SOLUTIONS TO PAIN

At Advanced Pain Centers of Alaska, we provide our patients with highly specialized interventional pain management treatments. This minimizes the need for oral pain medication and maximizes function.  No matter what your pain condition is, our goal is to help you achieve a more active pain-free lifestyle.

Acromioclavicular Joint Injection

Cervical Facet Injection


Pain Treatment


  • Chronic neck pain
  • Upper back pain
  • Shoulder pain
  • Headaches

Facet joints are used to connect the vertebrae and they help guide your spine as you move. They are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left C2-3 facet joins the second and third vertebrae on the left side of the spine.

Cervical facet joint pain can range from simple muscle tension to severe pain, and is dependent upon the injury and the joint that is affected. The injury can include the cartilage inside the joint itself or just the connecting ligaments surrounding the joint, with pain occurring from your head down to your shoulder blade.


Procedure


In a cervical facet injection, an anesthetic and steroid are injected into one or more of your cervical facet joints. The benefit of this injection can be twofold. The anesthetic and steroid may be injected to see if they temporarily relieve your pain. If they do, it tells the physician which facet joint is causing your pain (a diagnostic benefit). On the other hand, the steroid is used to treat inflammation of the facet joint (a therapeutic benefit).

The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle directly into the facet joint. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your neck for a few hours after the injection, which means the medication has reached the correct spot.
It’s normal for your pain to return after this initial pain-free period; and, it may even worsen for a day or two. You may be able to return to work the following day, but always make sure to consult your physician.

The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief, and sometimes long-term relief is acquired.


Video





Cervical Intralaminar Epidural Steroid Injection


Pain Treatment


  • Neck pain
  • Upper back pain
  • Shoulder pain
  • Arm pain

The cervical section of the spine has seven bones, or vertebrae. Soft discs between these vertebrae hold them together, cushion them and control motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Neck and/or upper back pain when you move your head may mean cervical disc and dural inflammation. If your pain travels down to your arm, you may have nerve root inflammation. Because tests such as MRIs may not show a torn or leaking disc, a thoracic epidural injection helps determine if disc or dural problems, or nerve root inflammation are causing your pain.


Procedure


A cervical epidural steroid injection consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. This Intralaminar injection is done from the back of the spine, and may begin with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your neck and arm for a few hours after the injection, which means the medication has reached the correct spot. It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. You may be able to return to work the following day, but always make sure to consult your physician.

The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief and sometimes long-term relief is acquired.


Video






Cervical Radiofrequency Ablation (RFA)


Pain Treatment


  • Neck pain
  • Chronic upper back pain
  • Shoulder pain

Facet joints are used to connect the vertebrae and help guide your spine as you move. They are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left C2-3 facet joins the second and third vertebrae on the left side of the spine.

An injured cervical facet joint can cause pain ranging from simple muscle tension to sever pain depending on the severity of the injury and the joint that is affected. The cartilage inside the joint can be injured; other times only connecting ligaments around the joint are injured. This pain can occur anywhere from your head down to your shoulder blade and usually lasts several months.

Because common tests like MRIs or X-rays don’t always show if a facet joint is causing pain, the best way to diagnose this pain is to block the pain signal in a medial branch nerve. RFA disrupts nerve function using radiofrequency energy; when done to a medial branch nerve it cannot transmit pain from the injured joint.


Procedure



The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle near the facet joint. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement. The physician then checks to make sure it is at the correct nerve by stimulating it. This may cause muscle twitching. When the needle is in the proper place, the area is numbed. Radiofrequency energy is then used to disrupt the medial branch nerve, which is often repeated at multiple levels of the spine.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may feel sore for a few days, which is absolutely normal and is usually a result of muscle and/or nerve irritation. A numb or itchy back for a couple weeks is also normal, with full pain relief in two to three weeks. The nerve may regenerate after an RFA, and your pain may or may not return. In the event your pain does eventually return, another RFA can be performed.


Video





Cervical Selective Nerve Root Blocks


Pain Treatment


  • Neck pain
  • Upper back pain
  • Shoulder pain
  • Arm pain

The cervical section of the spine has seven bones or vertebrae. Soft discs between these vertebrae hold them together, cushioning them and controlling motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Neck and/or upper back pain when you move your head may mean cervical disc and dural inflammation. If your pain travels down to your arm, you may have nerve root inflammation. Because tests such as MRIs may not show a torn or leaking disc, a thoracic epidural injection helps determine if disc or dural problems, or nerve root inflammation are causing your pain.


