Patient Instructions

Cryoablation
Electromyography & Nerve Conduction Studies
Epidural Steroid Injections
Facet Block Injection
Joint and Soft Tissue Injections
Lumbar Sympathetic Nerve Block
Medical Branch Block
Radiofrequency Ablation
Stellate Ganglion Block
Transforaminal Steroid Injections
Trigger Point Information / Injections

Cryoablation

What is cryoablation?
Cryoablation refers to the application of extreme cold to destroy tissues or nerves.
Why use cryoablation?
Cryoablation may produce prolonged analgesia where medications cannot. Cryoablation produces the least side effects such as neuritis or neuroma formation as possible with other techniques.
How does cyroablation work?
Cryoablation freezes the cells causing ice crystals to form inside and outside the cells. This changes the cell structure, damaging cellular proteins and causing membrane disruption by rapid water loss and physical destruction of the myelin sheath. Destruction of the nerve is temperature dependent. (At least -20˚C)
What are indications for cyrotherapy?
- Chronic Pain Syndromes
- Chest wall pain
- Facial pain syndromes such as trigeminal neuralgias and other nonherpetic neuralgias
- Occipital, subscapular, ilio-inguinal and other specific neuralgias.
- Facet Syndrome– including cervical, thoracic and lumbosacral.
- Coccydynia
- Perineal neuropathies
- Phantom limb
- Trigger Points
- Painful neuromas
- Painful superficial scars
- Chronic low back pain with neuropathies
How long will the effects last?
There is wide spread patient to patient variability depending upon the site of the procedure, the nature of the pain problem, psychological make up of the individual and experience of the operator. The effectiveness can be anywhere from 3 days to 3 years.
What complications are there?
Complications are frostbite to the skin, pneumothorax (intercostal procedures), damage to adjacent structures, and possible motor nerve damage which are generally reversible.
Will the procedure hurt?
There may be some mild burning when the site is injected with a local anesthetic.
Will I be sedated for this procedure?
At times it will be necessary to give mild sedation for this procedure only so you can maintain the position needed to complete the procedure. We ask that you have a driver for this procedure at any time.

Electromyography & Nerve Conduction Studies

Electromyography (EMG) and nerve conduction studies (NCS) are tests that measure muscle and nerve function. In most cases, both tests are performed. Most often the nerve conduction is done first.

During NCS, mild electrical currents are applied to the skin on certain parts of your body. This is done to see how quickly impulses travel between nerves. EMG assesses muscle function. To do this a fine needle is placed under your skin into the muscle being tested. This is repeated on other muscles. The needle shows the electrical activity in the muscles to be measured. No electrical currents are applied with the needle.

Before your test:

Shower or bathe, but don’t use any lotion, oil, or powder.
Wear loose clothing. You may be asked to put on a gown.
Take your routine medications, unless advised not to.
The entire test will take about 1 hour. Allow extra time to check in.

Things to tell your technologist:

If you have any bleeding problems.
If you take blood thinners (anticoagulants) or other medications, including aspirin.

What to expect during your test:

You will be asked to lie on an exam bed with a blanket over you.

For the nerve conduction study, small metal disks (electrodes) will be attached to your skin on the area of your body being tested. This will be done using water-based gel or paste. A mild electrical current will be applied to your skin. Your muscles will twitch but the test will not harm you. The same area may be tested again or the test will continue on other parts of your body.

For the EMG, most of the electrodes will be removed. The area being tested will be cleaned with alcohol. A fine needle will be inserted into the muscles of that region. You may feel as if your skin is being pinched. Try to relax and do as you are instructed.

After your test:

All the electrodes will be removed.
You may return to your normal routine. If you feel tired or have some discomfort, take it easy.
If you were asked to stop taking any medications for the test, you may start taking them again.
A copy of the results will be sent to the physician ordering your test.

