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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.

Results
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.

Risks
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.

Injections

Initially, you will be seen by one of our Physicians who will take a detailed history of your particular issue and will examine you to ascertain the correct pathway of treatment. This  treatment may include many things, such as a referral to an on-site Physiotherapist, Osteopath or Chiropractor. You might be sent for an X-ray or an MRI or you might have an injection during your first visit, if the Physician deems this to be the correct course of treatment for you.

Once your consultation with the Physician is complete, you will be taken through to the Nurses' room where you will meet our team of Nurses. They will help you change into a gown and then take you through to the Fluoroscopy theatre. Most of the injections at the Blackberry Clinic are done under fluoroscopic guidance. This is a very low dose type of X-ray which ensures that the Physicians are able to pinpoint exactly where to perform the injection. Once in theatre, you will be asked to lie down in the correct position and have a small probe placed on your finger. This records your pulse rate and oxygen levels and is there to help us check that you are coping well with the procedure.

There is always one Physician and one or two nurses present in theatre. Sometimes we have visiting practitioners who come to learn from the experienced Musculoskeletal and Sports Physicians at the Blackberry Clinic. If you are unhappy for them to be in the room to observe they will wait elsewhere. This will not in any way affect your treatment or who performs it. Once the procedure is over you will have your blood pressure monitored and the Nurses will check that you have fully recovered. You will then be taken back through to the Nurses' room where you will be able to get dressed again and any subsequent appointments can be made.

Following an injection, you may experience some numbness in the area that has been injected. This is due to the local anaesthetic that the Physicians use and will not cause any longer term problems. It will typically wear off after several hours. After this you may feel some discomfort for a couple of days at the injection site, this is not uncommon. The steroid injection can take three to five days to start working.

You will be sent home with a leaflet explaining what you can expect and giving you some information on how to alleviate some of your symptoms. Should you have any concerns about your treatment during Clinic opening hours, please do not hesitate to contact us. However, should there be any emergency problems when the Clinic is closed, please contact your GP or out-of-hours care provider.