Cervical Medial Branch/Facet Joint Injections
Your neck is made of small bones (vertebrae) stacked on top of one another. Between each pair are tiny hinge‑like connections called facet joints that let you bend and turn your head. Alongside each joint runs a thin nerve branch, the medial branch, that carries pain signals from the joint to your spinal cord. When arthritis, injury, or everyday wear and tear irritates a facet joint, the medial branch can keep sending pain messages, leading to ongoing neck pain, shoulder pain, or headaches.
Is a Cervical Medial Branch or Facet Joint Injection Right for You?
These injections are most helpful for those with chronic neck pain that flares when looking up, turning the head, or holding a phone between the ear and shoulder. They are also used when headaches or shoulder aches might start in the neck.
You may be a good candidate if:
- Pain has lasted three months or longer and centers in the neck or the back of the head.
- Bending backward or twisting the neck makes the pain worse.
- Imaging shows arthritis or other wear‑and‑tear changes in the facet joints.
- Other treatments have not provided lasting relief.
How Do Cervical Medial Branch and Facet Joint Injections Work?
During the procedure, your pain specialist guides a thin needle to the facet joint (or beside the medial branch) using live X‑ray. After confirming the spot with a tiny contrast dye picture, a fast‑acting local anesthetic is injected. If a steroid is added, it can calm inflammation inside the joint, offering extra comfort.
Because the numbing medicine wears off in a few hours, dramatic pain relief that returns as the medicine fades tells the doctor the facet joint is indeed the source. This “yes‑or‑no” answer helps plan the next step, often radiofrequency ablation (RFA), which can give longer‑lasting relief by gently heating the same nerve.
What to Expect During the Procedure
During your initial visit, your pain management doctor will review your symptoms, medical history, and any imaging studies. Be sure to discuss daily medications, especially blood thinners, during this review. On procedure day, you lie face‑down on an X‑ray table. After a small area of skin is numbed, the doctor advances a slim needle to the target joint or nerve and injects the medication. The process usually takes less than 30 minutes, and most people head home shortly afterward.
What to Expect After the Injection
Mild soreness at the injection site is common for a day or two and can be eased with an ice pack. Many people feel immediate relief once the anesthetic takes hold. Keep a simple pain diary for the next 24 hours. If your pain drops by at least 50 percent during that window, the facet joint is confirmed as the pain source, and you may be offered RFA for longer relief. If pain stays the same, another cause is likely, and the team will discuss other options.
Follow‑Up Care
You will return within one to two weeks to review your pain diary and plan next steps. If the injection helped, RFA can be scheduled, or another diagnostic injection can be done to double‑check. Light stretching is usually safe the next day, and you can resume normal activities unless your pain management physician advises otherwise.
Common Questions About Cervical Medial Branch and Facet Joint Injections
Does the shot hurt?
You might feel a quick pinch when the numbing medicine is given, but most people say the rest of the injection just feels like pressure or a strange sensation—not sharp pain.
How long does relief last?
The numbing medicine works for just a few hours. If a steroid is used, it may provide added relief for several days or even weeks. For longer-term results, your provider may recommend radiofrequency ablation (RFA) after a successful injection.
Is this a permanent solution?
This injection is mainly used to confirm whether the facet joint is the source of your pain. If it is, a follow-up treatment called RFA can offer longer-lasting relief, often for six to 12 months, sometimes longer.
Can I drive myself home?
If you don’t receive sedation, you can usually drive yourself home. If you choose light sedation, often given through an IV to help you relax, you’ll need someone to drive you and should plan to rest for the remainder of the day.
Do I need to stop medications first?
Be sure to tell your doctor about any medications you take, especially blood thinners, diabetes medications, or if you have any allergies. They’ll help you make a safe plan and let you know if any changes are needed before the procedure.
