General FAQs

Aetna, Blue Shield, Blue Cross, United Healthcare, Cigna. HMOs: Mills Peninsula Medical Group, Sutter Health.

Epidural Injection Procedure

After you have registered, a nurse will escort you to an examination room. You will be asked to disrobe and put on a hospital gown. You have the option of taking some oral medication (Ativan or Valium) that will help you relax prior to the procedure. You will then be escorted to the procedure room where the doctor, nurse and x-ray technologist will be waiting for you. If you elect to have sedation, an IV will be started in order to administer your medications. Next, you will be asked to lie on your stomach with your arms out in front. The nurse will monitor your vital signs throughout the procedure.
The doctor or nurse will then clean your back or neck with a sterile solution. The doctor will inject a local anesthetic into the appropriate area, numbing the skin, which may cause momentary discomfort and a slight burning sensation.
After the area is numb, the doctor will insert a needle through the skin and under x-ray guidance bring it to the location where he will inject the medicine. A small amount of contrast dye will be injected to check that the needle is properly positioned. After confirmation, the doctor will then inject the medicine and then remove the needle. The nurse will then place a small adhesive bandage on the injection site.
Some patients experience feelings of anxiety while undergoing this procedure. If you experience such feelings, your blood pressure and pulse may become slightly irregular. If so, the nurse will continue to monitor you for approximately 30 minutes while you sit or lie down. This short period of rest will help your blood pressure and pulse return to normal.

You can receive up to 3 epidural injections in a calendar year.

No, cortisone injections if used according to medical guidelines have not been proven to weaken bones.

The benefit of the injection can vary but can last 6 weeks to several years.  This variability from patient to patient is due to each individuals condition and other clinical factors.  Most people will begin to experience the benefit of the steroid injections after 3 days with the peak benefit felt after 1 week.

The epidural injection procedure takes approximately 20 minutes to complete.

Typically we recommend to apply ice to area injected for once every few hours as needed for only 20 minutes at a time. You may need to do this for 1-2 days. After several days then you resume using heat.

After your injection take it easy. You may resume normal day to day activities the following day. Do not participate in strenuous physical activity for a few days.
If you are currently undergoing physical therapy, you can resume your appointments 7 days after your injection.

You may experience a specific side effect of the medication such as flushing of the face and neck. This does not mean that you have developed an allergic response.

As a side effect of the cortisone, you may also develop hiccups, an increased or faster heart rate, water retention with swelling in the hands or feet, elevated blood pressure, and an possibly an increase in blood sugar if you are diabetic. These are possible side effects of the steroids and usually do not last longer than several days.

A spinal headache may occur after an epidural injection if the fluid-filled space surrounding the spinal cord is inadvertently punctured. This creates a passage for the spinal fluid to leak out, changing the fluid pressure around the brain and spinal cord causing a headache. If enough of the fluid leaks out, a spinal headache may develop. Usually this is a headache that is very severe and specifically improved with lying down and worsened by getting up.
If you experience a severe headache that doesn’t improve after a day please immediately notify your doctor.
If you develop an infection with fever, redness, swelling, tenderness, or warmth at the injection site, immediately notify your doctor.
Call 415-353-6000
If it is after hours or weekend and you are unable to contact your physician go to your nearest Urgent Care Center or Emergency Room.

Electromyogram and Nerve Conduction Study

An electromyogram (EMG) is a diagnostic study that has been used for over 50 years. An EMG provides information about the muscles and the nerves in your body. It is typically ordered by a physician to evaluate for muscle or nerve damage as part of a medical evaluation.
As part of the EMG a very fine and thin needle electrode is inserted into various muscles in the arm, leg, neck or back (dependant upon where you are having symptoms). All you need to do is to the best of your ability relax these muscles. Typically 5-7 muscles are explored. In many cases the examination will include areas far from where you are having symptoms because nerves can be very long.
A new disposable needle is used for each patient and thrown out after the examination is complete. There is virtually no chance to catch any diseases from having an EMG. Also, because the needle used is sterilized, the chance of infection is minimal. An EMG is only one portion of nerve testing; the second is called the nerve conduction study.

A nerve conduction study (NCS) is one part of a comprehensive nerve and muscle diagnostic test. Like an EMG, a NCS is typically ordered by a physician to evaluate for muscle or nerve damage as part of a medical workup.
Small electrodes are placed on your skin over muscles being tested in your arms or legs. Then a short, brief and very small electrical stimulation is applied to your skin near nerves being tested. The electrical signals produced by this stimulation and transmitted by the nerves are recorded by a computer. This information is then interpreted by a physician specially trained in electrodiagnostic medicine. The stimulator produces only a very small shock that does not cause damage to your body. Many different nerves which control your muscles and sensation are tested.

When you go to your physician with symptoms of pain (either radiating from the neck or back), numbness, weakness or tingling in an arm or leg, or with other neurologic components, it is important to find out what is causing your symptoms. There are many possible causes for the above symptoms. An EMG/NCS is one way to assess muscle and nerve function which hopefully will provide more insight into the nature of your problem. It is often used with other diagnostic tests such as MRI or CT scan.

After showering on the day of your examination, do not use any creams, moisturizers or powders on your skin. If you have any bleeding disorders, let the examining physician know prior to testing. If you take blood thinners, even any aspirin or aspirin like medications let the examining physician know. You may be asked to stop blood thinners and aspirin products prior to your examination. If you have a pacemaker or other devices that are implanted in your body to deliver medications, let the examining physician know. Any history of back or neck surgery should be discussed with the examining physician, as the examination may need to be modified. Also, any recent fevers or chills may indicate current bodily infection and should be mentioned to the examining physician.

As mentioned earlier, the testing includes both electromyogram (EMG) and nerve conduction studies (NCS). The EMG section includes a small sterilized needle being inserted in the muscles to be tested. There is some discomfort with needle insertion, but most tolerate the testing without difficulty. Some bruising can occur after the needle portion of the examination. Simply ice to sore areas later as this can help with discomfort and limit the bruising. Any time the skin is penetrated with a needle, there is a risk although very rare of infection developing.
The NCS portion of the examination includes a small electrical stimulation applied near nerves to make them fire. In most cases a series of shocks are necessary to get the optimal response. Any discomfort is transient, and the stimulus is not strong enough to cause damage to the body.

After EMG/NCS testing, the examining physician must analyze the data and combine all the information into a report. The electrodiagnostic examination report will be added to your medical record and a copy sent to the referring physician. The time for report generation varies from lab to lab, but generally is no more than a few days. Be sure to follow up with your health care provider.


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