Epidural Steroid Injections

What is an epidural steroid injection?
An epidural steroid injection is an injection of a long acting steroid (cortisone) into the epidural space. It can be injected anywhere along the spine from the neck to the lower back depending on the location of the pain.
Where is the epidural space?
The epidural space is a space outside the dura or covering of the spinal cord. It surrounds the nerves as they exit the spinal cord. It runs the entire length of the spine.
What is the purpose of an epidural steroid injection?
The steroid is a potent anti-inflammatory drug. It may help in reducing the nerve and disc inflammation and swelling thereby reducing the pain, tingling and numbness associated with it.
How is the procedure done?
The procedure is done either with the patient sitting on the side of the bed, lying on his/her side on the bed or with the patient lying on his stomach with x-ray guidance. The back is washed with an antiseptic solution. The area around the injection site is numbed with lidocaine and a needle is inserted into that area of numbness. The needle is passed between 2 vertebral bones into the epidural space. The steroid is injected, the needle removed, the back is washed off and a band aide is applied to that spot.
Will it hurt?
The injection involves inserting a needle through skin and deeper tissues so there is some discomfort involved. The skin and the deeper tissues are numbed with a local anesthetic prior to the epidural needle being inserted. The tissues along the middle of the back have less nerve supply, so usually you should only feel a strong pressure sensation and not pain.
What are the risks and side effects?
This procedure is relatively safe. The most common side effect is pain. You may experience greater pain for a few days after the procedure due to the injection itself. You may experience a headache after the procedure. Infection is a possibility but we use an antiseptic solution to clean the back and sterile supplies. Bleeding into the epidural space is also a possibility which is why you need to inform your provider if you are on any blood thinners. The clinic will direct you when to stop them prior to your visit. Other side effects noted are due to the steroid itself. These may include weight gain, increased appetite, increased blood sugar for several days after the injection, water retention and suppression of the body’s own natural production of cortisone.
How long will the effect of the medication last?
The effect of the steroid in usually noted in 2-5 days. Its effect can last for several days to several months. If the first injection does not relieve your symptoms in about one to two weeks, you may be recommended to have a second injection and possibly a third.
Will this help me?
It is difficult to predict if the injection will help you or not. Usually the patients with a recent onset of pain may respond much better than the ones with a longstanding pain. Also the patients with back pain mainly due to bony abnormalities may not respond adequately (i.e. spurs, severe arthritic growth, narrowing of the foramen or openings in the spine)
Who should not have an epidural steroid injection?
If you are allergic to any of the medications to be injected, if you are currently on a blood thinning medication (you have not stopped them for a specified number of days), or you have an active infection going on, you should not have the injection.

Facet Block Injection

What is a Facet Block?
A facet block is an injection of local anesthetic and steroid into a joint in the spine.
What are the Facet Joints?
The facet joints are located on the back of the spine on each side where one vertebrae (individual bones that make up the spine) slightly overlap the next vertebrae. They allow motion such as flexion, extension and turning in the spinal column.
Why do a Facet Block?
Typically these injections are ordered for patients who have pain primarily in their backs, occasionally down the back of their legs to the knee. The injection reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain and other symptoms caused by inflammation or irritation of the joint and surrounding tissues.
How is the procedure done?
With the patient lying on his/her stomach and x-ray available, the back is cleansed with an antiseptic soap. The skin is then numbed with a local anesthetic. Using x-ray guidance, a needle is advanced into the appropriate location, the joint, and a local anesthetic with a steroid medication is injected. The needle is removed, the back washed off and a band aide is applied.
Will it hurt?
Most people say the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure though every person’s response to any procedure is individual.
What are the risks and side effects of the injection?
Generally speaking, this procedure is safe. As with most procedures, there is a remote risk of bleeding, infection, nerve injury, or allergic reaction to the medications. Pain is a temporary side effect. Other side effects to consider are those of the cortisone drug itself; they include: weight gain, increased blood sugar (mainly in diabetics), water retention, suppression of the body’s own natural production of cortisone and increased appetite.
What should I expect after the injection?
Immediately after the injection, the pain may be gone or considerably less. This is due to the local anesthetic and will last only a few hours. The pain may return as a sore back or you could experience an increase in back spasms (This is due to the mechanical process of the needle insertion as well as initial irritation from the steroid itself.) The steroid takes two or three days to have an effect and peaks in one to two weeks.
How long will the effects last?
The effect of the local anesthetic is immediate but will last only one to four hours depending on the agent used. The cortisone starts working in two to three days. Its effect can last several days to a few months.
Will this injection work for me?
It is difficult to predict if the injection will indeed help or not. Generally, the patients with a recent onset of pain may respond much better than the ones with long standing pain.
Who should not have a Facet Block?
If you are allergic to any of the medications to be injected, if you are currently on a blood thinning medication (you have not stopped them for a specified number of days), or you have an active infection going on, you should not have the injection.

