Find the source of your pain. Find the fastest path to lasting relief.
A nerve block is a precision, image-guided injection that interrupts pain signals from a specific nerve. The procedure serves two purposes in one visit: it confirms the source of chronic pain and, in many cases, provides weeks to months of therapeutic relief.
Nerve blocks are for adults in League City and the Bay Area with chronic back, neck, knee, hip, shoulder, or sacroiliac joint pain that has not improved with conservative care. They are commonly used as the diagnostic step before radiofrequency ablation, and for workers’ compensation injuries from NASA, maritime, refinery, and healthcare employers.
or call 346-217-1111 · League City office
By the Pain Management Team at Performance Pain and Sports Medicine
Suzanne Manzi, MD · Jade Nemeth, PA-C
Updated May 2026
On This Page:
- What Is a Nerve Block?
- How Nerve Blocks Work
- Types of Nerve Blocks We Perform
- Medial Branch Block (Spine)
- Genicular Nerve Block (Knee)
- Lateral Branch Block (Sacroiliac Joint)
- Femoral and Obturator Nerve Block (Hip)
- Suprascapular and Axillary Nerve Block (Shoulder)
- Conditions That May Benefit
- The Procedure: Step by Step
- How to Prepare
- What to Expect After
- Risks and Side Effects
- Diagnostic vs. Therapeutic Nerve Blocks
- What Happens Next
- Cost and Insurance
- Nerve Block Injections at Our League City Office
- Frequently Asked Questions
League City sits at the crossroads of NASA aerospace engineering, the Bay Area maritime and petrochemical workforce, and a growing population of active-adult boaters and retirees. The common thread across these worlds is physical demand: long hours at a console, years of shift work at a port or refinery, repeated lifting, and the cumulative joint wear that comes with active retirement on Clear Lake and Galveston Bay. When chronic pain in the back, neck, knee, hip, shoulder, or sacroiliac joint stops responding to physical therapy and medication, a nerve block can pinpoint the source and, in many cases, provide meaningful relief. At Performance Pain and Sports Medicine in League City, Dr. Suzanne Manzi, MD uses image-guided nerve block injections to identify which nerves are carrying pain and to guide each patient toward an effective long-term treatment plan, exhausting non-surgical options first.
What Is a Nerve Block?
A nerve block is an injection of local anesthetic, sometimes combined with a corticosteroid, placed near a specific nerve that carries pain signals. By temporarily numbing that nerve, the injection interrupts pain transmission from the joint, muscle, or structure it serves.
Nerve blocks have two related uses. As a diagnostic tool, the block answers a clinical question: is this specific nerve the source of pain? If numbing the nerve eliminates or significantly reduces symptoms, the diagnosis is confirmed. As a therapeutic tool, the same injection (often with added anti-inflammatory medication) can provide pain relief lasting weeks to months, especially for joint-related or inflammatory pain.
The Cleveland Clinic notes that nerve blocks are a common option for chronic pain that has not improved with conservative treatments, and may delay or prevent the need for more invasive procedures (Cleveland Clinic, Nerve Block Overview).
How Nerve Blocks Work
Every painful joint or structure has a specific nerve supply. The medial branch nerves carry pain from the facet joints of the spine. The genicular nerves carry pain from the knee. The lateral branches of the dorsal rami carry pain from the sacroiliac joint. The femoral and obturator nerves carry pain from the hip joint capsule. The suprascapular and axillary nerves carry pain from the shoulder.
When a small volume of local anesthetic is placed next to one of these nerves, it blocks the electrical signal from reaching the brain. The patient experiences a marked reduction or complete elimination of the pain associated with that nerve.
Every nerve block at the League City office is performed under live X-ray (fluoroscopic) guidance. Real-time imaging confirms that the needle tip is in the correct anatomic location, which is critical for both diagnostic accuracy and patient safety.
Types of Nerve Blocks We Perform
Dr. Manzi performs five categories of nerve block injection at the League City office, each targeting a different region of the body.
Medial Branch Block (Spine)
A medial branch block is an injection placed near the small medial branch nerves that supply the facet joints of the spine. Each facet joint receives medial branch nerves from two spinal levels, which is why the injection targets specific nerve locations rather than the joint itself.
The primary purpose is diagnostic. International consensus guidelines recognize medial branch blocks as more predictive than intra-articular injections for identifying facet joint pain and selecting candidates for longer-term treatment (Cohen et al., Reg Anesth Pain Med, 2020).
