Services

What is it?

Facet injections are injections of medications into the actual facet joints. Facet joints are located between each set of vertebrae in the spine from the neck to the tailbone. Facet joints allow each vertebra to move against the vertebra just above and just below it. There are many other technical names for facet joints.

 

What is the purpose?

Facet injections are used to reduce the inflammation and swelling of tissue in and around the facet joint space. This may in turn reduce pain and other symptoms caused by inflammation or irritation of the facet joint and surrounding structures. Usually, we think of facet joint pain as primarily spine pain, though in some patients there can also be referred pain into the surrounding tissues and even into arms or legs.

 

How will it affect my daily life?

All patients will need a ride home. We advise patients to take it easy for a day or so after the procedure. You may want to apply ice to the injection sites to keep it from getting sore the following day. Otherwise, you should be able to perform the activities that you could do before the facet injections and possibly more. We do not advise that you test the limits right away, but rather build up over time. Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness or aching at the injection sites.

 

What can I expect?

The actual injections take only about 10 to 20 minutes. The procedure involves inserting a needle through the skin and deeper tissues. So, there is some pain involved but this procedure is generally well tolerated by patients.

 

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure, there are risks, side effects, and the possibility of complications. The most common side effect is pain; which is temporary. The other risks involve, infection, bleeding, worsening of symptoms, spinal block, Epidural block, etc. The other risks are related to the side effects of cortisone: These include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of the body’s own natural production of cortisone, etc. Fortunately, the serious side effects and complications are uncommon.

 

What is it?

Medial Branch Blocks are diagnostic procedures to determine the source of your back pain. Medial Branch Nerves come from the spinal cord and innervate the zygapophyseal joints. If numbing this nerve relieves pain, an appropriate treatment plan can be made. After successful Medial Branch Blocks, the next step would be to perform a Radiofrequency Ablation, which cauterizes the Medial Branch Nerves and provides longer lasting relief. Of note, most insurances require 2 MBBs for approval of radiofrequency ablation.

 

How will it affect my daily life?

For this injection, you will need a driver from the procedure if oral sedation is used. Activity after the injection is as tolerated.

 

What can I expect?

The desired effect is short-term (a couple of days) pain relief of around 80%.

 

What are the risks and side effects?

Complications may include bleeding, infection, pain at the site of injection, redness/irritation at the site of injection, or allergic reaction. A complete list of risks and complications will be provided before any procedure.

 

What is it?

The joints in your body, particularly your knees, hips, and shoulders, can become irritated and inflamed for a variety of reasons. Injecting a numbing medicine and steroid into the joint can decrease inflammation.

 

What is the purpose?

The medication injected, usually a steroid, is meant to reduce the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation or irritation of the joint and surrounding structures.

 

How will it affect my daily life?

You will need a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you. Unless there are complications, you should be able to return to work the next day. The most common thing you may feel is a sore joint.

 

What can I expect?

The actual injection takes only a few minutes. The procedure involves inserting a needle through the skin and deeper tissues. So, there is some pain involved. However, we sometimes numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the needle into the joint.

 

You may experience a post-injection flare of pain which usually resides within a few days. Relief from the injection can last up to 6 months or longer. Generally, up to 3-4 injections in a single joint should be performed in a year.

 

In a six to twelve-month period, we generally prefer not to perform more than three injections. This is because the medication injected is meant to last for several weeks to several months. If three injections have not helped you much, it is very unlikely that you will get any further benefit from an increasing number of injections. Also, giving more injections will increase the likelihood of side effects from the steroids. If the injections are not working, stronger consideration may need to be given to orthopedic surgery.

 

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure, there are risks, side effects, and the possibility of complications. The most common side effect is pain – which is temporary. The other risks involve, infection, bleeding, worsening of symptoms, etc. The other risks are related to the side effects of steroids: These include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of the body’s own natural production of cortisone, etc. Fortunately, the serious side effects and complications are uncommon.

 

What is it?

The piriformis muscle is present in the buttocks, connecting the sacrum to the outer surface of the hip. This muscle enables us to walk and run. The sciatic nerve is a thick, long nerve passing through or below the piriformis muscle. A spasm in or inflammation of the piriformis muscle can compress the sciatic nerve resulting in severe pain in the low back or gluteal area and often radiate into the leg (eg “sciatica” or “piriformis syndrome”).

 

What is the purpose?

The medication injected, typically a local anesthetic and steroid is meant to break up a reduced inflammation in the muscle and associated sciatic nerve. This may in turn reduce pain, and other symptoms caused by tight muscles and inflammation around the nerve causing pain. It is important to understand that a piriformis injection alone is not a treatment for piriformis syndrome, it allows you to participate in exercises and stretching which will ultimately be the cure for your pain.

 

How will it affect my daily life?

You will need a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you. Unless there are complications, you should be able to return to work the next day. The most common thing you may feel is a sore joint.

 

What can I expect?

The actual injection takes only a few minutes. The procedure involves inserting a needle through the skin and deeper tissues. So, there is some pain involved. However, a very thin needle is used and the pain is usually minimal and well-tolerated by the patient. Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. If the patient adheres to stretching and exercise recommendations the lasting effects of the injection may be indefinite. Following the procedure, you may experience nausea, sweating, and/or dizziness. You may also develop weakness or numbness in the leg for a few hours or up to one day. You may also notice a slight swelling, redness, bruising, and tenderness at the injection site, which may subside within a short period of time. Once the physician has confirmed that you are stable, you will be discharged to go home.

 

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure, there are risks, side effects, and the possibility of complications. The most common side effect is pain – which is temporary. The other risks involve, infection, bleeding, worsening of symptoms, etc. Further potential complications are associated with the steroid medication itself to include but not limited to elevated blood sugar for up to 4 days (if you are diabetic), kidney damage or failure (rare), Cushing’s syndrome, or allergic reaction to the medication. Fortunately, the serious side effects and complications are uncommon.

