Conditions Treated – Arkam Rehman, M.D. Premiere Spine & Musculo-Skeletal Pain Specialist using cutting edge procedures after a thorough evaluation to help your pain the best way he can.
Ankylosing Spondylitis is a type of arthritis that affects the spine. Ankylosing spondylitis symptoms include pain and stiffness from the neck down to the lower back. The spine ‘s bones (vertebrae) may grow or fuse together, resulting in a rigid spine. These changes may be mild or severe, and may lead to a stooped-over posture. Early diagnosis and treatment helps control pain and stiffness and may reduce or prevent significant deformity.
Who Is Affected by Ankylosing Spondylitis?
Ankylosing spondylitis affects about 0.1% to 0.5% of the adult population. Although it can occur at any age, spondylitis most often strikes men in their teens and 20s. It is less common and generally milder in women and more common in some Native American tribes. Read More
Arachnoiditis is a pain disorder caused by the inflammation of the arachnoid, one of the membranes that surrounds and protects the nerves of the spinal cord. It is characterized by severe stinging, burning pain, and neurological problems.
Symptoms of Arachnoiditis
Arachnoiditis has no consistent pattern of symptoms, but in many people it affects the nerves connecting to the lower back and legs. The most common symptom is pain, but arachnoiditis can also cause:
• Tingling, numbness, or weakness in the legs
• Sensations that may feel like insects crawling on the skin or water trickling down the leg
• Severe shooting pain that can be similar to an electric shock sensation
• Muscle cramps, spasms and uncontrollable twitching
• Bladder, bowel and sexual problems
As the disease progresses, symptoms may become more severe or even permanent. Many people with arachnoiditis are unable to work and suffer significant disability because they are in constant pain.
Causes of Arachnoiditis
Inflammation of the arachnoid can lead to the formation of scar tissue and can cause the spinal nerves to stick together and malfunction. The arachnoid can become inflamed because of an irritation from one of the following sources:
• Direct injury to the spine.
• Chemicals: Dye used in myelograms (diagnostic tests in which a dye called radiographic contrast media is injected into the area surrounding the spinal cord and nerves) have been blamed for some cases of arachnoiditis. The radiographic contrast media responsible for this is no longer used, however. Also, there is concern that the preservatives found in epidural steroid injections may cause arachnoiditis.
• Infection from bacteria or viruses: Infections such as viral and fungal meningitis or tuberculosis can affect the spine .
• Chronic compression of spinal nerves: Causes for this compression include chronic degenerative disc disease or advanced spinal stenosis (narrowing of spinal column).
• Complications from spinal surgery or other invasive spinal procedures: Similar causes include multiple lumbar (lower back) punctures.
Diagnosing arachnoiditis can be difficult, but tests such as the CAT scan (computerized axial tomography) or MRI (magnetic resonance imaging) have helped with diagnosis. A test called an electromyogram (EMG) can assess the severity of the ongoing damage to affected nerve roots by using electrical impulses to check nerve function.
Note: Myelograms with the radiographic contrast currently in use, combined with CAT scanning, are not considered to be responsible for causing arachnoiditis or causing it to worsen.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Is a hand and arm condition that causes numbness, tingling and other symptoms. Carpal tunnel syndrome is caused by a pinched nerve in your wrist.
A number of factors can contribute to carpal tunnel syndrome, including the anatomy of your wrist, certain underlying health problems and possibly patterns of hand use.
Bound by bones and ligaments, the carpal tunnel is a narrow passageway located on the palm side of your wrist. This tunnel protects a main nerve to your hand and the nine tendons that bend your fingers.
Compression of the nerve produces the numbness, tingling and, eventually, hand weakness that characterize carpal tunnel syndrome.
Fortunately, for most people who develop carpal tunnel syndrome, proper treatment usually can relieve the tingling and numbness and restore wrist and hand function.
Common causes of Carpal Tunnel Syndrome are hand use biomechanics, trauma, & pregnancy. Women are more inclined to develop CTS due to the unique shape of their wrists than men.
Treatment generally consists of improving the usage of the hands that is avoiding too much bending of the wrists and doing things such as typing etc with the wrists in neutral position. Anti-inflammatory medications and localized injections and splints can be utilized. If the symptoms are significant (weakness is felt in the hand), nerve conduction studies can be done to further assess the condition as nerve fiber death causing weakness is permanent and recovery would be limited in these patients. If the symptoms are significant or the nerve conduction studies show significant impingement, surgery can also help considerably. Most patients tend to do well with conservative or surgical treatment. Read More
Coccygodynia is defined as a disabling pain in and around the os coccyx. This pain is usually provoked by sitting or by rising from a seated to a standing position. It is also known as coccydynia or coccygeal neuralgia. The pain caused by coccygodynia is disabling and has a significant impact on the patient’s quality of life. The pain can be described as “pulling” or “lancinating,” and may also radiate to the sacrum, lumbar spine, and buttocks, or more rarely to the thighs.
