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Atlanto-Occipital (AO) Joint Injection
An atlanto-occipital (AO) joint injection is an
outpatient procedure for diagnosing and treating
chronic upper neck pain and
headache.
What is the atlanto-occipital joint?
Joints connect the vertebrae, the bones of your spine. These
joints help guide your spine when you move. The neck area of
the spine is called the
cervical
region. It contains seven vertebrae and the joints that
connect them.
The upper most of these joints connects the skull (also
called the occiput) to the first cervical vertebra (also
called the atlas). This joint is called the atlanto-occipital
joint. It is also sometimes called the AO or the CO-1 joint.
Half of the total neck forward bending (flexion) and
backward bending (extension) comes from the AO joint.
What is AO joint pain?
You may feel
pain if your atlanto-occipital joint is injured.
Sometimes it feels like muscle tension. But at other times
the pain may be severe. Sometimes cartilage inside the joint
is injured. Other times it is the connecting ligaments
surrounding the joint that are injured. AO pain can occur in
your
upper neck or it can cause
headaches.
How do I know if I have AO pain?
If you have
chronic upper neck pain or headaches you may have AO
pain. Common tests such as x-rays or
MRIs may not always show if this joint is causing pain.
An AO injection may be needed to determine this.
What is an AO injection?
In an AO injection, a local anesthetic (numbing medicine)
and a
corticosteroid (anti-inflammatory medicine) are injected
into the joint. The local anesthetic helps to temporarily
numb pain, and the steroid helps reduce inflammation.
This injection can be used to diagnose or treat your pain.
If it temporarily lessens your pain, and if it helps you
move better, it tells the doctor which
joint is causing the pain.
What happens during an injection?
A local anesthetic will be used to numb your skin. The
doctor will then insert a thin needle directly into the
atlanto-occipital joint.
Fluoroscopy, a type of x-ray, must be used to ensure the
safe and proper position of the needle. A dye may also be
injected to make sure the needle is at the correct spot.
When the doctor is sure the needle is at the correct place,
the anesthetic and steroid will be injected.
What happens after an AO injection?
You will be monitored for up to 30 minutes after the
injection. When you are ready to leave, the staff will give
you discharge instructions and a pain diary. It is important
to fill out the pain diary because it helps your doctor know
how the injection is working.
It may help to move your neck in ways that hurt before the
injection, to see if the pain is still there, but do not
overdo it. Take it easy for the rest of the day. You may
feel immediate
pain relief and
numbness in your upper neck for a period of time after
the injection. This may indicate the medication has reached
the right spot.
Your pain may return after this short pain-free period, or
may even be a little worse for a day or two. It may be
caused by needle irritation or by the steroid itself.
Steroids usually take two or three days to start working,
but can take as long as a week.
You can usually return to work the day after the injection,
but always check with your physician first.
How long can I expect pain relief?
The extent and duration of pain relief may depend on the
amount of inflammation and how many areas are involved.
Other coexisting factors may be responsible for your pain.
Sometimes an injection can bring several weeks to months of
pain relief, and then more
treatment
is needed. Other times, particularly if there is no
underlying bone or
joint problem, one injection brings long-term pain
relief. If your pain is caused by injury to more than one
area, only some of your symptoms may be helped by one
injection.
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