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An epiduroscopy, also called a spinal endoscopy, is used to diagnose and treat spinal nerve pain.

Epiduroscopy

What is Epiduroscopy?

An epiduroscopy, also called spinal endoscopy, is a procedure performed to treat spinal nerve pain such as sciatica and adhesions. In this procedure, a tiny fiber-optic camera is inserted into the epidural space through the sacral bone.

Who needs Epiduroscopy?

The procedure is utilized in relieving pain that arises due to adhesions that form following spinal surgery. It is also used in managing long standing sciatica. Epiduroscopy is also used for diagnostic purposes, as it can help your doctor determine the cause, location, and severity of scar tissue or adhesions.

What are the steps in Epiduroscopy?

Preparing for the Procedure

In order to perform the procedure, the patient is asked to lie on their stomach so that access can be obtained to the lower back. After cleaning the skin with antiseptic solution, a small amount of local anesthetic is injected into it to numb it.

Inserting the Needle

Under the guidance of x-rays, a needle is inserted into the sacral hiatus, which is a small opening in the bottom of the sacrum. The needle is passed all the way into the spine.

Inserting the Guide Wire

A small guide wire is then inserted through the needle, and the needle is pulled back out over the guide wire. A series of dilators are then passed over this guide wire in order to create a large enough opening to pass the epiduroscope through.

Inserting the Camera

A small catheter with a fiber-optic camera at the tip of it is passed through this opening into the epidural space. This helps visualize exactly where the catheter is being passed to. Sometimes additional imaging is also utilized to ensure the right location is reached with the catheter.

Administering the Injection

Once the catheter is in place, it is gently maneuvered to break down the adhesions. Then, an injection of local anesthetic and steroids is given. This can numb the nerves that are in this area and help reduce pain.

After Surgery

Following the procedure, the patient is observed for a short period of time and is discharged home after that. This procedure may effectively help reduce pain due to adhesions and sciatica. This is because the structures that are affected can be directly visualized, and treatment can be a lot more targeted.

Complications are fairly rare and can include mild bleeding at the site of the procedure. Patients may feel slightly uncomfortable and may experience mild pain following the procedure but this usually passes after a short period of time.


All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.

These injections can help relieve pain and confirm a diagnosis

Diagnostic Injections to Confirm Pain Location

What are Diagnostic Injections to Confirm Pain Location?

Pain is a common symptom of nerve irritation. In many cases, tests are required to confirm which nerve is causing the pain. In this article, we shall take a look at diagnostic injections as a tool used by your doctor for diagnosing and confirming the location of pain.

Diagnostic injections are injections that are utilized for making a diagnosis and sometimes even helping as a treatment. The fluid injected usually consists of a local anesthetic or a steroid injection that is used to aid in isolating the nerve that is causing the pain.

Who needs Diagnostic Injections to Confirm Pain Location?

Diagnostic injections to confirm the source of pain are usually performed when there is nerve involvement and pain due to a problem with the vertebral column. If you have osteoarthritis that is affecting the facet joints of the vertebra, your doctor may use this procedure.

What are the steps in Diagnostic Injections to Confirm Pain Location?

Locating the Affected Joint

The likely bone is identified through clinical examination and x-rays. The skin is cleaned with an antiseptic solution and the diagnostic injection is performed.

Numbing the Nerve

Once the likely facet joint is identified, a small amount of local anesthetic with or without the steroid is injected into the joint to numb the nerve. If blocking the nerve results in a reduction of pain, then the joint that is causing the pain can be isolated and treatment can be offered that is directed towards that joint.

After Surgery

The main advantages of diagnostic injections are that it helps identify which of the joints are affected and which nerves need to be treated. By itself, a diagnostic injection is a treatment method.

The risks are minimal and can include just mild pain and swelling in the site of injection. If the joint identified is the wrong one, further injections may be required to isolate the nerve.


All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.

Read this article to learn about a procedure used to treat neck pain

Cervical Facet Radiofrequency Denervation

Cervical Facet Radiofrequency Denervation

What is Cervical Facet Radiofrequency Denervation?

Cervical Facet Radiofrequency Denervation is a procedure used to treat neck pain. The cervical facet refers to a part of the vertebra in the neck through which nerve fibers arise from the spinal cord. Radiofrequency denervation is a procedure similar to a nerve block but that utilizes radiofrequency and offers a long term solution to pain.

Who needs Cervical Facet Radiofrequency Denervation?

Wear and tear of the cervical facets occurs with advancing age and constant movement of the neck, which can lead to pain during movement of the neck joints. While painkillers may help relieve the pain, in some cases the pain can persist despite maximal medical treatment. In such cases, nerve blocks can be performed that block the conduction of pain signals through the nerves around the facet joints.

