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Conditions

Arm Pain


Pain in the shoulder suggests a shoulder injury and shoulder injuries are more common in athletes participating in sports such as swimming, tennis, pitching, and weightlifting. The injuries are caused due to the over usage or repetitive motion of the arms. In addition to pain, shoulder injuries also cause stiffness, restricted movements, difficulty in performing routine activities, and popping sensation. Some of the common shoulder injuries that cause pain and restrict the movement of shoulders include sprains and strains, dislocations, tendinitis, bursitis, rotator cuff injury, fractures, and arthritis.

  • Sprains and Strains: A sprain is stretching or tearing of ligaments (tissues that connect adjacent bones in a joint). It is a common injury and usually occurs when you fall or suddenly twist. A strain is stretching or tearing of muscle or tendon (tissues that connect muscle to bone). It is common in people participating in sports. Strains are usually caused by twisting or pulling of the tendons.
  • Dislocations: A shoulder dislocation is an injury that occurs when the ends of the bone is forced out of its position. It is often caused by a fall or direct blow to the joint while playing contact sport.
  • Tendinitis: It is an inflammation of a tendon, a tissue that connects muscles to bone. It occurs as a result of injury or overuse.
  • Bursitis: It is an inflammation of fluid filled sac called bursa that protects and cushions your joints. Bursitis can be caused by chronic overuse, injury, arthritis, gout, or infection.
  • Rotator cuff injury: The rotator cuff consists of tendons and muscles that hold the bones of the shoulder joint together. Rotator cuff muscles allow you to move your arm up and down. Rotator cuff injuries often cause a decreased range of motion.
  • Fractures: A fracture is a break in the bone that commonly occurs as a result of injury, such as a fall or a direct blow to the shoulder.
  • Arthritis: Osteoarthritis is the most common type of shoulder arthritis, characterized by progressive wearing away of the cartilage of the joint.

Early treatment is necessary to prevent serious shoulder injuries. The immediate mode of treatment recommended for shoulder injuries is rest, ice, compression and elevation (RICE). Your doctor may also prescribe anti-inflammatory medications to help reduce the swelling and pain. Your doctor may recommend certain exercises to strengthen shoulder muscles and to regain shoulder movement based on the type and severity of injury of following a surgical correction of shoulder injury to regain the strength to the muscles in shoulder.




Back Pain


Back pain or backache is the pain felt in the back that may originate from muscles, nerves, bones, joints or other structures in the spine. Back pain is one of the most common medical problems experienced by most people at some time in their life. Back pain can be acute usually lasting from few days to few weeks, or chronic lasting for more than three months. Back Pain can occur as a dull constant pain or a sudden sharp pain. Back pain may be confined to one area or may radiate to other areas such as the arm and hand, the upper back, or the low back, and might radiate into the leg or foot. Other than pain you may have weakness, numbness or tingling in your arms or legs caused from damage to the spinal cord. Athletes participating in sports such as skiing, basketball, football, ice skating, soccer, running, golf, or tennis are at greater risk of developing back pain. During these sport activities, the spine need to bear more stress, take up more pressure, undergo twisting and turning, as well the bodily impact. This may cause strain on the back that can result in back pain. Athletes are at high risk of back pain both from trauma and from overuse injuries, especially in sports requiring hyperextension. Common causes of back pain include:

  • Musculoligamentous strain: It is the most common sports injury caused by injury to the soft tissues around the spine
  • Spondylolysis: It is most commonly found in athletes who participate in sports such as gymnastics, pole-vaulting, and football. All these activities require frequent hyperextension of the lumbar spine
  • Spondylolisthesis: It is a condition of the spine which occurs when one vertebra is displaced or slipped forward over the other below it
  • Herniated nucleus pulposus: When injury occurs, the central core of the disc is pushed through a tear in the outer hard layer of the disc, causing a bulge and pressing on nearby nerves. If the herniated disc presses on a spinal nerve, it can cause back pain.
Other causes include growth-related problems such as scoliosis and Scheuermann’s kyphosis. Your physician will diagnose back pain by asking appropriate questions or by taking a history of your problem and examining your spine. A complete examination includes examination of the signs of unusual curves of the spine, a rib hump, a tilted pelvis, and tilting of the shoulders and a test of your sensations. Other diagnostic tests may be needed to confirm the diagnosis. Treatment for back pain is usually non-surgical and includes:
  • Anti-inflammatory medications, or NSAIDs are recommended to provide relief from pain
  • Cold packs, heat packs or both applied to the back to help ease much of the discomfort and relieve stiffness as well the pain
  • Sleeping with the pillow between the knees while lying on one side or placing the pillow under your knees when lying on your back may help relieve back pain
  • Exercises to strengthen your trunk and back muscles
These measures help relieve your back pain however in certain conditions the pain may not be resolved and may require surgical treatment. Your physician will decide on the appropriate surgery based on several factors.