Clinically Relevant Anatomy
The coccyx is the most distal aspect of the vertebral column. It consists of three to five rudimentary vertebral units that are typically fused. The ventral part of the coccyx is concave, and the dorsal aspect is convex and features coccygeal articular processes. The coccyx articulates with the sacral cornu of the inferior sacral apex at S5.
The anterior aspect of the coccyx serves as the attachment site of ligaments and muscles important for many functions of the pelvic floor. The levator ani muscle includes m. coccygeus, m. pubococcygeus and m. iliococcygeus. The coccyx supports the position of the anus. Attached to the posterior side of the coccyx is m. gluteus maximus. Muscle weakness, disturbed tonus or damage to muscles or ligaments can cause abnormal positions of the coccyx. Read More
If you’re nearing age 60 and have back pain, don’t assume it’s a normal part of getting older. You could be affected by a spinal compression fracture.
Back aches and pains can be a sign that small fractures are occurring in your vertebrae – the bones that form your spine. Soft, weakened bones are at the heart of this problem. Compression fractures are often caused by bone-thinning osteoporosis, especially if you are a postmenopausal woman over age 50.
When bones are brittle, everyday activities can trigger minor spinal compression fractures. When you bend to lift an object, miss a step, or slip on a carpet, you can put your spinal bones at risk of fracture. Even coughing or sneezing can cause compression fractures in more severe cases of osteoporosis .
After a number of small compression fractures, your body begins to show the effects. The small hairline fractures can eventually cause a vertebra to collapse — called spinal compression fracture .
These tiny fractures can permanently alter the strength and shape of the spine. You lose height because your spine is shorter. Most compression fractures occur in the front of the vertebra, which causes the front part of the bone to collapse creating a wedge-shaped vertebra. The back of the bone is unchanged because it’s made of harder bone. This creates the stooped posture called kyphosis, or dowager’s hump.
About two-thirds of spinal compression fractures are never diagnosed because many patients and families think the back pain is merely a sign of aging and arthritis. In fact, many people put off seeing a doctor because they don’t realize what’s wrong, experts say. But if osteoporosis isn’t treated, it can lead to future fractures — and possibly more severe compression fractures. Osteoporosis treatment significantly reduces but does not eliminate the chance of developing another compression fracture.
Each spinal compression fracture can cause increased lung and breathing problems and even early death. The pain from fractures that don’t heal can lead to depression. And continued use of pain medication can cause constipation, which can worsen the depression . And the growing number of fractures can sometimes lead to a person being placed in a nursing home. Read More
Degenerative or Herniated Discs
What is degenerative disc disease?
Degenerative disc disease is not really a disease but a term used to describe the normal changes in your spinal discs camera.gif as you age. Spinal discs are soft, compressible discs that separate the interlocking bones (vertebrae) that make up the spine. The discs act as shock absorbers for the spine, allowing it to flex, bend, and twist. Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region).
The changes in the discs can result in back or neck pain and/or:
• Osteoarthritis, the breakdown of the tissue (cartilage) that protects and cushions joints.
• Herniated disc, an abnormal bulge or breaking open of a spinal disc.
• Spinal stenosis, the narrowing of the spinal canal camera.gif, the open space in the spine that holds the spinal cord camera.gif.
These conditions may put pressure on the spinal cord and nerves, leading to pain and possibly affecting nerve function.
What causes degenerative disc disease?
As we age, our spinal discs break down, or degenerate, which may result in degenerative disc disease in some people. These age-related changes include:
• The loss of fluid in your discs. This reduces the ability of the discs to act as shock absorbers and makes them less flexible. Loss of fluid also makes the disc thinner and narrows the distance between the vertebrae.
• Tiny tears or cracks in the outer layer (annulus or capsule) of the disc. The jellylike material inside the disc (nucleus) may be forced out through the tears or cracks in the capsule, which causes the disc to bulge, break open (rupture), or break into fragments.
These changes are more likely to occur in people who smoke cigarettes and those who do heavy physical work (such as repeated heavy lifting). People who are obese are also more likely to have symptoms of degenerative disc disease.
A sudden (acute) injury leading to a herniated disc (such as a fall) may also begin the degeneration process.
As the space between the vertebrae gets smaller, there is less padding between them, and the spine becomes less stable. The body reacts to this by constructing bony growths called bone spurs (osteophytes). Bone spurs can put pressure on the spinal nerve roots or spinal cord, resulting in pain and affecting nerve function. Read More
Disc Replacement for Low Back Pain
Is disk replacement surgery an effective treatment for low back pain?