The aim of radiofrequency denervation is to provide long-term pain relief. These effects can last for a few months up to a couple of years but sometimes the pain can return as the nerve fibers grow again. In such cases, a repeat procedure may need to be performed.

What are the steps in Cervical Facet Radiofrequency Denervation?

Preparing for the Procedure

This procedure may take up to half an hour to perform. You may be offered mild sedation during the procedure.

Numbing the Skin

After isolating the cervical facet joint that is causing the pain using an x-ray, the skin that covers the area is numbed with a local anesthetic.

Inserting the Needle

Using X-ray or fluoroscopic guidance, your surgeon will insert a tiny needle through the numbed skin, all the way to the cervical facet joint.

Administering Radiofrequency Waves

Radiofrequency waves, in the form of a tiny electric current passed through the needle, are then administered. These waves generate heat and destroy the nerve fibers that are causing the pain.

Reducing Inflammation

Once the nerve fibers have been destroyed, a small amount of steroids may be injected to help reduce any inflammation that may occur.

After Surgery

Following the procedure, the patients are observed and subsequently discharged home. Patients may feel mild tingling or numbness in the area where the procedure was performed. This is normal and passes after a short while. It is advised that a family member or friend take the patient home as the sedation takes time to wear off and driving is a risky.

Patients may experience mild amount of bleeding and bruising at the site of the procedure. Allergic reactions are rare and usually towards the medication used rather than the procedure itself. Radiofrequency denervation should be avoided if patients are suffering from an active infection or are on blood thinning medication.

It can take anywhere between a month to 6 weeks to recover fully following the procedure. Patients are recommended to rest for at least a couple of days before embarking on any sort of physical activity. When doing so, activities should be light and easy to perform for a few days before attempting anything strenuous.


All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.

Post-thoracotomy Pain is a type of pain felt after a procedure called a thoracotomy

Post-thoracotomy Pain

Post-thoracotomy Pain

What is Post-thoracotomy Pain?

Pain in any part of the body is always distressing and a nuisance. Post-thoracotomy pain refers to pain that occurs following a surgical procedure on the chest wall called a thoracotomy.

A thoracotomy is a surgical procedure that is carried out to deal with medical conditions that affect the chest, such as tumors or cancer. The procedure involves making a deep incision in the chest wall that penetrates the skin, muscles and ligaments along with the requirement of resecting the ribs. Access is thus obtained to the structures within the lung so that surgery can be carried out.

Post-thoracotomy pain is a severe form of pain that can cause tremendous amount of distress to patients following a thoracotomy. As a result, patients can have a number of problems, such as difficulty coughing out infected secretions, development of pneumonia, and a general difficulty in managing any form of activities because breathing is painful.

What causes Post-thoracotomy Pain?

There are two main types of post-thoracotomy pain: acute and chronic. Acute post-thoracotomy pain refers to pain that occurs immediately after surgery. It can cause difficulty in breathing and coughing. Chronic post-thoracotomy pain refers to persistent pain at the site of surgical incision that lasts at least two months following a thoracotomy procedure.

The most common reason why post-thoracotomy pain may occur is damage to the intercostal nerves. These are the nerves that run in between the ribs and supply the muscles, called intercostal muscles, that connect the ribs. While care is always taken to prevent any damage to the intercostal nerves, unfortunately it can still occur due to mechanical injury that can be precipitated by rib resection. Pain usually occurs at the site of skin incision and damage of the intercostal nerve.

As was previously mentioned, a thoracotomy may be conducted to remove a tumor within the lung. A recurrence of this tumor can result in pain. Finally, post-thoracotomy pain may occur due to damage that occurred inadvertently to surrounding muscles during the surgical procedure. While there are clearly a few causes of post-thoracotomy pain, there still remains debate as to what the exact cause for it is.

Symptoms and Diagnosis

The most common symptom of post-thoracotomy pain is pain at the site of surgery. Upon examination, the patient will complain of tenderness at the site of incision and occasionally may complain of altered sensation at the site.

How is Post-thoracotomy Pain treated?

The decision as to what treatment is best is decided by the doctor based on the patient's presentation and their response to symptomatic treatment.

  • Symptomatic treatment This refers to the application of hot or cold packs at the area of the incision to help relieve pain.
  • Painkillers This is probably the first-line of treatment that the doctor may recommend. Commonly used drugs include paracetamol and non-steroidal anti-inflammatory drugs. On occasion, stronger painkillers may be required and the doctor will decide this on a case-by-case basis.
  • Antidepressant medications such as tricyclic antidepressants are known to be extremely strong painkillers and may be offered to the patient.
  • Specialist treatments These include injecting the painful area with a combination of a local anesthetic along with a steroid compound. This numbs the area and reduces the inflammation.