CRPS/RSD


Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by severe pain, swelling and changes in the skin. It usually affects the arms, hands, legs or feet. It is also known as reflex sympathetic dystrophy or causalgia. It usually begins after trauma such as an injury to the tissue, bone or nerves of your limb. With early treatment, CRPS may be prevented from getting worse. Causes
The exact cause of CRPS is not known, however certain theories suggest that in some cases the sympathetic nervous system plays an important role in sustaining the pain. It may also be caused by triggering the immune response, which can result in inflammatory symptoms of redness, warmth, and swelling in the affected area. There are two forms of CRPS based on different causes:

  • CRPS I is triggered by a soft tissue injury, where nerve damage is not the primary cause
  • Whereas, CRPS II is triggered by damage to a nerve
Symptoms
The main symptom of CRPS is intense, burning pain that feels much worse than the injury and continues long after the injury has healed. Your skin color may change to red, blue or white. The skin over the affected area may become tender, thin or shiny and sensitive to hot or cold temperatures. You may also have muscle spasms, joint stiffness, and severe limited mobility in the affected area. Diagnosis
Diagnosis of complex regional pain syndrome is based on your medical history and physical examination. The best way to diagnose and treat CRPS is through a sympathetic block of the affected nerve plexus. The injected anesthetic should numb the affected extremity. Pain relief and improved temperature of the extremity is a positive diagnostic test for CRPS. Treatment Options
Treatment is aimed at relieving painful symptoms so that people can resume their normal lives. The following treatment options are often used:
  • Physical therapy to help decrease pain and improve range of motion and strength.
  • Medications including pain relievers, corticosteroids, bone-loss medications, antidepressants and anticonvulsants.
  • Cognitive behavioral therapy or psychotherapy can also be useful in helping you cope better with the pain.
  • Sympathetic nerve blocks: A nerve block is an injection of local anesthetics into a group of nerves around the spinal column to provide relief from the pain and discomfort.
  • Intrathecal drug pump: In this technique an external pump and implanted catheters may be used to administer pain-relieving medication into the spinal fluid to provide relief.
  • Spinal cord stimulation: This involves placement of stimulating electrodes next to the spinal cord. A small electrical current delivered to the spinal cord provides a pleasant tingling sensation to the painful area.
  • Surgical sympathectomy: It is a surgical technique that destroys the nerves involved in CRPS.
Complex regional pain syndrome causes intense pain that makes it difficult to use the affected part of the body. If you experience constant, severe pain that affects a limb and makes touching or moving that limb intolerable, see your doctor to determine the cause. It’s important to treat complex regional pain syndrome early to prevent the progression of the condition.




Facial Pain Syndrome


Facial pain may occur due to injury or trauma to the face, sinus infection or inflammation, or compression of a facial nerve. Facial pain syndrome, also called trigeminal neuralgia, is characterized by intense intermittent facial pain due to the compression of the trigeminal nerve, a large nerve that extends from the brain to your face. Consequently, the blood vessels rub against the trigeminal nerve root causing nerve irritation. Facial pain syndrome is most commonly seen in women, but rarely occurs before the age of 50 years. The pain feels like a sudden stabbing or shock-like pain that gets triggered while brushing your teeth, applying makeup, swallowing, touching your face or even with a slight breeze. You may experience the pain in your cheeks, scalp, forehead, around your eyes, nose, lips and jaws, usually on one side of your face. The pain usually last for a few seconds, and may repeat throughout the day for days or even months. Trigeminal neuralgia can be diagnosed with an MRI scan and treated with a combination of anti-seizure, pain and antidepressant medications. If medications fail to treat the pain or they have undesirable side effects, your doctor might suggest a neurosurgical procedure. The surgery helps to relieve the pressure on your nerve and decreases the sensitivity.