Procedure


This procedure consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. If the needle is positioned next to an individual nerve root it’s considered a selective nerve root block and medication is placed directly along an inflamed nerve root. The injection may begin with an IV to help you relax, and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your neck and arm for a few hours after the injection, which means the medication has reached the correct spot. It’s normal for your pain to return after this initial pain-free period and it may even worsen for a day or two. You may be able to return to work the following day, but always make sure to consult your physician.

The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief and sometimes long-term relief is acquired.


Video






Cervical Transforaminal Epidural Steroid Injection


Pain Treatment


  • Neck pain
  • Upper back pain
  • Shoulder pain
  • Arm pain

The cervical section of the spine has seven bones, or vertebrae. Soft discs between these vertebrae hold them together, cushioning them and controlling motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Neck and/or upper back pain when you move your head may mean cervical disc and dural inflammation. If your pain travels down to your arm, you may have nerve root inflammation. Because tests such as MRIs may not show a torn or leaking disc, a thoracic epidural injection helps determine if disc or dural problems, or nerve root inflammation are causing your pain.

Procedure


A cervical epidural steroid injection consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. When it is injected from the side it’s considered a transforaminal injection and it places the medication near the source of inflammation. The injection may begin with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed the physician injects the anesthetic and steroid.

You will be monitored for 30 minutes following the injection at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your neck and arm for a few hours after the injection, which means the medication has reached the correct spot. It’s normal for your pain to return after this initial pain-free period and it may even worsen for a day or two. You may be able to return to work the following day, but always make sure to consult your physician.

The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief and sometimes long-term relief is acquired.

Diagnostic Discogram


Pain Treatment


  • Middle back pain
  • Low back pain

A discogram is a diagnostic test performed to view and assess the internal structure of a disc and is the most effective test to determine if an intervertebral disc is the source of your pain. MRI scans do not always show tears in discs and it is impossible to diagnose a painful disc without performing a discogram in addition to other tests. This is the most common point of misunderstanding among patients and physicians alike; X-rays alone cannot tell us where pain is coming from.

The discogram can show if a disc is degenerative, if it has begun to rupture or if it has tears in the annulus (outer ring). It is a very valuable diagnostic tool because it increases the success rate of treatments for painful discs by ensuring that only the disc(s) causing pain will be treated.


Procedure



You will be given medication to help you relax and a local anesthetic is applied to numb the injection area. However, because this procedure is diagnostic in nature as opposed to treatment for pain, a steroid is not injected.

During discography, the physician inserts a needle in the patient’s back into the center of the disc. Radiographic dye is then injected causing pressure within the disc. If injecting the dye recreates the patient’s normal pain, it is then inferred that the specific disc is the source of pain for the patient. If the pain is unlike their normal pain it can be inferred that even though the disc may look degenerative on an MRI scan, it is in fact not the source of the patient’s pain.

Procedure Preparation

This procedure is performed under local anesthesia. Many patients receive additional sedation but it’s important that you remain awake during the test in order to let the doctor know what you are feeling. You will need to arrange for a ride home the day of your procedure. We advise patients to take it easy for a day or so after the test and usually recommend taking a couple days off work after the injection.

Who shouldn’t have this injection?

If you are allergic to any of the medications being injected, if you are on a blood thinning medication (Coumadin, Heparin, Plavix), if you are pregnant or if you have an active infection you should not have this procedure. If you have not responded to local anesthesia you may not be a candidate for this procedure. You should also not have a discogram if you have not already tried simpler treatments such as activity restriction or anti-inflammatory medications.