Joint and Soft Tissue Injections

What is a joint/soft tissue injection?
When a joint or soft tissue injection is given an anti-inflammatory agent (most likely a steroid) or lubricating medication (Hyalgan or Synvisc) is injected into an affected joint, bursa or tendon.
What conditions are treated with these injections?
1. Osteo or rheumatoid arthritis
2. Gout
3. Bursitis - inflammation or irritation of the bursa (a fluid filled sac providing a cushion between bones and tendons and/or muscles around a joint)
4. Tendonitis – includes trigger finger, tennis elbow and plantar fasciitis
5. Adhesive capsulitis (ex. Frozen shoulder)
6. Neuritis (ex. Carpal tunnel syndrome, tarsal tunnel syndrome, costochondritis (inflammation around the ribs/sternum area)
Why are these injections needed?
Inflammation is one of the body’s first reactions to injury. In acute situations rest, heat, ice, splinting and bracing may help. Over time physical therapy, massage therapy and general rehabilitative management becomes effective. When the pain continues or loss of motion becomes a problem, steroids may help by decreasing the inflammation. Most anti-inflammatory drugs will work slowly to clear up the inflammation damage, relieving the pain over a period of ten days.
What can I expect after the injection?
You may notice changes in sensation. It may feel numb around the area injected. You may notice improved mobility.
How long will the injection last? How much relief can I expect?
Everyone’s response is different. You may get anywhere from no relief to 100% relief. The relief time is different for each person as well. Not all pain conditions will respond to a steroid injection because not all pain conditions have inflammation as the cause of the problem.
Are there any contra-indications?
Yes…Any infections within the joint, skin over the area to be injected or generalized infections may prohibit you from having the injection. Other contra-indications may include anti-coagulant therapy (blood thinners), fractures, unstable or inaccessible joints, lack of response to previous injections and too many injections into that area/joint (ex: greater than 3 in one year).
Are there risk and/or side effects?
As with any procedure risks include bleeding and possible infection. Other risks/side effects include tendon rupture, facial flushing or changes in skin color and possible short term numbness/loss of strength to the extremity.
What should I do after the procedure?
You may apply ice over the injected area during the first 24 hours after the procedure. If you have band aids, they can come off later in the day or the following day. You may return to work after the procedure. You may be asked to go to physical therapy or see an orthopedic physician for continued care depending on your response.

