Injections
North Bay Sport Medicine is at the forefront of ultrasound use in sport medicine practice and recognizes the growing evidence that ultrasound guided injections for certain indications improves accuracy and effectiveness. All of our sport medicine physicians have background experience using ultrasound in the emergency department and within the field of Sport Medicine, and have completed additional expert training courses with Sport Medicine Ultrasound Canada. The clinic has access to a Clarius L7 handheld ultrasound for smaller joints and body parts, and a larger and more powerful Mindray TE7 for larger joints or difficult anatomy.
Please note: NBSM performs injections of all joints and soft tissues excluding the spine.
Injections We Offer
Click on any of the images below for more information about the specific injection or device, and be sure to watch our information videos at the bottom of the page.
Cortisone (Steroid)
Cortisone (Steroid)
Cortisone injections have been used for decades for painful and inflamed joints and soft tissues. It is a powerful antiinflammatory that is generally well tolerated, and is used in a variety of conditions including arthritis and tendonitis.
What to Expect
Our physicians will review the potential role for cortisone, particulary in conditions that have not responded to other conservative treatments like rest, icing, physiotherapy, exercise programs, bracing, and other medications or treatments where appropriate.
The joint or area will be examined and an ultrasound may or may not be used to better visualize the space. It will then be cleaned and a small needle will be used to inject the cortisone. While there can be a small pinch or some pain with injection, many patients aren't even aware that it has been done!
There may be soreness to the area for a day or two, but generally this fades quickly. Maximal effects can take up to six weeks. You will often be offered a quick telephone follow-up in the weeks following injection to see how you are responding.
Other potential risks and side effects:
- Pain - Post injection pain due to steroid 'flare' which can last for 2-3 days.
- Damage - Risk of cartillage damage in joints or tendon rupture in soft tissues. It has also been shown that repeated injections can lead to thinning of the cartilage.
- Infection - Rare, but serious. Increasing pain, redness, swelling, fevers.
- Skin changes - Discolouration or atrophy of the skin. May be more common with repeated injections.
- Systemic effects - Increased risk of hyperglycemia in those with diabetes.
Cost
$25 if cortisone supplied by NBSM
$0 if cortisone supplied by patient
Ultrasound is only covered by OHIP for cases where a joint injection failed elsewhere.
Prolotherapy
Prolotherapy
Prolotherapy injections strategically use an irriating solution, such as dextrose, to cause a new inflammatory response in an attempt to heal chronic joint and soft tissue pain.
What to Expect
Our physicians will review the potential role for prolotherapy, particulary in conditions that have not responded to other conservative treatments like rest, icing, physiotherapy, exercise programs, bracing, and other medications or treatments where appropriate.
The joint or area will be examined and an ultrasound may or may not be used to better visualize the space. It will then be cleaned and a small needle will be used to inject the prolotherapy treatment. While there can be a small pinch or some pain with injection, many patients aren't even aware that it has been done!
There may be soreness to the area for a day or two, but generally this fades quickly. Prolotherapy is typically offered as a series of 3-6 injections spaced about 3-4 weeks apart.
Other potential risks and side effects:
- Pain - Post injection pain can last for several days.
- Damage - Risk of damage due to the needle poke.
- Infection - Rare, but serious. Increasing pain, redness, swelling, fevers.
Cost
$250 per injection
(Prolotherapy is not an insured OHIP service)
Hyaluronic Acid (HA)
Hyaluronic Acid (HA)
Inside every joint is a naturally present fluid that contains HA. There is some evidence that supplementing our natural HA with an injection may provide symptom relief in patients with osteoarthritis (OA) and allow patients to return to their activities more quickly or defer or delay consideration of joint replacement surgery. There is also growing interest in the use of a different HA formulation specific to soft tissue tendon injuries.
What to expect:
Our physicians will review the potential role of HA in your condition, with an open discussion of the evolving evidence as well as potential risks.
As with the cortisone section above, risks may include pain, damage, infection. Of note is that a HA has not been shown to thin the cartilage or tendons. There can also be some financial risk, as outside of insurance coverage the injections can be costly.
