Joint Pain
Shoulders, knees, hips, and beyond — precise diagnosis and image-guided treatment, without rushing toward surgery.
Joint Pain is a symptom. The source is the answer.
Joint pain is not one condition. A painful shoulder may be a rotator cuff tear, an inflamed bursa, an arthritic joint, or a nerve problem referring pain from the neck. A painful knee may be arthritis, a meniscus injury, tendinopathy, or referred pain from the hip or spine.
Getting this right matters enormously, because the treatments diverge completely — and because the default path in much of medicine is to move quickly toward surgery or an injection into whatever joint hurts, without confirming that joint is the source.
We identify the specific structure generating your pain, treat it precisely with image guidance, and rehabilitate the mechanics that caused it. Surgery is a legitimate option for some patients. It should never be the first option for most.
There is also an economic reality worth naming. Joint pain is the entry point to some of the most lucrative procedures in medicine — replacements, arthroscopies, and an expanding market of injectables and devices. That doesn’t make any of them wrong. It does mean that a patient with a painful knee is walking into a system with strong financial currents, and those currents do not always flow toward the most conservative effective option.
We are physician-owned and independent, which means our recommendations answer to your examination rather than to a volume target. Surgery is right for some patients. For a great many others, precise diagnosis, targeted image-guided treatment, and genuine rehabilitation accomplish what they actually came for.
An injection into the wrong structure isn’t a treatment. It’s a delay. Accuracy is the whole game.
What can cause joint pain
Below are the conditions we most commonly identify and treat. Many patients have more than one contributing source at the same time — which is precisely why careful diagnosis matters.
Shoulder
Rotator Cuff Tendinopathy & Tears
Degeneration or tearing of the tendons stabilizing the shoulder, producing pain with overhead motion, night pain, and weakness. Many partial tears respond well to precise, non-surgical treatment.
Subacromial Bursitis & Impingement
Inflammation of the bursa beneath the acromion, causing pain with elevation of the arm. Image-guided injection places medication exactly where it’s needed rather than approximately.
Glenohumeral & AC Joint Arthritis
Degenerative change in the main shoulder joint or the acromioclavicular joint at the top of the shoulder. Each refers pain differently, and each requires a different injection target.
Adhesive Capsulitis (Frozen Shoulder)
Progressive stiffness and pain as the joint capsule contracts. Early, accurate treatment substantially changes the trajectory.
Knee & Hip
Knee Osteoarthritis
Cartilage loss producing pain with weight-bearing, stiffness, and reduced function. There is a great deal that can be done before joint replacement — and a great deal of pressure in medicine to move there faster than necessary.
Hip Osteoarthritis & Labral Pathology
Hip arthritis often presents as groin pain and can convincingly mimic low back pain. Labral tears and impingement produce a different pattern requiring different care.
Meniscal Injury
Tears of the knee’s cartilage cushions. Many degenerative meniscal tears do not require surgery, and evidence increasingly supports non-operative management for a substantial share of them.
Tendinopathies & Bursitis
Patellar tendinopathy, IT band syndrome, pes anserine and trochanteric bursitis — common, precisely treatable, and frequently misattributed to arthritis.
Other Joints & Contributors
Sacroiliac Joint Dysfunction
A frequently missed source of buttock, hip, and low back pain, particularly after pregnancy, trauma, or lumbar fusion.
Referred & Radicular Pain
Cervical radiculopathy can present as shoulder pain; lumbar radiculopathy as hip or knee pain. Treating the joint will never fix a problem originating at the nerve root — which is exactly why examination precedes injection.
Inflammatory Arthritis
Rheumatoid arthritis, psoriatic arthritis, and related conditions require systemic treatment. Recognizing them rather than treating them as mechanical joint pain is essential.
Central Sensitization
Long-standing joint pain can outlast its structural cause as the nervous system amplifies signaling — which is why some patients still hurt after a technically perfect joint replacement.
Contributing Factors & Perpetuating Causes
Movement Dysfunction & Compensation
Joints fail under bad mechanics. A painful knee frequently reflects hip weakness or ankle stiffness; a painful shoulder frequently reflects scapular dysfunction. Treating the joint without correcting the mechanics guarantees recurrence.
Weight, Metabolic Health & Inflammation
Load and systemic inflammation both influence joint pain and cartilage health. Our team includes a double board-certified internal and obesity medicine physician who consults on weight, GLP-1 therapy, and nutrition for exactly this reason.
Central Sensitization After Joint Surgery
Some patients continue to hurt after a technically flawless joint replacement. When the nervous system has amplified, the joint was never the whole problem — and this is treatable.
