Osteoarthritis of the wrist and hand joints is a common cause of chronic hand pain, stiffness, and reduced grip function. It affects the radiocarpal wrist joint, the intercarpal joints, the CMC joint at the base of the thumb, and the knuckle joints of the fingers.

For appropriately selected patients, image-guided orthobiologic injection into affected hand and wrist joints offers a precision approach to managing arthritis symptoms at Palm Beach Regenerative. Contact us to schedule your consultation.

Hand and wrist OA produces the characteristic joint pain, stiffness, bony enlargement, and reduced function that impacts fine motor activities, grip, and daily hand use. The small joints of the hand are accessible to precise ultrasound-guided injection, making this a condition well-suited for the Palm Beach Regenerative approach.

• Joint pain in the wrist, fingers, or thumb base with use
• Morning stiffness in the hands lasting 30 minutes or less
• Bony enlargements at finger joints (Heberden’s or Bouchard’s nodes)
• Reduced grip and pinch strength
• Pain with fine motor tasks such as writing or buttoning clothing

• Age-related joint degeneration
• Prior hand or wrist injuries
• Repetitive hand use in occupation or sport
• Genetic predisposition to hand OA, particularly in women
• Inflammatory arthritis transitioning to secondary OA

X-rays show joint space narrowing and osteophyte formation in affected hand and wrist joints. Ultrasound allows simultaneous assessment and guidance for injection into small hand joints.

• Activity modification and hand splinting
• Hand therapy and joint protection strategies
• NSAIDs and topical anti-inflammatories
• Intra-articular steroid injections
• Surgical joint fusion or arthroplasty for advanced cases

Dr. Ghattas uses real-time ultrasound guidance to deliver targeted orthobiologic injection precisely into the affected hand and wrist joints, providing a biological stimulus to the joint environment and reducing arthritis-driven inflammation.

These treatments do not regenerate cartilage but may meaningfully improve pain and function in appropriately selected patients with mild to moderate hand OA.

A pinched nerve in the neck, more precisely called cervical radiculopathy, occurs when a nerve root in the cervical spine is compressed or irritated, typically by a herniated disc, bone spur, or foraminal narrowing. The result is a characteristic pattern of pain, numbness, and weakness that follows the path of the affected nerve into the arm, hand, and fingers.

Dr. Ghattas’s neurological training makes him uniquely suited to evaluate and treat cervical radiculopathy, combining precise nerve localization with targeted image-guided orthobiologic treatment. Contact us today to schedule a visit.

Each nerve root exits the cervical spine through a bony opening called the foramen. When this space narrows from disc herniation, bone spurs, or joint arthritis, the nerve becomes compressed and inflamed. The pattern of symptoms, including which fingers are numb and which muscles are weak, helps identify the specific level affected.

• Sharp, burning, or shooting pain from the neck into the shoulder, arm, and hand
• Numbness or tingling in specific fingers corresponding to the affected nerve root
• Arm or hand weakness
• Pain that worsens with neck extension or looking upward
• Relief in certain positions, such as placing the hand on the head (abduction relief sign)
• Neck stiffness

• Cervical disc herniation compressing the nerve root
• Foraminal stenosis from bone spurs or disc degeneration
• Cervical facet arthritis narrowing the nerve exit
• Acute neck injury or whiplash
• Repetitive neck strain

Clinical examination, including specific neurological tests and reflexes, can localize the affected nerve root level. MRI of the cervical spine confirms the structural cause and severity of nerve compression. EMG and nerve conduction studies provide objective evidence of nerve function and help differentiate cervical radiculopathy from other causes of arm symptoms.

• Physical therapy with cervical traction and nerve mobilization exercises
• Oral anti-inflammatories and nerve pain medications
• Cervical epidural steroid injections for targeted nerve root inflammation relief
• Surgical discectomy and fusion or foraminotomy for severe or progressive cases

Dr. Ghattas combines his neurological precision with orthobiologic technique to address the inflammatory and structural contributors to cervical radiculopathy. Using fluoroscopic guidance, he delivers targeted platelet preparations to the affected nerve root level, reducing the inflammatory environment that amplifies nerve pain.

