Category Archives: Orthopedics/Bones

Straight, No Chaser: Prevention and Treatment of Carpal Tunnel Syndrome

carpel-tunnel-relief-

If you have carpel tunnel syndrome (CTS) or are at significant risk for developing it, you really should learn strategies to either prevent, limit progression or treat the condition. Of course, once you develop it, you’ll be more focused on treatment. Fortunately, very good options exist for all of these, and that’s what we’ll be reviewing in today’s Straight, No Chaser. Feel free to review this previous post on carpal tunnel syndrome, discussing its causes and risk factors.

carpal-tunnel-at-work prevention

How can carpal tunnel syndrome be prevented in the workplace?

Here are activities you should employ if you’re at risk for CTS. Your employer (through employee health services or even without such an entity) can develop an ergonomics program. This involves adapting the workplace (e.g. conditions and job demands) to the capability and needs of workers to complete assigned tasks. Components of ergonomics may include the following.

  • Redesign of workstations, tools and tool handles, and tasks to enable the wrist to maintain a natural position during work
  • Frequent rest breaks
  • Job rotation among workers
  • On-the-job conditioning
  • Stretching exercises
  • Use of splints to keep your wrists straight
  • Use of correct posture and wrist position
  • Wearing fingerless gloves to keep your hands warm and flexible

carpal tunnel syndrome keyboard

Of course if you have high-risk conditions such as obesity, arthritis or diabetes, you will do well to manage these conditions. Doing so will lessen the risk of subsequent development or worsening of CTS.

How is carpal tunnel syndrome treated?

In this post, we will address general, drug and surgical treatments. More detailed treatment considerations are covered at www.sterlingmedicaladvice.com.

Carpal-Tunnel-Syndrome-ice

General

  • Treatments for CTS should begin as early as possible and under a doctor’s direction.
  • Underlying causes such as diabetes or arthritis should be treated first.
  • Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending.
  • If there is inflammation, applying cool packs can help reduce swelling.

Carpal-tunnel-wrist-bracing

Drugs

  • In special circumstances, various drugs can ease the pain and swelling associated with CTS. Nonsteroidal anti-inflammatory drugs (e.g. aspirin, ibuprofen, and other nonprescription pain relievers) may ease symptoms that have been present for a short time or have been caused by strenuous activity.
  • Other drugs occasionally used include diuretics (“water pills”), meant to decrease swelling. Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. (Caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels. Additionally, some studies show that vitamin B6 (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome.

carpel-tunnel-syndrome-eagle-arms-cow-face-arms-open-the-shoulder-stretch-your-hands-the-idea-girl-says-youtube

Exercise and Alternative Therapies

  • Stretching and strengthening exercises can be helpful in people whose symptoms have abated. These exercises may be supervised by a physical therapist trained to use exercises to treat physical impairments, or an occupational therapist, who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being.
  • Acupuncture and chiropractic care have benefited some patients but their effectiveness remains unproven. An exception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome.

carpal-tunnel-surgery

Surgery

  • Carpal tunnel release is one of the most common surgical procedures in the United States. Generally recommended if symptoms last for 6 months, surgery involves cutting the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay.
  • Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Complications may include infection, nerve damage, stiffness, and pain at the scar. Occasionally the wrist loses strength because the carpal ligament is cut. Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties or even change jobs after recovery from surgery.
  • Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely.

If you focus on the prevention strategies, the need for surgery will be lessened, and treatments will be guided by your physician. Your first job should be to discuss the safety of your work environment and ensure you’re doing what’s needed to minimize your risk.

 

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Filed under Neurology, Occupational Health, Orthopedics/Bones

Straight, No Chaser: Carpal Tunnel Syndrome

carpal tunnel

Do you spend much time typing at work? Are you a construction worker who operates a jack hammer? Do you have arthritis that affects your wrist? Do you have occasional or constant numbness or tingling in your hand or wrist or pain that shoots up your wrist into your arm? If so I’d hope that you’ve had at least a passing conversation about carpal tunnel syndrome (CTS), a fairly common condition associated with work activities. CTS is part of a class of disorders called entrapment neuropathies.

Let’s review CTS by addressing common questions about the syndrome.

Carpal-tunnel-syndrome-picture

What is carpal tunnel syndrome?

CTS is basically a squeezing of the nerve (median nerve) that extends from the forearm to the palm; the pressure on the nerve occurs at the level of the wrist. The carpal tunnel is an area at the base of the hand (on the side of the thumb) that houses tendons and the median nerve. Because it is such a small space, irritation such as that which occurs from inflammation or injury can compress and/or pinch the median nerve.

carpel-tunnel-relief-

What are the causes of CTS?