Complex regional pain syndrome


Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by severe pain, swelling and changes in the skin. It usually affects the arms, hands, legs or feet. It is also known as reflex sympathetic dystrophy or causalgia. It usually begins after trauma such as an injury to the tissue, bone or nerves of your limb. With early treatment, CRPS may be prevented from getting worse. Causes
The exact cause of CRPS is not known, however certain theories suggest that in some cases the sympathetic nervous system plays an important role in sustaining the pain. It may also be caused by triggering the immune response, which can result in inflammatory symptoms of redness, warmth, and swelling in the affected area. There are two forms of CRPS based on different causes:

  • CRPS I is triggered by a soft tissue injury, where nerve damage is not the primary cause
  • Whereas, CRPS II is triggered by damage to a nerve
Symptoms
The main symptom of CRPS is intense, burning pain that feels much worse than the injury and continues long after the injury has healed. Your skin color may change to red, blue or white. The skin over the affected area may become tender, thin or shiny and sensitive to hot or cold temperatures. You may also have muscle spasms, joint stiffness, and severe limited mobility in the affected area. Diagnosis
Diagnosis of complex regional pain syndrome is based on your medical history and physical examination. The best way to diagnose and treat CRPS is through a sympathetic block of the affected nerve plexus. The injected anesthetic should numb the affected extremity. Pain relief and improved temperature of the extremity is a positive diagnostic test for CRPS. Treatment Options
Treatment is aimed at relieving painful symptoms so that people can resume their normal lives. The following treatment options are often used:
  • Physical therapy to help decrease pain and improve range of motion and strength.
  • Medications including pain relievers, corticosteroids, bone-loss medications, antidepressants and anticonvulsants.
  • Cognitive behavioral therapy or psychotherapy can also be useful in helping you cope better with the pain.
  • Sympathetic nerve blocks: A nerve block is an injection of local anesthetics into a group of nerves around the spinal column to provide relief from the pain and discomfort.
  • Intrathecal drug pump: In this technique an external pump and implanted catheters may be used to administer pain-relieving medication into the spinal fluid to provide relief.
  • Spinal cord stimulation: This involves placement of stimulating electrodes next to the spinal cord. A small electrical current delivered to the spinal cord provides a pleasant tingling sensation to the painful area.
  • Surgical sympathectomy: It is a surgical technique that destroys the nerves involved in CRPS.
Complex regional pain syndrome causes intense pain that makes it difficult to use the affected part of the body. If you experience constant, severe pain that affects a limb and makes touching or moving that limb intolerable, see your doctor to determine the cause. It’s important to treat complex regional pain syndrome early to prevent the progression of the condition.




Fibromyalgia


Fibromyalgia is a chronic disorder characterized by widespread body pain and tenderness of the joints, muscles, tendons and other soft tissues. Fibromyalgia may also be associated with fatigue, headaches, difficulty sleeping, depression, and anxiety. Causes The cause of fibromyalgia is not known, but certain factors such as sleep disorders, physical or emotional trauma, viral infection, and abnormal pain perception may trigger fibromyalgia. Middle-aged women are at an increased risk of developing fibromyalgia. Several other conditions such as chronic neck or back pain, chronic fatigue syndrome, Lyme disease, hypothyroidism, sleep and depressive disorders mimic the symptoms of fibromyalgia and may coexist with it. Symptoms The predominant symptom of fibromyalgia is generalized body pain. The intensity of pain may vary from mild to severe. Tender points, localized painful areas in the neck, shoulders, back, hips, arms or legs, are present. The pain may either be continuous or there may be a diurnal variation in pain, with an aggravation of the pain during the night. The pain may either be aching in nature or a shooting, burning pain that may increase with stress, anxiety, physical activity and cold or damp weather. Most people with fibromyalgia also experience fatigue, depression, and sleep disorders where they wake up with a feeling of tiredness despite long periods of sleep. People with fibromyalgia may also have other associated symptoms such as irritable bowel syndrome (IBS), headache, memory and concentration disorder, numbness and tingling sensation in the hands and feet, irregular heartbeat, and decreased ability to exercise. Diagnosis The diagnostic criterion for fibromyalgia includes:

  • Widespread pain lasting for at least three months

    • Pain in at least 11 of the 18 tender points including elbows, buttocks, chest, knees, shoulders, lower back, neck, rib cage, and thighs.

