Which injections fall outside the clinic’s scope?
Spinal injections and nerve blocks. Both need a different specialist setting and clinical pathway. Spinal injections are usually performed most safely under fluoroscopic guidance (real-time X-ray) and into the epidural space. Peripheral nerve blocks can be done under ultrasound guidance, but the procedure sits outside of this clinic’s scope. Most peripheral nerve blocks in the UK are done by medics who often are pain specialists.
Peripheral musculoskeletal injections treat joints, tendons and soft tissues, such as bursae, which are fluid-filled cushions that prevent tissues from rubbing.
The following injections are not offered by Sonoscope. Spinal injections require X-ray guidance and are therefore only done in hospital settings with access to X-ray machines. Peripheral nerve blocks are mostly carried out by medical pain specialists, as that is their area of expertise. This procedure is therefore not offered at Sonoscope.
- Epidural injections, spinal pain procedures that may use local anaesthetic and steroid.
- Spinal nerve root injections, which place local anaesthetic and steroid around a nerve root.
- Facet joint injections and medial branch blocks, both targeting structures linked with the spine.
- Peripheral nerve blocks place anaesthetic around a nerve or group of nerves to numb an area.
“Nerve block” is worth pausing on because it describes more than one procedure. A request needs an exact name before anyone can judge whether it suits a particular service.
What Is In This Article
How do spinal injections, nerve blocks and musculoskeletal injections differ?
An injection for a painful shoulder targets a joint, tendon, bursa or nearby soft tissue. A request to inject a trapped nerve in the back may concern a spinal nerve root, which is a different assessment route entirely.
The table below compares what each procedure targets, what it is for and the setting it usually needs.
| Procedure type | Target | Purpose and usual pathway |
|---|---|---|
| Peripheral musculoskeletal injection | A joint, tendon, bursa or other soft tissue | Steroid or another medicine may reduce pain and inflammation, assessed in a musculoskeletal injection clinic |
| Epidural injection | A spinal area | Local anaesthetic and steroids may be considered for acute severe sciatica, through a specialist spinal or pain service |
| Spinal nerve root injection | A nerve root | A local anaesthetic and steroid placed around the nerve root under imaging control, in a radiology setting |
| Peripheral nerve block | A nerve or group of nerves | An anaesthetic numbs part of the body, and these are commonly provided by anaesthetic services |
An epidural and a spinal nerve root injection are not the same procedure, and a cortisone injection into a painful joint has a different purpose again from a peripheral nerve block.
NICE, which covers England, places spinal injections outside the recommended management for low back pain. It says an epidural injection of local anaesthetic and steroid may be considered for acute, severe sciatica.
Sciatica means leg pain linked with a spinal nerve root, and it may come with numbness or tingling down the leg. If that describes your symptoms, it is useful information for whoever assesses you, because it points away from a peripheral joint or tendon problem.
Why can an injection be declined after the assessment?
Arriving with a procedure in mind does not settle what happens next. An injection is declined where the target sits outside this clinic’s scope or where the assessment finds no suitable peripheral target to treat.
Rob Mast personally examines you and performs the real-time ultrasound assessment before deciding whether a peripheral musculoskeletal injection fits what he finds. A suitable joint, tendon, bursa or soft-tissue target may support treatment. A spinal source needs a different specialist service.
What does the examination establish?
Your symptoms, how the area moves and exactly where the pain sits all help identify the structure likely to be causing it. Pain travelling into the leg points the assessment away from a peripheral joint or tendon.
The examination also tests whether an injection would actually reach the likely source. Medicine placed accurately into the wrong structure helps nobody.
What does the real-time scan show?
A real-time ultrasound scan shows the joints, tendons, bursae and soft tissues that might suit an injection, and it guides the needle precisely into whichever is chosen.
Some scans show no inflammatory or structural target at all. That is a useful answer rather than a wasted appointment, because a precise injection is only worth having when the target is the right one.
Which service should handle a spinal injection request?
For readers across Hertfordshire weighing up where a request belongs, the first question is whether it concerns a peripheral musculoskeletal structure or the spine. Spinal injections and nerve blocks may need a specialist spinal service, a pain-management service or interventional radiology.
The imaging follows the procedure rather than the other way round. Fluoroscopy uses real-time X-rays. Computed tomography, or CT, produces cross-sectional X-ray images. Ultrasound has a role in selected spinal procedures too. Which one suits it depends on the procedure, the anatomy and the setting.
A specialist also decides whether imaging would change anything for low back pain or sciatica. A scan is worth doing when the result is likely to guide the decision about care, rather than as a routine first step.
Before you approach any service, have three things ready: the name of the procedure you have been offered or are seeking, where the pain starts, and whether it travels into your leg. Those three answers separate a peripheral problem from a request that needs a spinal pathway.
A clinic that names its limits is giving you something you can check. The exact procedure, the target structure and the setting able to assess it are all more useful to you than a service willing to say yes to everything.
Common questions about injections outside clinic scope
Do I need a scan before a peripheral musculoskeletal injection assessment?
No. Not generally. You do not need a separate scan, X-ray or MRI beforehand. Examination and diagnostic ultrasound can take place in the same visit, where clinically appropriate.
However, prior to your consultation in the Sonoscope clinic, you will have submitted a consent form and questionnaire and if any of the information in those indicates that injection might not be appropriate, you will be contacted and informed.
Can I have a private assessment without a GP referral?
Yes, for a peripheral musculoskeletal problem. Spinal symptoms may need a different specialist service, and a GP can advise on that route.
Can ultrasound guide a spinal injection?
Yes, such guidance is possible for selected procedures (not at Sonoscope). However, most commonly, injections are done via fluoroscopy and CT, depending on the procedure, anatomy, and specialist setting.
Is a cortisone injection the same as a nerve block?
No. A cortisone injection may treat inflammation in a joint, tendon or bursa. A peripheral nerve block uses anaesthetic to numb the area a nerve supplies. Different medicines, different targets, different purposes.
What information helps identify the right injection service?
The history and symptoms of the pain. And whether any pain, numbness or tingling travels into the leg. With that information, a specialist can tell fairly quickly whether the target sits in a peripheral musculoskeletal pathway or needs spinal care.
This is general information, not medical advice.
Reviewed by Rob Mast, Advanced Practice Physiotherapist and Sonographer, Honorary Lecturer in Musculoskeletal Diagnostic Ultrasound at Brunel University.