Lumbar Sympathetic Nerve Block

What are the sympathetic nerves?
The sympathetic nerves are a network of nerves extending the length of the spine that we do not think about or have direct control over them. They control such things as sweating, heart rate, blood vessel dilation and constriction, pupil dilation, movement of food through the intestines and many other body functions.
What is a lumbar sympathetic nerve block and why is it helpful?
A sympathetic nerve block involves injecting numbing medicine around the sympathetic nerves in the low back. By doing this, the nerves in that area are temporarily “switched off” in hopes of reducing or eliminating pain. This can also be diagnostic to determine if excessive sweating is being sympathetically generated.
What can I expect during my procedure?
This procedure is performed in a room equipped with an x-ray machine. You will have an IV started prior to the procedure. You will have the temperature on both feet monitored with temperature dots. You will lie on the X-ray bed on your stomach. Your back will be cleansed with an antiseptic soap. Next, the physician will numb a small area of skin with numbing medicine which may sting a bit. Using the X-ray machine, he will carefully guide a thin needle into your back near the spine. He will inject a small amount of dye through the needle to make sure it is in the right place and an x-ray will be taken. Once the placement is confirmed, the numbing medication will be slowly injected.
Will it hurt?
The injection involves inserting a needle through skin and deeper tissues so there is some discomfort involved.
What can I expect after the procedure?
You may notice changes in the sensation, color, or temperature of your legs for several hours after the test. You may note improved mobility in the affected extremity.
What are the risks and side effects?
With any procedure, there are risks and the possibility of complications. Risks of this procedure are bleeding, puncture of a blood vessel and low blood pressure. Side effects would include: discomfort at the injection site, weakness or numbness in the affected extremity.
Is there anything I should do to prepare for my procedure?
- If you are on any type of blood thinning medications: i.e., Coumadin, Heparin, Ticlid, Plavix, Lovenox, Trental, Aggrenox, Agrylin, Aspirin, Pletal, please notify the clinic 2 weeks prior to your test.
- Stop any anti-inflammatories (Advil, Ibuprofen, Etodolac, Indomethacin, Naproxen, Aleve, Feldene, Diclofenac, Mobic, and Piroxicam) for 5 days prior to the procedure. (Celebrex does not need to be stopped)
- You may take your usual medications the morning of the procedure, except blood thinning medications.
- Wear comfortable clothing.
- Bring a driver with you.
What should I do after the procedure?
You may apply ice to the injection site during the first 24 hours after the procedure. You will have a band aide on your back, this may come off later in the day or the following day. You should not drive and should avoid any strenuous activities the day of the procedure. You may return to work the following day. You may be referred to physical therapy after your appointment.

Medical Branch Block

What is a medial branch?
Facet joints, those joints in the back where one vertebrae overlaps the next, are supplied by “medial branches”. These nerves carry pain signals to the spinal cord, then to the brain where the pain is noticed.
What is a medial branch block?
Medication (a local anesthetic mainly, possibly mixed with a steroid) is placed outside the facet joint near the nerve that supplies the joint.
What is the purpose of it?
The medial branch block is done to relieve pain and stiffness associated with facet joint arthritis. For the most part the procedure is done for diagnostic purposes. The nerves are “blocked” or “numbed” so they are unable to carry pain sensation to the spinal cord. If the pain is coming from the facet joint, the pain and stiffness should be relieved temporarily. Once it is determined the pain is coming from these joints, we can use a procedure called “radiofrequency ablation” to prevent the conduction of pain for several weeks to months.
Will it hurt?
There is some discomfort, but the skin and deeper tissues are numbed with a local anesthetic. The local anesthetic may burn when it is injected.
How is the procedure done?
The procedure is done with the patient lying on his stomach. The back is washed off with an antiseptic solution. The skin is numbed with a local anesthetic. Using x-ray to guide him, the doctor will position a needle outside the facet joint and he will place the numbing medication. The needle is removed, the back washed off and a bandaide is applied.
What should be expected?
Immediately after the procedure the patient should feel their pain gone or quite less. This may only last 2-8 hours depending on the numbing medication used. The pain will return and a “sore back or neck” may be noted for the next 2-3 days. The patient will be asked to keep track of his/her pain for the next 2-8 hours following the injection. The response to the injection will determine if the pain is coming from the facet joint.
Will this procedure help me?
For the most part, this procedure is diagnostic. We are trying to determine if the pain is coming from the facet joints. The relief will only be temporary.
Can I go back to work?
Unless there are complications, you should be able to return to work the following day.
Are there risks and side effects?
For the most part, the procedure is safe. As with any procedure, there are risks and side effects such as infection, bleeding, worsening of symptoms, spinal block, epidural block, etc. The most common side effect is pain, which is temporary.
Who should not have this injection?
Anyone allergic to any of the medication to be injected, on blood thinning medication (Coumadin, Plavix, Ticlid, etc.) or has an active infection going on should not have the injection.