Structural causes of nerve compression, such as significant disc herniation or severe foraminal stenosis, are carefully evaluated. When the structural compression is the dominant driver rather than inflammation, surgical consultation is recommended honestly and directly.

Knee ligament injuries affecting the medial collateral ligament (MCL), lateral collateral ligament (LCL), or posterior cruciate ligament (PCL) are common in contact and cutting sports. While some complete ligament tears require surgical reconstruction, many partial and complete tears of the non-ACL knee ligaments respond well to orthobiologic treatment.

At Palm Beach Regenerative, image-guided platelet injection directly to the site of ligament injury offers a precise, biologically active approach to supporting the body’s natural ligament healing response. Give us a call today to schedule an appointment.

The MCL, LCL, and PCL each serve distinct stabilizing roles in the knee. MCL tears are the most common and occur from valgus stress (blow to the outer knee). LCL tears occur from varus stress and are less common. PCL tears occur from posterior tibial force, such as a dashboard impact.

Grade 1 and 2 sprains with partial tearing generally have good healing potential. Grade 3 complete tears may or may not require surgery depending on the ligament involved and the patient’s activity demands.

• Pain and tenderness on the inner knee (MCL), outer knee (LCL), or posterior knee (PCL)
• Swelling and bruising following acute injury
• Knee instability in the direction of the injured ligament
• Pain with weight-bearing and changes of direction
• Sense of the knee giving way during activity

• Direct impact or valgus force to the knee (MCL)
• Varus force or hyperextension (LCL, combined posterolateral corner)
• Direct blow to the anterior tibia pushing it backward (PCL)
• Sports involving contact, cutting, or pivoting

MRI is the definitive imaging tool for grading ligament tears and assessing associated damage to other knee structures. Clinical examination with specific stress tests identifies ligament instability.

Dr. Ghattas reviews your MRI and clinical findings to determine the grade of injury and whether orthobiologic treatment is appropriate.

• MCL tears: Often managed non-surgically with bracing and physical therapy, even at Grade 3
• LCL and posterolateral corner tears: May require surgical reconstruction at higher grades given the complexity of the lateral complex
• PCL tears: Often managed conservatively for isolated injuries, surgical reconstruction for Grade 3 with functional instability

For partial and selected complete ligament tears, Dr. Ghattas delivers image-guided platelet injection directly to the site of ligament injury under real-time ultrasound guidance, providing a precise biological stimulus at the healing zone.

This approach supports the ligament’s natural repair process and may accelerate recovery and improve the quality of healing tissue compared to conservative treatment alone. The goal is to support the ligament’s structure and reduce the instability that perpetuates symptoms.

Bone marrow lesions (BMLs), also called bone marrow edema, are areas of inflammation and fluid accumulation within the bone tissue just beneath the cartilage surface of the knee. Research increasingly identifies BMLs as a primary driver of knee pain in osteoarthritis, often more closely associated with pain than cartilage loss alone.

At Palm Beach Regenerative, Dr. Ghattas addresses bone marrow lesions as part of a comprehensive knee treatment approach, using Intraosseous (IO) injection techniques that deliver orthobiologic material directly to the affected bone area. Give us a call today to learn more.

Bone marrow lesions appear on MRI as areas of abnormal signal within the subchondral bone, which is the bone layer directly beneath the joint surface. They represent a state of inflammation and structural stress within the bone that can be a significant pain generator in arthritic and injured knees.

Addressing the subchondral bone environment, not just the joint space, is an important distinction in the Palm Beach Regenerative approach to knee care.

• Deep, aching knee pain, often described as pain within the bone rather than the surface
• Pain at rest as well as with activity
• Swelling around the knee
• Pain that may not fully respond to standard joint injections
• Often occurs alongside or mistaken for general knee arthritis symptoms

• Osteoarthritis with associated mechanical overload on the subchondral bone
• Acute knee injuries with bone bruising
• Repetitive stress loading on the joint
• Obesity increasing compressive forces on the knee
• Prior knee injuries or surgeries

Bone marrow lesions are identified on MRI. They do not appear on standard X-rays. Dr. Ghattas reviews MRI findings to assess the size, location, and significance of any bone marrow edema as part of your knee evaluation.