Medial branch blocks are performed at three spinal levels. Lumbar (low back) blocks are the most common, with research indicating that facet joints contribute to 27 to 40 percent of chronic low back pain cases (Van Oosterwyck et al., Life, 2024). Cervical (neck) blocks address chronic neck pain, which involves the cervical facet joints in up to 49 percent of cases, with false-positive rates of 25 to 63 percent on a single block (Manchikanti et al., Pain Physician, 2020). Thoracic (mid-back) blocks are used when persistent mid-back pain points to thoracic facet involvement, often seen in patients who spend long hours in a seated, forward-flexed position such as aerospace engineers at consoles, maritime operators in pilot houses, and surgical staff at UTMB.
When a medial branch block confirms facet joint pain, the next step is typically radiofrequency ablation, which can provide six months or longer of relief.
Genicular Nerve Block (Knee)
The genicular nerves are small sensory branches that carry pain signals from the knee joint capsule. A genicular nerve block targets the superior medial, superior lateral, and inferior medial genicular nerves, the three primary contributors to knee pain.
This block helps patients with chronic knee pain from osteoarthritis who have not responded to physical therapy, anti-inflammatory medication, or intra-articular injections. It is also used in active-adult Clear Lake boaters and Galveston Bay residents who want to delay knee replacement, and in patients who are not surgical candidates due to medical comorbidities.
A systematic review of randomized controlled trials and retrospective studies concluded that both genicular nerve block and genicular nerve ablation effectively reduce pain and improve function in knee osteoarthritis, with minimal and transient adverse events (Toubasi et al., Cureus, 2025). In a placebo-controlled randomized trial, ultrasound-guided genicular nerve blocks produced statistically significant reductions in pain at 2, 4, and 8 weeks compared with saline (Shanahan et al., Arthritis Rheumatol, 2022).
A successful genicular nerve block also identifies patients who are good candidates for genicular radiofrequency ablation, a longer-lasting treatment option.
Lateral Branch Block (Sacroiliac Joint)
The lateral branches of the dorsal rami carry pain from the sacroiliac (SI) joint, the joint that connects the base of the spine to the pelvis. SI joint pain accounts for 15 to 30 percent of all chronic low back pain cases and is frequently overlooked in patients who report stubborn low back or buttock pain (Buchanan et al., J Pain Res, 2021).
A lateral branch block is the diagnostic standard for confirming SI joint pain. The block targets the L5 dorsal ramus and the S1 through S3 lateral branches. If the block significantly reduces pain, the next step is typically radiofrequency ablation of those same lateral branches. A 2023 evidence review found that radiofrequency ablation following positive diagnostic lateral branch blocks is efficacious for SI joint pain, with cooled radiofrequency showing the strongest evidence (Szadek et al., Pain Pract, 2023).
Patients who have had prior lumbar fusion often develop SI joint pain because the joint takes on additional load. This pattern is commonly seen in League City patients with a history of orthopedic surgery at Houston Methodist Clear Lake or UTMB.
Femoral and Obturator Nerve Block (Hip)
Pain from the hip joint is carried by sensory branches of the femoral and obturator nerves to the anterior hip capsule. A femoral and obturator nerve block targets these branches to relieve chronic hip pain, most commonly from advanced hip osteoarthritis.
This block is particularly useful for patients with severe hip osteoarthritis who are not surgical candidates due to medical comorbidities, who are waiting for surgery, or who prefer a non-surgical alternative. A randomized clinical trial of 44 patients with severe hip osteoarthritis who had failed conservative treatment found that obturator nerve block produced statistically significant improvements in pain (VAS) and function (WOMAC) at one and four months, with no severe adverse events reported (Crema et al., Acta Ortop Bras, 2023).
The procedure is performed under fluoroscopic or ultrasound guidance. As with other diagnostic blocks, a positive response may indicate that the patient is a candidate for radiofrequency ablation of the hip articular nerves for longer-lasting relief.
Suprascapular and Axillary Nerve Block (Shoulder)
The suprascapular and axillary nerves provide most of the sensation to the shoulder joint. A suprascapular and axillary nerve block targets these nerves to relieve chronic shoulder pain from rotator cuff disease, adhesive capsulitis (frozen shoulder), shoulder osteoarthritis, and post-surgical pain.
A 2025 systematic review of randomized controlled trials concluded that suprascapular nerve blocks combining local anesthetic with corticosteroid significantly reduce chronic shoulder pain at three months compared with standard non-operative care (Scattergood et al., Eur J Orthop Surg Traumatol, 2025). In an observational study of 71 patients with chronic shoulder pain, ultrasound-guided suprascapular nerve blockade produced pain reduction in 89.8 percent of patients at one month, with 43.7 percent achieving complete pain remission at six months (Sá Malheiro et al., Braz J Anesthesiol, 2020).
