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Cervical Epidural Steroid Injection

A cervical epidural steroid injection is a treatment method for pain in the neck and the upper region of the back. There are numerous conditions that may cause neck and upper back pain such as cervical radiculitis, a herniated disc, strained muscles, and pinched nerves.

Cervical radiculitis occurs due to excessive pressure that is placed on spinal nerves, especially in the neck region, causing the nerves to become irritated and inflamed. The inflamed nerves extend from the spinal cord into various areas of the body and, because nerves are responsible for pain signal transmission, damaged nerves can result in chronic pain. Patients who have cervical radiculitis typically report experiencing sharp pains that shoot down one of the arms as well as weakness and numbness in the extremities.

How are Cervical Epidural Steroid Injections Performed?

Before the injection procedure begins, topical anesthesia is applied to the skin. Next, in order to prevent healthy nerve roots from being exposed to too much medication, the physician will use imaging technology such as fluoroscopy to guide the insertion of the needle and to confirm its correct placement in the epidural space. In addition, contrast dye is typically injected in order to observe where the medication will be administered and to ensure that it will be properly distributed throughout the targets areas. The administration of steroids and an anesthetic such as Lidocaine directly onto the nerves roots results in dramatic or complete pain relief. The steroid decreases inflammation, while the anesthetic disrupts pain signal transmission.

A cervical epidural steroid injection is a non-surgical, outpatient procedure that can be quickly performed. Patients who receive epidural steroid injections typically experience an immediate decrease in their level of pain or complete pain relief.

What Additional Conditions Can be Treated with Cervical Epidural Steroid Injections?

A herniated disc: This occurs when one of the discs that act as a cushion between spinal vertebrae, ruptures, causing some of the jelly-like substance to leak out, irritating nearby nerves.
Cervical spondylosis: This relates to damage to spinal discs in the neck, as a result of age-related wear and tear.
Cervical radiculopathy: This refers to pain that results from any kind of condition or injury that causes damage to the nerves in the neck.
Cervical spinal stenosis: This is a narrowing of the open spaces in the spine that results in pressure on the spinal cord and nerves, causing symptoms such as pain and numbness.

Cervical Facet Radiofrequency Neurotomy

Radiofrequency neurotomy uses heat generated by radio waves to target specific nerves and temporarily turn off their ability to send pain signals. The procedure is also known as radiofrequency ablation.

Needles inserted through your skin near the painful area deliver the radio waves to the targeted nerves. Your doctor will use imaging scans during radiofrequency neurotomy to make sure the needles are positioned properly. Radiofrequency neurotomy is most commonly used for pain in the back, neck and buttocks (sacroiliac joint). It may also be helpful for long-term knee or hip joint pain.

Why It's Done?

Radiofrequency neurotomy is usually done by a doctor who specializes in treating pain. The goal is to reduce chronic back, neck, hip or knee pain that hasn’t improved with medications or physical therapy, or when surgery isn’t an option. For example, your doctor may suggest the procedure if you have back pain that:

  • Occurs on one or both sides of your lower back
  • Spreads to the buttocks and thighs (but not below the knee)
  • Feels worse if you twist or lift something
  • Feels better when you’re lying down
How is Cervical Facet Radiofrequency Neurotomy Performed?

Radiofrequency neurotomy is an outpatient procedure, so you’ll go home later that same day. The doctor will the use a special X-ray machine (fluoroscope) to guide the radiofrequency needles to the precise area — so only the targeted nerve tissue will be treated. During a radiofrequency neurotomy procedure, the heat comes from a small electrical current that travels through a needle that has been inserted next to these small nerves. The heat is directed at the nerve that is causing the pain, so that nearby healthy nerves are not damaged during the procedure.

What Conditions are Treated With A Radiofrequency Neurotomy Procedure?