The presence of BMLs can inform which treatment approach is most appropriate: standard joint injection alone, or a combined joint and intraosseous treatment strategy.

Bone marrow lesions are often undertreated in conventional care because they may not be recognized as a primary pain source:

• Activity modification and unloading to reduce compressive stress
• Weight management to decrease mechanical load
• Physical therapy focused on joint mechanics and muscle balance
• Standard anti-inflammatory medications (typically offering limited benefit for bone-level inflammation)
• Bisphosphonate medications have been studied for BMLs with variable results

At Palm Beach Regenerative, bone marrow lesions are addressed through Intraosseous (IO) injection, a technique that delivers concentrated platelet or bone marrow preparations directly into the subchondral bone, targeting the inflammatory environment where BMLs occur.

IO injection is typically combined with a standard intra-articular (joint space) injection for a comprehensive approach to knee joint health.

All procedures are performed under real-time fluoroscopic guidance to confirm accurate needle placement within the bone.

Thoracic outlet syndrome (TOS) is a group of conditions caused by compression of the nerves, arteries, or veins in the space between the collarbone and first rib, known as the thoracic outlet. Neurogenic TOS, the most common form, involves compression of the brachial plexus and produces arm pain, numbness, and weakness that can closely mimic a cervical pinched nerve.

At Palm Beach Regenerative, Dr. Ghattas’s dual expertise in neurology and interventional pain management positions him ideally to evaluate and manage neurogenic thoracic outlet syndrome. Schedule an appointment with Dr. Ghattas today.

The thoracic outlet is a narrow passage between the collarbone, first rib, and surrounding muscles through which the brachial plexus nerve bundle and subclavian vessels pass. Compression in this space can produce a complex pattern of symptoms affecting the entire arm.

Neurogenic TOS is the most common type and is often associated with scalene muscle tightness, cervical rib variants, or prior shoulder and neck injuries.

• Aching pain in the neck, shoulder, and arm
• Numbness and tingling in the arm, often involving the ring and small fingers
• Arm fatigue with overhead activities
• Weakness of grip or fine motor function
• Symptoms worsening with prolonged computer use or overhead reaching
• Cold sensitivity in the hand in some cases

• Scalene muscle tightness or hypertrophy compressing the brachial plexus
• Cervical rib or fibrous band congenitally narrowing the thoracic outlet
• Poor posture with forward head and rounded shoulders
• Prior whiplash, shoulder injury, or clavicle fracture
• Repetitive overhead activities in athletes or overhead workers

TOS diagnosis requires a thorough clinical assessment including postural evaluation, special provocative tests (Adson’s, costoclavicular, EAST test), and neurological examination. Cervical MRI helps rule out concurrent cervical pathology, and electrodiagnostic testing assesses brachial plexus function.

Dr. Ghattas correlates all findings to distinguish neurogenic TOS from cervical radiculopathy and other causes of arm symptoms.

• Physical therapy focused on scalene stretching, postural correction, and first rib mobilization
• Scalene muscle injections with local anesthetic or Hyaluronic acid to reduce muscle compression
• Anti-inflammatory medications
• Surgical first rib resection or scalenectomy in refractory cases

Dr. Ghattas uses ultrasound-guided nerve hydrodissection around the brachial plexus at the scalene level, combined with targeted platelet injection to reduce the inflammatory environment contributing to nerve compression and irritation.

This approach addresses the neurogenic component of TOS through precise, image-guided technique rather than empirical treatment. It is combined with a structured rehabilitation program and the BioMod support protocols that are unique to Palm Beach Regenerative.

Cervical facet disease refers to arthritis or degeneration of the small facet joints that line the back of the cervical (neck) vertebrae. These joints guide and limit neck movement, and when they degenerate, they become a significant source of neck pain, stiffness, and referred headache.

