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joint injections

Therapeutic joint injections are a minimally invasive treatment option used to relieve pain caused by inflammatory joint conditions such as rheumatoid arthritis, tendonitis, bursitis and gout. Corticosteroids, used to reduce inflammation and minimize pain as a result, are injected into the affected joint. This medication only affects the targeted area and does not usually cause side effects. Joint injections are administered under local anesthesia and only cause mild, brief discomfort for patients.

 

Join injections can be used in the:

  • Knee

  • Shoulder

  • Ankle

  • Elbow

  • Wrist

  • Thumb

  • Hip

Most patients can benefit from therapeutic joint injections and are good candidates for treatment, unless they have an infection in the joint or an allergy to one or more of the medications to be used.

Trigger point injections

Trigger point injections are a treatment option for pain in areas that contain trigger points, or knots of muscle that form when muscles do not relax. Trigger points may develop after injury or overuse of the affected muscle, or may be caused by stress and anxiety. These points can also irritate the nerves around them and therefore cause pain in other areas of the body. The chronic pain that is brought on by trigger points may result in a decreased range of motion in the affected muscle as well.

A needle containing a local anesthetic, and sometimes a steroid to reduce inflammation, is inserted into the trigger point to make it inactive and therefore alleviate the pain. The procedure typically takes between 15 and 20 minutes and is done in the doctor's office. Multiple sites can receive trigger point injections in one appointment, if necessary.

facet injection

A facet injection is a minimally invasive treatment option for back pain caused by inflamed facet joints. Facet joint pain is often related to spinal stenosis, sciatica or arthritis and is characterized by neck, arm, low back or leg pain. Each vertebra has 4 facet joints that connect it to the vertebra above and below. The injection may also be used as a diagnostic test to determine if facet joint inflammation is the source of a patient's pain.

A facet injection is a combination of a long-lasting steroid and a local anesthetic that are injected either into the joint capsule or its surrounding tissue. The steroid reduces inflammation and can relieve pain for a few days to a few years. This procedure can be repeated up to 3 times a year for those who experienced successful but short-term pain relief.

Discography

A discography, also known as a discogram, is a diagnostic test performed to determine whether back pain is a result of certain spinal disc abnormalities.

The intervertebral discs are spongy pads of cartilage that offer cushioning and allow for flexibility between the vertebrae of the spine. A herniated disc, also called a ruptured or slipped disc, is a common condition that may occur as a result of gradual wear and tear on the disc or from an injury to the spine that cracks or tears the disc and causes it to bulge or break open. This can produce pain, numbness and weakness in the back or legs as the disc presses on the nearby nerve roots. It is important to determine which disc or discs are damaged in order to ensure that the patient will receive the appropriate form of treatment.

A discography test is performed by injecting a special dye into the patient's spinal discs and using imaging technology to view the area in greater detail. Due to its invasive nature, a discography is only considered for patients with persistent back pain that remains unresponsive to treatment. A discography may also be performed on candidates for spinal fusion surgery to identify the damaged discs that will need to be removed during surgery.

spinal cord stimulator

A spinal cord stimulator is an electronic device that is implanted in the body to help relieve chronic pain. Also known as a dorsal column stimulator, the device sends low electrical currents through wires placed near the spinal cord to treat pain. It allows patients to control when pain relief is needed or not.

The device does not cure chronic pain, but usually provides a 50% or greater decrease in pain and allows patients to be more active and have less of a need for pain medication. This procedure is usually considered when other solutions, such as surgery, injections and medications, have failed. Before implantation, patients will often be asked to go through a trial period with an external device. The trial will test patients' pain levels and see if they increase with the help of the device.

During the implantation of the permanent device, wires are fed with a needle and positioned on the spinal cord. The actual device is placed dependent on where the pain is. The device can be removed if necessary. The battery of the device must be replaced every 2 to 5 years. Complications rarely occur as the procedure is very safe and minimally invasive. Proper care following the procedure is required and includes limiting movement and avoiding driving for the first few weeks.

Radiofrequency rhizotomy

Radiofrequency ablation (RFA), also called radiofrequency neurotomy is a procedure that involves heating a part of a pain-transmitting nerve with a radiofrequency needle to create a heat lesion. This resulting lesion prevents the nerve from sending pain signals to the brain. RFA treatment typically provides longer-lasting pain relief compared to other therapeutic injections. RFA is considered for treating facet joint pain in the cervical, thoracic, or lumbar spine; or for sacroiliac joint pain in the posterior pelvis.

Once the RFA lesion is created, the pain-transmitting ability of the nerve fibers is lost and pain signals from the source (facet or sacroiliac joint) do not reach the brain. The effects of RFA may last for a few months to years, after which the nerve usually regenerates, and the pain may or may not return.