Fortunately, very few people who experience low back pain will require a surgery to obtain relief from their discomfort. But if conservative treatments haven’t resolved your pain within six months and your doctor has determined that your disk joint is the source of your chronic pain, you might be a candidate for disk replacement surgery.
Spinal fusion — the most common type of back surgery for painful joints — involves fusing two or more vertebrae together. Disk replacement surgery is a newer procedure that replaces the problem disk joint with an artificial one made of metal and plastic.
In general, it appears that spinal fusion and disk replacement procedures are equally effective. But in some cases, intensive rehabilitation programs appear to work just as well as either type of surgery — at a lower cost and with fewer complications. Read More
Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar can injure nerve fibers throughout your body, but diabetic neuropathy most often damages nerves in your legs and feet.
Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in your extremities to problems with your digestive system, urinary tract, blood vessels and heart. For some people, these symptoms are mild; for others, diabetic neuropathy can be painful, disabling and even fatal.
Diabetic neuropathy is a common serious complication of diabetes. Yet you can often prevent diabetic neuropathy or slow its progress with tight blood sugar control and a healthy lifestyle.
There are four main types of diabetic neuropathy. You may have just one type or symptoms of several types. Most develop gradually, and you may not notice problems until considerable damage has occurred.
The signs and symptoms of diabetic neuropathy vary, depending on the type of neuropathy and which nerves are affected.
Peripheral neuropathy is the most common form of diabetic neuropathy. Your feet and legs are often affected first, followed by your hands and arms. Signs and symptoms of peripheral neuropathy are often worse at night, and may include:
• Numbness or reduced ability to feel pain or temperature changes
• A tingling or burning sensation
• Sharp pains or cramps
• Increased sensitivity to touch — for some people, even the weight of a bed sheet can be agonizing
• Muscle weakness
• Loss of reflexes, especially in the ankle
• Loss of balance and coordination
• Serious foot problems, such as ulcers, infections, deformities, and bone and joint pain
The autonomic nervous system controls your heart, bladder, lungs, stomach, intestines, sex organs and eyes. Diabetes can affect the nerves in any of these areas, possibly causing:
• A lack of awareness that blood sugar levels are low (hypoglycemia unawareness)
• Bladder problems, including urinary tract infections or urinary retention or incontinence
• Constipation, uncontrolled diarrhea or a combination of the two
• Slow stomach emptying (gastroparesis), leading to nausea, vomiting, bloating and loss of appetite
• Difficulty swallowing
• Erectile dysfunction in men
• Vaginal dryness and other sexual difficulties in women
• Increased or decreased sweating
• Inability of your body to adjust blood pressure and heart rate, leading to sharp drops in blood pressure after sitting or standing that may cause you to faint or feel lightheaded
• Problems regulating your body temperature
• Changes in the way your eyes adjust from light to dark
• Increased heart rate when you’re at rest
Radiculoplexus neuropathy (diabetic amyotrophy)
Radiculoplexus neuropathy affects nerves in the thighs, hips, buttocks or legs. Also called diabetic amyotrophy, femoral neuropathy or proximal neuropathy, this condition is more common in people with type 2 diabetes and older adults.
Symptoms are usually on one side of the body, though in some cases symptoms may spread to the other side. Most people improve at least partially over time, though symptoms may worsen before they get better. This condition is often marked by:
• Sudden, severe pain in your hip and thigh or buttock
• Eventual weak and atrophied thigh muscles
• Difficulty rising from a sitting position
• Abdominal swelling, if the abdomen is affected
• Weight loss
Mononeuropathy involves damage to a specific nerve. The nerve may be in the face, torso or leg. Mononeuropathy, also called focal neuropathy, often comes on suddenly. It’s most common in older adults.
Although mononeuropathy can cause severe pain, it usually doesn’t cause any long-term problems. Symptoms usually diminish and disappear on their own over a few weeks or months. Signs and symptoms depend on which nerve is involved and may include:
• Difficulty focusing your eyes, double vision or aching behind one eye
• Paralysis on one side of your face (Bell’s palsy)
• Pain in your shin or foot
• Pain in your lower back or pelvis
• Pain in the front of your thigh
• Pain in your chest or abdomen
Sometimes mononeuropathy occurs when a nerve is compressed. Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes.
Signs and symptoms of carpal tunnel syndrome include:
• Numbness or tingling in your fingers or hand, especially in your thumb, index finger, middle finger and ring finger
• A sense of weakness in your hand and a tendency to drop things
When to see a doctor
Seek medical care if you notice:
• A cut or sore on your foot that doesn’t seem to be healing, is infected or is getting worse
• Burning, tingling, weakness or pain in your hands or feet that interferes with your daily routine or your sleep
• Changes in your digestion, urination or sexual function
These signs and symptoms don’t always indicate nerve damage, but they may signal other problems that require medical care. Early diagnosis and treatment offer the best chance for controlling symptoms and preventing more-severe problems.