The block is often repeated as part of a treatment plan and can be combined with physical therapy to support recovery of shoulder range of motion, an important consideration for League City patients whose work involves overhead motion, sustained keyboard use, or boating activity.
Conditions That May Benefit
Nerve block injections may be recommended when imaging, physical examination, and a patient’s pain pattern point toward a specific structure as the source of symptoms. League City patients commonly present with one of the following conditions:
- Spine (Medial Branch Block):
- Facet joint osteoarthritis, especially in patients over 50
- Chronic axial back or neck pain from prolonged seated work (aerospace engineering, maritime operations, healthcare)
- Spondylolisthesis-related facet loading
- Persistent pain after spinal fusion
- Knee (Genicular Nerve Block):
- Knee osteoarthritis in active adults
- Chronic post-surgical knee pain after total knee replacement
- Patients who want to delay or are poor candidates for knee replacement
- Diagnostic step before genicular radiofrequency ablation
- Sacroiliac Joint (Lateral Branch Block):
- Sacroiliac joint dysfunction
- Pain after lumbar fusion (the SI joint takes on increased load)
- Chronic low back or buttock pain that does not respond to other treatments
- Hip (Femoral and Obturator Nerve Block):
- Hip osteoarthritis
- Patients awaiting hip replacement or not eligible for surgery
- Chronic hip joint pain after fracture or surgery
- Shoulder (Suprascapular and Axillary Nerve Block):
- Rotator cuff tendinopathy and partial tears
- Adhesive capsulitis (frozen shoulder)
- Shoulder osteoarthritis
- Persistent post-surgical shoulder pain
A careful clinical evaluation is always the first step in identifying the most likely pain generator and selecting the appropriate block.
The Procedure: Step by Step
Most nerve block injections take 15 to 30 minutes and are performed in an outpatient setting. Patients remain awake throughout. Sedation is available for patients who experience significant anxiety, though many patients complete the procedure comfortably without it.
- Positioning. The patient is positioned to provide the physician access to the area being treated (face down for spine and SI joint, supine for hip and knee, seated or face down for shoulder).
- Skin preparation. The skin over the injection site is cleaned with antiseptic solution and numbed with a small amount of local anesthetic.
- Image guidance. Using fluoroscopy (live X-ray), Dr. Manzi advances a thin needle to the precise location of the target nerve. Contrast dye may be used to confirm correct needle placement.
- Injection. A small volume of local anesthetic (sometimes combined with corticosteroid) is injected near the nerve. Multiple levels or nerve sites may be treated in a single session.
- Observation. The patient is monitored briefly and asked to perform movements that normally provoke pain. The response is documented in a pain diary that the clinical team provides.
The anesthetic typically takes effect within minutes, and most patients leave the office within 30 minutes after the procedure.
How to Prepare for Your Nerve Block
Preparation is straightforward, but a few steps help ensure accurate diagnostic results:
- Blood thinners. The physician may advise pausing certain blood-thinning medications several days before the procedure. Instructions depend on the specific medication.
- Fasting. If sedation is planned, the patient may need to avoid eating for several hours beforehand. Patients not receiving sedation typically do not need to fast.
- Clothing. Wear loose, comfortable clothing that allows easy access to the area being treated.
- Transportation. Arrange for someone to drive you home, especially if sedation is used or a lower extremity is being numbed.
- Pain diary. The clinical team provides instructions on tracking pain levels before and after the block.
The League City office staff confirms specific instructions during scheduling.
What to Expect After
Pain relief from the local anesthetic typically begins within minutes and may last several hours. With longer-acting agents such as bupivacaine, some patients experience meaningful relief for several days. When corticosteroid is added, relief can last weeks to months as the anti-inflammatory effect develops.
Most patients return to normal activities the same day or the following day. Mild soreness at the injection site is common and typically resolves within 24 to 48 hours.
- Tracking your response matters. The clinical team asks patients to document pain levels carefully in the hours and days following the block. For diagnostic blocks, a 50 percent or greater reduction in pain is generally considered a positive response and guides the next treatment decision. For therapeutic blocks, the goal is sustained pain relief that allows the patient to participate in physical therapy and return to daily activities.
Patients should avoid strenuous activity for the first 24 hours, then resume their normal routine as tolerated. The office schedules a follow-up to review the pain diary and discuss next steps.
