Two Case Studies Of Treatment For Cervical Radiculopathy
Subject: A 38 year-old male complains of severe pain in his neck that radiated down his right arm with numbness of his right index finger and posterior wrist . His pain began earlier that month after lifting a TV. Prior to this injury, he was an active person who was pain-free. The patient stated that his pain was at its worst when lying down , but is helped by wearing a neck brace while sleeping. He was taking Norco two to three times per day for pain, a Medrol dose pack, and Daypro at the time of his first visit. An MRI ordered by his primary doctor revealed a right-sided disc herniation at C5-C6 and C6-C7.
Upon initial exam, his right arm muscle strength was normal but had slightly diminished sensation in C6 dermatome (an area of skin that the nerves that pass through, in this case, the C6 area. Upon extension of his neck and right lateral rotation, he had shooting pains down his right arm. The patient received;Prolotherapy;at his first visit to his entire neck and right scapular region. He was taken off Norco and Daypro and given Ultram for pain and Ambien to help him sleep.
What Complications Are Associated With Sciatica
Most people recover fully from sciatica. However, chronic pain can be a complication of sciatica. If the pinched nerve is seriously injured, chronic muscle weakness, such as a drop foot, might occur, when numbness in the foot makes normal walking impossible. Sciatica can potentially cause permanent nerve damage, resulting in a loss of feeling in the affected legs. Call your provider right away if you lose feeling in your legs or feet, or have any concerns during your recovery time.
Diagnoses And Conventional Treatments
If you suspect the cause of your symptoms is a problem affecting the SI joint, visit your doctor for a physical examination. After ruling out red flag symptoms that suggest another type of disease could be to blame for your pain , youll likely receive a physical exam to test your range of motion, strength, flexibility, posture and symptoms when standing or sitting in different positions.
Because SI dysfunction can be hard to distinguish from other problems, your doctor might also choose to inject the SI joint with an anesthetic blocking drug in order to test your response and symptom improvements.
NSAID pain relievers, and sometimes anesthetic injections or corticosteroids, remain the first-line treatment for most forms of spinal problems and disc diseases. NSAIDs help control inflammation and dull throbbing, but they usually dont address the root cause of the problem and can cause side effects when used long term. For patients with severe pain, NSAIDs might need to be taken for long durations of time, or else symptoms will return. Problems associated with long-term NSAID use can include digestive discomfort, such as acid reflux, stomach ulcers, blood pressure changes, kidney problems and fluid retention.
To recap, heres the most common steps in conventional treatment of sacroiliitis:
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Treatment Plan For A Pinched Nerve
Radicular pain and radiculopathy caused by a pinched nerve can typically be relieved by nonsurgical treatments. Some initial treatments may include:
- Short period of rest or modified activities to avoid irritating the nerve and causing a flare-up of symptoms
- Nonsteroidal anti-inflammatory drugs , such as aspirin, ibuprofen, or naproxen
- Heat or ice applications for 15 or 20 minutes at a time, with a 2-hour break between applications to protect skin
- Physical therapy to improve the neck or backs strength, flexibility, and posture, which may relieve nerve inflammation
- Epidural steroid injections to bathe inflamed nerve in anti-inflammatory medication
- Chiropractic care including cervical traction to help alleviate cervical radiculopathy
In rare cases when symptoms have not responded to 6 or 12 weeks of nonsurgical treatment, or you have severe weakness or intractable pain, surgery may be considered.
Visit a doctor if you have symptoms of pain, tingling, numbness, or weakness that radiate into the arm or leg. The sooner you seek medical attention, the sooner you can receive an accurate diagnosis and start an effective treatment plan.
Anatomy Of A Pinched Nerve
There are several different types of disorders affecting root nerves, which are commonly grouped together under the umbrella term pinched nerve:
- Lumbar radiculopathy: The type of pinched nerve located in the;lower region of the spine. Lumbar refers to the five large, flexible vertebrae toward the bottom of the spine. This is the most common place for a pinched nerve to develop since the lower back bears a lot of weight and stress, especially during movement or lifting.
- Cervical radiculopathy: The type of pinched nerve located near the neck, which causes nerve pain and numbness to travel outward down the arms, upper back, chest or shoulders. Cervical refers to the seven vertebrae at the top of the backbone. Cervical radiculopathy is linked to conditions including herniated disc, a bulging disc, degenerative disc disease, osteoarthritis and stenosis.
- Thoracic radiculopathy: This is the least common type of pinched nerve, which affects the root nerves of the middle section of the spine . Due to the middle backs;lack of flexibility and mobility , the thoracic vertebrae are usually far less stressed than the other spinal regions.
- Sciatica: Sciatic nerve pain radiates downward from the lower back through one or;both thighs and legs.
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Sacroiliac Joint Pain Statistics
- Low back pain is an extremely common problem among adults, affecting somewhere between 15 percent to 45 percent of all people over 40 .
