Epidural Steroid Injections

Epidural steroid injections (ESI) are performed to place anti-inflammatory medication (steroid) and local anesthetic in the epidural space to target irritated nerves and relieve pain. They are most commonly performed for patients with spine pain and radiating pain into either the arms or legs.

There are three different ways to do an epidural steroid injection and your physician will choose the route that offers the best chance of relieving your pain based on several factors.

Facet Joint Injections & Radiofrequency Ablation

The facet joints are small joints on the back of your spine, and are found in all levels from your low-back to your neck. Facet joint pain is usually due to arthritis or degeneration of the joints and is usually described as an ache that stays along the spine and is worse with prolonged sitting, standing or driving. If your pain condition is consistent with facet joint pain, your physician will likely recommend one of the following procedures.

Joint Injections for Knee, Hip, & Shoulder

If you have joint pain due to osteoarthritis your physician may recommend joint injections as part of your treatment plan. Injections of steroid and local anesthetic can provide good lasting relief of pain arising from essentially any peripheral joint to include the knees, hips, shoulders and elbows.

Some joint injections are best performed with x-ray guidance, while others are performed with ultrasound guidance.

Sacroiliac (SI) Joint Injections and Radiofrequency Ablation

The sacroiliac joint (SIJ) is formed where your pelvic bones join to the base of spine, or sacrum. This joint can be a source of pain like any other joint, and it may cause hip, low-back or buttock pain.

Sacroiliac joint dysfunction may also be associated with radiation of pain into the groin and/or back of your thigh.

Spinal Cord Stimulation

Spinal cord stimulation (SCS) is an advanced procedure that has evolved in clinical use since the late 1960’s. It involves the placement of programmable electrodes into the epidural space where they emit signals to the spinal cord to mask pain signals.

If your physician recommends spinal cord stimulation, you will first undergo a trial placement in an outpatient clinic setting. Electrodes will be placed with x-ray guidance and custom programmed to provide relief of your particular pain condition. Over the next 3-5 days you will be able to test the spinal cord stimulation system to see how much it relieves your pain and improves your function.

If the trial is successful, then you will be scheduled to undergo surgical implantation at an area hospital. The implantation is similar to that required for placement of a pace-maker and does not require an overnight stay in-hospital.

Trigger Point Injections

This procedure, which does not require x-ray or ultrasound guidance, is for the treatment of painful areas of muscle tension or spasm. Muscle spasms in the neck, low or middle back can be quite painful and may persist for weeks to months.

Trigger point injections involve the placement of a thin needle directly into the worst areas of pain for injection of local anesthetic and sometimes steroid. They can provide pain relief for weeks to months, and can also be useful for treating pain associated with Fibromyalgia or tension-type headaches.



Viscosupplementation is a highly effective treatment for osteoarthritis (OA), also referred to as “wear and tear” arthritis. It is commonly performed for knee osteoarthritis.

The viscosupplementation procedure consists of weekly injections of concentrated hyaluronic acid (HA), which is found in our joints. It helps to provide lubrication to the joint, and to improve shock absorption during weight bearing activities. The series is carried out over a 3-5 week period.