Risks and Side Effects
Nerve block injections have a strong safety record. A systematic review of more than 200,000 interventional spine procedures reported an overall infection rate of 0.04 percent for facet joint procedures (Santiago et al., Pain Physician, 2021). Across nerve block studies in the knee, shoulder, hip, and SI joint, reported adverse events are minimal and transient.
- Common (mild and temporary):
- Soreness or bruising at the injection site
- Temporary numbness in the area
- Mild headache
- Uncommon:
- Allergic reaction to the anesthetic or contrast dye
- Temporary increase in pain before improvement
- Vasovagal reaction (lightheadedness)
- Rare:
- Infection at the injection site
- Nerve damage
- Bleeding (more likely in patients on blood thinners)
Patients with active infections, bleeding disorders, or known allergies to local anesthetics should inform Dr. Manzi before the procedure.
Diagnostic vs. Therapeutic Nerve Blocks
Patients often ask whether a nerve block is meant to diagnose the pain or to treat it. The answer depends on the type of block and the goal.
- Diagnostic nerve blocks use only local anesthetic. Their purpose is to confirm or rule out a specific structure as the pain generator. Medial branch blocks and lateral branch blocks are primarily diagnostic, since their main role is to identify candidates for radiofrequency ablation. The numbing effect is temporary by design.
- Therapeutic nerve blocks add a corticosteroid for longer-lasting anti-inflammatory effects in addition to the immediate numbing. Suprascapular nerve blocks, genicular nerve blocks, and femoral and obturator nerve blocks for hip pain are often performed therapeutically, with relief that can last weeks to months.
Many nerve blocks serve both purposes simultaneously: the immediate numbing confirms the diagnosis, while the corticosteroid provides extended relief.
What Happens Next: From Diagnostic Block to Long-Term Relief
The next step depends on the response to the block.
- If the block provides significant relief (positive response): For spine, knee, and SI joint pain, Dr. Manzi may recommend a confirmatory second diagnostic block, typically using a different local anesthetic. This two-block protocol reduces false-positive rates and identifies the patients most likely to benefit from radiofrequency ablation.
A 2015 multicenter study found that patients selected through medial branch blocks achieved 50 percent or greater pain relief at three months post-RFA at a significantly higher rate than patients selected by intra-articular injection (P=0.041) (Cohen et al., Reg Anesth Pain Med, 2015). A systematic review of dual medial branch block protocols with strict relief criteria reported substantially better RFA outcomes than less rigorous selection (Schneider et al., Pain Med, 2020).
For shoulder and hip pain, the physician may recommend repeat therapeutic blocks combined with physical therapy, or, in select cases, radiofrequency ablation of the suprascapular nerve or hip articular branches.
- If the block does not provide meaningful relief (negative response): This is still a valuable clinical finding. It indicates that the suspected nerve is likely not the primary pain generator, allowing the physician to redirect the evaluation toward other potential causes.
Cost and Insurance
Most major insurance plans, including Medicare and Texas workers’ compensation, cover medically necessary nerve block injections. Coverage typically requires documentation that conservative treatments (physical therapy, anti-inflammatory medication) have not provided adequate relief.
Cost depends on insurance coverage, the number of nerves treated in a single session, whether the block is purely diagnostic or includes corticosteroid, and whether sedation is used. The League City office team can verify benefits and provide a cost estimate before the procedure is scheduled. For coverage questions, call 346-217-1111.
Nerve Block Injections at Our League City Office
Performance Pain and Sports Medicine performs nerve block injections at the League City office at 1216 East Main Street, Suite A, League City, TX 77573. The office is positioned on the corridor between Clear Lake and Galveston Bay, with easy access from I-45, NASA Parkway (NASA Road 1), and Highway 96. The location serves patients from Clear Lake, Friendswood, Kemah, Dickinson, Webster, Seabrook, Texas City, and the surrounding Bay Area communities.
- Dr. Suzanne Manzi, MD, the physician at the League City office, is quadruple board-certified in Physical Medicine and Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine. She completed fellowship training in Interventional Spine and Pain Management at Michigan State University. Dr. Manzi performs all nerve block injections personally, under live fluoroscopic guidance, with continuity of care from initial evaluation through follow-up treatment.
The League City patient population reflects the unique mix of the Bay Area: aerospace engineers and contractors at NASA Johnson Space Center who develop facet joint pain after years at workstations and during long-duration mission support; maritime workers, port operators, and petrochemical commuters whose physically demanding jobs at Bayport and Texas City often produce chronic spine, hip, and shoulder injuries; healthcare staff at UTMB and Houston Methodist Clear Lake whose work involves repeated lifting, bending, and patient transfers; and active-adult boaters and retirees on Clear Lake whose knee and shoulder osteoarthritis interferes with the lifestyle they retired to enjoy. The League City office accepts most major commercial insurance, Medicare, and workers’ compensation, and routinely handles referrals from NASA contractor health plans, UTMB, and Methodist Clear Lake.