Your anatomy sets the table for CTS in some cases. Some individuals simply are predisposed to CTS because of a smaller carpel tunnel. Beyond this, conditions that cause injury to the wrist and result in swelling are likely culprits; that said, in some cases no cause is identified. Known causes and/or contributors include the following.

  • Development of a cyst or tumor in the canal
  • Fluid retention during pregnancy or menopause
  • Fracture or sprain
  • Hypothyroidism
  • Overactivity of the pituitary gland
  • Repeated use of vibrating hand tools
  • Rheumatoid arthritis
  • Work stress

Interestingly and contrary to the popular narrative, there is little clinical data to prove that repetitive and forceful movements of the hand and wrist during work or leisure activities can cause CTS. However, it does stand to reason that if you have CTS, these activities can exacerbate the situation.

carpal tunnel syndrome sx

What are the symptoms of carpal tunnel syndrome?

Symptoms are easy to figure out if you view your nerve as electrical conductors of various signals caused by stimulation. Frequent burning, tingling, or itching starts gradually, as does numbness in the palm of the hand and the fingers, especially the thumb, index and middle fingers. Symptoms may begin at work or during the night (if you sleep with your wrists cupped). Other symptoms may include a sensation of hand swelling without visual evidence, hand tingling that progressively worsens throughout the day and decreased grip strength. Over time, some untreated patients may lose the ability to distinguish between hot and cold sensations by touch. Symptoms are usually first seen in the dominant hand.

Who is at risk of developing carpal tunnel syndrome?

  • Women are three times more likely than men to develop CTS.
  • Diabetics or those with other disorders directly affect the body’s nerves are more susceptible to nerve compression.
  • CTS usually occurs only in adults.
  • CTS is especially common in those performing assembly line work , such as manufacturing, sewing, finishing, cleaning and packing (e.g. meat, poultry, or fish). In fact, CTS is three times more common among assemblers than among data-entry personnel.

The next Straight, No Chaser will address prevention and treatment of carpal tunnel syndrome.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Straight, No Chaser: A Foot Glossary and Introduction to Conditions Affecting Your Feet

 

footproblems

We talk a lot about health in Straight, No Chaser. We also try to help you recognize potentially troubling signs and symptoms. It’s appropriate to do so from the bottom up because so much weight is placed on your feet (no pun intended). Also, many people take their feet for granted and allow different types of conditions to progress before doing anything about them.

Today’s blog, done in conjunction with the American Podiatric Medical Association, aims to give you a working knowledge of conditions that affect your feet. Over the next few weeks, please use the posts on some of the individual topics mentioned below as a starting point for understanding various entities, conditions and diseases that relate to your feet.

Arthritis

rheumatoid-arthritisfeet

Arthritis is inflammation of your joints, which are the spaces where various bones meet. The inflammation typically leads to pain, swelling, warmth and redness. As we age or as disease strikes, we are even more subject to arthritis in our feet, in the same way other joints are affected, because each foot has nearly three-dozen joints (33 to be exact). Straight, No Chaser has previously addressed the treatment of arthritis here.

Bone Spurs

 heel-bone-spur

Osteophytes (aka bone spurs) are bony projections that extend along the edges of bones. The main cause of bone spurs is the wear-and-tear damage associated with osteoarthritis (degenerative joint disease).

Cardiovascular Disease

Pvdfeet

High Blood Pressure Your feet are especially susceptible to the effects of hypertension (aka high blood pressure), because they represent the most distant point from your heart. As your heart’s function worsens–a manifestation of hypertension–your feet suffer from the effects of poor circulation (e.g., receiving suboptimal amounts of the oxygen and nutrients supplied by healthy blood). Check here for the Straight, No Chaser review of high blood pressure.

Peripheral Arterial Disease When fatty deposits (i.e., plaques) partially or completely block our arteries, the blood supply to various organs is compromised. This becomes even worse as the arteries become hardened with prolonged exposure. With the feet’s location being as far from the heart as it is, they are at higher risk.

Diabetes

Diabetic Wound Care

DM foot ulcer

We have described diabetic foot ulcers here in Straight, No Chaser. You must be aware of the risks of losing limbs if you’re diabetic, as this occurs in approximately 15% of diabetics.