All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.

This procedure is used to treat trigger points, or painful knots in the muscle. Learn more about Trigger Point Injections here:

Trigger Point Injection

Trigger Point Injection

What are Trigger Point Injection?

Trigger point injections are a common procedure performed in clinical practice. Here we discuss this procedure in a bit more detail. Muscle tightening, or knot formation, can occur due to constant stress. These knots, which are easily felt and painful when touched, are called trigger points.

A trigger point injection is a procedure that is performed to loosen these tightened muscles and to reduce pain. It usually involves injecting the site with a local anesthetic agent to help numb the pain. Sometimes, the local anesthetic agent may be injected along with a steroid injection to help reduce the inflammation. The entire procedure is completed within a few minutes.

Who needs Trigger Point Injection?

Sometimes, muscle tightening can occur due to excessive activity and stress. Certain conditions such as fibromyalgia and myofascial pain can also be treated using trigger point injections.

What are the steps in Trigger Point Injection?

Preparing for the Injection

Once the areas where the trigger point injections need to be administered have been identified, the skin of these areas is cleaned with an antiseptic solution.

Administering the Injection

The injection, containing either local anesthetic or a combination of a local anesthetic with a steroid, is then administered into the muscle.

After Surgery

The procedure is performed on an outpatient basis and does not require admission to a hospital. Following the completion of the procedure, the area of injection will be covered with a bandage, and the patient will be observed for a short period of time. If all is well, the patient is discharged home.

Since the procedure is fairly straightforward and simple, the risks and side effects are only very few and are rare. A mild amount of pain at the site of injection and occasional bruising may be seen. Patients who are injected with steroids may have altered blood sugar levels and changes in weight if they receive multiple injections throughout the year.

Trigger point injections do provide significant relief from pain due to muscle tightening. However, it must be kept in mind that while these injections reduce pain, they are not a cure. Once the procedure is complete and the patient is discharged home, they are often reviewed in clinic or in the outpatients department after 4 or more weeks.


All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.

Sacroiliac Joint Injections may help your lower back pain. Find out more about this nonsurgical procedure here:

Sacroiliac Joint Injections

What are Sacroiliac Joint Injections?

The sacroiliac joint can sometimes be the cause for lower back pain. In such cases, sacroiliac joint injections may be performed to relieve the pain.

Who needs Sacroiliac Joint Injections?

The sacroiliac joint is a faceted joint that connects the lower end of the spine, called the sacrum, to the hip bone. There are two sacroiliac joints, and they are under constant stress from movement of the hips. As a result, it is no surprise that they can be subject to injury or arthritis and can become quite painful. Those suffering sacroiliac joint pain may benefit from this procedure.

What are the steps in Sacroiliac Joint Injections?

Identifying the Injection Area

Is important to recognize that sacroiliac joint injections are performed primarily to reduce pain and improve movement of the hip and lower back. The procedure begins by identifying the area where the injection needs to be administered. This may be done by performing an x-ray or a special test called fluoroscopy.

Positioning the Patient

Consent for the procedure is obtained and the patient is placed in the required position to gain access to the sacroiliac joint. This is usually the patient lying on their chest. The skin over the sacroiliac joint is cleaned with antiseptic solution.

Administering the Injection

Local anesthetic may be injected into the skin, all the way down to the surface of the joint. Once this is done, the injection, containing a local anesthetic along with a steroid drug, is injected into the joint. The purpose of the local anesthetic is to help reduce the pain, while the purpose of the steroid is to reduce both inflammation and pain. The entire procedure takes only a few minutes to perform.

After Surgery

Following the procedure, the patient will be monitored for a short period of time and will then be discharged home. They will be advised to take a rest for a day or two and can resume normal activities after that.

In most cases, following sacroiliac joint injections, patients may experience immediate relief. This is usually due to the local anesthetic component of the injection. The steroids may take a day or two to begin affecting the pain, but the effects are longer lasting, often lasting for up to a few months. Sometimes, once the effects of the steroids are worn off, the pain may return, and repeat injections may be required.

The treatment is relatively safe and has very few risks. The most common risk is that of mild bruising and pain at the site of injection. This usually passes after a few hours. The other risks include persistent pain and allergic reactions to the drugs. Joint infection is a rare side effect, as absolute sterility is observed during the procedure.


All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.