Blood and urine tests may be recommended to rule out other conditions with similar symptoms. Treatment The treatment for fibromyalgia is aimed at resolution of the symptoms and helping the patient to cope with these symptoms. The treatment options for fibromyalgia include physical therapy, fitness and exercise program, stress relief techniques, and medications. Several medications such as antidepressants, muscle relaxants, anticonvulsants (anti-seizure), and pain killers can be prescribed to patients. These medications provide symptomatic relief from pain and also improve their quality of sleep. Cognitive behavioral therapy (CBT) is an important aspect of fibromyalgia treatment and helps in modification of an individual’s response to pain. Support groups may be also helpful in managing fibromyalgia. A well-balanced diet, abstinence from caffeine, a regular sleep pattern, and acupuncture therapies may also relieve fibromyalgia symptoms. Contact your doctor for any questions or concerns.




Hand Pain


Hand pain is characterized by distress in the joints and tissues of the hand or fingers. Hand pain can be depicted as pulsating, aching, increased warmth, prickling, irritation and inflexibility. The hand is composed of nerves, bones, blood vessels, muscles, tendons and skin. Each part has its specific function such as nerves transfer sensation, joints control movements, blood vessels maintain circulation, muscles provides motion, tendons anchor the muscles to the bones and skin receives sensations. Injury or inflammation of any of these structures, due to a disorder or disease condition, may produce hand pain. Even compression of the nerves supplying these structures may cause hand pain. Causes The conditions and disorder that frequently play a role in hand pain are:

  • Accidental injury and trauma
  • Serious infections in the blood (Septicemia)
  • Fracture of the hand bones
  • Nerve compression
  • Incident of conditions such as tenosynovitis and carpal tunnel syndrome
  • Strains in muscles and ligaments
  • Osteoarthritis and rheumatoid arthritis
  • Suffering from diabetes and peripheral neuropathy
  • Tedious lifting, twisting or gripping
  • Long-term use of keyboards
Treatment Hand pain can be treated normally by resting the hand, medications, bracing, heat or ice application, compression, stretching and strengthening exercises, and by treating the underlying cause or condition. In cases of chronic hand pain unresponsive to conservative treatment measures, hand surgery may be recommended.




Joint Pain


Joints are connections where two bones meetto provide support and mobility. Any damage to the joint and its surrounding tissues, due to disease or injury can interfere with movement and cause pain. Joint pain can be mild or debilitating, and can be either long term (chronic) or short term (acute) pain. Severe pain may cause swelling in the joints which may affect your quality of life. The most common joint pain is knee, shoulder and hip pain. Joint pain may be caused due to various conditions such as osteoarthritis, rheumatoid arthritis, strains, gout, bursitis, sprains and other injuries. Pain is also a feature of joint inflammation, infection or tumors in the joint. Moderate to severe pain can be treated with pain medications such as non-steroidal anti-inflammatory drugs (NSAID’s), muscle relaxants and antiepileptic drugs. Your doctor may also suggest PRICE protocol (Protect, Rest, Ice application, Compression and Elevation), steroid injection at the region of pain and physical therapy to relieve joint pain.




Leg Pain


Pain in your legs may occur as a result of problems that affect the bone, joints, muscles, tendons, ligaments, blood vessels, nerves or skin of the leg, or sometimes due to problems in your lower spine. The most common cause for pain is inflammation or infection of the tissues, due to wear and tear, injury or diseases. Leg pain can also occur due to nerve compression or blockages in the flow of blood to the legs. Since the leg contains a number of different structures and tissue types, various conditions and injuries can cause leg pain; some of them include a fracture, arthritis, muscle cramps, sprains, strains, varicose veins and peripheral neuropathy. Leg pain can be persistent or intermittent, develop gradually or suddenly, and can be felt on your whole leg or to a specific region. It can be characterized as stabbing, sharp, dull or aching pain. Severe leg pain can affect your ability to walk or put weight on your leg. Leg pain is a common symptom and usually resolves with rest, application of ice, elevation of your leg or taking pain medication. However, when you experience severe leg pain, or your symptoms do not improve but instead get worse, you need to visit your doctor. You should seek immediate medical intervention after any leg injury with a deep cut or bone exposure, when you are unable to bear weight or walk, or have swelling or redness in your calf. Do not ignore signs of infection such as redness and fever, swelling, calf pain after sitting for a long time, or swelling in the legs along with breathing problems. These may indicate serious problems that would require medical treatment. Your doctor will evaluate your leg thoroughly and treat the underlying cause of your leg pain, which may include pain medication, massage, manipulation, exercise or surgery.




