US is used to guide injections it leads to:  1) Improved accuracy (research has shown that injections into the knee without using US are at best 80% accurate) 2) Less pain for the patient 3) Better results.  MSK US is used in joint injections (shoulder, elbow, wrist, hand, hip, knee, ankle and foot) as well as for specialized injections for carpal tunnel syndrome and back pain (called an SI joint injection). 

MSK US is  cutting edge method of performing diagnostic exams and performing  injections,  and is fast becoming the standard of care in institutions like Duke Sports medicine, and the Mayo Clinic.  Now patients can have the benefit of this technology in Goldsboro.  Both Dr. Suneya and David Hogarty have had extensive training—including a course at the Mayo Clinc—as well as 7 years of hands on experience (which has included performing hundreds of US guided injections and diagnostic exams).

DeXA 

Bone densitometry (DeXA) is a diagnostic tool used to help diagnose osteoporosis, a condition which is associated with weakening of bones, and in many cases fractures (broken bones).  The test allows early diagnosis, which can lead to effective treatments which decrease risk for future fractures.  Both Dr. David and sunya Hogarty, as well as JW BAS PA, are certified by the ISCD to read the DeXA images.  We are the only group in Wayne county with this certification, which ensures that patients will get the proper diagnosis and treatment that they need.

EMG/NCS 

Electromyography (EMG) and nerve conduction studies (NCS) are done by Dr. David Hogarty to help diagnose problems with the muscle and nerve.  EMG/NCS are often ordered by surgeons or other doctors to diagnose conditions such as carpal tunnel syndrome (CTS), radiculopathy (a pinched nerve in either neck of lower back), and polyneuropathy (often due to nerve damage from diabetes, chemotherapy, or other problems).  This test is very helpful in making sure that the proper treatments are used—such as injections or surgery for carpal tunnel syndrome, for example.

Synvisc 

This is a special type of injection used to treat osteoarthritis (OA) of the knee.  Unlike steroid (“cortisone”) injections, it is thought that Synvisc injections can help repair damaged cartilage associated with OA.  It is a safe procedure, and is injected with the assistance of MSK US (Ultrasound) to ensure 100% accuracy.  Interestingly, research has shown that injections into the knee without using US are at best 80% accurate.

Botulinum Toxin (Botox) Injections 

Injection of the medication Botox is used by Dr. Dave to treat 2 major issues:  

  1. Spasticity is a condition which causes muscle to be tight and painful, which limits function.  It is commonly due to having a stroke or cerebral palsy.  Botox injections can help loosen muscles for up to 3 months, which leads to better function (such as improved walking) and decreased pain.  The treatment effects last for 3 months, and then a repeat injection is performed as long as the medication is helpful.
  2. Migraine headaches.  Smaller doses of Botox are injected into muscles of the forehead and scalp.  This is reserved for patients who have severe migraine Has, which have not responded to more conventional treatments.
Steroid Injections 

Most people know this as a “cortisone injection”.  Actually these days we use a newer, better version of cortisone called betamethasone.  The medication is injected into joints affected by arthritis, and is also used to treat conditiojs such as carpal tunnel syndrome (CTS), plantar fasciitis, bursitis of the hip or shoulder, tendonitis (usually of shoudler, wrist, knee, or heel), and tennis elbow

As discussed in another section (MSK US), most of these injections are performed with ultrasound (US) guidance, which improves accuracy, decreases pain of injection, and leads to better results.

Platelet Rich Plasma (PRP) 

PRP is a cutting edge medical treatment which helps the body heal damaged tissue. It is part of an emerging field called regenerative medicine, which taps into the natural healing power of our bodies.  The details are a bit technical, but in summary a sample of the patients blood is drawn and processed in a special way so that a sample of the patients own plasma, rich in platelets (hence the name platelet rich plasma) is obtained.  The PRP is then injected back into the body, in a site where there is tissue damage, such as in a knee with osteoarthritis (OA).  Many conditions have been treated successfully with PRP including: 1) rotator cuff tendonitis/tears, 2) Achilles tendonitis, 3) patellar tendonitis 4) tennis elbow, 5) plantar fasciitis, and 6) knee OA.

PRP has been used to treat elite level athletes such as Olympic level skiers, but can have benefit for any person.  It is used for problems that have not responded to traditional therapies (such as steroid injections), and especially in situations where patients are trying to avoid or post-pone surgery.  Dr. David Hogarty performs PRP injections using MSK US to guide injections, ensuring a high degree of accuracy, decreased patient discomfort, and the best possible results.

Osteopathic Manipulative Treatment (OMT) 

OMT is a hands on method which can be used in the treatment of a wide variety of musculoskeletal (MSK) conditions.  Most commonly it is used to treat neck and back pain, but is also very effective in the treatment of headaches.  Drs. David and Suneya Hogarty received their initial training in osteopathic medical school, but have also spent many 100s of hours of addition training to hone their manual (hand-on) diagnostic and treatment skills.  Dr. Dave has had the privilege of using OMT in the  treatment of  many of our armed forces personnel as they have developed back pain on the front line and in their duties at home.  OMT is not only very safe and effective, but is covered by most insurance plans. 

Acupuncture 

Dr. David Hogarty has been doing acupuncture since completing extensive (300 hours) training in 2009.  Acupuncture is part of an ancient system of healing developed over 2500 years ago in China.  Since crossing the Pacific into the US, acupuncture has gained wide popularity and acceptance as an extremely effective treatment of medical conditions, especially in the treatment of pain.  Scientific research has shown that the acupuncture needles increase the levels of endorphins—our body natural pain killers—as well as increasing the body’s sensitivity to these substances. 

Acupuncture can also be used to treat insomnia, anxiety, and in motivated individuals, can assist in smoking cessation.  It can also help decrease the severity of the side effects of chemotherapy—it is especially effective in treatment of nausea.  The treatments are very relaxing to most patients, and last for about 40 minutes.

Rheumatology

Infusions

The use of infusion therapies (medications delivered intravenously) for the treatment of rheumatologic diseases represent the most advanced and state-of-the-art approach toward many types of arthritis, autoimmune illness, and osteoporosis.  These therapies have revolutionized the field of rheumatology and have improved the quality of life of many rheumatology patients.

If your condition requires an intravenous medication, you will appreciate our comfortable and efficient infusion suite, staffed by a caring and highly experienced team of infusion nurses.  In office infusion therapy also ensures your safety, as a physician is always on site.

Examples of medicines we currently infuse include, but are not limited to: 

  • Remicade
  • Orencia
  • Actemra
  • Rituxan
  • Simponi Aria
  • Cimzia
  • Reclast
  • Benlysta
  • Boniva
  • Prolia
  • Krystexxa

X-Rays

We offer in-house x-ray imaging to assist in diagnosing musculoskeletal and chest diseases.  A certified x-ray technician with many years of experience obtains these images.  This is another service which provides you with one-stop convenience.