After a cervical epidural steroid injection or nerve root block, most people rest for the rest of the day and return to light activity the next day. The neck may be sore at the needle site for 1 to 3 days, and arm pain can briefly flare. Relief usually starts within 3 to 7 days, sometimes up to 2 weeks. When it helps, it often lasts weeks to a few months.
These injections are mainly used for a pinched nerve in the neck (cervical radiculopathy), where a disc bulge or narrowed opening irritates a nerve root and sends pain, tingling or numbness into the shoulder blade, shoulder or arm. Most people do not need one. Many cases settle with time and physical therapy.
Key takeaways
- Two common types: an epidural places steroid in the space around the spinal cord and nerves; a nerve root block targets one nerve as it leaves the spine.
- Same day: plan on someone driving you home and a quiet rest of the day.
- Onset: relief usually starts within 3 to 7 days and can take up to 2 weeks.
- Limits: doctors usually cap steroid injections in the spine at about three or four a year.
- Urgent signs: new arm or leg weakness, a severe headache, fever, or trouble breathing or swallowing after a neck injection need same-day or emergency care.
What the injection is and why it is used
Using X-ray (fluoroscopy) or CT guidance and contrast dye to check placement, a doctor places a needle near the irritated nerve and injects a corticosteroid, often with a local anesthetic. The steroid reduces inflammation around the nerve root, which can ease arm pain.
A selective nerve root block targets a single nerve. Besides treating pain, it can help confirm which level of the neck is causing symptoms, which matters if surgery is being considered. An epidural spreads more widely in the space around the spinal cord. Arm pain tends to respond better than neck pain alone.
Neck injections carry rare but serious risks, including bleeding, infection, nerve injury and, very rarely, spinal cord injury or stroke. Your doctor will discuss these, along with any blood thinners you take.
Day by day: the first week
- Day 0: you may be observed for 15 to 30 minutes. The arm can feel numb, heavy or warm for a few hours from the anesthetic. Do not drive for the rest of the day. Rest, with short walks around the house.
- Days 1 to 3: soreness at the needle site and a temporary rise in arm pain are common. A flushed face, poor sleep or feeling restless can follow the steroid. Light daily activity is usually fine. Many doctors ask you to avoid baths, pools and hot tubs for 24 to 48 hours.
- Days 1 to 5, if you have diabetes: blood sugar often runs higher for a few days. Check more often than usual.
- Days 3 to 7: arm pain often starts to ease. Keep a simple daily log of arm pain, tingling and sleep, so you and your doctor can judge the result.
Weeks 2 to 6
- Weeks 1 to 2: most people return to desk work within a few days. Physical work, heavy lifting and contact sport usually wait until you see how the arm responds.
- Weeks 2 to 6: this is a useful time for physical therapy: neck and shoulder blade movement, posture endurance, gentle nerve mobility and graded strengthening of the arm.
- Follow-up: doctors commonly review you at 2 to 6 weeks to decide whether the injection helped enough.
The injection quiets the nerve. The weeks after are for teaching the neck to carry load again.
How long the effect usually lasts, and how to use the window
Relief varies widely. For some people it lasts a few weeks; for others, several months. In many cases a pinched nerve settles gradually over 6 to 12 weeks or longer anyway, and the injection helps get through the worst of it. Use the lower-pain weeks to move the neck, sleep better and rebuild tolerance for sitting, driving and work.
How many injections are usually considered
Most doctors limit spinal steroid injections to about three or four a year across all sites, usually spaced several weeks apart. If one injection gives good, lasting relief, another may not be needed. If two do little, doctors often reconsider the diagnosis, review the imaging, or talk through other options, including surgery where nerve symptoms are severe or getting worse.
Is this normal?
- Arm pain worse for a day or two: common, and usually settles.
- Numbness in the arm on day 0: expected from the anesthetic and usually gone within a few hours.
- A mild headache: can happen for a day and settles with rest and fluids. A severe headache is different. See below.
- Neck sore where the needle went in: common for 1 to 3 days.
- No change in the first few days: normal. The steroid can take up to 2 weeks to work.
Call your local emergency number or go to the emergency department if
- New weakness: new or spreading weakness or numbness in an arm or leg after the anesthetic should have worn off, or unsteady walking.
- Breathing or swallowing trouble: difficulty breathing, swallowing or speaking.
- Stroke signs: face drooping, slurred speech, sudden vision loss or confusion.
- Bladder or bowel changes: new loss of control of your bladder or bowels.
See a doctor today if
- Severe headache: especially one that is worse when sitting or standing and eases lying flat.
- Fever with neck stiffness: a temperature of 100.4°F (38°C) or higher, with neck stiffness or feeling unwell.
- Signs of infection: redness, heat, swelling or drainage at the injection site.
- Severe new neck or arm pain: far worse than before the injection and not settling.
- Blood sugar out of range: if you have diabetes and readings stay above your target for more than a few days.
Get it checked soon if
- No change after 2 weeks: the source of the arm pain may need another look.
- Pain returning quickly: relief that fades within days each time.
- Grip or fine-hand changes: dropping things or clumsiness in the hand, which can point to pressure on the spinal cord.
More on this area: injections for neck and shoulder pain.
Rest for a day, watch for the urgent signs, then use the quieter weeks to rebuild.
Written by Louise Yow, Neck & Shoulder Physio.