Experience is important for the proper performance of joint aspiration and injection procedures. Physicians skilled in arthrocentesis usually have had the opportunity to gain experience with a rheumatologist or other physician who performs many procedures. Each joint has different anatomic landmarks, and novice physicians may need to review a textbook for approaches to an unfamiliar joint. Although arthrocentesis is a simple technique with minimal risk, physicians should have assistance or supervision with their first attempts at any site. Family physicians wanting to perform arthrocentesis on deep joints, such as the hip or vertebral joints, should obtain extensive training in these higher risk procedures. Additional training in arthrocentesis is available from the American Academy of Family Physicians.
Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back ( lumbar radiculopathy ), such as from lumbar spinal stenosis , cervical spinal stenosis, herniated disc , and foraminal encroachment, causes back pain that goes down the leg. Epidural injection is also used as a minimally invasive procedure to treat nerve compression in the neck (cervical spine), referred to as cervical radiculopathy , which causes pain.