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Specialist Orthopaedic Doctors

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Back Pain Injections

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Fluoroscopically Guided Digital X-Ray Injections

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Spinal Manipulation

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Exercise & Rehabilitation Programmes for the Young...

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...and the Not So Young

Cervical Facet Joint Injections

Diagnostic medial branch block

The procedure known as a medial branch block is a diagnostic injection given to numb one or two joints to see if the pain reduces significantly for a few hours. If this is the case then a cervical facet joint injection may be given on the next visit into the joint or joints identified as producing pain. This diagnostic injection is the best single way of identifying a painful joint. X-rays, MRI scans and clinical examination will also help to exclude other problems.

Cervical facet joint injection
The procedure known as cervical facet joint injection is given for pain arising from the small joints in the neck. The pain is usually caused by osteoarthritis and is often known as cervicalgia. Most backache related to facet joints can be treated successfully with a combination of exercise and improved posture. If your symptoms are very severe or difficult to treat, you may need an injection. In this case, your doctor will inject a mixture of local anaesthetic and cortisone into your inflamed facet joint. The treatment may be given in the fluoroscopy theatre and may be slightly painful.

These injections can be very successful but occasionally provide relief for only a few months. If you are suffering from severe osteoarthritis, you may find that some of the newer techniques are beneficial. These include facet joint denervation by which the nerve supplying the joints are stopped from working using a radio frequency probe in order to reduce pain. This is not a major procedure and referral can be made by your GP. Facet joint injections take less than 1 minute per joint and the results can be dramatic, the response can also help in the diagnosis.

Treatments and Side Effects
The doctor will have discussed alternative treatments with you first. He may have talked about Manipulation, Acupuncture, TENS or alternative medications/injections, but these may not be suitable for everybody. You will be asked if you agree to the treatment. If you do, you will be asked to lie on your stomach under an X-ray machine. Identified joints may then be injected. The X-rays used are a much smaller dose than you would receive if you had a normal back X-ray.

Local anaesthetic is used so it is not an excessively painful procedure, and patients are rarely sedated. Being awake is important, because we need to know which joint is tender when the needle comes into contact with it. For short-term relief and diagnostic purposes, only anaesthetic need be injected. Adding a long-acting cortisone however, can sometimes result in several months of pain relief. This is not the same as taking steroids for long periods, as in rheumatoid arthritis.

After the procedure you will need to lie down for a short period before going home. You will be given something to eat and drink if you wish.

Sometimes, as a result of local anaesthetic reaching the neighbouring nerve roots that supply the arms, there is a feeling of numbness or weakness in one or both arms. This always wears off after a few hours. If this does happen, you must have help getting about at home or, preferably, lie down until normal feeling returns. You might not feel any benefit for the first day or two and some people feel worse temporarily for a few days. This may be due to bruising or soreness near to the injection site. Some patients experience a few days of 'hot flushing'. However, most have no significant side-effects from these single dose cortisone injections.

After Care and Benefits
The diagnosis is confirmed with increasing pain relief and this should allow you to gradually increase your activities. It is important that you do not immediately take up unaccustomed exercise until your muscles have had time to acclimatise to it. Ideally, you should start exercising in a mild fashion, taking two walks a day but limiting the distance and time to the level that you know you can easily manage. Working with experienced therapists such as Physiotherapists and Osteopaths will help you to regain the strength and mobility lost due to the pain.

You should be able to reduce your drug intake, sleep should be improved and there should be improvement in your posture. You will be followed-up by your therapist in the weeks following the injections.