Video






Genito-femoral Nerve Block

Greater or Lesser Occipital Nerve Block

Iliolingual Nerve Block

Interarticular Hip Joint Injection


Video 1






Video 2






Interarticular Knee Joint Injection


Video





Interarticular Shoulder Joint Injection


Video




Lumbar Caudal Epidural Steroid Injection


Pain Treatment


  • Lower back pain
  • Leg pain

A lumbar epidural steroid injection consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. The spinal cord and its nerves are protected by a covering called the dura. The space around the dura is called the epidural space. In the lower back, it’s called the lumbar epidural space.
The lumbar section of the spine has five bones, or vertebrae. Soft discs between these vertebrae hold them together, cushioning them and controlling motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Lower back pain when you bend your back may mean lumbar disc and dural inflammation. If your pain travels to your leg when you move your back, you may have nerve root inflammation. Because tests such as MRIs may not show a torn or leaking disc, a cervical epidural injection helps determine if disc or dural problems, or nerve root inflammation are causing your pain.


Procedure


A caudal injection is done from the opening in your tailbone, and is the safest and easiest of the epidural injections. It may begin with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement, and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your back and leg for a few hours after the injection, which means the medication has reached the correct spot. It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. You may be able to return to work the following day, but always make sure to consult your physician.

The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief, and sometimes long-term relief is acquired.[/wptabcontent]

Video




Lumbar Facet Injection


Pain Treatment


  • Lower back
  • Hip pain
  • Buttock pain
  • Groin pain

Facet joints are used to connect the vertebrae and they help guide your spine as you move. The lumbar region of the spine is your lower back and it contains five vertebrae, each roughly the size of a thumbnail. Lumbar facet joints are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left L4-5 joins the fourth and fifth vertebrae on the left side of the spine.

A lumbar joint injury can feel like simple muscle tension or even severe pain. The cause could be an injury to ligaments around the joint or cartilage inside the joint itself. Lumbar facet joint pain occurs from your lower back to your buttocks depending on the affected joint or joints and usually lasts longer than a couple months. Typical diagnostic tests such as MRIs and X-rays may not show if a facet joint is causing your pain.


Procedure



The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle directly into the facet joint. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your back for a few hours after the injection, which means the medication has reached the correct spot.
It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two.  You may be able to return to work the following day, but always make sure to consult your physician.

The steroid will start working after a couple of days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief, and sometimes long-term relief is acquired. If your pain is caused by injury to multiple areas, it’s possible that only some of the symptoms may respond.


Video






Lumbar Intralaminar Epidural Steroid Injection

Pain Treatment


  • Lower back pain
  • Leg pain

The lumbar section of the spine has five bones, or vertebrae. Soft discs between these vertebrae hold them together, cushioning them and controlling motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Lower back pain when you move or bend may mean cervical disc and dural inflammation. If your pain travels to your leg, you may have nerve root inflammation. Because tests such as MRIs may not show a torn or leaking disc, a thoracic epidural injection helps determine if disc or dural problems, or nerve root inflammation are causing your pain.


Procedure


A lumbar epidural steroid injection consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. This Intralaminar injection is done from the back of the spine, and may begin with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your neck and arm for a few hours after the injection, which means the medication has reached the correct spot. It is normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two.  You may be able to return to work the following day, but always make sure to consult your physician.

The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief and sometimes long-term relief is acquired.


Video






Lumbar Medial Branch Block


Pain Treatment


  • Lower back pain
  • Hip pain
  • Buttock pain
  • Groin pain

Facet joints are used to connect the vertebrae and they help guide your spine as you move. They are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left L4-5 facet joins the fourth and fifth lumbar vertebrae on the left side of the spine.

Medial branch nerves are found near facet joints and transmit pain signals from the facet joints to the brain. 
Lumbar facet joint pain can range from simple muscle tension to severe pain, and is dependent upon the injury and the joint which is affected. The injury can include the cartilage inside the joint itself or just the connecting ligaments surrounding the joint, with pain occurring from your lower back down to your buttocks.


Procedure



In a lumbar medial branch block, an anesthetic is injected near the medial branch nerve. This stops the transmission of pain signals from the facet joint. If this relieves or reduces your pain and allows you to move your back normally, it tells the physician which facet joint is causing your pain.

The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle near the facet joint. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your back for a few hours after the injection, which means the medication has reached the correct spot.

Relief varies from person to person and depends on the amount of inflammation involved, as well as the number of injured areas. If your pain subsides for a short time only to return, you may be a good candidate for radiofrequency ablation (RFA) to the medial branch nerve, which can provide a more permanent disruption of pain signals.