Disuse, Weakness & Instability
Pain drives protection, protection drives weakness, and weakness drives further joint stress. Interrupting this cycle requires enough pain relief to permit meaningful rehabilitation.
When joint pain is an emergency
Seek immediate care for: a hot, swollen, exquisitely painful joint with fever (possible septic joint); inability to bear weight after trauma; obvious deformity or suspected fracture; or sudden loss of function with severe pain. Joint infection is a surgical emergency. This page is educational and is not a substitute for evaluation.
Diagnosis is a procedure, not a guess
Imaging alone rarely provides the answer. Findings of degeneration are extraordinarily common in people with no pain whatsoever — so an abnormal image doesn’t prove we’ve found the culprit. Conversely, some of the most treatable causes may not appear on imaging at all.
So we build the diagnosis from several converging sources:
01 — A genuinely thorough history and physical examination
Provocative testing, range of motion, strength, stability, and a careful search for referred sources. Most of the diagnosis is made here — which is why our visits are longer than the industry norm.
02 — Correlated imaging
X-ray, MRI, or ultrasound interpreted against your symptoms and exam. Degenerative findings are extraordinarily common in people with no pain; the finding matters only if it explains your pain.
03 — Virtual MSK Movement Assessment
Our proprietary, wearable-free assessment measures how the joint actually functions in motion — objective data on range, control, and compensation that a static image cannot show, and a baseline to track real improvement.
04 — Diagnostic injections
Anesthetizing a specific structure — a joint, a bursa, a tendon sheath — and observing whether your pain resolves confirms the pain generator with precision. If numbing the joint doesn’t relieve the pain, the joint isn’t the problem.
This is the difference between treating a picture and treating a patient. We confirm the source before committing you to a therapeutic procedure.
Precise, non-opioid, physician-performed care
Once we know the source, treatment can be targeted. Every procedure is performed personally by Dr. Joshi, using low-dose imaging, non-opioid sedation when appropriate, and hand-selected medications and products. We do not delegate procedures, and we do not use opioids as a treatment strategy.
Image-Guided Joint Injections
Corticosteroid or anesthetic injections placed under fluoroscopic or ultrasound guidance — into the joint, not near it. Landmark-guided “blind” injections miss their target far more often than most patients realize.
We use image guidance for accuracy, and we use low-dose, pulsed technique to minimize your radiation exposure. Precision is not optional; it’s the difference between a treatment and an experiment.
Bursa & Tendon Sheath Injections
Precisely targeted treatment of subacromial bursitis, trochanteric bursitis, and tendinopathies — placing medication exactly where the pathology lives.
Regenerative Medicine: PRP & Orthobiologics
Platelet-rich plasma and orthobiologic approaches aim to support the body’s own repair of injured tendon, ligament, and cartilage rather than simply suppressing inflammation. For appropriate candidates, this can meaningfully delay or avoid surgery.
This field has filled with franchises, med-spas, and non-physician operators marketing miracle cures. Every regenerative procedure here is performed and overseen by a physician, using quality-controlled biologics, with careful attention to who is — and isn’t — an appropriate candidate. We will tell you honestly when a therapy isn’t right for you.
Genicular Nerve Blocks & Radiofrequency Ablation
For knee osteoarthritis, blocking and then ablating the genicular nerves can substantially reduce pain — including for patients who are not surgical candidates or who wish to postpone replacement.
Sacroiliac Joint Injections & Ablation
Targeted diagnosis and treatment of a joint that is missed more often than almost any other source of pain.
Nerve Blocks for Referred Pain
When shoulder or hip pain originates at the cervical or lumbar nerve root, treating the spine — not the joint — is what resolves it.
Ketamine Infusion Therapy
For joint pain amplified by central sensitization, including persistent pain after joint replacement, ketamine infusions can reduce the nervous system’s amplified response.
Rehabilitation & Movement Retraining
Joints fail under bad mechanics. Our multi-disciplinary team — including chiropractic and musculoskeletal expertise — builds rehabilitation into every plan, because a pain-free joint with unchanged mechanics is a joint that will hurt again.
Hip & Shoulder Nerve Blocks and Ablation
For patients with advanced arthritis who are not surgical candidates, or who wish to postpone replacement, targeted nerve procedures can meaningfully reduce pain and improve function.
Metabolic & Weight Optimization
Reducing joint load and systemic inflammation changes the trajectory of joint disease. Our internal and obesity medicine consultant works directly with patients on weight, GLP-1 therapy, and nutrition.