Neck Pain


The Neck supports and assists in movement of the head. It is the most flexible part of the spine and consists of 7 cervical vertebrae, cervical segment of the spinal cord, spinal nerves, ligaments, tendons and muscles. Neck pain can be secondary to a problem affecting any of these structures. Usually neck pain occurs due to damage to the soft tissue such as muscles, ligaments and nerves which may occur either due to an injury or wear and tear associated with the ageing process. The cervical spine is more prone to injury as it has comparatively less protection when compared to the thoracic and lumbar spine. Some of the common causes of neck pain include incorrect body posture, disease affecting the spine, trauma, inherited abnormalities of the cervical spine, infection or tumor of the spine. Spondylosis and cervical spinal stenosis may also result in neck pain. Spondylosis is a result of degeneration of the intervertebral discs between the cervical vertebrae. This increased wear and tear of the vertebral joints cause damage to the cartilage and formation of bone spurs. The intervertebral disc may also protrude out of its normal anatomical space and cause spinal nerve compression. Cervical spinal stenosis refers to the narrowing of the spinal canal in the neck. It occurs due to age related changes of the spine and its surrounding structures such as thickening of ligaments, degeneration of intervertebral discs and excessive bone formation around the intervertebral joints. A compression of cervical spinal nerves or the spinal cord, due to any of these factors, results in neck pain. Symptoms The intensity of neck pain may be vary from mild to intense and may be associated with difficulty in movement of the neck (neck stiffness). The affected region may be tender to touch. Neck pain may also be associated with numbness, tingling or weakness in the arm or hand. Neck pain may sometimes also lead to gait and balance disturbances, headache, dizziness, jaw pain and ringing in the ears. In rare cases neck pain may also be associated with loss of bowel and bladder function. Diagnosis Proper diagnosis is crucial for effective management of neck pain. To arrive at an accurate diagnosis, a detailed medical history coupled with a physical and neurological examination is essential. Neurological examination helps identify any signs of neurological injury and involves evaluation of reflexes and muscle weakness. An X-ray or CT scan of the neck may also be required to confirm the diagnosis. Treatment

  • Non-surgical treatment
    • Non-surgical options for the management of neck pain include activity modification, pain medication, non-steroidal anti-inflammatory drugs, muscle relaxants, physical therapy and spinal injections. A neck collar may be recommended for few days to keep the neck still and reduce mechanical pain due to movement.
  • Surgical Treatment
    • Surgery is rarely required for treating neck pain. Surgery is considered only if pain and symptoms fail to improve with non-surgical treatment and neurologic dysfunction and neck instability are evident at diagnosis.
Consult your doctor to clarify any doubts or unanswered questions about neck pain or to know more about the available treatment options.




Neuralgias


Neuralgia is a sharp, stabbing severe pain felt along the path of an irritated or damaged nerve. Pain may occur anywhere in the body, but is most common in the neck and face. The pain may be triggered by nerve compression or injury, old age or an underlying disease such as diabetes, herpes zoster infection, HIV, syphilis and chronic renal insufficiency. It may also result due to chemical irritation, certain medications or surgery. Neuralgia affects the overall quality of life as the pain may be long lasting and debilitating. The different types of neuralgia are:

  • Postherpetic neuralgia may occur anywhere in your body due to shingles (viral infection accompanied by painful rashes and blisters).
  • Trigeminal neuralgia occurs when blood vessels press against the trigeminal nerve (passes through the face). It usually affects one side of the face and is most commonly seen in the elderly.
  • Glossopharyngeal neuralgia is a rare type of neuralgia which affects the glossopharyngeal nerve in the throat, and is characterized by pain in the neck and throat.
Apart from pain, neuralgia may also be associated with increased sensitivity (with even a touch), paralysis of muscles and weakness. When you experience symptoms of neuralgia, your doctor will review your history, examine you and order blood tests to check for infection, MRI, ultrasound, spinal tap (examination of cerebrospinal fluid that bathes the brain and spinal cord) or electromyography (measures nerve conduction). A dental examination may be required to rule out other causes of facial pain. The treatment of neuralgia focuses on treating the underlying causes. Your doctor may prescribe analgesics, antiseizure, antidepressant and anticonvulsant medications for pain. A nerve block injection (reduces inflammation and turns off pain signals) may be administered in cases of severe pain. Physical exercise might help you in alleviating pain and increasing movement. You will be advised to keep your blood sugar levels under control if you are diabetic. Rarely, a surgery might be required to relieve the pressure of impeding structures such as blood vessels, tumors, bones and ligaments off of the nerves.