Videos





Lumbar Radiofrequency Ablation (RFA)

Pain Treatment


  • Lower back pain

Facet joints are used to connect the vertebrae and they help guide your spine as you move. They are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left C2-3 facet joins the second and third vertebrae on the left side of the spine.

An injured lumbar facet joint can cause pain ranging from simple muscle tension to severe pain depending on the injury and the joint that is affected. The cartilage inside the joint can be injured; other times only connecting ligaments around the joint are injured. This pain can occur anywhere from your lower back down to your buttocks and usually lasts several months.

Because common tests like MRIs or X-rays don’t always show if a facet joint is causing pain, the best way to diagnose this pain is to block the pain signal in a medial branch nerve.
 RFA disrupts nerve function using radiofrequency energy. This disruption interferes with pain transmission from the affected facet joint for several months to years.


Procedure



The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle near the facet joint. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement. The physician then checks to make sure it is at the correct nerve by stimulating it, this may cause muscle twitching. When the needle is in the proper place, the area is numbed. Radiofrequency energy is then used to disrupt the medial branch nerve, which is often repeated at multiple levels of the spine.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may feel sore for a few days, which is absolutely normal and is usually as a result of muscle and/or nerve irritation. A numb or itchy back for a couple weeks is also normal, with full pain relief coming in two to three weeks. The nerve will regenerate after an RFA and your pain may or may not return. In the event that your pain does eventually return, another RFA can be performed.


Video





Lumbar Selective Nerve Root Block


Pain Treatment


  • Lower back
  • Leg pain

The lumbar section of the spine has five bones or vertebrae. Soft discs between these vertebrae hold them together, cushioning them and controlling motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Lower back pain when you bend your back may indicate a lumbar disc and dural inflammation. If your pain travels to your leg you may have nerve root inflammation. Because tests such as MRIs may not show a torn or leaking disc, a thoracic epidural injection helps determine if disc or dural problems, or nerve root inflammation are causing your pain.


Procedure



This procedure consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. If the needle is positioned next to an individual nerve root, it’s considered a selective nerve root block and medication is placed directly along an inflamed nerve root.

The injection may begin with an IV to help you relax, and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your back and leg for a few hours after the injection, which means the medication has reached the correct spot.
 It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. You may be able to return to work the following day, but always make sure to consult your physician.

The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief and sometimes long-term relief is acquired.

Lumbar Sympathetic Block


Video





Lumbar Transforaminal Epidural Steroid Injection

Pain Treatment


  • Lower back
  • Leg pain

The spinal cord and its nerves are protected by a covering called the dura. The space around the dura is called the epidural space. The thoracic area of the spine has 12 bones or vertebrae. Soft discs between these vertebrae hold them together, cushioning them and controlling motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Lower back pain when you bend your back may indicate lumbar disc and dural inflammation. If your pain travels to your leg when you bend you may have nerve root inflammation. Because tests such as MRIs may not show a torn or leaking disc, a thoracic epidural injection helps determine if disc or dural problems, or nerve root inflammation are causing your pain.


Procedure



A lumbar epidural steroid injection consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. When it is injected from the side it’s considered a transforaminal injection, and it places the medication near the source of inflammation.

The injection may begin with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your back and leg for a few hours after the injection, which means the medication has reached the correct spot.
It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. You may be able to return to work the following day, but always make sure to consult your physician.

The steroid will start working after a couple of days, but can sometimes take up to a week. Relief varies from person to person and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief and sometimes long-term relief is acquired.


Video




Pulsed Radiofrequency Ablation (Pulsed RFA)

Sacroiliac Joint Injection


Video




Stellate Ganglion Block


Video






Spinal Cord Stimulation


Pain Treatment


  • Lower Back Pain
  • Leg Pain

Spinal Cord Stimulation is an advanced treatment for chronic pain where pain is being blocked from effectively reaching the brain through interference with the spinal transmission of pain signals. It uses low-level electrical impulses to stimulate targeted nerves along the spine. When successful, painful sensations are replaced with what some patients describe as a more pleasing sensation, called paresthesia.


Procedure



Spinal cord stimulation requires a minor surgical procedure to implant the system components. During the procedure, one or more leads are placed in the epidural space (the space just above the spinal cord). The leads contain electrodes that produce the electrical signals that result in stimulation. The leads are then connected to a small electronic device placed just under the skin.