Diabetic (Peripheral) Neuropathy 
The effects of high blood glucose (sugar) levels include damage of our peripheral nerves, called peripheral neuropathy. This phenomenon is most prevalent in the fingers and toes.

Foot & Ankle Injuries

Sprains, Strains & Fractures
 These injuries compromise the ability of the feet to support and move the body.

calcaneal fracture

  • A sprain is an injury to the soft tissue of a structure such as the foot.
  • A strain (aka a pulled muscle) is an injury that results from excessive stretching and/or tearing of a structure’s supportive muscles.
  • A fracture is a disruption (e.g., break) in a bone.

Muscle & Tendon Problems

Haglund’s Deformity 

HaglundsDeformity


If you’ve ever heard the term “pump bump,” you know what Haglund’s Deformity is. This bony enlargement on the back of the heel often occurs in women who wear pumps. 

Heel Pain 
The heel bone (the calcaneus) is the largest of the 26 bones in the human foot. Due to size and stress, it is especially susceptible to injury.

Tendinitis 
Tendinitis is the inflammation of a tendon prior to its disruption and represents one of the most common causes of foot or ankle pain.

Plantar fasciitis

Plantar_Fasciitis1

Plantar fasciitis is inflammation of the tissue that connects the heel bone to the toes and creates the arch of the foot. This occurs when the thick band of tissue on the bottom of the foot is overstretched or overused. Plantar fasciitis is usually quite painful, and that pain makes walking difficult.

Skin Disorders

Athlete’s Foot 

toes+athletes+foot


This fungal infection is the result of conditions favorable to fungal growth: dark, warm and humid conditions. It itches and hurts, but treatment is readily available when preventative measures don’t control it.

Corns and Calluses

cornscalluses

Irritation to a part of the foot will prompt the body to form thicker skin to prevent irritation and injury. These present as corns and calluses.

Psoriasis 

psoriasis

We have discussed 
psoriasis here in Straight, No Chaser. It represents abnormally rapid production and replacement of skin cells. This causes a build up of dead cells on the surface that is recognized as scaly, dry and silver patches.

Skin Cancers of the Feet
 Although more common on exposed areas of the body, skin cancer can develop anywhere, including on the feet. Skin cancers of the feet tend to present as recurrent cracking, bleeding or ulceration more so than with pain.

Sweaty Feet 
Hyperhidrosis is the medical term for excessive sweating. This often presents on the palms of the hands and the soles of the feet.

Warts 

Planters Warts

When warts present on the feet, they tend to be painful. These are fleshy manifestations of a virus infection.

Toe Joint & Nerve Disorders

bunion

Bunions
 Bunions occur at the base of the great toe and is an enlargement of the joint that forms when the bone or tissue actually moves out of place.

Hammer-Toe-3

Hammer Toes
 A hammer toe is a bending (contracture) of the toe at its first joint, (i.e., the proximal interphalangeal joint). This produces an appearance of an upside-down V.

Neuroma

Neuromas
 A neuroma (aka “pinched nerve”) is a non-cancerous growth of nerve tissue, most commonly located between the 3rd and 4th toes (the two next to your pinkie toes). Given that this involves growth of nerve tissue, it shouldn’t surprise you that neuromas are painful.

Toenail Problems

ingrown_toenail

Ingrown Toenails   Ingrown toenails represent the most common nail impairment and involve a condition when the corners of the nail dig painfully into your soft tissue, producing signs of infection and inflammation.

toenail-fungus

Toenail Fungus
 When you notice an ongoing change in the color and quality of your toenails, you should suspect toenail fungus. These infections occur under the nail’s surface and require antifungal medications.

Treatment Terms

orthotics

Shoe Inserts Inserts are simply foot supports that are placed inside your shoes. Shoe inserts don’t require a prescription.

Orthotics
 Orthotics are typically custom-designed and prescribed devices designed to support and comfort your feet.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Straight, No Chaser: When Back Pain Could Be Life Threatening

Emergency

Back pain hurts, but there are various causes of that pain that will kill or cripple you.  Here’s some information on some diseases that present with back pain representing life-threats.  Be advised that as an Emergency Physician, my initial orientation is more toward ruling out the life-threatening consideration than making a definitive diagnosis, which comes afterwards.  Forewarned is forearmed.

Let’s start where we left off on post discussion general low back pain and identify what I was talking about….

Here are a few clues to help you hone in on whether your back pain requires emergency attention.  Remember pain and pathology (serious disease) are two different considerations.  I’m describing medical emergencies here and admittedly being overly simplistic.