What is it?

Radiofrequency ablation is a procedure using radio waves or electric current to generate sufficient heat to interrupt nerve conduction on a semi-permanent basis. The nerves are usually blocked for 6-9 months, although it may last as short as 3 months or as long as 18 months or longer. Radiofrequency ablation disrupts nerve conduction, specifically interrupting the conduction of pain signals. In turn, this may reduce pain and other related symptoms.

 

How will it affect my daily life?

Initially, there will be muscle soreness for up to a week afterward. Ice packs will usually control this discomfort. After that first several days, your pain may be gone or quite less. You should be able to return to work the next day. For some patients, soreness at the injection site or sites may cause you to be off work for several days.

 

What can I expect?

Depending upon the areas to be treated, the procedure can take from twenty minutes to an hour. The procedure involves inserting an introducer needle or needles through the skin and those layers of muscle and soft tissues, so there is some pain involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the introducer needle or needles.

 

This procedure is done under local anesthesia. Some patients also receive intravenous sedation, which makes the procedure easier to tolerate. The amount of sedation given generally depends upon patient tolerance. It is necessary for you to be awake enough to communicate easily with the physician during the procedure. However, some patients receive enough sedation that they have amnesia and cannot always remember parts or all of the actual procedure.

 

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure, there are risks, side effects, and the possibility of complications. The risks and complications are dependent upon the sites that are ablated. Since the introducer needles have to go through the skin and soft tissues, there will usually be some soreness and occasionally bruising. The nerves to be ablated may be near blood vessels or other nerves that can be potentially damaged. Electricity is also used during the procedure raising the possibility of an electrical burn. Great care is taken when placing the radiofrequency needles and using the electrical current, but sometimes complications occur. Fortunately, serious complications or side effects are uncommon.

 

What is it?

A sacroiliac injection is an injection of a steroid or other medication into a sacroiliac joint. The sacroiliac joints are located on either side of the sacrum or tailbone. They connect the tailbone to the pelvis. This injection is used to treat sacroiliac (SI) joint dysfunction which is a common source of pain in the lower back, buttocks, groin, and legs.

 

What is the purpose?

SI joints connect the pelvic bones to the spine. They are small and don’t move much, but they absorb all the forces of the upper body before balancing and transferring the weight to the hips and legs. When one or both of these joints become irritated or injured, they can cause chronic discomfort and pain. The steroid injected reduces the inflammation and swelling of tissue in and around the joint space. This may in turn reduce pain, and other symptoms caused by inflammation or irritation of the joint and surrounding structures.

 

How will it affect my daily life?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness at the injection site. You should have a ride home because the injection could cause some temporary weakness in the legs if the medication spreads to the sciatic nerve in front of the joint. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. You should perform only those activities you can reasonably tolerate.

 

What can I expect?

The actual injection takes about 5 to 10 minutes. You will be given relaxing medicine and pain medicine during the procedure if you desire to help make it more comfortable for you. The amount of sedation given generally depends upon the patient. Sometimes patients receive enough sedation that they may have amnesia and not remember parts or all of the actual procedure. Immediately after the sacroiliac injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will typically last only for a few hours. Your pain may return and you may have soreness at the injection site for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. You should start noticing pain relief starting the 3rd to 5th day or so.

 

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure, there are risks, side effects, and the possibility of complications. The most common side effect is temporary pain at the injection site. Uncommon risks involve infection, bleeding, or worsening of symptoms. The other uncommon risks are related to the side effects of steroids, including weight gain, increase in blood sugar in diabetics, water retention, and suppression of the body’s own natural production of cortisone. Fortunately, the serious side effects and complications are uncommon.

 

What is it?

The stellate ganglion is formed by the inferior cervical ganglion and the first thoracic ganglion and relays sympathetic information as part of the autonomic nervous system. This serves as an unconscious regulator of respiratory and heart rate, digestion, and vascular dilation and constriction, among others.

 

What is the purpose?

Indications for stellate ganglion block include Complex Regional Pain Syndrome (CRPS), postherpetic neuralgia, phantom pain, vascular headaches, Long QT syndrome, or intractable angina.

 

How will it affect my daily life?

For this injection, you may need a driver from the procedure if oral sedation is used. Activity is as tolerated.

 

What can I expect?

This is an outpatient procedure that is well tolerated. You will need a driver from the procedure if you receive oral sedation or if your condition warrants.

 

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure, there are risks, side effects, and the possibility of complications. The most common side effect is pain – which is temporary. The other risks involve, infection, bleeding, worsening of symptoms, etc. The other risks are related to the side effects of steroids: These include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of the body’s own natural production of cortisone, etc. Though uncommon, serious side effects and complications include risk of stroke and internal bleeding (due to the injection site being near vascular structures and the neuroaxis), seizure, and paralysis.

What is it?

Suprascapular nerve blocks are injections of local anesthetic and steroid around the suprascapular nerve in the upper back. Ultrasound guidance is used to ensure proper placement of the anesthetic solution.

 

What is the purpose?

The purpose is to reduce pain in the shoulder caused by adhesive capsulitis, reflex sympathetic dystrophy, or for after shoulder surgery. It is especially helpful to allow a full range of motion when participating in physical therapy.

 

How will it affect my daily life?

This is a simple outpatient procedure that does not require limiting activities.

 

What can I expect?

Some patients experience immediate relief, although it may take a few days for the full effect to take place.

 

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure, there are risks, side effects, and the possibility of complications. The most common side effect is pain – which is temporary. The other risks involve, infection, bleeding, worsening of symptoms, or no relief.