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This study is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [15]

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Injectional Treatment: Scar Tissue/Bone Spurs Injection Technique Technique: Involves gentle needling and sometimes chiseling for bone spurs all guided by ultrasound Goal: to free up the ligament, joint, tendon that may overlap the spur and bring healthy blood flow and O2 to the area to encourage fibroblastic resorpion and prevent reattachment Following injection of scar tissue/bone spur, a second injection (of a proliferant) is used to tighten the ligament or tendon or joint 17