  • Direct blow to your back:  Think Fracture
    • The trauma literature suggests that most motor vehicle collisions don’t have enough direct force to break your back.  It’s suggested that the force of a baseball bat is needed to break something in your back if you were previously healthy.  That said, the consequences of fracture are such that direct back trauma from a fall or other direct blow are such that you should at least be evaluated.
  • Fever and new onset back pain: Think Spinal Epidural Abscess
    • A spinal epidural abscess is a ‘pus pocket’ (i.e. infection) that collects between the spinal cord’s outer covering and the bones.  It can result from a recent back surgery, a back boil, a bony spinal infection (vertebral osteomyelitis), from IV drug abuse, or as part of an infection otherwise delivered from the blood.  Antibiotics for about a month and/or surgery may be required.
  • Loss of control of your bowel movements or bladder: Think Cauda Equina Syndrome (CES)
    • There are many neurologic causes of low back pain, but the ones associated with ‘hard’ neurologic findings represent true medical emergencies.  CES is caused by something compressing on the spinal nerve roots, like a ruptured lumbar disk, a tumor, infection, bleeding or fracture or various birth defects.  This could lead to loss of bowel and bladder control and possibly permanent paralysis of your legs.  Again, there are several other causes of these symptoms, but for the purposes of this blog, get evaluated quickly, and let us figure out whether this or something else is going on.
  • New onset back pain after age 65: Think Cancer
    • There are several considerations in play when it comes to back pain in the elderly, including fractures and arthritis, but the life-threatening consideration I’m focusing on is cancer.  The spine is a common place for cancer cells to metastasize; in fact approximately 70% of patients with metastatic cancer will have spinal involvement.  Given that only about 10% of these patients tend to be initially symptomatic, it’s imperative that you get evaluated if symptoms present.  It could represent a significant advancement of disease.
  • Numbness and tingling in both of your legs: see Cauda Equina Syndrome above
  • Night-time back pain: Think Metastatic Cancer.
    • Bone pain at night in a patient previously diagnosed with cancer is the most ominous symptom in patient with metastatic cancer, that which spreads throughout the body.
  • Sudden sexual dysfunction: See Cauda Equina Syndrome above
  • Weakness and/or loss of motion or sensation in your legs: See Cauda Equina Syndrome above
  • Unexplained new weight loss and new onset back pain: Think Cancer
    • There are a few considerations here, but I’m focusing on the life threatening consideration and working backwards from there.
  • Work-related back injuries
    • This isn’t as much a life-threatening consideration as it is a limb and career-threatening one.  Given the degree of disability that is work-related and the need to continue working at the same level of productivity required to keep your job, it’s a pretty good idea to have incremental changes in symptoms and function assessed.  Ignoring symptoms when they occur can lead to failure to qualify for worker’s compensation, not to mention it places you at risk for worsening injuries and ongoing disability.

Other diseases present with back pain, including kidney stones and infection, pancreatitis and certain ruptured abdominal organs.  I’d like to make special mention of the latter, which may include abdominal aortic aneurysms and ectopic pregnancies, both of which I’ll address in the future.  The take home consideration here is to use these cues to know when to get rapidly evaluated.  Even though people use the Emergency Room for seemingly everything these days, knowing when time is of the essence for true emergencies is a life-saver.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Filed under Neurology, Orthopedics/Bones

Straight, No Chaser: Management of Herniated Disks

discrx1

Approximately 40 million Americans have low back pain. Odds are the presence of low back pain is not associated with a herniated disk. Truthfully, herniated disks are more commonly the result of degenerative changes in your spine due to aging and the wear and tear associated with how we live. So, if you really want to decrease your risks, adjust your lifestyle. However, it is important that you appreciate the circumstances under which medical attention is indicated and may make a difference to you.

Today’s post is not a prompt for you to ask your family physician, emergency department or orthopedist for surgery. In fact, the overwhelming majority (approximately nine of 10 patients) of patients who actually have herniated disks are treated conservatively, meaning without surgery. This post is meant to empower you with information about prevention and treatment as well as an overview of medical management principles.