Facet joint injections are among the most commonly performed procedures at Palm Beach Regenerative, and Dr. Ghattas’s precision with image-guided cervical injections is a cornerstone of the practice’s spine care approach. Contact us today to schedule a visit.

Each cervical vertebra has two facet joints, one on each side, connecting it to the vertebra above and below. As these joints degenerate with age or injury, the cartilage thins, bone spurs form, and the joint capsule becomes inflamed. The C2-C3 through C6-C7 levels are the most commonly affected.

• Aching neck pain, often localized to one side
• Pain that worsens with neck extension or rotation
• Morning stiffness that improves with movement
• Referred pain or aching into the shoulder, upper back, or base of skull
• Headaches originating from the upper cervical facet joints
• Limited neck range of motion

• Age-related joint degeneration
• Prior neck injury or whiplash
• Repetitive neck strain from posture or occupation
• Cervical instability placing excess load on the facet joints
• Inflammatory arthritis affecting the cervical joints

Cervical MRI or CT can show facet joint arthritis. Diagnostic medial branch nerve blocks, which temporarily anesthetize the nerves supplying the facet joints, are the most reliable way to confirm that the facets are the primary pain source.

Dr. Ghattas uses both imaging review and diagnostic injections to accurately identify whether cervical facet disease is the driver of your symptoms before recommending a treatment approach.

• Physical therapy for cervical stabilization and posture correction
• NSAIDs and pain medications
• Facet joint steroid injections for temporary relief
• Medial branch radiofrequency ablation (RFA): Burning the nerves supplying the facet joints for longer-term but non-permanent pain reduction

Rather than temporarily numbing or destroying the nerves supplying the facet joints, Dr. Ghattas targets the facet joints directly with orthobiologic treatment, using image-guided PRP injection to address the underlying inflammatory arthritis.

This approach supports the joint’s biological environment and may provide more durable relief by addressing the root cause rather than the pain signal alone.

For patients with confirmed cervical facet pain who have responded to diagnostic blocks, orthobiologic facet injection represents a meaningful non-surgical alternative to repeated steroid or RFA procedures. Reach out to Palm Beach Regenerative today.

Peroneal neuropathy is a condition involving injury or compression of the common peroneal nerve at the fibular head on the outer knee, causing foot drop, weakness of ankle dorsiflexion, and numbness on the outer lower leg and top of the foot. It is the most common mononeuropathy of the lower extremity.

Dr. Ghattas’s neurological background directly applies to the accurate diagnosis and targeted treatment of peroneal neuropathy, an area where many musculoskeletal practices have limited expertise. Request an appointment with Dr. Ghattas to learn more.

The common peroneal nerve wraps around the head of the fibula just below the outer knee, where it is superficial and vulnerable to compression and injury. Damage here affects ankle and toe dorsiflexion and eversion, as well as sensation on the outer lower leg and dorsal foot.

• Foot drop: difficulty lifting the front of the foot when walking
• Weakness of ankle eversion
• Numbness and tingling on the outer lower leg and top of the foot
• High-stepping gait pattern to compensate for foot drop
• Pain or pressure sensitivity at the fibular head
• Scuffing of the foot with walking

• Prolonged leg crossing compressing the nerve at the fibular head
• Cast or brace pressure over the fibular head
• Knee surgery or trauma
• Prolonged immobilization in bed or during surgery
• Cysts or masses at the fibular head
• Fibula fracture

Electrodiagnostic testing (nerve conduction studies and EMG) is the gold standard for confirming peroneal neuropathy, localizing the injury to the fibular head, and assessing severity and prognosis. Ultrasound allows visualization of the nerve at the compression site.

Dr. Ghattas performs and interprets the full neurological evaluation as part of the assessment.

• Ankle foot orthosis (AFO) to support foot drop during recovery
• Physical therapy for ankle strengthening and gait rehabilitation
• Avoidance of compression at the fibular head
• Nerve hydrodissection for perineural adhesion-related compression
• Surgical decompression in cases of structural entrapment

Dr. Ghattas uses real-time ultrasound-guided peroneal nerve hydrodissection at the fibular head, delivering platelet preparations around the nerve to reduce perineural inflammation and free any adhesive compression.