Video





Video 2





Subachromial Bursa Injection


Video




Thoracic Facet Joint Injection 



Pain Treatment


  • Upper back pain
  • Middle back pain
  • Chest wall/rib pain

Facet joints are used to connect the vertebrae and they help guide your spine as you move. The thoracic region of the spine is between your neck and lower back and it contains 12 vertebrae, each roughly the size of a thumbnail. Thoracic facet joints are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left T4-5 joins the fourth and fifth vertebrae on the left side of the spine.

A thoracic joint injury can feel like simple muscle tension or even severe pain. The cause could be an injury to ligaments around the joint or cartilage inside the joint itself. Thoracic facet joint pain occurs from the upper back and shoulders to the hips and varies depending on the affected joint or joints. The pain usually lasts longer than a couple months. Typical diagnostic tests such as MRIs and X-rays may not show if a facet joint is causing your pain.


Procedure



The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle directly into the facet joint. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your back for a few hours after the injection, which means the medication has reached the correct spot.
 It’s normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. You may be able to return to work the following day, but always make sure to consult your physician.

The steroid will start working after a couple days but can sometimes take up to a week. Relief varies from person to person and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief and sometimes long-term relief is acquired. If your pain is caused by injury to multiple areas, it is possible that only some of the symptoms may respond.


Videos





Thoracic Intralaminar Epidural Steroid Injection


Pain Treatment


  • Neck pain
  • Upper back pain
  • Middle back pain
  • Chest wall/rib pain

Facet joints are used to connect the vertebrae and they help guide your spine as you move. They are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left C2-3 facet joins the second and third vertebrae on the left side of the spine.

An injured thoracic facet joint can cause pain ranging from simple muscle tension to severe pain depending on the injury and the joint that is affected. The cartilage inside the joint can be injured; other times only connecting ligaments around the joint are injured. This pain can occur anywhere from your upper back and shoulder down to your hips, and usually lasts several months.

Because common tests like MRIs or X-rays don’t always show if a facet joint is causing pain, the best way to diagnose this pain is to block the pain signal in a medial branch nerve.
RFA disrupts nerve function using radiofrequency energy and when done to a medial branch nerve, it cannot transmit pain from the injured joint.


Procedure



The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle near the facet joint. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement. The physician then checks to make sure it is at the correct nerve by stimulating it, this may cause muscle twitching. When the needle is in the proper place, that area is numbed. Radiofrequency energy is then used to disrupt the medial branch nerve, which is often repeated at multiple levels of the spine.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may feel sore for a few days, which is absolutely normal and is usually a result of muscle and/or nerve irritation. A numb or itchy back for a couple weeks is also normal, with full pain relief coming in two to three weeks. The nerve will regenerate after an RFA and your pain may or may not return. In the event that your pain does eventually return, another RFA can be performed.


Video




Thoracic Medial Branch Block 



Pain Treatment


  • Upper back pain
  • Middle back pain
  • Chest wall/rib pain

Facet joints are used to connect the vertebrae and they help guide your spine as you move. They are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left T4-5 facet joins the fourth and fifth thoracic vertebrae on the left side of the spine.

Medial branch nerves are found near facet joints, and transmit pain signals from the facet joints to the brain.
Thoracic facet joint pain can range from simple muscle tension to severe pain, and is dependent upon the injury and the joint which is affected. The injury can include the cartilage inside the joint itself or just the connecting ligaments surrounding the joint, with pain occurring from your head down to your shoulder blade.

In a thoracic medial branch block, an anesthetic is injected near the medial branch nerve. This stops the transmission of pain signals from the facet joint. If this relieves or reduces your pain and improves your necks mobility, it tells the physician which facet joint is causing your pain.


Procedure



The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle directly into the facet joint. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your back for a few hours after the injection, which means the medication has reached the correct spot.

Relief varies from person to person and depends on the amount of inflammation involved as well as the number of injured areas. If your pain subsides for a short time only to return, you may be a good candidate for thoracic radiofrequency ablation (RFA) <<link>>to the medial branch nerve, which can provide a more permanent disruption of pain signals.