The best approaches to limiting pain associated with herniated disks (or any low back pain for that matter) are prevention in the first place, then prevention of worsening of the situation.

lower-back-exercise

  • Posture. Posture is important because normal alignment of the spine and back keeps everything working as designed. Good posture limits pressure and reduces the occurrence of injuries. Focus on keeping your back straight. This is so important. Do this when sitting, standing and lifting. Use your legs when lifting and not your back. Find something on which to prop one of your legs when standing.
  • Exercise. Exercise is all about strengthening your core. You don’t want extra belly girth pulling against your spine. Furthermore, strengthening the abdominal/trunk muscles stabilizes and supports the spine. All those times you slip and don’t injure your back are largely due to this stability.
  • Weight. Being overweight places excess pressure on the spine and disks and predisposes you to misalignment of your spine. This places you more at risk for herniation.

herniated_disc2

I’d imagine that most of you with low back pain have sought medical attention at some point. However, there are basic considerations that you can address prior to seeking medical attention. If you haven’t, it’s likely that your first doctor interaction on the subject will simply consist of instructions to perform some of the following steps:

  • Identify and reduce causes. If you have knowledge of what causes your pain, often the first course of action is to reduce or avoid those triggers. Of course this isn’t always easy when the discomfort is caused by work-related activities.
  • Reduce your stress. It’s true. Stress does intensify pain. Practice relaxation techniques such as deep breathing, mediation, massage, etc. when your stress level rises.
  • Consider professional help. The idea here is to change the way you feel about your pain even if you can’t eliminate it or while you’re taking steps to eliminate it. As mentioned, stress increases physical pain. Mental health professionals do wonderful work in this regard and can help you set realistic expectations.
  • Heat or ice.
  • Try over-the-counter pain medicines. Acetaminophen, aspirin and anti-inflammatory medicines such as ibuprofen and naproxen have worked for millions. This is an appropriate first step.

There’s a difference between when your pain requires medical attention and when it requires emergency medical attention. Your desire for an explanation, worsening of pain, radiation of your pain from your neck or back to your arm or leg, or the development of weakness, numbness and tingling are generally accepted prompts to seek an evaluation for your pain.

There are also prompts for you to get immediately evaluated because your pain could be life threatening. Such prompts include these symptoms.

  • Worsening symptoms. “Worsening pain” refers to that pain this renders you unable to work or perform your regular daily activities.
  • Bladder or bowel dysfunction. If you become unable to control your bladder (either holding your urine or being able to urinate), this needs to be immediately evaluated.
  • Loss of sensation in certain areas. Loss of sensation in the areas that would touch a saddle (i.e., the back of your legs, your inner thighs, and the areas surrounding your rectum) indicates the possible presence of a specific type of emergency that requires immediate evaluation.

Feel free to ask your SMA expert consultant any questions you may have on this topic.Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Filed under General Health and Wellness, Orthopedics/Bones

Straight, No Chaser: My Back and Neck Pain Has a Name – Herniated Disks

 herniation_2

It’s quite common for someone to come to me and say, “I have a herniated disk.” I used to ask how they knew, but I came to realize the answer to be unimportant. The pain and relative disability of those suffering from low back pain can be dramatic, both physically and emotionally. Being able to place a name of what’s causing that discomfort is meaningful in and of itself.

Herniated-disc2-resized-600.jpg

We’ve discussed low back pain (LBP) before on Straight, No Chaser, but herniated disks are special considerations among its causes. A herniated (aka ruptured or slipped) disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine. A common and effective way to understand a spinal disk is to picture a jelly donut, with a softer center captured inside of a tougher exterior. A herniated disk occurs when some of the softer portion protrudes through the exterior. Keep in mind that your spinal column runs from your neck down your lower back, so herniation may occur anywhere along the spine, although the low back is the most common site.Herniated-Disc

Herniated disks may or may not produce symptoms, and you may not even know you have one. Of course, some herniated disks are extremely painful and incapacitating. The problems with herniated disks aren’t just related to the manual eruption of the disk’s contents. You can experience irritation of surrounding nerves, which can produce pain, numbness or weakness in an arm or leg.

The most common signs and symptoms of a herniated disk are relative to the nerves affected by the herniation. Nerves have a distribution (i.e., affected areas of the body) associated with them. The following symptoms can be produced by a herniated disk and will be seen along that distribution.

  • Arm or leg pain Arm and shoulder pain may result from herniated disks in your neck, including pain that radiates down the arm. Certain motions and actions (e.g., coughing, sneezing and neck rotation) may exacerbate your symptoms. If your herniated disk is in your lower back, intense pain may be present in your buttocks, thigh, calf and part of the foot.
  • Numbness or tingling
  • Weakness Similarly, muscles that are served by nerves affected by a herniated disk tend to weaken, and this may cause stumbling and other signs of lessened strength (e.g., decreased ability to lift or hold).