Even minor sores on the feet that don’t heal can turn into ulcers. In the most severe cases, untreated foot ulcers may become gangrenous — a condition in which the tissue dies — and require surgery or even amputation of your foot. Early treatment can help prevent this from happening. Read More
Fibromyalgia syndrome affects the muscles and soft tissue. Symptoms include chronic muscle pain, fatigue, sleep problems, and painful tender points or trigger points, which can be relieved through medications, lifestyle changes and stress management.
What Is Fibromyalgia?
Think you might have fibromyalgia? Learn more about fibromyalgia with its chronic muscle pain, fatigue, sleep disturbances, and tender points. Read about standard and alternative treatments for fibromyalgia.
Fibromyalgia in Children and Teens
Learn about features of fibromyalgia in children and teenagers and how it’s treated.
Learn more about what causes the pain, stiffness, and fatigue of fibromyalgia, including the link to genetics, stress, injuries, and hormones.
Fibromyalgia and Depression
Does fibromyalgia cause depression? Or does depression lead to fibromyalgia? Discover the connection between fibromyalgia and depression and find out if you or a loved one is at risk.
Headache is pain in any region of the head. Headaches may occur on one or both sides of the head, be isolated to a certain location, radiate across the head from one point, or have a vise-like quality. A headache may be a sharp pain, throbbing sensation or dull ache. Headaches may appear gradually or suddenly, and they may last less than an hour or for several days.
Your headache symptoms can help your doctor determine the cause and the appropriate treatment. Most headaches aren’t the result of a serious illness, but some may result from a life-threatening condition requiring emergency care.
Headaches are generally classified by cause:
A primary headache is caused by problems with or over activity of pain-sensitive structures in your head. A primary headache isn’t a symptom of an underlying disease. Chemical activity in your brain, the nerves or blood vessels of your head outside your skull, or muscles of your head and neck — or some combination of these factors — may play a role in primary headaches. Some people may carry genes that make them more likely to develop such headaches.
The most common primary headaches are:
• Cluster headache
• Migraine (with and without aura)
• Tension headache (medically known as tension-type headache)
• Trigeminal autonomic cephalalgia (TAC), including cluster headache and paroxysmal hemicrania
There are other headache patterns that are generally considered types of primary headache but are less common. These headaches have distinct features, such as an unusual duration or pain associated with a certain activity. Although these headaches are generally considered primary, each of them could be a symptom of an underlying disease. These headaches include:
• Chronic daily headaches
• Cough headaches
• Exercise headaches
• Sex headaches
Some primary headaches can be triggered by lifestyle factors, including:
• Alcohol, particularly red wine
• Certain foods, such as processed meats that contain nitrates
• Changes in sleep or lack of sleep
• Poor posture
• Skipped meals
A secondary headache is a symptom of a disease that can activate the pain-sensitive nerves of the head. Any number of conditions — varying greatly in severity — may cause secondary headaches. Sources of secondary headaches include:
• Acute sinusitis
• Arterial tears (carotid or vertebral dissections)
• Blood clot (venous thrombosis) within the brain — separate from stroke
• Brain aneurysm (a bulge in an artery in your brain) Read More
Hip Pain: Causes and Treatment
The hip joint is designed to withstand repeated motion and a fair amount of wear and tear. This ball-and-socket joint — the body’s largest — fits together in a way that allows for fluid movement.
Whenever you use the hip (for example, by going for a run), a cushion of cartilage helps prevent friction as the hip bone moves in its socket.
Despite its durability, the hip joint isn’t indestructible. With age and use, the cartilage can wear down or become damaged. Muscles and tendons in the hip can get overused. The hip bone itself can be fractured during a fall or other injury. Any of these conditions can lead to hip pain.
If your hips are sore, here is a rundown of what might be causing your discomfort and how to get hip pain relief.
Symptoms of Hip Pain
Depending on the condition that’s causing your hip pain, you might feel the discomfort in your:
• Inside of the hip joint
• Outside of the hip joint
Sometimes pain from other areas of the body, such as the back or groin (from a hernia), can radiate to the hip.
You might notice that your pain gets worse with activity, especially if it’s caused by arthritis. Along with the pain, you might have reduced range of motion. Some people develop a limp from persistent hip pain.
Hip Pain Relief
If your hip pain is caused by a muscle or tendon strain, osteoarthritis, or tendinitis, you can usually relieve it with an over-the-counter pain medication such as Tylenol or a nonsteroidal anti-inflammatory drug such as Motrin or Aleve.
