Therapeutic Injection Treatments

Therapeutic Injection Procedures

Regional blocking injection procedures have been utilized for a multitude of painful conditions. These procedures, when combined as diagnostic and therapeutic tools are particularly efficacious in the management and treatment of spinal and peripheral joint disorders. Therapeutic blocking procedures are also very effective for spinal nerve impingement/radiculopathy as well as peripheral (upper extremity and lower extremity nerve entrapment syndromes), i.e., carpal tunnel syndrome, femoral nerve syndrome. The applications of steroids or Sarapin (a natural anti-inflammatory pharmaceutical derived from pitchers plant) near sites of pathology will often open a treatment window where physical therapy, manipulative therapy, and other interventional maneuvers may be directed with increased effectiveness for pain disorders.

Typically, blocking procedures utilizes a combination of a local anesthetic with a steroid/Sarapin. The use of a local anesthetic provides comfort.
This will allow the therapeutic blocking procedures to break up this vicious cycle that is best typified by a hyperactive/inflammatory condition that is causing the pain.

Rationale

Therapeutic Injection procedures are based on the theory that there may be a mechanical, chemical, or auto-immune response in the affected area of pain that will lead to an inflammatory process. Currently corticosteroids are the most potent anti-inflammatory medicines at our disposal. Therapeutic injection procedures will allow the physician to apply the medicine as close as physically possible to the inflammation. This will allow the area of concern to be alleviated from the symptomatology of pain.

Epidural Steroid Injections

Epidural steroid injections have been used for the reduction of inflammation and pain of the cervical, dorsal and lumbar spines. Usually the patient presents with arm or leg pain, numbness and weakness and this is known as radiculopathy or encroachment/impingement of the nerve root. The cervical, dorsal, lumbar, lumbosacral radiculopathy are usually caused by encroachment in the neural canal or spinal canal. The causes of this can be herniated or protruded discs, arthritis causing arthritis of spinal joints or spinal canal. This could also be caused by internal disc disruption where there are no protrusions or herniations but is degenerative in nature thus causing tears in the fibers and allowing the inflammatory substances to escape from the disc onto the nerve causing a chemical radiculopathy.

Epidural steroid injections are done with or without needle guidance techniques where the physician finds the interspace between two vertebrae closest to the
involved nerve root. This technique may be injected either translaminar or by the caudal technique at the sacral coccyx (tailbone) junction. These techniques are done under sterile conditions to avoid possible infections to skin, muscle, epidural space, and disc. The standard of care is usually three injections every two to three weeks for these types of conditions and procedures. Postoperative care will be explained at the time of injection.

Selective Nerve Blocks have the same treatment rationale as the epidural steroid injections of cervical, dorsal and lumbar and sacral spines. The difference is the physician directed the injection site into the foramina where the impinged or inflamed nerve root is involved. This is a more specific diagnostic and treatment procedure. This is usually at the level of disc lesion which is causing the nerve irritation/inflammation.

Facet Joint Blocks

The facet joints of cervical, dorsal and lumbar spines are also known as spinal joints. They are the joints that allow us to move with the discs in the different ranges of motion. These ranges of motion include flexion, extension, lateral bending, and rotation of spinal areas. These joints have capsules that are highly innervated by sensory nerves. These nerves help us with proprioception and movement. The sensory nerve that innervates the facet joint also innervates the disc, posterior ligaments, and the small muscles of the spine. When these sensory nerves get irritated or inflamed, this will cause the so called facet syndrome. This is a type of mechanical pain that usually causes diffuse dull achy referred pain into the extremities. This can mimic a “pinched nerve” in the arms or legs.

The facet joint block is a specific injection directed into the painful joints of the cervical, dorsal, lumbar spine. This could be done either with or without needle guidance by directing the needle into the affected joint. This is usually done with steroids/Sarapin and anesthetic. The standard of care of facet joint blocks (spinal joint blocks) is every two to three weeks. Sometimes after joint blocks if pain recurs or plateaus, the physician will then decide if medial branch blocks of the sensory nerve should be denervated (burned). This can be done either chemically or by radiofrequency. Regenerative injection therapy has also been used to stabilize this type of spinal joint pain.

Joint Injection

Peripheral joint injections (upper extremity/ lower extremity are usually done in the inflamed joint of concern, i e. shoulder, elbow, hip, and knee. Joint pain may be caused by bursitis, tendonitis, or arthritis. These disorders may be acute or chronic in nature. The physician may direct these joint injections with or without needle guidance. Many times musculoskeletal ultrasound will be used for specific needle guidance. The medications used in these are anesthetic and steroids/Sarapin. The standard of care is 1-3 injections within a nine to twelve month period. Small joint injections can also be beneficial wrist elbows, ankles and finger/toe joints.

Myofascial Trigger Point Injections

Myofascial trigger point injections are commonly used for muscular/tendon/ ligamentous pain syndromes. These pain sites are usually focal in nature, where there is exquisite pain upon palpation and the patient’s response is what they call (jump signs). These painful nodules-sites