To understand Medial Branch Block, first, we need to understand What is a Medial Nerve?
So, What is a Medial Nerve?
The medial nerves, or medial branch nerves, carry pain signals to the facet joint of the spine. From there, those pain signals are transmitted to the brain, which in turn makes the body aware of the pain. The facet joints connect each vertebra of the spine and determine the neck’s range of motion. The medial branch nerves originate from the cervical nerves that supply impulses to the muscles and skin, particularly in the forearms and hands. There are also medial plantar nerves located in the foot.
Properly functioning medial nerves can lead to debilitating pain, such as low back pain, simply by being the source from which the brain is informed of the pain impulse. This led to a pain treatment known as Medial Branch Block. Doctors who perform such a block inject the medicine into an area of the spine outside of a joint but close to the nerve or nerves that control the area’s pain impulses. It doesn’t necessarily fix the underlying medical condition. Still, it prevents the medial nerve from relaying pain signals to the spine to relay to the brain, leaving the body unaware that it should hurt.
A medial nerve block that fails to relieve pain is considered a therapeutic failure but serves as a diagnostic tool for doctors, who use ongoing pain to determine that the joint is not the problem. Pain that subsides for a short time before returning tells doctors that the problem is the joint, but the medicine used, sometimes steroids, has been ineffective. The pain that goes away comes back and goes away tells doctors that the block was therapeutic and can be repeated as needed. Medial nerve blocks may only last a short time, but such effective short-term therapy can lead doctors to perform another procedure that has similar but longer-lasting effects.
Although many related conditions are easily treatable without surgery, improper functioning medial nerves can also be a problem. Excessive pressure on the medial nerve can lead to conditions such as medial epicondylitis or golfer’s elbow. The condition is a form of tendonitis caused by stress on the muscles that bend the wrists forward. Surgery is rarely needed in the treatment of a golfer’s elbow because the pain usually subsides when the affected muscles can rest. Strengthening and stretching exercises after the pain subsides can help prevent the condition from returning.
Intervention with Medial Branch Block?
A medial branch block is a medical procedure in which an anesthesiologist numbs the medial branch nerves that emerge from the spinal cord to determine if they are a source of chronic pain. These nerves emerge from the facet joints between the vertebrae and can be a significant source of pain. The procedure will temporarily reduce pain if facet joints are the problem, indicating that a procedure to sever or ablate the nerves might be helpful for long-term pain management. Medial branch blocks are not therapeutic or curative but primarily serve a diagnostic effect.
Before the test, the doctor will interview the patient to check for allergies and other contraindications. For the procedure, the patient lies down on a table and receives intravenous sedation for comfort. Once the sedatives take effect, the doctor can clean an area of interest along the spine and insert a needle, using fluoroscopy as a guide to making sure the needle goes to the right place. Next, the doctor may inject a tracer dye to confirm placement. Next, he adds an anesthetic to block the nerve temporarily.
The doctor asks the patient to wait 20 to 30 minutes for the anesthetic to take effect, then instructs the patient to perform a usually painful activity, such as bending or stretching. If the problem is with the facet joints, the medial branch block will limit pain signals, allowing the patient to complete the activity without pain or with minimal pain. This pain-free state will last until the anesthetic wears off and the nerves are able to function again.
When the medial branch block works, the doctor knows that treating the nerves around the facet joints should help with the patient’s chronic pain. Doctors can use lasers and other tools to burn nerves and carefully cut their signals in a neurotomy procedure. As a result, the patient should experience drastically reduced pain levels after surgery and may be more able to engage in physical activities.
In cases where the medial branch block has no or little effect, the problem resides somewhere else in the patient’s body, and further diagnostic tests are needed to find out what is going on. Failure of a medial branch block indicates that severing the nerves would provide no benefit to the patient. The doctor may repeat the test at another time to see if anything changes, depending on the situation and the patient’s response to other treatments.
Do not wait to begin the conversation for your mobility issues or back pain relief. Dr. Munish Lal will assist you in solving your frequent concerns and help you master how to enhance the health of your spine for optimal wellness. Right at the heart of Torrance, CA, pain care is just a call away.