Injections

EPIDURAL INJECTION SERIES

Epidural injections are done for many common pain problems. Given in the neck and the thoracic spine as well as the lumbar spine, there are multiple kinds of epidural injections. The primary epidural injection used in pain management is the epidural transforaminal injection, otherwise called “selective nerve root injection”, “midline epidural injection” or “translaminar injection”. These injections are historically done in a series of three.

This practice has been called into question by studies as well as insurance payers. Epidural injections currently are completed with a subsequent evaluation to determine if significant benefit was achieved. If significant benefit was achieved, the injection may be repeated. Alternately, an injection may be done at a different level or a different type of epidural may provide greater benefit. Epidural injections are typically done at least 2 weeks apart and contain some kind of steroid with or without a local anesthetic. The most common steroid utilized would be Dexamethasone (DecadronⓇ).

FACET INJECTIONS / MEDIAL BRANCH BLOCK

Facet injection refers to an injection of local anesthetic plus steroid into the joint area involving the neck, thoracic spine or lumbar spine. These injections are sometimes beneficial when someone has had an injury involving such body parts. Facet injections are typically not repeated multiple times. Medial branch blocks are a specific grouping of the nerves of the cervical, thoracic or the lumbar nerves. This branch of nerves is associated with the facet joint, also known as the zygapophyseal joint. Medial branch blocks are a test to determine if one is a candidate for radiofrequency ablation of the medial branch and subsequent long-term pain relief of 6 months to 2 years. Most insurance companies require patients to undergo two separate medial branch blocks to qualify for radiofrequency ablation.

Joint Injections

Joint injections usually involve most of the joints in the human body. In some cases, these are performed under x-ray guidance; typically, the hip joint injection. Joint injections can be performed under ultrasound guidance or x-ray guidance; typical for the knees, shoulders, ankles, and elbows. Injections are normally received every 3-4 months and typically contain a local anesthetic and a steroid, such as triamcinolone. Knee injections can also be done with one of multiple hyaluronic acid base injections. These go by many names, including: Supartz, Orthovisc, Monovisc, Gelsyn and many others. These injections are done in a series for degenerative joint disease or arthritis of the knee.

SI Joint Injections

Sacrioliac (SI) pain is a common cause of low back pain. It is difficult to differentiate from hip pain as well as L5 nerve root pain. SI injections can be beneficial to help diagnostically determine whether pain is originating from the SI joint. These joint injections should be done under x-ray guidance to assure adequate placement of the medication. SI pain is more common in female patients than male patients.

Trigger Point Injections

Trigger point injections are done to break muscle spasms. They are typically done with a very small needle; 30-gauge or 27-gauge with a local anesthetic injected into the muscle. The goal of trigger point injections is to break acute muscle spasms so the patient can complete stretching exercises and physical therapy or chiropractic therapy to improve function of the muscular group. Trigger point injections are not a long-term treatment but simply a modality to break muscle spasms.

Bursa Injections

The human body contains many bursas. The most common bursa requiring injections is the greater trochanteric bursa. The greater trochanter is part of the hip-joint complex. Often times, patients develop trochanteric bursitis secondary to abnormal gait. Trochanteric bursa injections can be done with or without ultrasound and or x-ray guidance. Typically, the medication injected is a local anesthetic plus steroid. Usually, part of an overall plan to rehabilitate the affected body part is utilizing exercises or chiropractic therapy.

Transforaminal epidural injection

Transforaminal epidural injection is an epidural steroid injection that is done through the nerve root opening in the cervical, thoracic, or lumbar spine. These injections are frequently used for problems such as sciatica or cervical, thoracic, or lumbar radiculopathy. Such epidural injections are frequently used when the nerve is being impinged where it leads to the spine through the foramina. The medication injected in a transforaminal epidural is typically dexamethasone with or without a local anesthetic.

Transforaminal epidurals, like other epidural injections, are evaluated subsequent to the procedure being done for significant pain benefit. For instance, if someone does not benefit from a right L5 transforaminal injection, this might be repeated. However, if they do not benefit, the most appropriate treatment might be a right L4 transforaminal to inject a different nerve. Transforaminal injections are very location specific.