All HA injections are performed under ultrasound guidance.
Common HA products used at NBSM for joints: Monovisc®, Durolane®
Combination HA + Cortisone product: Cingal®
Soft tissue HA: SportVis®
Cost: (covered by many 3rd party insurance plans)
$500 for Monovisc®, Durolane®, or Cingal® (HA + Cortisone) injections
$250 per SportVis® injection (offered as a series of two injections)
$50 injection fee if HA product is supplied by patient (injection of HA is not covered by OHIP)
Platelet Rich Plasma (PRP)
Platelet Rich Plasma (PRP)
PRP involves collecting some of your own blood, spinning it in a centrifuge, and then injecting a concentrated mixture of platelets and anti-inflammatory factors into a joint or tendon injury. There is growing interest and evidence that PRP injections may be effective in helping promote healing in certain conditions.
What to expect:
Our physicians will review the potential role of PRP in your condition, with an open discussion of the evolving evidence as well as potential risks.
The main risks include pain, damage, and infection. There can also be some financial risk, as many insurance companies do not provide coverage at this time.
All PRP injections are performed under ultrasound guidance.
Cost: (Sometimes covered by Insurance Health Spending Accounts, but rarely regular benefits)
$600 PRP injection
Clarius V2 L7
Clarius V2 L7 Portable Ultrasound
The Clarius L7 handheld ultrasound is very portable and versatile, allowing for convenient assessment of joints and soft tissues. This device is preferentially used by North Bay Sport Medicine physicians when conducting hospital consults or in clinic for ultrasound guided injections of small joints or body parts. It connects to the physician's phone or tablet to display the image.
nStride® APS
nStride® APS
nStride® APS, similar to PRP, involves collecting some of your own blood, double spinning it in a centrifuge, and then injecting a hyperconcentrated mixture of platelets, anti-inflammatory, and growth factors into your knee joint.
Some patients refer to APS as "PRP+".
nStride® APS is an exciting single injection treatment intended to provide significant relief in patients experiencing mild to moderate knee osteoarthritis.
What to expect:
Our physicians will review the potential role for APS in your knee osteoarthritis, with an open discussion of the evolving evidence as well as potential risks.
The main risks include pain, damage, and infection. There can also be some financial risk, as most insurance companies do not provide coverage at this time.
All APS injections are performed under ultrasound guidance.
Cost: (Covered by some Insurance Health Spending Accounts, but rarely covered by standard benefits)
$1500 for each nStride® APS injection.
Arthrosamid®
Arthrosamid®
Arthrosamid® is a non-biodegradable hydrogel 'implant' injection intended to provide longlasting relief from osteoarthritis pain.
What to expect:
Our physicians will review the potential role for Arthrosamid® injections for your knee osteoarthritis, with an open discussion of the evolving evidence as well as potential risks.
The main risks include pain, damage, and infection. There can also be some financial risk, as many insurance companies do not provide coverage at this time (it was introduced in Canada in the spring of 2025).
All Arthrosamid® injections are performed by ultrasound guidance.
Cost: (Rarely covered by insurance plans at this time)
$4500 per Arthrosamid® injection.
Mindray TE7
Mindray TE7
The Mindray TE7 is a larger and more powerful ultrasound device for clinical use, and is the same model used in the North Bay Emergency Department. It is preferentially used by North Bay Sport Medicine for deeper joints or difficult anatomy. It has been upgraded with software for enhanced needle visualization to help with more accurate injections.
Quick Comparison
For Cortisone and HA products patients may prefer in some cases to bring their own supply.
A $50 injection fee applies to patient supplied HA.
* Cortisone may be repeated depending on persisting inflammatory pain or partial effect.
†Soft tissue HA is typically 2 injections spaced one week apart ($250/each).
^PRP may be one injection or multiple depending on how aggressive the treatment plan.
Some products are more routinely covered by insurance plans. In some cases a treatment may fit under procedure, medical device, or Health Spending Account coverage.
Some injections can be used in joints.
Some injections can be used in soft tissues.
*For HA, this references Sportvis only, as all other HA products are intended for joints.