For patients who need procedures not performed at the League City location, such as Discseel®, referrals to the Houston office or to Dr. Matthias Wiederholz, MD are arranged seamlessly within the practice.
To schedule an evaluation, call the League City office at 346-217-1111 or contact us online. Nerve block injections are also available at the Houston, Baytown, and Lawrenceville, NJ Performance Pain locations.
Performance Pain and Sports Medicine
Address: 1216 East Main Street, Suite A, League City, TX 77573
Landmark: On East Main Street, near Highway 96
Major Cross Streets: East Main Street between I-45 and NASA Parkway
Parking: On-site parking available
Phone: 346-217-1111
Frequently Asked Questions
Is the nerve block procedure available in League City?
Yes. Nerve block injections for the spine, knee, hip, shoulder, and sacroiliac joint are performed at the League City office by Dr. Suzanne Manzi, MD. All procedures use live fluoroscopic guidance and are completed as outpatient visits, with most patients leaving the office within 30 minutes of the injection.
Do you accept workers' compensation for aerospace, maritime, or refinery injuries?
Yes. The League City office accepts Texas workers’ compensation and routinely treats injured workers from NASA Johnson Space Center, Bayport and Texas City petrochemical facilities, and maritime employers. The office handles the documentation and authorization process directly with carriers.
Do you accept referrals from local providers and NASA contractor health plans?
Yes. The League City office accepts referrals from UTMB, Houston Methodist Clear Lake, HCA Houston Healthcare Clear Lake, and NASA contractor health plans. Self-referral is also accepted for most insurance plans.
Are nerve block injections painful?
Most patients describe mild pressure or a brief sting when the local anesthetic numbs the skin. The procedure itself typically causes minimal discomfort. Sedation is available for patients who prefer it.
How long does a nerve block last?
Pure diagnostic blocks (with anesthetic only) usually wear off within several hours. When corticosteroid is added, relief can last weeks to months. Radiofrequency ablation, which follows positive nerve block testing, commonly produces relief lasting six months to a year or longer.
Can I drive home after a nerve block at the League City office?
Patients who receive only local anesthetic at the injection site can usually drive home. Patients who receive sedation or have a lower extremity nerve block (knee or hip) need someone to drive them.
What if my nerve block does not work?
A negative result is still clinically useful. It indicates the suspected nerve is likely not the pain source, allowing Dr. Manzi to redirect diagnostic efforts toward other potential causes.
Does insurance cover nerve blocks in League City?
Most major insurance plans, Medicare, and Texas workers’ compensation cover medically necessary nerve blocks. Prior authorization is often required. The League City office team verifies coverage before scheduling.
What is the difference between a nerve block and radiofrequency ablation?
A nerve block uses local anesthetic to temporarily numb a nerve, lasting hours to months. Radiofrequency ablation uses controlled heat to disable the nerve’s pain-signaling capacity for six months or longer. A nerve block is typically the diagnostic step that identifies candidates for radiofrequency ablation.
Do I need to travel to Houston for nerve blocks, or are they performed at the League City office?
Standard diagnostic and therapeutic nerve blocks for the spine, knee, hip, shoulder, and SI joint are performed at the League City office. Some specialty procedures, such as Discseel®, are performed only at the Houston office. The clinical team coordinates referrals when needed.
Schedule Your Nerve Block Evaluation in League City
For patients in League City and the surrounding Bay Area communities living with chronic back, neck, knee, hip, shoulder, or sacroiliac joint pain that has not responded to conservative treatment, a nerve block injection may be the next step toward a clear diagnosis and lasting relief. Contact Performance Pain and Sports Medicine or call 346-217-1111 to schedule a consultation with Dr. Suzanne Manzi, MD.
MEDICAL DISCLAIMER
This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. The information presented reflects an interventional pain management perspective and is intended to support, not substitute, your relationship with a qualified healthcare provider. Individual results vary based on diagnosis, pain duration, overall health, and response to treatment. Some procedures may not be covered by insurance. Treatment outcomes depend on proper patient selection and accurate diagnosis. Always consult a board-certified physician before pursuing any pain management treatment.
Performance Pain and Sports Medicine
Dr. Suzanne Manzi, MD · Jade Nemeth, PA-C
Medically reviewed by Suzanne Manzi, MD
Board-Certified in Physical Medicine & Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine
Last reviewed: May 2026
