What is a herniated disc?A disc herniation is when a portion of the intervertebral disc material bulges and “Sticks out” into the neural canal. This can produce pressure on the spinal cord or nerve roots and cause pain, numbness, or tingling in the arm or leg. This is very rarely a surgical condition and usually responds with non–surgical treatment. This is also often referred to as a “Slipped disc” and is different from the ruptured disc fragment, which can sometimes lead to surgery.
What are other causes of low back pain?There are many conditions that can cause back pain. Some of these are congenital, such as scoliosis. Most causes of back pain, however, result from injury or trauma. Common causes of back pain include:
- Muscle strain.
- Bulging or herniated disc.
- Degenerative disc disease.
- Spinal stenosis.
- Sciatica or pinched nerve.
- Sacroiliac joint inflammation.
What is sacroiliac joint pain?Inflammation in the sacroiliac (SI) joint can cause pain in the low back or buttocks. This is especially common in women, and often radiates into the leg, masquerading as sciatica. SI joint pain responds well to non–steroidal medications and physical therapy. Occasionally, injections into the joint space are necessary to completely alleviate the pain and dysfunction.
What is an Epidural Steroid Injection?=The epidural steroid injection is the placement of cortisone, a powerful anti–inflammatory agent, into the epidural space which approximates the disc and spinal column. The treatment of epidural injection has been around for over 40 years. It involves using either steroids or anesthetic agents, allowing good benefit with minimal risk factors. The main goal of the epidural injection is to shrink the swelling in bulging or herniated disc, and to decrease any inflammation that surrounds the disc and may be pressing on a spinal nerve.
What causes numbness and the tingling in the upper or lower limbs?Pain or a “Pins and needles” sensation can sometimes be present in the arms, hands, legs, or feet. There are many items that cause these symptoms, including:
- Carpal Tunnel Syndrome.
- A pinched nerve in neck or in the lower back.
- Peripheral nerve damage.
- A herniated or inflamed disc in the back can irritate or compress a nerve that travels into the arm or leg, and thereby produce symptoms of pain, numbness, or tingling.
How can steroids be helpful?Steroids are very effective in decreasing swelling and inflammation in the body. Often steroid injections are used to “Cool off” inflammation in a joint or in the spine around a disc. This is a very effective treatment method with few side effects. Many patients ask about the potential risks or side effects of steroid use. While it is true that long term repetitive use of steroids over many years can increase the risk of side effects, short term cortisone use in the form of injections or oral medications is thought to be relatively safe with hardly any side effects or problems.
Are there any non–surgical treatment of back pain?Surgery is a treatment of the last resort. Most back pain can be treated successfully, non–surgically. Only when all the above treatment options fail, is surgery a consideration. Most back pain can be treated non–surgically. There are a variety of treatment options that are available. Here are steps you can take on your own to alleviate pain, as well as a few guidelines to prevent further pain.
Medications can be very helpful in the initial treatment of back and neck pain. Three types of medications are often utilized in treating both acute and chronic pain. They can be used in combination or by themselves.
These help to decrease the swelling and inflammation in the spine. They also promote healing.
These help the muscles to relax and also decrease muscle tension and spasm.
These are used exclusively for acute pain.
Physical therapy is an important component in the treatment and prevention of back pain. The initial treatment ranges from passive modalities such as ultrasound to back school and spinal stabilization classes. The second phase focuses on flexibility and strengthening, conditioning exercises, and muscle endurance training.
Exercise can be the key to your recovery, as well as a good prevention against future pain.
There are four basic injections used in the treatment of Back pain
- Joint Injections.
- Trigger point injections.
- Epidural steroid injection.
- Therapeutic spine injections.
What is the rotator cuff in the shoulder?The rotator cuff is a group of flat tendons which fuse together and surround the front, back, and top of the shoulder joint like a cuff on a shirt sleeve. These tendons are connected individually to short, but very important, muscles that originate from the scapula. When the muscles contract, they pull on the rotator cuff tendon, causing the shoulder to rotate upward, inward, or outward, hence the name “rotator cuff.”