Factors that increase your risk of a herniated disk may include a genetic predisposition, excess weight producing ongoing stress on the apparatus of the back,and various jobs (including those involving heavy or repetitive lifting, bending, twisting, pushing or pulling).

The next post will address treatment options and self-help considerations for herniated disks.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

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Comments Off on Straight, No Chaser: My Back and Neck Pain Has a Name – Herniated Disks

Filed under Musculoskeletal System, Orthopedics/Bones

Straight, No Chaser: Sciatica

Sciatica

My pain has a name, and it’s sciatica. There’s always a sense of relief in patients when a name is given to a medical sign or symptom. This Straight, No Chaser places sciatica in context among various problems of the low back and gives you basic information for you to use in seeking solutions.

What is sciatica?

sciatica nerve

This is important for you to understand. Sciatica is a symptom, not a diagnosis. Sciatica is any of various clinical presentations that result from any injury to or inflammation of the sciatic nerve. The sciatic nerve is a large nerve that extends from the lower back and travels down the back of each of your legs. This nerve provides muscle control and sensation to various parts of your thighs, legs and soles of your feet.

What are the symptoms of sciatica?

sciatica screams

Once you know the distribution of the sciatic nerve, the symptoms are pretty self-evident. Simplistically, a nerve is just an electrical conductor sending signals down its distribution. The typical symptoms of sciatica include the following:

  • Pain (e.g. pins and needles, burning or aching)
  • Weakness (can progress to an outright inability to move)
  • Numbness
  • Tingling

The discomfort usually occurs on one side and worsens under certain conditions, such as the following:

  • After sneezing, coughing or laughing
  • After walking or bending backwards
  • At night
  • When standing or sitting

What causes sciatica?

sciatica spinal stenosis

If you ever get diagnosed with sciatica, your immediate next question should be “What’s next?” Be reminded, sciatica is caused by something causing irritation, inflammation or injury to the sciatic nerves. Here are some common and/or important causes of sciatica; feel free to ask your physician if these actual diagnoses are being considered if you’re told you have sciatica.

  • Bruise or fracture to one of your pelvic bones
  • Degenerative disc disease (erosion of the cushions between your vertebrae/spine; this naturally occurs with aging)
  • Infection (a rare but important cause in those with new fever and back pain)
  • Piriformis syndrome (this buttock muscle can irritate or pinch a nerve root than leads to the sciatic nerve)
  • Pregnancy
  • Slipped/herniated disk (aka pinched nerve; sciatica is the most common symptom of this condition)
  • Spinal stenosis (narrowing of the spinal canal in the lower back; it’s relatively common over age 60)
  • Spondylolisthesis (the slipping of one vertebrae/spinal bone forward over another one; it’s usually associated with a small stress fracture)
  • Tumors (this is rare; please don’t assume you have cancer if you have back pain, but do ask if your doctor has considered it if you develop new back pain after age 50. Accept “you don’t have it” as good news). 

How is sciatica treated?

If you actually have sciatica, treatment begins with identifying the underlying cause. Here are some general principles of treatment.

SCIATICA PAIN RELIEF

  • In some cases, no treatment is required and recovery occurs on its own.
  • Non-surgical treatment is best in many cases. You likely will be told to apply ice for the first 48-72 hours then use heat to reduce inflammation.
  • Over-the-counter pain medicines such as ibuprofen (aka Advil, Motrin) or acetaminophen (aka Tylenol) are the medicines you should be using. Narcotics too often are a slippery slope that are unnecessary and don’t actually address inflammation when it is a causal factor.
  • Reduced and limited activity is best for the first few days. Bed rest is not recommended.

Sciatica treatment

  • For the first 6 weeks of symptoms, you should not engage in heavy lifting or twisting of your back.
  • Wait 2-3 weeks to restart exercising. Focus on exercises that strengthen your abdomen and improve flexibility of your spine. Exercises are best if part of physical therapy.
  • Many of you try to jump straight to such measures as injection of medicines, acupuncture, chiropractic manipulation or surgery. If these measures are needed, your physician will direct if and when they will be beneficial.
  • Similarly if you have ongoing problems, your physician may refer you to a neurologist or pain specialist.

Tomorrow’s Straight, No Chaser post will focus on life-threatening causes of sciatica and other back pain. There are specific symptoms that should prompt an immediate visit to your physician or emergency room. Be sure to check back, and be aware.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Copyright © 2018 · Sterling Initiatives, LLC · Powered by WordPress

1 Comment

Filed under Musculoskeletal System, Neurology