- Low back pain is considered the No. 1;type of disability that people are most likely to live with for years, especially during the end of their lifetimes.
- SI joint pain accounts for up to 30 percent of all radiating low back pain cases.
- Women are more likely than men to have SI joint pain. The age group most affected by SI dysfunction is those 3060 years old.
- Some surveys found that around 20 percent of college-age adults with back pain have SI joint dysfunction.
- Between 8 percent and 16 percent of people with sacroiliac dysfunction or abnormalities dont experience any symptoms.
SI Joint Pain vs. Other Spinal Disk or Joint Diseases
What makes sacroiliac pain different from other common causes of back pain, like arthritis or sciatica, for example?
Common Symptoms Of A Pinched Nerve
A pinched nerve in your neck occurs when soft tissues in the body apply too much pressure to a nerve and restrict its ability to function properly. Bones, muscles, tendons, ligaments and cartilage can all press against a nerve, causing irritation, inflammation and pain. The most common places for a pinched nerve to develop are in your low back and neck, where nerve roots travel out of the spinal canal and send sensations to other areas of your body.
What causes a pinched nerve in the neck or back? A bulging or herniated disc, inflammation and degenerative changes from arthritis, bone spurs, a back injury, chronic stress from repetitive movements or obesity can all cause soft tissues to compress a nerve or the spinal cord. Aging, being overweight, playing high-impact sports or having a job that requires physically demanding, repetitive work can all increase your risk of developing a pinched nerve.;
If youre experiencing unexplained back or neck pain, keep reading to learn 5 symptoms that may indicate you have a pinched nerve.;;;
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Neck Pain And Sciatica
Neck pain and sciatica seem like unrelated symptomatic expressions, since they are so far removed from one another anatomically. In some cases, there may be no relationship at all between these 2 coincidental expressions of suffering. However, in other instances, the 2 symptom sets may be sourced from the exact same causative process.
This article will explore the often mysterious relationship between 2 of the most prevalent of all dorsalgia concerns; sciatica and neck pain. We will look at how these 2 pain syndromes might coexist without a common link, as well as why the expressions may also be tied to a single causative mechanism in the cervical spine.
Get Relief For Your Pain Whatever The Cause
At The Spine Institute of Southeast Texas, we provide custom care solutions tailored to the needs of the individual patient. If you’re experiencing pain or other uncomfortable or unusual symptoms, we can help you get the relief you need to feel better. The first step in relieving pain and other symptoms is to schedule an office visit so you can be evaluated. To schedule your evaluation,;book an appointment online today.
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Otc Treatments For Nerve Pain
Over-the-counter painkillers may be the first treatment your doctor recommends. These may include nonsteroidal anti-inflammatory drugs — such as ibuprofen — or other analgesics, such as acetaminophen or prescription medicines. Other options include painkilling creams, ointments, oils, gels, or sprays that are used on the skin.
Si Joint Pain Symptoms Causes And Risk Factors
Although some people experience pain in both legs or hips, most with SI dysfunction have symptoms in only one leg along with the low back.
The most common signs and symptoms of SI joint pain include:
- Low back pain
- Pain in the hips, butt or upper thighs sometimes pain radiates down the legs, especially when moving, but usually stays above the knees
- Throbbing when exercising, bending, squatting, standing up from a sitting position, running or walking
- Reduced range of motion and limited flexibility
- Discomfort when sleeping on the painful side/hip or;pain in certain lying positions
- Loss of balance/stability
- At times numbing, tingling or muscle weakness in the lower extremities
SI joint pain is primarily caused by:
What sort of medical conditions or lifestyle factors make you more susceptible to developing SI joint pain?
Risk factors for sacroiliac joint dysfunction include:
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Frequently Asked Questions About Sciatica
Even after knowing the reasons for sciatica and identifying the triggers, you may still have certain lower body pain that may or may not be related to the sciatic nerve. Understanding the difference between sciatic nerve pain and other types of body pain is essential. While what causes sciatic nerve pain in pregnancy is often an easy answer, causes for other nerve pain issues in the lower back, hips and legs may be more difficult to pinpoint.
Symptoms Of A Pinched Nerve
The pain, weakness and tingling associated with pinched nerves can come and go. The symptoms may also be worse while sleeping or right after waking up. Depending on the area supplied by the nerve that is being compressed, the symptoms may be felt in the immediate surrounding area. The most common symptoms associated with a pinched nerve include:
- Numbness in the affected area
- Sharp or burning pain
- Muscle weakness in the affected area
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Brain To The Spinal Cord And Beyond
Nerves extend from the brain into the arms and legs to send messages to the muscles or skin. A nerve that leaves the spine to go into the arms or legs is called a peripheral nerve. Peripheral nerves are bundles of millions of nerve fibers that leave the spinal cord and branch outward to other parts of the body such as muscles and skin. For example, these nerves make muscles move and enable skin sensation .
