August 19, 2011
Pain in the Neck
Michael Cuddyer, MIN (Cervical disc herniation) [AGL: 4 (73DL), ATD: +.011 (-.011DL)] (Explanation)
We've talked about epidural injections before, but we haven’t discussed how they are performed. An epidural is an injection of strong anti-inflammatories similar to cortisone in the area just outside the sheath surrounding the spinal cord, called the dura. Injections follow a pretty standard protocol and take between 15 and 30 minutes to perform. Often the injections are performed in a series of three or more, spread out over several weeks, in order to provide maximal benefit.
After entering the room, the patient will usually change into a hospital gown for improved visualization and easier access to the injection site. The patient will then lie face down on an x-ray table under a fluoroscope—a machine that takes real-time x-rays—to make sure the needle will be in the proper position. The area of the neck designated for the injection will then be cleaned and draped to ensure a sterile field.
After a local anesthetic numbs the skin, the epidural needle will be inserted and guided under fluoroscopy to the proper spot. Often when the needle reaches the proper position, the patient can report feeling a cold sensation or sense of pressure in the back away from the injection site. In order to ensure that the anti-inflammatory medication reaches everywhere it needs to be, a very small amount of dye is often used and injected into the epidural space. The anti-inflammatory is then injected before the needle is slowly withdrawn. The procedure may be uncomfortable but not overly painful, much like the preceding paragraph may have been for those of you who don’t like thinking about needles.
The medication usually takes anywhere from 24 to 72 hours to take full effect, although some people report immediate relief. These injections are geared to relieve symptoms caused by the inflamed nerves of the neck and not other injuries like stress fractures. For the best chance at full resolution of symptoms, repeated injections are often performed over a three- to six-week period.
Cuddyer's symptoms will likely improve following the injection, but the degree of improvement remains to be seen.
Kevin Youkilis, BOS (Sore back) [AGL: 3, ATD: -.004]
David Ortiz, BOS (Right heel bursitis) [AGL: 3 (50DL), ATD: +.028 (+.021DL)]
Jason Kipnis, CLE (Right Hamstring Tightness) [AGL: 1 (23DL), ATD: -.017 (+.018DL)]
Already battling a right oblique injury for the past several days, Kipnis was scratched from the lineup Thursday with right hamstring tightness. It would be extremely rare for an oblique muscle to cause the hamstring to tighten. Therefore, the hamstring has also likely been an issue; now that his oblique has improved, the hamstring has become the main focus. Other than the hamstring not being better after several days off, there are no signs that a move to the disabled list is in his near future.
Philip Humber, CHA (Head contusion) [AGL: 1 (TBD DL), ATD: -.043 (TBD DL)]
Randy Choate, FLA (Left elbow inflammation) [AGL: 36, ATD: -.037]
Flesh Wounds: Carlos Ruiz, testicle contusion. Enough said... Oakland pitcher Trystan Magnuson was placed on the disabled list with right shoulder inflammation... Denard Span was placed on the disabled list with migraine symptoms... Brian Wilson remained sidelined from right elbow soreness, although there were no structural issues, according to Dr. Andrews... Rickie Weeks has been taking some light batting practice, an important step in his recovery from an ankle sprain. He's likely at least a week away, though... Bryce Harper left yesterday's Double-A game with a strained right hamstring. It should be minor, given that he walked off the field showing only a slight limp... Reliever Brian Sanches was placed on the disabled list with a right elbow strain... Ryan Westmoreland will watch live pitching for the first time since undergoing brain surgery.
Corey Dawkins is an author of Baseball Prospectus. Follow @CoreyDawkinsBP