The radiofrequency neurotomy procedure can help patients who suffer from:

  • Osteoarthritis, a chronic condition of the joints in which the cartilage, the smooth material between the joints, wears away;
  • Spine conditions that are a result of a traumatic injury, such as a car accident in which the spine is injured.
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Electromyography (EMG)

Electromyography (EMG) is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons). EMG results can reveal nerve dysfunction, muscle dysfunction or problems with nerve-to-muscle signal transmission.

Motor neurons transmit electrical signals that cause muscles to contract. An EMG uses tiny devices called electrodes to translate these signals into graphs, sounds or numerical values that are then interpreted by a specialist.

During a needle EMG, a needle electrode inserted directly into a muscle records the electrical activity in that muscle. A nerve conduction study, another part of an EMG, uses electrode stickers applied to the skin (surface electrodes) to measure the speed and strength of signals traveling between two or more points.

Why is Electromyography Performed?

Your doctor may order an EMG if you have signs or symptoms that may indicate a nerve or muscle disorder. Such symptoms may include:

  • Tingling
  • Numbness
  • Muscle weakness
  • Muscle pain or cramping
  • Certain types of limb pain

The results of an EMG can help your doctor determine the underlying cause of these symptoms. Possible causes could include:

  • muscle disorders, such as muscular dystrophy
  • disorders that affect the ability of the motor neuron to send electrical signals to the muscle, such as myasthenia gravis
  • radiculopathies
  • peripheral nerve disorders that affect the nerves outside the spinal cord, such as carpal tunnel syndrome
  • nerve disorders, such as amyotrophic lateral sclerosis (ALS)
What Happens During an Electromyography?

There are two components to an EMG test: the nerve conduction study and needle EMG. The nerve conduction study is the first part of the procedure. It involves placing small sensors called surface electrodes on the skin to assess the ability of the motor neurons to send electrical signals. The second part of the EMG procedure, known as needle EMG, also uses sensors to evaluate electrical signals. The sensors are called needle electrodes, and they’re directly inserted into muscle tissue to evaluate muscle activity when at rest and when contracted.

The nerve conduction study is performed first. During this portion of the procedure, your doctor will apply several electrodes to the surface of your skin, usually in the area where you’re experiencing symptoms. These electrodes will evaluate how well your motor neurons communicate with your muscles. Once the test is complete, the electrodes are removed from the skin. After the nerve conduction study, your doctor will perform the needle EMG. Your doctor will first clean the affected area with an antiseptic. Then, they will use a needle to insert electrodes into your muscle tissue. You may feel slight discomfort or pain while the needle is being inserted.

The needle electrodes will evaluate the electrical activity of your muscles when contracted and when at rest. These electrodes will be removed after the test is over. During both parts of the EMG procedure, the electrodes will deliver tiny electrical signals to your nerves. A computer will translate these signals into graphs or numerical values that can be interpreted by your doctor. The entire procedure should take between 30 and 60 minutes.

Facet Joint Injections

The facet joints are found in the spine, where they connect the backbones to each other. They allow the spine to bend and twist. Like a knee or hip, facet joints have cartilage between the bones and a fluid-filled capsule to allow for smooth movement. When damaged, facet joints can cause debilitating pain in the neck or back. This condition is known as Facet Syndrome. It may occur due to an injury, overuse, or the onset of an inflammatory condition.

Facet joint injections deliver pain-relieving medication (anesthetic and/or steroids) to the spine. Facet joint injections focus on the joints that connect and articulate the vertebrae. The needle may penetrate the facet joint itself, or it may penetrate a medial nerve branch that routes nerve signals from a particular facet joint.

When is a Facet Joint Injection Done?

A facet joint injection is performed to treat neck and back pain in combination with other non-surgical spine treatments like rest, medications, chiropractic manipulations, and physical therapy. It is one of two types of injections that treat pain arising from the joints of the spine:

  • Facet joint injections – place medication directly into the joint.
  • Medial branch blocks (MBBs) – stop the transmission of pain signals by targeting the nerves along the facet joint.
How Often Should a Facet Joint Injection be Done?