An angiogram is a test that allows physicians to see how blood flows through a specific blood vessel (an artery or a vein). The procedure uses a dye that makes blood vessels visible on X-rays. An angiogram can be used to look at the blood vessels in the head, chest, back, abdomen, arms or legs. An angiogram can reveal the presence of any blockage or damage in an artery or vein, an aneurysm, as well as coronary artery disease and its extent.

Angiogram

What is an Angiogram?

An angiogram is a test that allows physicians to see how blood flows through a specific blood vessel (an artery or a vein). The procedure uses a dye that makes blood vessels visible on X-rays. An angiogram can be used to look at the blood vessels in the head, chest, back, abdomen, arms or legs. An angiogram can reveal the presence of any blockage or damage in an artery or vein, an aneurysm, as well as coronary artery disease and its extent.

Some angiograms have specific names.

  • Cerebral angiogram: used to look at a blood vessel in the brain
  • Carotid angiogram: used to look at a blood vessel in the neck
  • Coronary angiogram: used to look at blood vessels around the heart
  • Pulmonary angiogram; used to look at a blood vessel in the lungs
  • Peripheral angiogram: used to look at a blood vessel in an arm or leg

During an angiogram, a catheter (a thin, flexible tube) is placed into a blood vessel and guided to the area to be examined. Then a dye is injected into blood stream. This dye causes the blood vessel to be visible on an X-ray. Therefore, the X-rays must be taken while the dye is flowing through the blood vessel being studied.

Why is an Angiogram Performed?

Angiograms may be done to:
  • Detect/locate an aneurysm
  • Detect things that adversely affect blood flow in a vessel (e.g., a tear, or areas of blockage)
  • Look for the cause of internal bleeding
  • Prepare for peripheral arterial disease surgery
  • Observe the blood vessels of organs that have been damaged or injured
  • Determine which blood vessels are supplying nutrients to a tumor
  • Determine the exact location, number and condition of blood vessel prior to certain organ transplants
  • Assess the extent of atherosclerosis
  • Provide access to a blood vessel for treatment (e.g., insertion of a catheter to open a blocked vessel, stop internal bleeding, or deliver medicine directly into a tumor)

How is an Angiogram Performed?

An angiogram can be done as an outpatient procedure; however, after the procedure, patients stay in a recovery room for several hours before they can go home. A radiologist and another doctor, in addition to other support staff, perform the test.

An angiogram may last anywhere from 30 minutes to several hours. Patients are awake during the test and are often given a mild sedative to help them relax. Most patients will have an intravenous line in a vein in their arm to administer any medication or fluids that are needed. Small pads will be placed in several areas to help monitor the patient’s heart rate.

The test requires several steps:

  • The catheter will be inserted either into the groin, neck or just above the elbow. This area first must be shaved, cleaned then numbed with a local anesthetic.
  • A needle is then inserted into a blood vessel; a small wire will be passed through the needle and the needle removed.
  • A thin hollow tube (catheter) is placed over the wire and moved into the blood vessel.
  • The catheter is then guided through the blood vessel until it reaches the area to be studied.
  • X-rays are taken to help see the exact location of the tip of the catheter.
  • Once the catheter is in place, a dye is injected through it. The dye flows through the blood vessel and makes it visible on an X-ray.
  • As soon as the dye is injected a series of X-ray will be taken. These reveal how the dye moves through the vessel. These X-ray are called angiograms.
  • The catheter is removed when the test is completed, and pressure is applied to the needle site for 10 to 15 minutes to stop any bleeding.
  • The insertion site will be bandage and an ice pack may be applied to relieve any pain and/or swelling.

Patients do not experience pain when the catheter is in the blood vessel. They may, however, feel pressure as the catheter is inserted and moved around. Patients generally feel some warmth for a few seconds when the dye is injected.

What can the Results of an Angiogram Reveal?

The results of an angiogram are typically available the same day as the procedure. Since an angiogram is a test to see how blood flows through a specific blood vessel, it can reveal the presence of any blockage or damage in an artery or vein, an aneurysm, and coronary artery disease and its extent.

Normal angiogram: the dye flows evenly through the blood vessel(s) examined. This means that those specific blood vessels are normal; there is no blockage, narrowing, bulging or other problems.

Abnormal angiogram: here the dye does not flow evenly through the blood vessel(s); a bulge or narrowing is seen in the vessel; the dye leaks from the vessel; or the vessel is in an abnormal location and/or there is an abnormal pattern of vessels. Abnormal results may be due to a variety of things including: a clot, a deposit of fat or minerals, an aneurysm, a hole in the vessel, or the presence of a tumor.


All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.