What is impingement syndrome?The uppermost tendon of the rotator cuff, the supraspinatus tendon, passes beneath the bone on the top of the shoulder, called the acromion. In some people, the space between the undersurface of the acromion and the top of the humeral head is quite narrow. The rotator cuff tendon and the adherent bursa, or lubricating tissue, can therefore be pinched when the arm is raised into a forward position. With repetitive impingement, the tendons and bursa can become inflamed and swollen and cause the painful situation known as “chronic impingement syndrome.”
How does impingement syndrome relate to rotator cuff disease?When the rotator cuff tendon and its overlying bursa become inflamed and swollen with impingement syndrome, the tendon may begin to break down near its attachment on the humerus bone. With continued impingement, the tendon is progressively damaged, and finally, may tear completely away from the bone.
Why do some people develop impingement and rotator cuff disease while others do not?There are many factors that may predispose one person to impingement and rotator cuff problems. The most common is the shape and thickness of the acromion (the bone forming the roof of the shoulder). If the acromion has a bone spur on the front edge, it is more likely to impinge on the rotator cuff when the arm is elevated forward. Activities which involve forward elevation of the arm may put an individual at higher risk for rotator cuff injury. Sometimes, the muscles of the shoulder may become imbalanced by injury or atrophy, and imbalance can cause the shoulder to move forward with certain activities which again may cause impingement.
What is Pediatric Orthopedics?Pediatric Orthopedics is the study and treatment of growing bones, joints and muscles. Pediatric Orthopedists use many techniques, including observation of growth, physical therapy, braces and splints, and occasionally surgery to treat various conditions such as congenital deformities, injuries, neurological disorders, and scoliosis. These conditions are discussed in general below, with links being added to more specific information as time goes by.
Variations of normal anatomy and congenital deformities
Frequently, young children and adolescents have conditions that are variations of normal anatomy. These include children who toe–in or toe–out excessively, children with “Bad posture” such as round–back or sway–back, and children who are delayed in learning to walk or have unusual patterns of walking such as “Toe walking”. Often these problems are variations of normal developmental patterns and do not represent an underlying disease. In such cases, the child’s growth and patterns of walking, posture, and muscular development need to be observed over time in order to establish whether the child’s growth pattern will return to normal spontaneously. A small percentage of children have birth defects. These include spinal problems such as spina bifida, limb deformities such as clubfoot, or other congenital defects such as extra fingers or toes. Pediatric Orthopedists frequently follow these children through years of growth and into adult life.
Children often break bones. With these fractures there is often a potential injury to the growth centers of the skeleton. Pediatric orthopedists evaluate the child for potential growth problems that may happen after the injury heals and treat growth disturbance if it occurs. Appropriate treatment of fractures, sprains and dislocations can ensure minimal disturbance of function and a quick return to normal childhood growth and activity.
Pediatric sports injuries
Pediatric Sports Medicine is an important part of health care. Children who engage in activities like soccer, karate, and skateboarding may have acute injuries such as broken bones, sprains, and dislocations. Many times chronic stress injuries occur, such as fractures, tendinitis, and apophysitis. Examples are Little Leaguer’s Elbow, Osgood–Schlatter’s disease of the knee, and Sever’s Disease of the foot. Treatment of these injuries is usually simple and seldom requires surgery.
Many patients seen by Pediatric orthopedists have neurological disorders such as cerebral palsy, spina bifida, or the family of diseases known as dystrophies. Most of these disorders result in muscle imbalance and deformity in the areas involved, such as drop foot, scoliosis, or paralytic clubfoot. Children with cerebral palsy or spina bifida frequently require bracing or surgery to improve their ability to function to their greatest potential.
Scoliosis and Kyphosis
These conditions are deformities of the spinal column and may occur at any time before or after birth, but are more frequent during the adolescent growth spurt. Scoliosis is curvature of the spine seen in about 5 per cent of teenage girls. Kyphosis is an excessive round–back deformity common in teenagers.