Radiofrequency Ablation

What is radiofrequency ablation (RF)?
Radiofrequency ablation is a procedure which heats up the sensory nerves. This heating interrupts the pain impulses, stopping them before they can be sent to the brain.
Am I a candidate for radiofrequency ablation?
To be a candidate for this procedure, you must first have been evaluated using a diagnostic block with local anesthetics and responded well to them. Radiofrequency ablation is a possibility with certain diagnoses such as mechanical pain due to facet joint disease or complex regional pain syndrome (depending on the affected site).
How is it done?
Since nerves cannot be seen, we use x-ray to find bony landmarks that indicate where the nerves usually are. A local anesthetic is injected to minimize the discomfort of the needle insertion. After confirming the position of the needle, a special tip is inserted and electrical stimulation is done. This stimulation may produce a buzzing or tingling or pressure sensation. You could also feel your muscles jump or a “tap, tap, tap” sensation. When we have confirmed the needle is in the right spot, more numbing medication is given and the needle tip is heated up using a special machine.
Will I be "put out" for this procedure?
No. This procedure is done using a local anesthetic. You may receive mild IV sedation to make the procedure easier to tolerate. It is necessary for you to be awake enough to talk to your doctor during this procedure.
Will the procedure hurt?
The procedure involves inserting a needle through skin and those layers of muscle and soft tissues, so there is some discomfort involved. We numb the skin and deeper tissues with a local anesthetic using thin needles prior to inserting the needle.
What risks are there?
The procedure is very safe. The most common potential complications include bleeding, infection, or possible nerve damage, although these are very unlikely. There is a small possibility of reaction to the IV anesthetic also. Please discuss your specific concerns with your physician.
What should I expect after the procedure?
You may have some muscle soreness for a day or so after the procedure. This can be treated with your pain medication or Tylenol, Motrin, or Naproxen, and you may use ice to the treated area. You may notice a “deep sun-burn” type feeling. You may have immediate pain relief or it could take up to 2 weeks to notice a difference.
What should I do after the procedure?
You should have a ride home. You may resume your normal activities as tolerated by you. You may be able to return to your work the next day. You may want to apply ice to the affected area.
How long will the pain stay away?
The pain may be gone or lessened for 3 months to 18 months or longer. If the first procedure does not relieve your symptoms completely, you may be recommended to have a repeat procedure after re-evaluation. Because these are not permanent procedures, they may need to be repeated when the numbness wears off.
Who should not have this procedure?
If you are on a blood thinning medication (e.g. Coumadin, Plavix), or if you have an active infection going on, you should not have the procedure. If you have not responded to local anesthetic blocks, you may not be a candidate for this procedure.
Is there anything I must do prior to the procedure?
If you are currently taking a blood thinner such as Coumadin or Plavix, please inform the office and they will give you directions about how long to stop them prior to the procedure. Any anti-inflammatories (e.g. Motrin-Ibuprofen, Aleve-Naproxen, Etodolac, Lodine, etc.) should be stopped 5 days prior to the injection. You may have a light breakfast the morning of the procedure.