 

Success usually depends on the accuracy of diagnosis, variations in the anatomy of the nerve, and the type of technique used. Pain-relief typically lasts from 6 months to 2 years, although some studies have reported relief for up to 3 years.

 

A common side effect of radiofrequency rhizotomy is that in the first few weeks or days, a sunburn type burning and or numbness may be felt over the injection site, typically for RFA performed in the neck. Resting, using an ice-pack, and using topical or oral medications may help relieve the discomfort. Risks, although rare, may involve infection, adjacent nerve damage, injury to blood vessels, and/or abnormal sensations in the skin over the treatment site.

peripheral nerve block

A nerve block is a procedure used to treat or diagnose severe pain. The block is placed by injecting an anesthetic into the affected nerve to either numb the pain or determine if the pain is coming from the nerve. If the pain is relieved when the block is injected, it can be assumed that the pain is caused by the nerve. After a diagnostic nerve block, the procedure may be repeated as a more long-term treatment method.

Nerve blocks are placed with the help of ultrasound imaging, and injected directly into the affected nerve. Pain outside the spinal area is diagnosed with a peripheral nerve block, which may be inserted in the occipital nerves in the cervical area, the ilioinguinal nerve in the pelvic area or other motor nerves. Nerve blocks are not an option for all patients and can cause serious side effects.

Selective Nerve Blocks

A nerve block is a treatment used to both treat and diagnose severe pain. The block is placed by injecting a substance like alcohol or phenol into or around the nerve to numb it and interrupt the pain signals sent to the brain.

A therapeutic nerve block is used to treat pain and often contains a local anesthetic that will relieve pain. Nerve blocks used to treat chronic pain can work for up to 6-12 months and can be repeated as needed. They can be helpful to cancer patients. Diagnostic nerve blocks insert an anesthetic for a certain amount of time to determine the source of the pain.

However, nerve blocks can cause serious side effects such as paralysis and damage to arteries. They can also cause low blood pressure, puncturing of the lung or damage to the kidney. Some newer blocks use extreme heat or cold instead of a chemical to prevent some of these side effects. Nerve blocks are sometimes used to avoid surgical procedures, but are not always the answer.

sympathetic nerve blocks

A sympathetic nerve block involves the injection of a medication to numb a nerve and interrupt the pain signals it sends to the brain. It is used to both diagnose damage and treat pain caused by the sympathetic nerves, which run throughout the spine. The sympathetic nerves are responsible for essential bodily functions, including the regulation of blood vessels, heart rate, perspiration and more.

A therapeutic nerve block is used to treat pain and typically contains a local anesthetic that will relieve pain. Nerve blocks used to treat chronic pain can work for up to 6 to 12 months and can be repeated as needed. Diagnostic nerve blocks insert an anesthetic for a certain amount of time to determine the source of the pain.

 

Sympathetic nerve blocks can be performed along several areas of the spine. A Stellate block focuses on the sympathetic nerves in the upper spine, including those that run to the chest, arms, neck and head. A  Lumbar sympathetic nerve block targets the sympathetic nerves of the lower spine that affect the legs and feet. A nerve block of the Thoracic region involves the sympathetic nerves in the middle of the spine that reach the abdomen.

sympathetic ganglion block

A sympathetic ganglion block is a type of nerve block used in the treatment of severe or chronic pain. It involves the injection of an anesthetic medication that will numb the affected bundle of nerves, which is known as a ganglion. These nerves branch out to provide sensation to a particular part of the body and if they are damaged or compressed in any way, they can produce significant pain and other symptoms.

The stellate ganglion is part of the sympathetic nerve chain. It runs through a portion of the upper body, including parts of the head, neck, arms and chest area. Damage to the ganglion nerves can result in pain in one or more of these regions. A sympathetic ganglion block involves the injection of a medication to numb the nerve and interrupt the pain signals it sends to the brain. It can be used in a diagnostic capacity in order to determine whether the source of the discomfort is due to damage to the ganglion nerves as well as to effectively treat pain.

transforaminal epidural steroid injection

A transforaminal injection is a long acting steroid delivered into a nerve root exit in the spine known as a foramen. The injection helps to reduce inflammation and swelling in the spinal cord nerve roots and relieves pain and numbness. A transforaminal injection consists of a small dosage of steroid medication mixed with saline and local anesthesia. The anesthesia numbs the area so the injection often feels like just pinching and pressure.