Neuropathy


Neuropathy is damage to the nerves as a result of injury or disease, and is most commonly associated with the peripheral nerves (nerves outside the brain and spinal cord). Peripheral nerve damage can cause problems in the way internal organs such as the digestive system, heart and bladder function, but most often affects the hands and feet. The main cause of peripheral neuropathy is diabetes, but may also result from advanced age, injury, tumors compressing a nerve, arthritis, alcoholism, certain neurological disorders (spina bifida and fibromyalgia) and certain medicines (chemotherapy drugs). Neuropathy causes abnormal sensations of numbness, burning, tingling, sensitivity or stabbing pain in the extremities. It may also be associated with loss of sensation, weakness or paralysis. It is necessary to examine your feet regularly as you may be more prone to injury due to the loss of protective sensation. There is no cure for neuropathy. Treatment is centered on slowing down its progression, alleviating symptoms, managing the underlying condition and maintaining the health of your feet. Your doctor will prescribe medication for pain and recommend physical therapy to strengthen muscles. Symptoms may also be alleviated with acupuncture, relaxation techniques and transcutaneous electrical nerve stimulation (TENS), which stimulate and block the nerve pathways of pain. The underlying causes of neuropathy, such as diabetes and vitamin B12 deficiency, may be treated with lifestyle modifications, appropriate medication and supplements. You are advised to visit your podiatrist (foot doctor) regularly, wear properly fitted shoes and avoid walking barefoot to protect your feet and prevent injury. Surgery may be required to remove tumors or release nerve compressions causing neuropathy.




Post Neck & Back Surgery Pain


Neck and back surgeries are performed to alleviate pain and disability locally as well as in your arms and legs. However, post-operative pain is a common symptom experienced once the anesthetic begins to wear-off. This can be due to tissue trauma or nerve injury that occurs during the surgery. Pain control following neck and back surgery is of priority to you and your doctor as it increases your comfort level, and prepares you for rehabilitation and a faster recovery. In addition, when your pain is well controlled, you will be able to walk and perform deep breathing exercises, which are important for the prevention of complications, such as blood clots and pneumonia. Pain control first starts with you – talk about your pain and inform your doctor about the region and intensity of the pain. Following surgery, you will be connected to a patient-controlled analgesia (PCA) machine, which dispenses small amounts of medication when you press a button at preset intervals. Significant pain management following surgery is one of the criteria considered before discharge. When you are discharged, do not wait for the pain to increase before taking your medications. Instead, take your prescribed medications regularly as advised by your doctor. Other methods of pain relief can be achieved with hot or cold compresses, relaxation, massage, epidural injections or spinal cord stimulation. If your pain is unbearable and you are not getting relief with your prescription pain medication, immediately inform your doctor for further intervention.




Sacroiliitis


Sacroiliac joints are the joints located in the pelvic bone that connect to the lower spine. They act as shock absorbers to the spine through a gliding movement. Sacroiliitis is an inflammation of these joints, and is characterized by pain and stiffness in your buttocks and lower back, which may radiate to your groin, thighs and feet. Pain may become severe with prolonged standing or sitting, climbing, walking and running. Other symptoms such as eye inflammation, psoriasis (inflammatory skin condition), bloody diarrhea and low-grade fever may occur in rare cases. Sacroiliitis may be caused due to a traumatic injury (fall or motor vehicle accident), degenerative arthritis, and infection and lifting heavy weights. Women are generally considered to be at a risk of developing sacroiliitis during pregnancy, as the pelvic area stretches to allow childbirth. When you present to your doctor’s clinic with lower back pain, your doctor will perform a thorough physical examination, during which pressure is applied to certain points on your hips and buttocks, and your legs are moved in different positions to determine the region of pain. Your doctor may also order an X-ray and MRI scan. Sometimes an anesthetic injection is administered at various points to see if your pain is relieved. This helps diagnose the exact point of pain. Treatment of sacroiliitis focuses on relieving symptoms and improving function. Your doctor may prescribe analgesics and muscle relaxants to reduce pain and alleviate muscle spasms. Spinal injections, containing a local anesthetic and steroid may be injected to relieve pain. Physical therapy may be ordered to improve range of motion, flexibility and strength of the joints. Surgery is rare and recommended when these methods do not provide relief. Joint fusion may be performed to fuse two bones with metal hardware.




