Thoracic Medial Branch Block

A THORACIC MEDIAL BRANCH BLOCK is an outpatient procedure for diagnosing and treating upper and middle back pain. This information has been provided by your doctor so you can  better understand this procedure. Your doctor will make the best recommendation for your specific needs.

WHAT ARE THORACIC FACET JOINTS?

Facet joints connect the vertebrae, the bones of the spine. They help guide your spine when you  move. The area of the spine between your neck and low back is called the thoracic region. It contains twelve vertebrae. Facet joints are found on both sides of the spine. Each is about the size of a thumbnail. Thoracic facet joints are named  for the vertebrae they connect and the side of the spine where they are found. The right T4-5 facet joint, for example, joins the 4th and 5th thoracic vertebrae on the right side. Medial branch nerves are found near facet joints. They transmit pain signals from the facet joints to your brain.

WHAT IS THORACIC FACET JOINT PAIN?

You may feel pain if a thoracic facet joint is injured. Sometimes it feels like muscle tension.  Other times it can be severe pain. The cartilage inside the joint may be injured. Other times only connecting ligaments surrounding  the joint are injured. Facet pain also depends on which facet joint is affected. Pain from thoracic facet joints occurs in  a large area from your upper back and shoulder to your hips. The diagram shows areas of pain  usually associated with specific joints.

HOW DO I KNOW IF I HAVE THORACIC FACET PAIN?

If you have pain in one or more of these areas, and it lasts longer than two months, you may have  thoracic facet pain. Common tests such as X-rays or MRIs, may not always show if a facet joint is causing pain.

WHAT IS A THORACIC MEDIAL BRANCH BLOCK?

During this procedure, a local anesthetic (numbing medicine) is injected near the medial branch nerve,  which stops the transmission of pain signals from the facet joint. If your pain is reduced and you are able to move your back normally, then the doctor will know which facet joint has been causing your pain.

WHAT HAPPENS DURING AN INJECTION?

A local anesthetic may be used to numb your skin. The doctor will then insert a thin needle near the medial branch nerve. Fluoroscopy, a type of x-ray, may be used to ensure the safe and proper position of the needle. A dye may also be injected to make sure the needle is in the correct spot.  Once your physician is sure the needle is correctly placed, the medicine will be injected.

WHAT HAPPENS AFTER AN INJECTION?

You will be monitored for up to 30 minutes after the injection. Before you leave, the clinic will give you discharge instructions as well as a pain diary. Keeping track of your pain helps the doctor know what the next step will be. You may want to check for pain by moving your upper back in ways that hurt before the injection, but do  not overdo it. You may feel immediate pain relief and numbness in your back for up to six hours after the  injection. This means the medication has reached the right spot.You should be able to return to work the day after the injection, but always check with your doctor.

HOW LONG CAN I EXPECT PAIN RELIEF?

How long you can expect pain relief depends on how many areas are injured, and on the amount of  inflammation. If your pain goes away for a short time, but then returns, you may be a candidate for radiofrequency  ablation (RFA) to the medial branch nerve. This procedure provides a more permanent disruption of pain  signals.

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