• Medial Branch Blocks

    Medial Branch Blocks are performed to relieve facet mediated pain. Dr. Ring can perform these injections in your neck, or back. Typically, facet joint injections are performed as a part of a workup for back or neck pain.

    The injection of local anesthetic into the facet joint area is diagnostic and potentially therapeutic. Using X-ray guidance, Dr. Ring will place the injection directly into the facet joint area. Pain relief following this injection generally confirms that the facet is the pain generator.

    Patients referred for facet injections most often have acute injury, chronic injury or egenerative disease of the facet joints. However, even if the facet joint appears radiologically normal, facet injections still may be of use, as radiologically occult synovitis can cause facet pain, particularly in younger patients. There are many diagnoses such as facet mediated pain, postlaminectomy syndrome, or nonradicular pain occurring after laminectomy, which are an acceptable reason to perform facet injections.

    Patients with lumbar facet pain (so-called facet syndrome) typically present with back, buttock, or hip pain. If the patient has only back pain, this pain may radiate into the buttocks or hips, and the pain is typically worse with extension. Radiculopathy, leg weakness, and leg numbness are not normally considered part of the facet syndrome and suggest nerve root compression, although this may be secondarily caused by facet hypertrophy and can actually be part of the facet syndrome.

    Occasionally, synovial cysts (out-pockets of the facet joint synovium) may be symptomatic. Most often, they cause foraminal or spinal stenosis. Typically, on T2-weighted MRIs, synovial cysts are seen as rounded areas of increased signal intensity with a peripheral rim of decreased signal intensity. These cysts are located adjacent to a facet joint. The injection of steroids into the associated facet joint is effective in resolving synovial cysts in 30-40% of patients, although repeated injections may be necessary.

    Cervical or thoracic facet pain is not characterized as easily as lumbar facet pain, and it can occur with a variety of symptoms, depending on the level and the individual patient. Headaches, neck muscle spasms, and general or focal neck pain can originate from the facet joints. Chest or rib pain can occur. In particular, the upper cervical facets can often cause occipital headaches.

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