Sciatica


Sciatic nerve is the largest and longest nerve in the body. It originates in the lower back, runs along the hip and back of the leg and finally terminates in the foot. Sciatica is characterized by severe pain in the leg resulting from compression or damage to this nerve. The pain is usually present below the knee and may also extend to the foot. The intensity of pain varies from a mild pain to a sharp pounding pain. This may also be associated with numbness, tingling or burning sensation in the hip, leg and foot. The pain is usually intensified at night and exaggerated by coughing, laughing, sneezing, sitting and standing. Sciatica may also result in muscle weakness. In rare cases bladder and bowel function may also be affected (cauda equine syndrome) requiring emergency medical intervention. Causes Some of the common causes of sciatica include herniated disc, piriformis syndrome, hip injury or fracture and tumors of the lumbar spine. Other conditions of the lumbar spine that may cause sciatica include compression fracture, degenerative disc disease, spinal stenosis, spondylosis and spondylolisthesis. Poor posture, prolonged sitting, lack of proper exercise, smoking, diabetes and a fall can also lead to sciatica. Diagnosis Sciatica is a symptom rather than a disease and can be secondary to a number of conditions, some of which have been mentioned above. Diagnosis of the exact underlying cause is very crucial in determining effective treatment. Diagnosis of sciatica includes medical history along with a physical and neurological examination. Neurological examination helps to detect any signs of neurological injury and also evaluates muscle weakness, numbness and abnormal reflexes. Imaging tests such as X-rays may be required for severe and chronic sciatica pain. CT and MRI scans are more sensitive and may also be performed to identify changes in soft tissue such as intervertebral discs and nerves. Treatment Sciatica may often resolve by itself, without any treatment. Sometimes conservative treatment is recommended to reduce the pain and inflammation around the nerve. Conservative management of sciatica includes activity modification, ice pack application followed by heat treatment, pain medication, non-steroidal anti-inflammatory drugs, muscle relaxants, spinal injection and physical therapy. Back braces may also be recommended to support the back and keep the lower back still to reduce mechanical pain. Acupuncture may also be beneficial in a few cases. Spinal surgery may be indicated if the symptoms do not respond to a conservative approach. Sciatica can recur after treatment. Regular stretching exercises and simple lifestyle changes such as bending from the knees while lifting weights can help to maintain a healthy spine and prevent sciatica. Consult your doctor for any doubts or unanswered questions about sciatica or its treatment.




Spinal Stenosis


Spinal stenosis is the compression of spinal nerves caused by narrowing of spinal canal and it is one of the common causes of low back pain. The symptoms include back pain, burning or aching type of pain in buttocks that radiates to the legs (sciatica), weakness in the legs or "foot drop”. One of the causes for spinal stenosis is the ageing and other causes include Paget’s disease, achondroplasia, spinal tumors and spinal injuries. As age advances the chances of developing osteoarthritis, disc degeneration and thickening of ligaments may increase and these conditions cause spinal stenosis. Spinal stenosis may be treated with conservative treatment approaches such as use of pain medications, physical therapy, steroid injections, or acupuncture. In chronic cases, surgery may be required to treat the condition. Nonsurgical Treatment

  • Physical Therapy: Physical Therapy involves stretching exercises, massage, and lumbar and abdominal strengthening.
  • Anti-inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) initially provide pain relief and also reduce swelling.
  • Steroid Injections: Cortisone steroid injections are given around the nerves or in the "epidural space” to decrease swelling and pain.
  • Acupuncture: Acupuncture can be helpful in cases where the pain is less severe.
  • Chiropractic Manipulation: Chiropractic manipulation can be done in some cases but not when there is co-existing osteoporosis or herniated disc because these cases increase the symptoms or cause injuries.
Surgical Treatment Surgery is considered for patients in whom the pain and weakness is causing debilitation such as inability to walk for a long time. The two main surgical procedures to treat lumbar spinal stenosis are laminectomy and spinal fusion.
  • Laminectomy: This procedure involves removal of the bone, bone spurs, and ligaments that compress the nerves.
  • Spinal fusion: In this procedure, two or more vertebrae are permanently fused together.