Rheumatoid arthritis treatments also include prescription anti-inflammatory medications such as corticosteroids, or disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate and sulfasalazine.
Another way to relieve hip pain is by holding ice to the area for about 15 minutes a few times a day. Try to rest the affected joint as much as possible until you feel better.
If you have arthritis , exercising the hip joint with low-impact exercises, stretching, and resistance training can reduce pain and improve joint mobility. For example, swimming is a good non-impact exercise for arthritis. Physical therapy can also help increase your range of motion. Read More
Knee Pain Overview
Knee pain can be caused by a sudden injury, an overuse injury, or by an underlying condition, such as arthritis. Treatment will vary depending on the cause. Symptoms of knee injury can include pain, swelling, and stiffness.
Most people have had a minor knee problem at one time or another. Most of the time our body movements do not cause problems, but it’s not surprising that symptoms develop from everyday wear and tear, overuse, or injury. Knee problems and injuries most often occur during sports or recreational activities, work-related tasks, or home projects.
The knee is the largest joint in the body. The upper and lower bones of the knee are separated by two discs (menisci). The upper leg bone (femur) and the lower leg bones (tibia and fibula) are connected by ligaments, tendons, and muscles. The surface of the bones inside the knee joint is covered by articular cartilage, which absorbs shock and provides a smooth, gliding surface for joint movement. See a picture of the structures of the knee.
Most people have had a minor knee problem at one time or another. Most of the time our body movements do not cause problems, but it’s not surprising that symptoms develop from everyday wear and tear, overuse, or injury. Knee problems and injuries most often occur during sports or recreational activities, work-related tasks, or home projects.
The knee is the largest joint in the body. The upper and lower bones of the knee are separated by two discs (menisci). The upper leg bone (femur) and the lower leg bones (tibia and fibula) are connected by ligaments, tendons, and muscles. The surface of the bones inside the knee joint is covered by articular cartilage, which absorbs shock and provides a smooth, gliding surface for joint movement. See a picture of the structures of the knee camera.gif.
Although a knee problem is often caused by an injury to one or more of these structures, it may have another cause. Some people are more likely to develop knee problems than others. Many jobs, sports and recreation activities, getting older, or having a disease such as osteoporosis or arthritis increase your chances of having problems with your knees.
Injuries are the most common cause of knee problems. Sudden (acute) injuries may be caused by a direct blow to the knee or from abnormal twisting, bending the knee, or falling on the knee. Pain, bruising, or swelling may be severe and develop within minutes of the injury. Nerves or blood vessels may be pinched or damaged during the injury. The knee or lower leg may feel numb, weak, or cold; tingle; or look pale or blue. Acute injuries include:
• Sprains, strains, or other injuries to the ligaments and tendons that connect and support the kneecap.
• A tear in the rubbery cushions of the knee joint (meniscus).
• Ligament tears, such as the anterior cruciate ligament (ACL). The medial collateral ligament (MCL) is the most commonly injured ligament of the knee.
• Breaks (fracture) of the kneecap, lower portion of the femur, or upper part of the tibia or fibula. Knee fractures are most commonly caused by abnormal force, such as a falling on the knee, a severe twisting motion, severe force that bends the knee, or when the knee forcefully hits an object.
• Kneecap dislocation. This type of dislocation occurs more frequently in 13- to 18-year-old girls.
• Pieces of bone or tissue (loose bodies) from a fracture or dislocation that may get caught in the joint and interfere with movement.
• Knee joint dislocation. This is a rare injury that requires great force. It is a serious injury and requires immediate medical care. Read More
Kyphosis is a forward rounding of the back. Some rounding is normal, but the term “kyphosis” usually refers to an exaggerated rounding of the back. While kyphosis can occur at any age, it’s most common in older women.
Age-related kyphosis often occurs after osteoporosis weakens spinal bones to the point that they crack and compress. Other types of kyphosis are seen in infants or teens due to malformation of the spine or wedging of the spinal bones over time.
Mild kyphosis causes few problems, but severe cases can cause pain and be disfiguring. Treatment for kyphosis depends on your age, the cause of the curvature and its effects.
Symptoms: In addition to an abnormally curved spine, kyphosis can also cause back pain and stiffness in some people. Mild cases of kyphosis may produce no noticeable signs or symptoms.
When to see a Doctor
Make an appointment with your doctor if you notice an increased curve in your upper back or in your child’s spine
The individual bones (vertebrae) that make up a healthy spine look like cylinders stacked in a column. Kyphosis occurs when the vertebrae in the upper back become more wedge-shaped. This deformity can be caused by a variety of problems, including:
• Osteoporosis. This bone-thinning disorder can result in crushed vertebrae (compression fractures). Osteoporosis is most common in older adults, particularly women, and in people who have taken high doses of corticosteroids for long periods of time.