Stellate Ganglion Block

What are the sympathetic nerves?
The sympathetic nerves are a network of nerves extending the length of the spine that we do not think about or have direct control over them. They control such things as sweating, heart rate, blood vessel dilation and constriction, pupil dilation, movement of food through the intestines and many other body functions.
What is a stellate ganglion block and what is its purpose?
A sympathetic nerve block involves injecting numbing medicine around the sympathetic nerves located on either side of the voice box, in the neck. It is done as apart of the treatment of Complex Regional Pain Syndrome (CRPS or RSD), Herpes Zoster of the neck or head (shingles), upper extremity pain due to arterial insufficiency, Raynaud syndrome of the upper extremities, and a test for hyperhidrosis of the neck and head (excessive sweating).
What can I expect during my procedure?
This procedure is performed in a room equipped with an x-ray machine. You will have an IV started prior to the procedure. You will have the temperature on both hands monitored with temperature dots. You will lie on the X-ray bed on your back. A pillow will be placed under your neck to arch your neck backwards. The skin in the front of the neck, next to the “voice box”, is cleansed with an antiseptic soap. Next, the physician will numb a small area of skin with numbing medicine which may sting a bit. Using the X-ray machine, he will carefully guide a thin needle into front of your neck. He will inject a small amount of dye through the needle to make sure it is in the right place and an x-ray will be taken. Once the placement is confirmed, the numbing medication will be slowly injected. During the block, you will be asked to lie very still and not talk, swallow, or cough.
Will it hurt?
The injection involves inserting a needle through skin and deeper tissues so there is some discomfort involved.
Will I be “put out” for this procedure?
No. This procedure is done under local anesthesia.
What can I expect after the procedure?
For the first few hours, you can expect any of these to occur on the side of the body where the body where the test was done:
- Watery, red eye
- Constricted pupil
- Droopy eyelid
- Droopy face
- Hoarse voice
- Nasal stuffiness
- Flushed face
- Decreased pain
- Increased warm to the arm and/or side of the face
- Improved mobility to the affected extremity
What are the risks and side effects?
With any procedure, there are risks and the possibility of complications. Risks of this procedure are bleeding, puncture of a blood vessel or injection into the surrounding organs. Side effects would include: discomfort at the injection site, weakness or numbness in the affected extremity and headache.
Is there anything I should do to prepare for my procedure?
- If you are on any type of blood thinning medications: i.e., Coumadin, Heparin, Ticlid, Plavix, Lovenox, Trental, Aggrenox, Agrylin, Aspirin, Pletal, please notify the clinic 2 weeks prior to your test.
- Stop any anti-inflammatories (Advil, Ibuprofen, Etodolac, Indomethacin, Naproxen, Aleve, Feldene, Diclofenac, Mobic, and Piroxicam) for 5 days prior to the procedure. (Celebrex does not need to be stopped)
- You may take your usual medications the morning of the procedure, except blood thinning medications.
- Wear comfortable clothing.
- Bring a driver with you.
What should I do after the procedure?
You may apply ice to the injection site during the first 24 hours after the procedure. You will have a band aide on your neck, this may come off later in the day or the following day. You should not drive and should avoid any strenuous activities the day of the procedure. You may return to work the following day. You may be referred to physical therapy after your appointment.

Transforaminal Steroid Injections
(Nerve Root Block)