Prognosis for peroneal nerve recovery depends heavily on the severity of the nerve injury as assessed by electrodiagnostics. Dr. Ghattas incorporates this objective data into realistic expectations for each patient.

Achilles tendon pathology ranges from chronic degenerative tendinosis to partial and complete tears, and it is among the most common and disabling lower extremity conditions in active adults. Palm Beach’s year-round running, tennis, pickleball, and golf culture make Achilles conditions a frequent presentation at Palm Beach Regenerative.

Image-guided orthobiologic treatment of Achilles tendinopathy and partial tears is well-supported by evidence and is a core treatment capability at Palm Beach Regenerative. Request a Consultation at Palm Beach Regenerative.

Achilles tendinosis involves degeneration of the tendon’s collagen structure without significant acute inflammation. It occurs in two anatomical zones: midportion (2 to 6 centimeters above the heel) and insertional (at the heel bone attachment), each with distinct characteristics and treatment approaches.

Partial tears represent a spectrum of structural damage within the tendon. Complete Achilles rupture is a surgical emergency requiring prompt evaluation.

• Aching or sharp posterior heel or calf pain, worst with the first steps in the morning
• Pain during and after running, jumping, or stair climbing
• Tendon thickening and nodularity in chronic tendinosis
• Pain with direct palpation of the tendon
• In insertional Achilles: pain at the heel bone, worsened by shoe heel counters
• A ‘pop’ and sudden loss of calf strength with complete rupture

• Sudden increases in training volume or intensity
• Repetitive calf loading from running and court sports
• Tight calf muscles and limited ankle dorsiflexion
• Prior Achilles injury
• Fluoroquinolone antibiotic use (risk factor for Achilles pathology)
• Age-related tendon degeneration

Diagnostic ultrasound provides real-time assessment of Achilles tendon structure, degeneration, partial tearing, and neovascularity. It also directly guides injection treatment.

MRI offers the most comprehensive assessment of partial tear extent and surrounding structures. Dr. Ghattas uses the appropriate imaging tool based on your specific presentation.

• Eccentric and heavy slow resistance loading programs: First-line treatment with strong evidence for midportion Achilles
• Heel lifts for insertional Achilles to reduce tendon compression at the insertion
• Shock wave therapy
• Steroid injection: Avoided for Achilles due to well-documented risk of tendon rupture
• Surgical debridement for refractory tendinosis; repair for complete rupture

Dr. Ghattas uses real-time ultrasound guidance to deliver Regenexx SCP platelet preparations precisely to the area of Achilles tendon degeneration or partial tearing, avoiding the central tendon vasculature and targeting the degenerative zone accurately.

Steroid injection into the Achilles tendon is specifically avoided given the well-documented risk of tendon weakening and rupture. Orthobiologic injection supports the healing response without this risk.

Complete Achilles rupture requires surgical evaluation and Dr. Ghattas will assess and refer appropriately. Request an appointment at our clinic.

A cervical disc herniation occurs when the soft inner material of a disc in the neck pushes through its outer casing and irritates or compresses nearby nerve roots or the spinal cord. The result can range from localized neck pain to radiating arm pain, numbness, and weakness, depending on which nerve is involved.

At Palm Beach Regenerative, Dr. Ghattas brings both neurological expertise and interventional orthobiologic training to the treatment of cervical disc herniations, offering a comprehensive spinal approach that addresses the full cervical unit rather than the disc in isolation. Request your appointment at Palm Beach Regenerative today.

The cervical spine has seven vertebrae and eight pairs of nerve roots. When a disc herniates at a specific level, it typically compresses the nerve exiting at that level, producing a predictable pattern of symptoms in the neck, shoulder, arm, and hand. The most commonly affected levels are C5-C6 and C6-C7.

