Tuesday, March 17, 2009

Cortisone Injections, Epidural Steroid Injections, and Other Therapeutic Injections for Work Injuries

If you’ve sustained a work injury, your doctor may prescribe a cortisone injection, epidural steroid injection, or other therapeutic injection procedure. 

Often, cortisone injections, epidural injections, and other therapeutic injections, are considered an “intermediate” treatment, falling somewhere in between conservative therapies and more drastic procedures, such as surgery.

These therapeutic injections are covered by Minnesota workers’ compensation if they are reasonable and necessary to cure or relieve the effects of your work related injury.

Cortisone Injection

Cortisone injections are injections of a synthetic corticosteroid (cortisol) medication into an affected area of the body. Injections of cortisone are used to suppress immune response which in turn can decrease inflammation and pain. A numbing medication, such as novacaine, is typically mixed with the cortisone to provide some immediate relief and to help the cortisone spread throughout the affected area.

Cortisone injections are typically used to treat inflammatory problems that can cause pain and loss of function, including arthritis, epicondylitis (“tennis elbow”), trigger finger, de Quervain’s tenosynovitis, trochanteric bursitis of the hip, subacromial bursitis of the shoulder or shoulder impingement syndrome.

The relief provided by cortisone injections varies from person to person. Typically, cortisone starts to take effect within about a week, but may take up to two weeks to reach maximum effectiveness. Sometimes, cortisone injections don’t work for some people. In that case, it may be that your problem is not primarily an inflammatory condition, or your condition is too far along in its course for cortisone to provide relief.

Epidural Steroid Injection

Epidural steroid injections are very similar to cortisone injections, except that they are done on the spine. Epidural steroid injections are injections of corticosteroid medication and local anesthesia (numbing medication) into the lumbar, thoracic, or cervical spine, using a needle and syringe. This type of injection is aimed at providing relief from neck or back pain.

When nerve roots are irritated by a bulging or herniated disc, or by degenerative conditions such as spinal stenosis, it can cause pain and numbness, which may extend from the neck into the shoulders and arms, or from the back into the buttocks and legs.

The medication is injected into the epidural space around the nerve roots at the affected level of your spine. Epidural steroid injections work by reducing inflammation of the nerve roots, which is swelling and irritation, thereby providing pain relief. Some people receive immediate relief from epidural steroid injections, although it may take up to two weeks for the treatment to reach maximum effectiveness. Some people experience permanent relief of their neck or back pain following an epidural steroid injection, but for most people, the relief lasts for up to a few months.

Facet Joint Injection

Facet joints are small pairs of joints where vertebrae meet on the back side of the spine. These joints provide stability to spine by interlocking two vertebrae. Facet joints also allow the spine to bend forward (flexion), bend backward (extension), and twist. Inflammation of the areas surrounding the facet joints can cause pain and discomfort.

Facet joint injections are very similar to epidural steroid injections, but they are aimed at relieving inflammation in the facet joints rather than the nerve roots.

Sacroiliac Joint Injection

The sacroiliac (SI) joint connects the sacrum (the triangular bone at the bottom of the spine) with the pelvis (iliac crest). This joint transmits all the forces of the upper body to the pelvis and legs and acts as a shock-absorbing structure. This “joint” does not have much motion. The sacroiliac (SI) joint can become inflamed from an acute injury or from chronic postural abnormalities. Pain from a sacroiliac joint problem occurs in the low back, buttock/hip, abdomen, groin, or legs.

The sacroiliac joint can become inflamed from an acute injury or from chronic postural abnormalities. Undue stress on the joint following low back fusion surgery can also cause inflammation and pain here. Pain from sacroiliac joint abnormalities occurs in the low back, buttock/hip, abdomen, groin, or legs.

A sacroiliac joint injection can serve two purposes. First, the injection can be used as a diagnostic tool to confirm whether or not the pain is coming from that joint. Second, the local anesthetic and cortisone medication can provide symptom relief which can help facilitate a program of rehabilitation.


Facet joints are pairs of small joints that separate the vertebra on the back side of the spine in the lumbar (low back), thoracic (mid-back), and cervical (neck) regions. These joints can become inflamed and painful from either injuries or arthritic conditions. When facet injections of local anesthetic and/or cortisone provide temporary pain relief, you may be a candidate for a facet neurotomy.

A facet neurotomy involves destroying the nerves that relay pain messages from the facet joints. This is accomplished by using a technology called Radio Frequency Thermal Coagulation (RFTC). Under x-ray guidance, your physician places a fine probe, not much larger than the needle used in facet injections, down to the nerves that supply the facet joint(s). A controlled heat lesion is then made using RTFC. Each facet joint has at least two nerve branches therefore several lesions may need to be done at the time of the procedure.

Neurotomies are more intensive procedures than epidural steroid injections or facet joint injections. Expect moderate pain for several days following the procedure, and it may take several weeks to experience the maximum effect of the treatment. A neurotomy can provide up to six months or more of relief.

There are several other types of minimally-invasive injection-based therapies available for people suffering from work injuries to the hips, knees, elbows, shoulders, neck or back. The workers’ compensation lawyers at Meuser & Associate can help you get the medical treatment you need to treat your work injuries. Call us at 877-746-5680 or click here to send us an email to schedule a free, no-obligation consultation.

Visit our website at MeuserLaw.com!

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