Thoracic Facet Joint Injection Information

Peer Reviewed

What are thoracic facet joints?

Thoracic facet joints are small joints located in pairs in your mid-back. These joints provide stability and guide motion in your spine.
Illustration of Facet Joints in Motion.Facet joints provide stability and guide motion in your spine. Photo Source:

Why are facet joint injections helpful?

If the joints become painful due to arthritis, injury, or mechanical stress, they can cause pain in various areas. The thoracic facet joints can cause pain in your mid-back, chest, and on rare occasions, your arm.

A facet joint injection serves several purposes. First, by placing numbing medicine into the joint, the amount of immediate pain relief you experience will help confirm or deny the joint as a source of your pain. That is, if you obtain complete relief of your main pain while the facet joints are numb, then these joints are likely your pain source. Furthermore, time-release cortisone will be injected into these joints to reduce any presumed inflammation, which can, on many occasions, provide long-term pain relief.

What will happen to me during the procedure?

An IV will be started so that adequate relaxation medicine can be given, if needed. After lying on an x-ray table, the skin over the area of the spine to be treated will be well cleansed. Next, the physician numbs a small area of skin with numbing medicine (anesthetic), which stings for a few seconds. Next, the physician will use x-ray guidance to direct a very small needle into the joint. He then injects several drops of contrast dye to confirm that the medicine only goes into the joint. A small mixture of numbing medicine (anesthetic) and anti-inflammatory cortisone is then slowly injected.

What should I do after the procedure?

20-30 minutes after the procedure, you move your area of usual discomfort to try to provoke your usual pain. You report your remaining pain (if any) and record the relief you experience during the next week in a "pain diary" we provide*. You may or may not feel improvement during the first few hours after the injection. This depends on if the joints injected are your main pain source. The pain diary is an important component of your care. It helps your treating physician to be informed of your results so future tests and/or needed treatment can be planned.

How will I feel after the procedure?

On occasion, the part of your treated spine may feel slightly weak or odd for a few hours after the injection. You may notice a slight increase in your pain lasting for several days, as the numbing medicine wears off before the cortisone becomes effective.

Ice is typically more helpful that heat during the first 2-3 days after the injection.

You may begin to notice an improvement in your pain 2-5 days after the injection. If you do not notice improvement within 10 days after the injection, it is unlikely to occur.

Can I take my regular medications after the procedure?

You may take your regular medications after the procedure, but try to limit any pain medications for the first 4-6 hours after the procedure. This will ensure that the diagnostic information obtained from the procedure is accurate.

You may be referred for physical or manual therapy after the injection while the numbing medicine is effective and/or over the several weeks while the cortisone is working.

When can I resume activity?

On the day of the injection you should not drive and should avoid any strenuous activities. On the day after the procedure, you may return to your regular activities.

When your pain is improved, start your regular exercise in moderation. Even if you are significantly improved, gradually increase your activities over 1-2 weeks to avoid recurrence of your pain.

*SpineUniverse Editorial Comment: Dr. Dreyfuss has provided excellent information for patients who undergo this procedure. Instructions and information provided by your physician may vary.

Commentary by: Curtis W. Slipman, MD

Thoracic facet joints can precipitate mid-back pain with possible referred symptoms into the chest and/or abdomen. The only test that proves that the facet joint is the source of pain is a diagnostic facet joint block, as CT scan, x-Ray, and MRI are usually unremarkable. In contrast to a treatment or therapeutic block (injection) in which a steroid is used, a diagnostic injection only uses a local anesthetic.

It is essential that the specific offending joint be identified so that a targeted therapeutic injection can be offered. While many patients will be successfully relieved of their symptoms, not everyone is cured. In those cases a procedure known as radiofrequency denervation should be considered.

Updated on: 08/27/19
Continue Reading
Radiofrequency Ablation Treatment for Neck, Back and Sacroiliac Pain
Curtis W. Slipman, MD
Chief Executive Officer
Cutting Edge Medical Solutions, LLC
Continue Reading:

Radiofrequency Ablation Treatment for Neck, Back and Sacroiliac Pain

Radiofrequency ablation may help manage your back pain, and may be combined with other non-surgical therapies. Radiofrequency neurotomy and rhizotomy are other names for this procedure.
Read More