Minimally Invasive Procedure For Cervical Radiculopathy
A September 2017 study also discusses the short-term/long-term problem with determining the success of a minimally invasive procedure for cervical radiculopathy.
German doctors writing in the medical journal Orthopedics and traumatology examined surgical techniques designed to relieve foraminal root impingement due to lateral soft disc fragments, bony spurs, or other rarer causes. Lateral soft disc fragments or pressing of the disc material on the nerve accounts for possibly 7 12 % of disc herniations.
The doctors report success and less than successful outcomes:
- Minimally invasive posterior cervical foraminotomy was used to treat 103 patients for unilateral cervical radiculopathy.
- After follow up to 32 months average Despite 1 cerebrospinal fluid leak, 1 wound hematoma, and 1 radiculitis during the early postoperative period, no patients required revision surgery. Not revision surgery but other surgeries were required, see below
- Pain scores for neck/shoulder and arm improved significantly in the early postoperative period and were maintained with time.
- Neck Disability Index improved significantly postoperatively but worsened slightly during follow-up.
- Anterior decompression and fusion was required at the index level by 3 patients on average 55 months laterand at the adjacent level by 4 patients .
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How We Treat Peripheral Neuropathy
Again, most people have been to their medical doctor already, and sometimes to a neurologist.
Depending on your care, you may be uncertain at this point whether you have sciatica or peripheral neuropathy or another condition.
Some patients have been given an EMG or a nerve test. Some have been told nothing can be done. Many have tried various medications with varying degrees of success, but all have unwanted side effects.
Peripheral neuropathy patients come to us for an alternative to strong drugs with side effects. They are looking to get to the cause of the problem and not cover it up with meds.
To do that we may use one or more of the following:
- Super pulsed laser This type of laser produces nitric oxide, which boosts circulation.
- Seated vibration Patients sit with their feet on a vibrating platform. The vibration increases blood flow to the feet and toes.
- Standing vibration This treatment improves circulation and balance.
- Rebuilder therapy Patients wear a conductive garment that looks like a sock. The garment conducts specialized electrical signals over the feet and toe, helping heal damaged nerve endings.
- Massage Massage increases circulation and blood flow to the feet and toes.
- Custom-made orthotics Orthotics help if foot bio-mechanics cause pain and also improve balance.
- Diet and nutrition Eating better decreases inflammation, controls blood sugar, increases circulation, and also heals nerve tissue.
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Can Anyone Suffer From Radiculopathy
One of the common questions we get among patients seeking a chiropractic atlas adjustment is: can anyone develop a pinched nerve? Many believe that spinal nerve compression only affects older adults, especially those with pre-existing health problems like herniated discs. However, recent studies explain that even younger folks can struggle with radiculopathy, especially the cervical type.;
This happens because apart from degenerative diseases, injuries or physical trauma can also cause cervical radiculopathy. Other studies note that radiculopathy can also occur due to other conditions like spinal tumors, spinal infections, and Sarcoidosis.
Radiculopathy may also develop and cause you excruciating pain if you have the following risk factors:;
- Often carry heavy items
- Drive equipment with strong vibrations
- Smoke cigarettes
- Previously suffered from radiculopathy
Minimally Invasive Spine Surgery For A Pinched Nerve
If you have tried conservative treatment but continue with symptoms, you may benefit from visiting with a NJ neurosurgeon who can assess your need for spine surgery to definitively treat your pain.
There are many approaches to spine surgery for a pinched nerve. Some surgeons use a standard open approach. This involves a large incision and dissection of your back muscles so your surgeon can visualize your spinal structures and decompress your spinal nerve.
A few specially trained neurosurgeons use an innovative technique called minimally invasive spine surgery. During this procedure, your neurosurgeon makes a small incision in your lower back. Small portals are made in your back muscles, sparing them from complete dissection. Specialized instruments are then used to visualize your spine and cut away any disc material that is pinching your nerve.
The benefits of minimally invasive spine surgery for a pinched nerve include:
- Rapid recovery time
- Less pain
When dealing with pinched nerve symptoms, finding a neurosurgeon who performs minimally invasive spine surgery can maximize your chance of a rapid recovery with minimal pain.
If you have limited mobility and function due to pinched nerve symptoms, you may benefit from different treatments to help you regain your normal mobility. Sometimes, surgery may be necessary to fully treat your problem, and minimally invasive spine surgery may be a good option to consider.
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Ask A Spine Surgeon: Why Does My Back And Neck Pain Come And Go
Have you ever woken up in the morning with increased back or neck pain, only for it to resolve later in the afternoon and return again later that evening? Its not uncommon to hear patients mention differences in the location and intensity of their back pain depending on the level of activity, weather, or even time of day. Why does this happen? Many would think if a spinal structure is damaged it should ache all the time..right? You arent necessarily wrong in this respect, but the specific type of pain experienced largely depends on three main factors: 1.) what is injured, 2.) medications used, and 3.) whether inflammation occurs.