Electromyography (EMG) and nerve conduction study (NCS) are tests to measure muscle and nerve function. It is performed to assess symptoms such as pain, numbness and weakness that may be caused by a nerve or muscle disorder. This test can help your doctor identify and localize the source of the problem, rule out certain diagnoses, determine the prognosis and severity of the injury, and help guide your physician if future testing is needed. If you have hand pain or numbness, for instance, this test can differentiate between carpal tunnel syndrome (pinched nerve at the wrist), polyneuropathy (nerve dysfunction due to an underlying condition such as diabetes or thyroid disease), and radiculopathy (pinched nerve in the neck).
The nerve conduction study consists of applying electrodes to your skin and recording your sensory and motor nerve responses using an electrical stimulus. During the EMG part of the test, the physician will insert a small pin electrode through your skin into individual muscles. The electrode records muscle activity at rest and with muscle contraction. No electrical stimulus is applied. This test may be uncomfortable and some patients may report soreness. Most patients tolerate this test with minimal discomfort after the test is completed.
Epidural steroid injections can help relieve pain in your neck, low back, arms and legs caused by inflamed spinal nerves due to herniated discs, stenosis, sciatica and other spinal problems. Steroid and anesthetic numbing agent are injected into the space around the spinal nerves and spinal cord (epidural space) to provide relief from pain and inflammation. There are several types of epidural steroid injections including cervical (neck), lumbar (low back) and caudal (tailbone).
This procedure is performed on-site using X-ray fluoroscopy. The patient lies on an X-ray table. Local anesthetic is used to numb the treatment area to minimize discomfort. The physician directs a hallow needle through the skin and between the bony vertebrae into the epidural space. Fluoroscopy enables the physician to watch the needle in real-time to ensure the needle goes to the precise location. Once the needle is correctly positioned, the steroid and anesthetic are injected into the epidural space around the nerve roots. Some may have discomfort, but patients more commonly report pressure.
Facet joints are the small joints in your spine that allow you to bend and twist and also provide flexibility and stability. Facet joint injections are a treatment for spinal pain that can benefit patients with facet syndrome or arthritis when cartilage loss causes stress to the bone, inflammation and enlargement of the joint. These injections can be done in the cervical, thoracic or lumbar spine.
This procedure is performed on-site using X-ray fluoroscopy. The patient lies on an X-ray table. Local anesthetic is used to numb the treatment area to minimize discomfort. The physician directs a hallow needle using fluoroscopy to ensure the needle goes to the precise location. Once the needle is correctly positioned, the steroid and anesthetic are injected into the facet joint at one or multiple levels of the spine.
A nerve block is in injection to alleviate pain by turning off the pain signal along a specific distribution of a nerve.
A medial branch nerve block is a diagnostic procedure in which an anesthetic is injected near a small nerve that innervates the facet joint. This is a test run before the radiofrequency ablation procedure. The amount of pain relief that a patient experiences from a medial branch block provides an impression of whether or not radiofrequency ablation will be successful for reducing pain.
Occipital nerve block is a therapeutic procedure used to treat chronic headaches and pain originating from the back of the head. A steroid and local anesthetic are injected into the base of the skull where the occipital nerves are located. The immediate effect is usually from the local anesthetic injected which will wear off in a few hours. The steroid starts working within 2 to 3 days and its effect can last for several days to a few months.
Radiofrequency ablation (RFA) or “burning of the nerves” is a procedure performed to treat facet joint pain or sacroiliac joint pain caused from arthritis or an injury. RFA uses radio waves to heat up a small area of nerve tissue. By selectively destroying nerves that carry pain impulses, this procedure can provide lasting relief for patients with chronic neck and back pain.
Before the RFA, a medial branch nerve block will have already been performed to prove the patient’s pain is being transmitted by these nerves. The doctor will use X-ray to guide an insulated needle to the proper place next to the nerve after local anesthetic has been given. A small electrode is placed inside the needle, then a radiofrequency current is directed to the medial branch nerve of the joint capsule for 60 to 90 seconds. The radiofrequency waves create heat and destroy the nerve tissue that is sending the pain signals to the brain. The patient should not feel pain or discomfort during the heat application, as he/she will have received sufficient anesthetic medications. Patient may experience pain relief for up to 6 to 12 months.
A lumbar puncture or spinal tap is performed in the low back and can help diagnose central nervous system disorders, infections or cancers. A local anesthetic is injected into the lower back to numb the puncture site before the needle is inserted. Using X-ray guidance, the physician inserts a needle between the two lower vertebrae in the lumbar region, through the spinal membrane (dura) and into the spinal canal. Pressure in the back may be experienced during this part of the procedure. The cerebrospinal fluid pressure is measured and a small amount of fluid is withdrawn. The needle is removed and the puncture site is covered with a bandage.
Peripheral joint injections, such as steroid injections in the shoulder or the knee, can help relieve pain and inflammation and enhance joint mobility. The procedure takes minutes but the benefits can last for months. The effects are typically seen within 2-3 days following the procedure.
Trigger point injection is an easy, safe procedure used to treat painful areas of muscle that contain trigger points or knots of muscles that form when muscles do not relax. The clinician will identify the trigger points and insert a small needle into the area. A local anesthetic and steroid are injected into the muscle. Patients should apply ice if there is soreness following the procedure.