What We Decline to Do
We do not push patients toward joint replacement, arthroscopy, or implants earlier than the evidence and the patient’s condition warrant. We do not offer regenerative therapy to patients whose arthritis is too advanced to benefit. Turning away a paying patient is the clearest test of whether a practice’s incentives are aligned with the patient’s.
We don't rush to implant
A spinal cord stimulator is a legitimate tool for the right patient at the right time. But it’s an implant, and we treat it as a genuine last resort — not an early default reached for after a couple of quick attempts. First we find the root cause, address it, and rehabilitate it. Only when the better options are truly exhausted do we consider going there.
The same procedure is not the same procedure
Two practices can list the same procedure on a website and deliver profoundly different experiences, risks, and outcomes. Here is what changes when the details are done right.
Performed personally by Dr. Joshi
Never delegated to a technician, resident, or rotating staff. You’re treated by the physician who developed and teaches the technique — and in image-guided procedures, the difference between physicians is measured in millimeters.
Dramatically less radiation
Pulsed, low-dose imaging and a few precisely targeted spot images instead of continuous live X-ray. Based on our own procedural dose data, this reduces radiation exposure by at least 50% — and often far more — versus conventional continuous fluoroscopy, with no compromise in accuracy. For conditions treated repeatedly over years, that difference compounds.
Non-opioid sedation
When sedation is used, we use ketamine-based sedation, not fentanyl. Opioid sedation exposes you to unnecessary opioids, can complicate workplace drug testing, and can actually increase pain sensitivity. Ketamine can do the opposite.
Smaller needles, tissue-sparing lesions
Precision means we don’t need to be destructive to be effective — smaller-gauge needles and lower-temperature, longer-duration ablation that spares the healthy tissue around the target.
We actually numb you first
Thorough local anesthesia of skin and underlying tissue before the procedure begins. It takes an extra minute. We take it.
Independent, and obsessive about quality
Nearly four out of five U.S. physicians now answer to a corporate owner. We’re physician-owned, so our only incentive is your outcome. What a practice refuses to do tells you as much as what it offers.
Joint Pain, answered
Possibly — but far less often, and far less urgently, than many patients are told. There is a great deal that can be done first: precise image-guided injections, genicular nerve procedures, regenerative options for appropriate candidates, and genuine rehabilitation. We do not rush patients toward irreversible procedures.
Because “blind” landmark-guided injections miss the intended target a significant portion of the time. Medication delivered near a joint rather than into it produces a disappointing result that gets blamed on the treatment. We use image guidance — with low-dose, pulsed technique to minimize your radiation exposure.
Sometimes yes, sometimes no — and we’ll tell you which. This space is full of operators selling hope by the vial. We are physician-led early adopters, we’re candid about what the evidence supports today versus what remains emerging, and we decline to treat patients who aren’t appropriate candidates.
This is more common than patients are told. Causes include central sensitization, referred pain from the spine or hip, soft-tissue and tendon problems, or nerve irritation. A technically perfect joint does not guarantee a pain-free one — and it usually means the actual pain generator was never fully identified.
A normal MRI doesn’t mean nothing’s wrong. It may mean the source is a nerve referring pain from the neck, a bursa, or a tendon that images poorly. A careful examination and diagnostic injection will often find what the scan missed.
No. Dr. Joshi has never prescribed OxyContin or oxycodone in more than three decades of practice. Our approach identifies and treats the source of pain rather than suppressing the signal — and even our procedural sedation is non-opioid.
Used judiciously and placed accurately, corticosteroid injections are a valuable tool. Used repeatedly and indiscriminately, they carry real risks to cartilage and tendon. The key is accurate diagnosis, image-guided placement, and appropriate spacing — not a reflexive injection at every visit.
Substantially. Reducing load on a weight-bearing joint and lowering systemic inflammation both influence pain and progression. This is a major reason our team includes a double board-certified obesity medicine physician who consults on weight, GLP-1 therapy, and nutrition.
Night pain is a hallmark of rotator cuff pathology and bursitis, partly because lying down changes the position and pressure within the joint. It is a useful diagnostic clue rather than an inevitability — and it usually responds well to precisely targeted treatment.
Find out what's actually causing your pain.
A precise diagnosis is the beginning of a real solution. Let’s find your pain generator — and treat it.
This page is provided for general educational purposes and does not constitute medical advice, diagnosis, or treatment, nor does it create a physician-patient relationship. Individual results vary, and no specific outcome is promised or guaranteed. Radiation-reduction figures reflect National Pain Centers’ own procedural dose data compared with conventional continuous-fluoroscopy technique. Certain regenerative therapies are considered emerging or investigational and are not FDA-approved for all uses. Always consult a qualified physician regarding your medical condition. If you are experiencing a medical emergency, call 911.