What is a transforaminal steroid injection?
A transforaminal epidural steroid injection is also known as a nerve block. It is an injection of local anesthetic and a steroid medication injected, under x-ray guidance where the nerve exits the spinal column. It is usually ordered when your pain follows the path of a single nerve.
What is the purpose of an epidural steroid injection?
The steroid is a potent anti-inflammatory drug. It may help in reducing the nerve inflammation and swelling thereby reducing the pain, tingling and numbness associated with it.
How is the procedure done?
The procedure is done with the patient lying on his/her stomach. The back is washed with an antiseptic solution. The area around the injection site is numbed with lidocaine and a needle is inserted into that area of numbness. Using x-ray guidance, the needle is advanced to the proper location. A dye may be injected at this point (Please let the doctor know if you have an allergy to contrast dye.) Local anesthetic and steroid are then injected through the needle and the needle removed. Your skin is washed off and a band aide applied.
Will it hurt?
The injection involves inserting a needle through skin and deeper tissues so there is some discomfort involved. The skin and the deeper tissues are numbed with a local anesthetic prior to the epidural needle being inserted. The tissues along the middle of the back have less nerve supply, so usually you should only feel a strong pressure sensation and not pain.
What are the risks and side effects?
- Infection: Steroids can lower the body’s ability to fight infections. The procedure can not be performed if you have an active infection (flu, cold, abscess, wounds that are not healing). Anytime a needle is inserted into the body there is a small chance of infection. We use an antiseptic solution to clean the back and sterile supplies.
- Bleeding: An epidural injection can result in a hematoma (a collection of blood caused by an injury to a blood vessel. This can cause problems with the bowels and bladder, or extremity weakness. (You must inform you provider if you are on any blood thinners.)
- Bladder Dysfunction: We use a local anesthetic with this injection, it can actually paralyze the nerves to the bowel and bladder for a short period. You may not have control over your bladder for one to two hours following the procedure.
- Steroid related: Weight gain, increased appetite, increased blood sugar for several days after the injection, water retention and suppression of the body’s own natural production of cortisone.
Will this help me?
It is difficult to predict if the injection will help you or not. This injection may be diagnostic and/or therapeutic. Three things can happen: 1. The pain does not go away – which means that the pain is probably not coming from the nerve at the level of the injection – this has diagnostic value. 2. The pain goes away and stays away for a few hours but the original pain comes back and doesn’t get better again. This would mean the block was also of diagnostic value – the pain is probably coming from the nerve at the level of the injection, but the steroid was not of benefit. 3. The pain goes away after the block, the pain may come back later that day, but then the pain gets better again over the next few days. This means the block was of therapeutic value – the steroid had a long lasting effect on the pain.
Who should not have an epidural steroid injection?
If you are allergic to any of the medications to be injected, if you are currently on a blood thinning medication (you have not stopped them for a specified number of days), or you have an active infection going on, you should not have the injection.
Should I have a driver?
We are using a local anesthetic with the steroid. The potential for your leg to become numb, heavy or even lose strength is a possibility. You will be required to have someone drive you home.

Trigger Point Information / Injections

What is a trigger point?
A trigger point is a muscle knot, a small patch of tightly contracted muscle. Chemical changes in the muscle can cause even more discomfort. Trigger points occur only in muscles. They can be localized (meaning in one area) or the discomfort may be referred to another area.
How do I get a trigger point?
Trigger points are caused by a number of things: chronic muscle overload (over use of the muscle), injury to the area, accident trauma (like a car accident), radiculopathy (pain involving a nerve root), infection or health issues such as smoking.
How is a trigger point diagnosed?
Diagnosis is made by your physician listening to your health history, examining the signs and symptoms of your pain patterns and pushing on the muscles involved.
How are trigger points treated?
Trigger points are treated in various ways: massage therapy, electro stimulation (TENS), ultrasound, stretching techniques and injections.
What is a trigger point injection?
A trigger point injection is inserting a small gauge needle into the muscle knot itself. A short acting anesthetic agent (numbing medication) is injected through it. At times an anti-inflammatory or steroid medication may be used with it.
Will the injection hurt?
As with any injection, you may feel some burning or pressure sensation at the site.
What can I expect after the injection?
You may notice changes in sensation. It should feel numb around the area injected. You may notice your ability to move has improved.
Are there any risks or side effects?
As with any procedure the risks would be possible bleeding or infection. An antiseptic soap is used prior to the injection to decrease any possibility of infection. A band aid will be applied if there is any bleeding. Side effects include soreness at the injection site.
What should I do after the procedure?
You may apply ice to the injection site during the first 24 hours after the procedure. If you have band aids on, they can come off later in the day or the following day. You may return to work after the procedure. You may be referred to physical therapy after your follow up appointment.