Video






Thoracic Selective Nerve Root Block


Pain Treatment


  • Neck pain
  • Upper back pain
  • Middle back pain
  • Shoulder pain
  • Arm pain
  • Chest wall/rib pain

The thoracic section of the spine has twelve bones, or vertebrae. Soft discs between these vertebrae hold them together, cushion them, and control motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Upper back pain when you move your head may mean thoracic disc and dural inflammation. If your pain travels to the front of your chest, you may have nerve root inflammation. Because tests such as MRIs may not show a torn or leaking disc, a cervical epidural injection helps determine if disc or dural problems, or nerve root inflammation are causing your pain.


Procedure



This procedure consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. If the needle is positioned next to an individual nerve root, it’s considered a selective nerve root block and medication is placed directly along an inflamed nerve root.

The injection may begin with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement, and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your neck and arm for a few hours after the injection, which means the medication has reached the correct spot.
It is normal for your pain to return after this initial pain-free period, and it may even worsen for a day or two. You may be able to return to work the following day, but always make sure to consult your physician.

The steroid will start working after a couple days but can sometimes take up to a week. Relief varies from person to person and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief and sometimes long-term relief is acquired.


Thoracic Radiofrequency Ablation (RFA) 



Pain Treatment


  • Upper back pain
  • Middle back pain
  • Chest wall/rib pain

Facet joints are used to connect the vertebrae and they help guide your spine as you move. They are found on both sides of the spine and are named for the vertebrae they connect and the side of the spine in which they are found. For example, the left C2-3 facet joins the second and third vertebrae on the left side of the spine.

An injured thoracic facet joint can cause pain ranging from simple muscle tension to severe pain depending on the severity of the injury and the joint that is affected. The cartilage inside the joint can be injured; other times only connecting ligaments around the joint are injured. This pain can occur anywhere from your upper back and shoulder down to your hips, and usually lasts several months.

Because common tests like MRIs or X-rays don’t always show if a facet joint is causing pain, the best way to diagnose this pain is to block the pain signal in a medial branch nerve.
RFA disrupts nerve function using radiofrequency energy and when done to a medial branch nerve, it cannot transmit pain from the injured joint.


Procedure



The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle near the facet joint. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement. The physician then checks to make sure it is at the correct nerve by stimulating it, this may cause muscle twitching. When the needle is in the proper place, that area is numbed. Radiofrequency energy is then used to disrupt the medial branch nerve, which is often repeated at multiple levels of the spine.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may feel sore for a few days, which is absolutely normal and is usually as a result of muscle and/or nerve irritation. A numb or itchy back for a couple weeks is also normal, with full pain relief coming in two to three weeks. The nerve will regenerate after an RFA and your pain may or may not return. In the event that your pain does eventually return, another RFA can be performed.


Video





Thoracic Transforaminal Epidural Steroid Injection 



Pain Treatment


  • Upper back pain
  • Middle back pain
  • Chest wall/rib pain

The spinal cord and its nerves are protected by a covering called the dura. The space around the dura is called the epidural space. The thoracic area of the spine has 12 bones or vertebrae. Soft discs between these vertebrae hold them together, cushioning them and controlling motion. If a disc tears, chemicals inside may leak out causing an inflamed nerve root or even a disc bulge. Bone spurs can also press against nerve roots and cause pain.

Upper back pain when you move your head may mean thoracic disc and dural inflammation. If your pain travels to the front of your chest you may have nerve root inflammation. Because tests such as MRIs may not show a torn or leaking disc, a thoracic epidural injection helps determine if disc or dural problems, or nerve root inflammation are causing your pain.


Procedure



A thoracic epidural steroid injection consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation. When it is done from the side it’s considered a transforaminal injection, and medication is placed near the source of inflammation. The injection may begin with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed, the physician injects the anesthetic and steroid.

You will be monitored for 30 minutes following the injection, at which time you will be given your discharge instructions and be allowed to leave the clinic. You may notice immediate relief and numbness in your neck and arm for a few hours after the injection, which means the medication has reached the correct spot.
 It is normal for your pain to return after this initial pain- free period, and it may even worsen for a day or two.  You may be able to return to work the following day, but always make sure to consult your physician.

The steroid will start working after a couple days, but can sometimes take up to a week. Relief varies from person to person, and depends on the amount of inflammation involved. Sometimes this injection brings several months of pain relief and sometimes long-term relief is acquired.


Video





Trigger Point Injections


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Trochanteric Bursa Injection