• Disk degeneration. Soft, circular disks act as cushions between spinal vertebrae. With age, these disks dry out and shrink, which often worsens kyphosis.
• Scheuermann’s disease. Also called Scheuermann’s kyphosis, this disease typically begins during the growth spurt that occurs before puberty. Boys are affected more often than are girls. The rounding of the back may worsen as the child finishes growing.
• Birth defects. If a baby’s spinal column doesn’t develop properly in the womb, the spinal bones may not form properly, causing kyphosis.
• Syndromes. Kyphosis in children can also be associated with certain syndromes, such as Marfan syndrome or Prader-Willi disease.
• Cancer and cancer treatments. Cancer in the spine can weaken vertebrae and make them more prone to compression fractures, as can chemotherapy and radiation cancer treatments.
An increased curve in the upper spine also can be caused by slouching. Called postural kyphosis, this condition doesn’t involve any deformities in the spine. It’s most common in teenagers. Ref: http://www.mayoclinic.org/diseases-conditions/kyphosis/basics/definition/con-20026732
A condition in which the normal roundback in the upper spine (called a kyphosis) is increased. Most people with Scheuermann’s disease will have an increased roundback (e.g. a hunch back or hump back) but no pain.
The name of this condition comes from Scheuermann, the person who in 1921 described changes in the vertebral endplates and disc space that can occur during development and lead to kyphosis, or roundback deformity of the thoracic spine (upper back).
There is some confusion in terminology, however, as Scheuermann also described changes that occur in the disc spaces of the lumbar spine that can lead to back pain. This is really another condition, called juvenile disc disorder, but is often confused with Scheuermann’s kyphosis and is sometimes called Lumbar Scheuermann’s disease. To avoid confusion, the preferred terminology is now:
• Scheuermann’s disease (or Scheuermann’s kyphosis) to describe the condition of adolescent kyphosis
• Juvenile disc disorder (or juvenile discogenic disorder) to describe the condition of adolescent degenerative disc disease. Read More
Low Back Pain
Low Back Pain
Can be caused by a variety of problems with any parts of the complex, interconnected network of spinal muscles, nerves, bones, discs or tendons in the lumbar spine. Typical sources of low back pain include:
• The large nerve roots in the low back that go to the legs may be irritated
• The smaller nerves that supply the low back may be irritated
• The large paired lower back muscles (erector spinae) may be strained
• The bones, ligaments or joints may be damaged
• An intervertebral disc may be degenerating
• Learn more: Lumbar Spine Anatomy and Pain
An irritation or problem with any of these structures can cause lower back pain and/or pain that radiates or is referred to other parts of the body. Many lower back problems also cause back muscle spasms, which don’t sound like much but can cause severe pain and disability.
While lower back pain is extremely common, the symptoms and severity of lower back pain vary greatly. A simple lower back muscle strain might be excruciating enough to necessitate an emergency room visit, while a degenerating disc might cause only mild, intermittent discomfort.
Identifying the symptoms and getting a diagnosis that pinpoints the underlying cause of the pain is the first step in obtaining effective pain relief. Read More
Neck and shoulder pain can be classified in many different ways. Some people experience only neck pain or only shoulder pain, while others experience pain in both areas.
What Causes Neck Pain?
Causes of neck pain include:
• Abnormalities in the bone or joints
• Poor posture
• Degenerative diseases
• Muscle strain
What Causes Shoulder Pain?
The shoulder is a ball and socket joint with a large range of movement. Such a mobile joint tends to be more susceptible to injury. Shoulder pain can stem from one or more of the following causes:
• Strains from overexertion
• Tendonitis from overuse
• Shoulder joint instability
• Collar or upper arm bone fractures
• Frozen shoulder
• Pinched nerves (also called radiculopathy)
What is Neuropathic Pain?
When the sensory system is impacted by injury or disease, the nerves within that system cannot work to transmit sensation to the brain. This often leads to a sense of numbness, or lack of sensation. However, in some cases when this system is injured, individuals experience pain in the affected region. Neuropathic pain does not start abruptly or resolve quickly; it is a chronic condition which leads to persistent pain symptoms. For many patients, the intensity of their symptoms can wax and wane throughout the day. Although neuropathic pain is thought to be associated with peripheral nerve problems, such as neuropathy caused by diabetes or spinal stenosis, injuries to the brain or spinal cord can also lead to chronic neuropathic pain.