Immediate pain relief is found because of the injection of anesthesia, but this wears off quickly. Effective relief is usually noticeable by the third day after the injection and can last for several months. This treatment is most successful for patients with pain that radiates through the arms or legs rather than just back or neck pain.

interlaminar Epidural steroid injections

Epidural steroid injections, or ESIs, are a minimally invasive treatment that has been used for decades to temporarily relieve low back and leg pain (sciatica). They have been shown to be effective for pain in the neck (cervical) and mid-spine (thoracic) as well. While they do not treat serious underlying spinal conditions, ESIs are often effective in relieving the chronic pain these conditions often cause.

Comprised of cortisone and a local anesthetic or saline solution, ESIs work by reducing inflammation and flushing out particles that cause swelling and pain. Medication is delivered directly to the source of the pain rather than dispersing it throughout the body, as oral painkillers and steroids do. They are injected into the epidural space, the area between the dura (a membrane covering the brain and spinal cord) and the actual cord itself.

CANDIDATES

Epidural steroid injections can be used to relieve pain within the lower back, arms, legs and neck, which may be caused by conditions such as:

  • Lumbar disc herniation

  • Degenerative disc disease

  • Lumbar spinal stenosis

  • Vertebral compression fractures

  • Facet joint or nerve root cysts

  • Annular tear

Epidural steroid injections can be used alone to provide pain relief or given as part of a rehabilitation program to help the patient perform his/her exercises with less discomfort. Relief from a single injection typically lasts from one week up to one year. These injections can also be of diagnostic value to determine the cause and severity of pain and develop an appropriate treatment plan.

epidural blood patch

An epidural blood patch is an injection of your own blood into the epidural space, which surrounds the spinal cord. It is done for patients experiencing severe headaches after receiving a spinal injection. These headaches occur as a result of spinal fluid leaking into the epidural space. An epidural blood patch stops the leak, making the headache go away.

PROCEDURE

An epidural blood patch only requires local anesthetic, although sedation is an option for anxious patients. During the procedure, you will be lying down on your stomach. The skin on your back, as well as the skin surrounding one of your veins, is cleaned with an antiseptic solution. Then, a small intravenous catheter is inserted into your vein. Once the needle has been properly positioned over the epidural space, your doctor will draw about 20-25cc of blood from your vein and inject it into the epidural space. While an epidural blood patch only takes a few minutes to perform, you will remain at our office for about an hour and a half; this includes consulting with your doctor before the procedure and recovery room observation afterwards.

medial branch blocks

A medial branch block is a minimally-invasive procedure to diagnose and treat neck or back pain. This procedure can determine whether a facet joint-which connects the bones of your spine, providing support as you move-is the source of your pain. Next to the facet joints are the medial branch nerves, which transmit pain signals from these joints to your brain.

Before undergoing a medial branch block, you will be given intravenous medication to help you relax. With the assistance of imaging technologies, a small needle will be inserted near your medial branch nerve. Once it is situated properly, an anesthetic will be injected through it.

The effectiveness of a medial branch block varies depending on your individual condition. Patients whose pain returns after a short period of time may require a different form of treatment if it is confirmed that the facet joint is not the source of the pain.

Vertiflex

We offer cutting edge care the Vertiflex Procedure for the treatment of moderate lumbar spinal stenosis. The Vertiflex Procedure uses a small implant (the Superion® Indirect Decompression System) that is placed inside the spine to help prevent reduction of the space when standing or walking. This provides relief by lifting pressure off the nerves to alleviate leg and back pain symptoms that often accompany the condition. Developed with patient safety and comfort in mind, this FDA-approved, outpatient treatment aims to give those with lumbar spinal stenosis the freedom to get on with their daily lives, as it offers a significant reduction in symptoms and improves physical function.The Vertiflex is a minimally invasive stand-alone interspinous process decompression (IPD) procedure. IPD involves implanting a device (or spacer), such as the Superion®, between the spinous processes, which are the thin, bony projections on the back of the spine.

The Superion® device is made of titanium alloy.Once the Superion® device is implanted it creates more space for your spinal cord and nerves in your spinal column without removing any bone (as in a traditional laminectomy) and with less trauma to your muscles and ligaments.The other added benefits are that it helps to preserve some spinal motion (unlike spinal fusion that permanently limits movement), there is less blood loss, and there is reduced risk for infection.

MILD

MILD® is an early treatment option to consider when conservative therapies (e.g., physical therapy, pain medication, chiropractic) are not providing adequate relief. The mild® Procedure addresses a major root cause of LSS by removing excess ligament tissue to restore space in the spinal canal. The mild® Procedure typically takes less than an hour and can be performed through a single, tiny incision smaller than the size of a baby aspirin (5.1 mm).

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