- Numbness
- Weakness
- Loss of muscle mass or muscle bulk
- Pain
- Sciatica

Electromyelograms ( EMG’s ) consist of two parts:

1. Nerve Conduction Velocity
Taping electrodes over muscles and stimulating specific nerves using small electric shocks.

2. Needle Exam
Placing a fine needle into select muscles and recording the electrical activity within the muscle.

The Nerve Conduction Velocity and the Needle Exam enables the physician to determine the integrity of the nerve, muscle and nerve muscle junction. This is accomplished by calculating how fast the electrical impulse travels down the nerve, determining the amount of electrical energy traveling down the nerve and studying the electrical wave forms within muscle.
 
INTRASPINAL INJECTIONS
 
Intraspinal injections are procedures in which a needle is placed at the site of a suspected pain source. These injections are typically performed using a machine called a fluoroscope. The fluoroscope takes real time x-ray images that enable the physician to accurately place the needle. Once the needle is positioned at the desired location a dye solution is infused to outline the structures. If the physician is satisfied with the dye flow pattern the next step is to inject an anesthetic, steroid or combination of both.

These injections are done in a ambulatory surgery center or hospital setting. Patients are offered intravenous sedation prior to the procedure to help make them more comfortable. Most procedures are done with the patient laying on their stomach. Monitoring devices may be attached to the chest, upper arm and finger to monitor heart rate, blood pressure and blood oxygen levels. The injection site is cleaned with solution and sterile towels are draped over the area. Like at the dentist office, a local anesthetic shot is used to numb the skin and underlying tissue near the injection site. These procedures may yield immediate relief, however, often it takes several days for the pain to lessen. Ask your doctor for details regarding the specific procedure.

The most common intraspinal injection procedure is an epidural steroid injection to treat pain radiating down the leg(s). The extremity pain often responds dramatically within a week because of the powerful anti-inflammatory effect of the steroid. An epidural injection often does not eliminate all the low back and leg pain. However, one goal of the injection is to break the pain cycle and allow patients to increase their physical activity and accelerate recovery. Some patients may need more than one injection to achieve optimal results.

Intraspinal injections can be both therapeutic and diagnostic. The therapeutic effect occurs if pain decreases after the procedure. If pain is not relieved with the procedure this yields important diagnostic information. Specifically, it may mean that the pain is coming from another level in the spine or that the pain is not from inflammation. The results and information obtained from injections may help planning back surgery. Some patients may unfortunately suffer from degenerative changes in both the back and the hip joint. It may be a diagnostic challenge in determining if the main pain generator is the hip joint versus referred pain from the back to the hip. Selective injections may help tease out the answers. For example, the doctor may recommend a hip injection first and the patient will report how much symptomatic relief occurs.

Some examples of diagnoses that may be helped with fluoroscopically guided injections include:

- Sciatica
- Spinal Stenosis
- Degenerative Disc
- Facet Joint Pain
- Low Back Pain
- Sacroiliac Joint Pain
- Degenerative Hip Joint Pain

Edward J. Lairson, MD
Board Certified Physical Medicine and Rehabilitation
Electrodiagnostics and Intraspinal Injection Medicine
Orthopedic & Fracture Clinic