Neuropathic pain can be contrasted to nociceptive pain, which is the type of pain which occurs when someone experiences an acute injury, such as smashing a finger with a hammer or stubbing a toe when walking barefoot. This type of pain is typically short-lived and usually quite responsive to common pain medications in contrast to neuropathic pain.
What are the risk factors for neuropathic pain?
Anything that leads to loss of function within the sensory nervous system can cause neuropathic pain. As such, nerve problems from carpal tunnel syndrome or similar conditions can trigger neuropathic pain. Trauma, causing nerve injury, can lead to neuropathic pain. Other conditions which can predispose patients to developing neuropathic pain include diabetes, vitamin deficiencies, cancer, HIV, stroke, multiple sclerosis, shingles, and cancer treatments. Read More
Pseudarthrosis (commonly referred to as a nonunion or false joint) is a bone fracture that has no chance of mending without intervention. In pseudarthrosis the body perceives bone fragments as separate bones and does not attempt to unite them. Often this is the result of inadequate healing after the fracture, though it can also be the result of a developmental failure. In the U.S., FDA guidelines allow a period of 9 months for fracture union, after which intervention is considered to facilitate union.
The point of movement can be treated with electrical stimulations that hopefully will trigger the bone cells to form the hydroxyapatite structure that keeps bones from bending too much. More recently, non-unions are treated by bone grafting, internal fixation, and external fixation, including a technique pioneered by Ilizarov, used to compress the bones at the site of the fracture. Ilizarov originally used bicycle spokes; the modern Taylor Spatial Frame is similar. Read More
Piriformis syndrome is an uncommon neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve. The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint. This muscle is important in lower body movement because it stabilizes the hip joint and lifts and rotates the thigh away from the body. This enables us to walk, shift our weight from one foot to another, and maintain balance. It is also used in sports that involve lifting and rotating the thighs — in short, in almost every motion of the hips and legs.
The sciatic nerve is a thick and long nerve in the body. It passes alongside or goes through the piriformis muscle, goes down the back of the leg, and eventually branches off into smaller nerves that end in the feet. Nerve compression can be caused by spasm of the piriformis muscle.
Piriformis Syndrome Signs and Symptoms
Piriformis syndrome usually starts with pain, tingling, or numbness in the buttocks. Pain can be severe and extend down the length of the sciatic nerve (called sciatica). The pain is due to the piriformis muscle compressing the sciatic nerve, such as while sitting on a car seat or running. Pain may also be triggered while climbing stairs, applying firm pressure directly over the piriformis muscle, or sitting for long periods of time. Most cases of sciatica, however, are not due to piriformis syndrome. Read More
A retrolisthesis is a posterior displacement of one vertebral body with respect to the adjacent vertebrae to a degree less than a luxation (dislocation). Clinically speaking, retrolisthesis is the opposite of spondylolisthesis (anterior displacement of one vertebral body on the subjacent vertebral body), and is also called retrospondylolisthesis. Retrolistheses are most easily diagnosed on lateral x-ray views of the spine. Views, where care has been taken to expose for a true lateral view without any rotation, offer the best diagnostic quality.
Retrolistheses are found most prominently in the cervical spine and lumbar region but can also be seen in the thoracic area.
Signs and Symptoms
Retrolisthesis may lead to symptoms of greatly varying intensity and distribution. This is because of the variable nature of the impact on nerve tissue and of the mechanical impact on the spinal joints themselves.
Structural instability may be experienced as a local uneasiness through to a more far reaching structural compensatory distortion involving the whole spine. If the joints are stuck in a retrolisthesis configuration there may also be changes to range of motion.
Pain may be experienced as a result of irritation to the sensory nerve roots by bone depending on the degree of displacement and the presence of any rotatory positioning of the individual spinal motion segments. The soft tissue of the disc is often caused to bulge in retrolistheses. These cannot be determined by plain films, as the x-ray passes through the soft tissue. A study by Giles et al., stated that Sixteen of the thirty patients (53%) had retrolisthesis of L5 on S1 ranging from 2–9 mm; these patients had either intervertebral disc bulging or protrusion on CT examination ranging from 3–7 mm into the spinal canal. Fourteen patients (47%) without retrolisthesis (control group) did not show any retrolisthesis and the CT did not show any bulge/protrusion. On categorizing x-ray and CT pathology as being present or not, the well positioned i.e. true lateral plain x-ray film revealed a sensitivity and specificity of 100% ([95% Confidence Interval. = [89%–100%]) for bulge/protrusion in this preliminary study.”