This treatment does not offer permanent pain relief. Patients may have one or two repeat injections over a six-month period. It is not recommended that a patient receive more than three injections in this time frame.

How is a Facet Joint Injection Done?

In order to guide the injection to the facet joint, your pain specialist will use fluoroscopic (X-ray) guidance during the injection. This will allow the physician to see the joint and ensure that the needle is in place before injecting the anesthetic-cortisone mixture. The procedure takes between 5-15 minutes. Thanks to the anesthetic used, the injection can provide immediate pain relief.

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Fluoroscopic Guided Hip Injection

Fluoroscopic Guided Hip Injection is non-operative, outpatient procedure that is designed to provide relief for patients with arthritis of the hip joint. The technique allows the physician to inject numbing and anti-inflammatory medications with maximum accuracy.

The physician swabs the front of the hip and injects a numbing medication. A special X-ray device called a fluoroscope is positioned over the hip. To make sure the medicine injection is in the hip joint, the physician first uses an injection of dye. The dye shows up on the fluoroscope image. If the dye pools in the soft tissue at the front of the hip joint, the physician adjusts the needle placement.

When the dye reaches the target area – the space inside the joint – the physician is ready to inject the medication. The rear of the syringe is removed from the needle and a syringe filled with medication is attached. The physician injects the medication into the joint.

How is It Done?

When you are in the procedure room, you will be asked to lie on your back on a cushioned x-ray table. A fluoroscope (x-ray machine) assists the provider in visualizing the hip. After visualization of the joint under x-ray, a small needle is placed into the skin, and positioned into the joint space. A small amount of a solution of local anesthetic (numbing medication) and a small amount of x-ray contrast is used to confirm placement into the joint. Once confirmed a cortisone derivative (anti-inflammatory medication) is injected into the joint. A small band aid is applied after the procedure is completed.

How Long Does It Take?

Hip joint injections are safely performed on an outpatient basis. The procedure typically requires 20 minutes, including preparation time, and is followed by a short period of observed recovery time.

What are The Expected Results?

As a proven alternative to surgery, hip joint injections successfully reduce pain for patients. Following the procedure, however, you may have soreness for one to two days. It’s recommended that you take it easy the day of the procedure, but return to your usual activities the following day. You can expect immediate relief minutes after the procedure and prolonged relief from the corticosteroid medicine.

HYALGAN® Injection for Knee Pain

Hyalgan is regarded as treatment therapy, not drug therapy. The U.S. FDA approved Hyalgan for use in patient’s with knee osteoarthritis. The treatment is indicated for those patients who have failed to achieve pain remission with other non-drug treatments and simple analgesics.

A common treatment is Hyalgan injections. In this process, Hyalgan gel is injected into the knee joint, bonding with the natural synovial fluid found in the body. This gel increases cushioning and lubrication of the knee, thus mending the knee and diminishing pain, inflammation, and swelling afflicting the area.

How Soon Will I Get Pain Relief With HYALGAN®?

Each patient’s response to HYALGAN® may vary, depending on severity of your OA, degree of pain, and pre-existing medical conditions. In some patients, successful treatment may reduce pain within the first week after treatment begins. However, based upon clinical trials, most patients experienced pain relief after their third injection of HYALGAN®.

How Long Will Pain Relief From HYALGAN® Treatment Last?

Five injections given at weekly intervals can provide most patients with long-lasting pain relief for up to 6 months. The duration of pain relief you experience may vary.

Will Treatment With HYALGAN® Be All That I Need To Relieve Osteoarthritis Knee Pain?

Everybody responds differently to pain. For some people, HYALGAN® may provide all the osteoarthritis knee pain relief that’s needed. Other people may get the greatest pain relief by adding HYALGAN® injections to the nonprescription or prescription medicines they’re already taking.