Epidural

What is an epidural steroid injection?
An epidural injection places anti-inflammatory medicine into the epidural space in your spine to decrease inflammation of the nerve roots, hopefully reducing the pain in the back or legs. The epidural injection may help the injured nerve roots heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing.

What is the epidural space?
The membrane that covers the spinal cord and nerve roots in the spine is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to the back and into the legs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from spinal stenosis (due to arthritis). The medication can be placed into the main epidural space (called an interlaminar injection) or into the space surrounding a specific nerve root (called a transforaminal or selective nerve root injection).

How is the procedure done?
The patient lies flat on an x-ray table on his/her stomach. Before the injection, the skin is numbed with lidocaine (a “local” anesthetic). Using fluoroscopy (live x-ray) for guidance, the physician directs a needle toward the epidural space. The physician uses a small amount of contrast (dye) to verify that the needle is in the correct position and then injects a long acting pain medication and the steroid. An epidural steroid injection usually takes between 25 and 30 minutes. The patient will be observed for approximately 30 minutes after the procedure.

What should you expect during the procedure?
Most often, the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure. You may have some cramping or pressure as the medications are injected.

What should you expect after the procedure?
Most patients feel improvement in his/her pain immediately after the injection due to the anesthetic, which may only last for 8-12 hours after the procedure, and then the pain may return. The steroid takes 2-3 days to start to have an effect in most people and peaks in about 2 weeks. Therefore, it may be a while before the patient feels a change in his/her pain. Some local tenderness may be experienced for a couple of days after the injection. Using an ice pack 3-4 time a day with helps with the tenderness.

We recommend no heavy lifting (more than 10 pounds) or exercise, no prolonged standing or walking (more than 20 minutes), and decreased stair climbing and bending for 3 days after the procedure. This will help your back relax as the steroids are working to decrease the inflammation in your back. No heat is to be used in the injected area for the remainder of the day. No tub bath or soaking in water (i.e. pool, jacuzzi, etc.) for 24 hours.

Joint Aspiration

What is a joint aspiration?
A joint aspiration, or arthrocentesis, is a procedure whereby a sterile needle and syringe are used to drain fluid from the joint.

What is the purpose of joint aspiration?
Joint aspiration is used to obtain fluid for examination in the laboratory. Analysis of joint fluid can help determine causes of joint swelling or arthritis, such as infection, gout and rheumatoid disease. Joint fluid can also be cultured for infection.

How is the procedure done?
The patient will be asked to lie flat on an x-ray table, either on his/her back. The skin over the joint is cleansed with antiseptic soap. The skin is then numbed with lidocaine (a “local” anesthetic). Using fluoroscopy (live x-ray) for guidance, the physician directs a needle toward the joint space. The physician will try to aspirate fluid from the joint using a syringe. If fluid cannot be obtained, then some sterile saline (salt water) will be injected into the joint to try to “wash out” any infection. A small amount of contrast (dye) will be injected into the joint to verify that the needle is in the correct position. A joint aspiration usually takes between 10 an 20 minutes. The patient will be observed for about 20 minutes after the procedure.

What should you expect during the procedure?
Most often, the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure. You may feel some cramping or pressure in the area as the fluid is aspirated or saline is injected.

Joint Injection

What is a joint injection?
A joint injection is the administration of a corticosteroid and anesthetic (numbing medication) directly into the joint. There are many joints throughout the body that can be injected. This procedure may reduce inflammation, resulting in long-term pain relief and provides valuable information about the source of your pain.

What are the types of joints injected?
Shoulder and hip joints are the most common joints in the body to be injected. We can also inject the ankle, wrist and elbow joints. These joints are usually inflamed due to overuse, injuries or arthritic changes.

Facet joints are small joints located on the back (posterior) of the spine on each side of the vertebrae where it overlaps the neighboring vertebrae. The facet joints provide stability and give the spine the ability to bend and twist. If these joints have changes due to trauma or arthritis, they may cause pain in the low back.

How is the procedure done?
The patient will be asked to lie flat on an x-ray table, either on his/her back or front (depending on the joint to be injected). The skin over the joint is cleansed with antiseptic soap. The skin is then numbed with lidocaine (a “local” anesthetic). Using fluoroscopy (live x-ray) for guidance, the physician directs a needle toward the joint space. The physician uses a small amount of contrast (dye) to verify that the needle is in the correct position, and then injects lidocaine and the steroid. A joint injection usually takes between 20 and 40 minutes. The patient will be observed for approximately 20-25 minutes after the procedure.

What should you expect during the procedure?
Most often, the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure. You may feel some cramping or pressure in the area as the medications are injected.

What should you expect after the procedure?
Most patients feel improvement in their pain immediately after the injection due to the anesthetic, which may only last for 8-12 hours after the procedure,then the pain may return. The steroid takes 2-3 days to start to have an effect in most people and peaks in about 2 weeks. Therefore, it may be awhile before the patient feels a change in his/her pain. Some local tenderness many be experienced for a couple of days after the injection. Using an ice pack 3-4 times a day helps with the tenderness.

We recommend no heavy lifting (more than 10 pounds) or exercise, no prolonged standing or walking (more than 20 minutes), and decreased stair climbing and bending for 3 days after the procedure. This will help your joint relax as the steroids are working to decrease the inflammation. No heat is to be used in the injected area for the remainder of the day. No tub bath or soaking in water (i.e. pool, jacuzzi, etc.) for 24 hours.

Requirements for Epidural Injections

  • Patient must have an MRI of the lumbar spine within one year of injection.   We must have MRI images prior to injection.
  • MRI and injection may be scheduled the same day.
  • Plain films are also recommended.
  • If on Coumadin or blood thinners, stop 5 days prior to injection. Patients may resume Coumadin or blood thinners the day after the injection.
  • Patients can continue taking aspirin.
  • Patients receiving epidural injections must have a driver.
  • Three days of rest is recommended after the injection, injections are less effective otherwise.
  • Patients may receive up to 4 injections per year, allow at least 2 weeks between injections.

Requirements for Joint Injection

Recent plain film (within a year)
If on Coumadin or blood thinners, stop 5 days prior to injection. Patients may resume Coumadin or blood thinners the same day after injection.
Patients can continue taking asprin.
Three days of rest recommended after the injection, injections are less effective otherwise.
Patients may receive up to 4 injections per year, allow at least 2 weeks between injections.