• Neck pain and stiffness
• Sharp, shooting, or burning pain radiating from the neck into the shoulder, arm, or hand
• Numbness or tingling in the fingers or hand, corresponding to the affected nerve root
• Arm or hand weakness
• Symptoms worsening with certain head positions
• In rare severe cases, difficulty with balance or coordination if the spinal cord is affected

• Age-related disc degeneration reducing disc resilience
• Sudden neck injury or trauma
• Repetitive neck strain from occupation or posture
• Prior cervical spine pathology
• Genetic predisposition to early disc degeneration

MRI of the cervical spine is the definitive imaging tool for identifying the level and severity of disc herniation and assessing nerve compression. Dr. Ghattas reviews cervical MRI in detail, correlating imaging findings with your neurological examination findings.

Electrodiagnostic testing (EMG/nerve conduction studies) may be used to objectively assess nerve function and localize the affected root.

• Physical therapy with cervical traction and targeted strengthening
• Anti-inflammatory medications and nerve pain agents (gabapentin, etc.)
• Cervical epidural steroid injections for nerve root inflammation
• Surgical discectomy and fusion or artificial disc replacement for severe or progressive neurological deficits

Dr. Ghattas treats cervical disc herniations as a whole-unit problem, addressing the disc environment, facet joints, paraspinal ligaments, and nerve structures together. Most cervical spine procedures at Palm Beach Regenerative use platelet-rich plasma (PRP) delivered under real-time fluoroscopic guidance to reduce nerve inflammation and support the surrounding structural tissues.

Direct disc injection is reserved for very specific circumstances and is not the default approach. The focus is on improving the inflammatory environment around the affected nerve root and supporting the stability of the cervical spinal segment.

These treatments do not rebuild the disc. They work by reducing the inflammatory component that amplifies nerve pain, which in many cases provides meaningful functional improvement.

Whiplash is a soft tissue injury to the neck resulting from rapid acceleration-deceleration of the head, most commonly from a rear-end vehicle collision. Despite its common occurrence, whiplash can result in persistent, complex symptoms when the underlying structural injuries are not fully addressed.

At Palm Beach Regenerative, Dr. Ghattas takes a comprehensive approach to whiplash recovery, identifying and treating the specific cervical structures damaged in the injury rather than simply managing symptoms. If you’re suffering from whiplash, contact us right away.

Whiplash can damage multiple cervical structures simultaneously, including the facet joint capsules, intervertebral discs, paraspinal ligaments, and muscles. Cervical ligament laxity resulting from whiplash can create persistent instability that perpetuates pain long after the initial injury.

Dr. Ghattas’s neurological background is particularly valuable in whiplash cases, where nerve root irritation, headache, and cognitive symptoms may all be part of the clinical picture.

• Neck pain and stiffness, often beginning hours after the injury
• Headache, typically starting at the base of the skull
• Shoulder and upper back pain
• Arm pain, numbness, or tingling from nerve root involvement
• Dizziness, particularly with head movement
• Difficulty concentrating or memory issues in more significant injuries
• Jaw pain from concurrent TMJ injury

• Rear-end or side-impact vehicle collisions
• Sports injuries involving rapid head deceleration
• Falls with cervical hyperextension
• Contact sport injuries

Cervical MRI evaluates disc, ligament, and facet joint injury. Flexion-extension X-rays assess for cervical instability. Dr. Ghattas performs a comprehensive neurological and musculoskeletal examination to map all structures injured.

A thorough injury assessment guides the treatment plan, which often needs to address multiple cervical structures simultaneously.

• Initial rest, ice, and gentle range of motion
• Physical therapy for cervical stabilization and pain management
• Anti-inflammatory medications and muscle relaxants
• Cervical epidural or facet injections for persistent pain

Whiplash recovery at Palm Beach Regenerative involves a structured, multi-tissue approach. Dr. Ghattas uses image-guided PRP injections targeting the specific structures damaged in your injury: the cervical facet joints, ligaments, and disc environment, based on your MRI and clinical examination findings.

Prolotherapy may also be considered for cervical ligament laxity, supporting the stabilization of an unstable cervical segment that perpetuates chronic whiplash symptoms.

Your recovery plan is structured with systematic follow-up to monitor progress and adjust your treatment as your cervical spine heals.