Spinal cord compressions are also possible with patients experiencing pain, rigidity and neurologic signs that may follow some distance along nerves to cause symptoms at some distance from the location of the retrolisthesis. Read More
Shoulder Impingement and Bursitis
Shoulder impingement syndrome is a common cause of shoulder pain. It occurs when there is impingement of tendons or bursa in the shoulder from bones of the shoulder. Overhead activity of the shoulder, especially repeated activity, is a risk factor for shoulder impingement syndrome. Examples include: painting, lifting, swimming, tennis, and other overhead sports. Other risk factors include bone and joint abnormalities.
With impingement syndrome, pain is persistent and affects everyday activities. Motions such as reaching up behind the back or reaching up overhead to put on a coat or blouse, for example, may cause pain.
Over time, impingement syndrome can lead to inflammation of the rotator cuff tendons (tendinitis) and bursa (bursitis). If not treated appropriately, the rotator cuff tendons can start to thin and tear.
What Are the Symptoms of Shoulder Impingement Syndrome?
The typical symptoms of impingement syndrome include difficulty reaching up behind the back, pain with overhead use of the arm and weakness of shoulder muscles.
If tendons are injured for a long period of time, the tendon can actually tear in two, resulting in a rotator cuff tear. This causes significant weakness and may make it difficult for the person to elevate his or her arm. Some people can have rupture of their biceps muscle as part of this continuing impingement process. Read More
While the term “stenosis” comes from Greek and means “choking,” spinal stenosis, however, has little in common with choking. So what is spinal stenosis?
There are two types of spinal stenosis: lumbar stenosis and cervical stenosis. While lumbar spinal stenosis is more common, cervical spinal stenosis is often more dangerous because it involves compression of the spinal cord, as explained below in more detail.
Lumbar Spinal Stenosis vs. Cervical Spinal Stenosis
• In lumbar stenosis, the spinal nerve roots in the lower back are compressed, or choked, and this can produce symptoms of sciatica tingling, weakness or numbness that radiates from the low back and into the buttocks and legs – especially with activity.
• Spinal stenosis pain in the neck (cervical spinal stenosis) can be far more dangerous by compressing the spinal cord. Spinal cord stenosis may lead to serious symptoms, including major body weakness or even paralysis. Such severe spinal stenosis symptoms are virtually impossible in the lumbar spine, however, as the spinal cord is not present in the lumbar spine. Read More
Spinal fusion is surgery to permanently connect two or more vertebrae in your spine, eliminating motion between them.
Spinal fusion involves techniques designed to mimic the normal healing process of broken bones. During spinal fusion, your surgeon places bone or a bone-like material within the space between two spinal vertebrae. Metal plates, screws and rods may be used to hold the vertebrae together, so they can heal into one solid unit.
Because spinal fusion surgery immobilizes parts of your spine, it changes the way your spine can move. This places additional stress and strain on the vertebrae above and below the fused portion, and may increase the rate at which those areas of your spine degenerate. Read More
Spondylolysis is a condition in which the there is a defect in a portion of the spine called the pars interarticularis (a small segment of bone joining the facet joints in the back of the spine). With the condition of spondylolisthesis, the pars interarticularis defect can be on one side of the spine only (unilateral) or both sides (bilateral). The most common level it is found is at L5-S1, although spondylolisthesis can occur at L4-5 and rarely at a higher level.
Spondylolysis is the most common cause of isthmic spondylolisthesis, in which one vertebral body is slipped forward over another. Isthmic spondylolisthesis is the most common cause of back pain in adolescents; however, most adolescents with spondylolisthesis do not actually experience any symptoms or pain. Cases of either neurological deficits or paralysis are exceedingly rare, and for the most part it is not a dangerous condition. The most common symptom is back and/or leg pain that limits a patient’s activity level.
Since spondylolysis is the most common cause of spondylolisthesis, it may be referred to as an isthmic spondylolisthesis and sometimes these terms are used interchangeably, although this is not correct. There are at least 6 recognized causes of slippage as seen in spondylolisthesis in the literature. According to Dr. Leon Wiltse, these causes are listed as:
Dysplastic spondylolisthesis (which includes congenital)
• Isthmic spondylolisthesis (which includes lytic or stress fracture, an elongated but intact pars or an acute fracture of the pars)
• Degenerative spondylolisthesis (Pseudospondylolisthesis) — secondary to long-standing degenerative arthrosis (degenerative disc disease and degeneration of the facet joints)
• Traumatic spondylolisthesis (secondary to a fracture of the neural arch)
• Pathologic spondylolisthesis (from bone disease such as metastatic disease, tumor, osteoporosis, etc.)
Importantly, spondylolysis only refers to the separation of the pars interarticularis (a small bony arch in the back of the spine between the facet joints), whereas spondylolisthesis refers to anterior slippage of one vertebra over another (in the front of the spine). Therefore, although the terms are sometimes used interchangeably, this is incorrect and the two are technically not interchangeable. Read More
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