Epidural steroid injections for hip pain
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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To better explain an epidural steroid injection (ESI), it is helpful to understand the anatomy.
There is a thin membrane called the dura which forms an envelope in which cerebrospinal fluid, the spinal cord, and nerve roots are located. This dural envelope lies within a bony canal. The space between the walls of the bony canal and the dural envelope is called the epidural space. Nerves exit from the spine through the epidural space.
An epidural steroid injection delivers medication into the epidural space around spinal nerve roots to relieve pain - back pain, hip pain, leg pain, or other pain—caused by irritated spinal nerves. Hip and leg pain are common symptoms when a patient has a “pinched nerve” in the lumbar area.
The steroid used in the epidural steroid injection reduces the inflammation of nerves. The inflammation is due to nerve root irritation and the subsequent production of substance P and other cytokines. An epidural steroid injection is not a cure for back pain or leg pain.
An epidural steroid injection reduces pain for approximately 50% of patients. In addition to relieving pain, natural healing can occur more quickly once the inflammation is reduced.
Spinal nerves can become inflamed due to irritation from a damaged disc or bone spur. Depending on the location of the inflamed nerves, pain and/or other symptoms (such as numbness, tingling) may be experienced in the low back, hip, buttock, or leg.
The injection procedure for an epidural includes the following steps:
The patient lies face down or sits up on the examination table and the skin is cleaned with an antiseptic.
Diagnostic ultrasound or fluoroscopy is used to localize landmarks.
The area where the epidural needle will be inserted is numbed with a local anesthetic.
A combination of an anesthetic and steroid is injected.
The procedure usually takes approximately 30 minutes. On the day of the epidural steroid injection the patient should not drive.
Following the epidural injection, some partial numbness from the anesthetic may occur in the patient’s legs. The numbness subsides after a few hours.
Again, epidural injections should be administered using either ultrasound or fluoroscopy for needle guidance.
There can be an temporary increase in the patient’s pain that may last for up to several days. This occurs after the numbing medicine wears off but before the steroid has a chance to work. Ice packs may help reduce the inflammation. Improvement in pain will generally occur within 10 days after the epidural injection.
On the day following the procedure, the patient may return to his or her regular activities. When the pain has improved, exercise may be resumed. Activities should be increased slowly over one to two weeks to avoid recurrence of pain.
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