Epiduroscopy

An epiduroscopy, also called a spinal endoscopy, is used to diagnose and treat spinal nerve pain.

Epiduroscopy

What is Epiduroscopy?

An epiduroscopy, also called spinal endoscopy, is a procedure performed to treat spinal nerve pain such as sciatica and adhesions. In this procedure, a tiny fiber-optic camera is inserted into the epidural space through the sacral bone.

Who needs Epiduroscopy?

The procedure is utilized in relieving pain that arises due to adhesions that form following spinal surgery. It is also used in managing long standing sciatica. Epiduroscopy is also used for diagnostic purposes, as it can help your doctor determine the cause, location, and severity of scar tissue or adhesions.

What are the steps in Epiduroscopy?

Preparing for the Procedure

In order to perform the procedure, the patient is asked to lie on their stomach so that access can be obtained to the lower back. After cleaning the skin with antiseptic solution, a small amount of local anesthetic is injected into it to numb it.

Inserting the Needle

Under the guidance of x-rays, a needle is inserted into the sacral hiatus, which is a small opening in the bottom of the sacrum. The needle is passed all the way into the spine.

Inserting the Guide Wire

A small guide wire is then inserted through the needle, and the needle is pulled back out over the guide wire. A series of dilators are then passed over this guide wire in order to create a large enough opening to pass the epiduroscope through.

Inserting the Camera

A small catheter with a fiber-optic camera at the tip of it is passed through this opening into the epidural space. This helps visualize exactly where the catheter is being passed to. Sometimes additional imaging is also utilized to ensure the right location is reached with the catheter.

Administering the Injection

Once the catheter is in place, it is gently maneuvered to break down the adhesions. Then, an injection of local anesthetic and steroids is given. This can numb the nerves that are in this area and help reduce pain.

After Surgery

Following the procedure, the patient is observed for a short period of time and is discharged home after that. This procedure may effectively help reduce pain due to adhesions and sciatica. This is because the structures that are affected can be directly visualized, and treatment can be a lot more targeted.

Complications are fairly rare and can include mild bleeding at the site of the procedure. Patients may feel slightly uncomfortable and may experience mild pain following the procedure but this usually passes after a short period of time.

These injections can help relieve pain and confirm a diagnosis

Diagnostic Injections to Confirm Pain Location

What are Diagnostic Injections to Confirm Pain Location?

Pain is a common symptom of nerve irritation. In many cases, tests are required to confirm which nerve is causing the pain. In this article, we shall take a look at diagnostic injections as a tool used by your doctor for diagnosing and confirming the location of pain.

Diagnostic injections are injections that are utilized for making a diagnosis and sometimes even helping as a treatment. The fluid injected usually consists of a local anesthetic or a steroid injection that is used to aid in isolating the nerve that is causing the pain.

Who needs Diagnostic Injections to Confirm Pain Location?

Diagnostic injections to confirm the source of pain are usually performed when there is nerve involvement and pain due to a problem with the vertebral column. If you have osteoarthritis that is affecting the facet joints of the vertebra, your doctor may use this procedure.

What are the steps in Diagnostic Injections to Confirm Pain Location?

Locating the Affected Joint

The likely bone is identified through clinical examination and x-rays. The skin is cleaned with an antiseptic solution and the diagnostic injection is performed.

Numbing the Nerve

Once the likely facet joint is identified, a small amount of local anesthetic with or without the steroid is injected into the joint to numb the nerve. If blocking the nerve results in a reduction of pain, then the joint that is causing the pain can be isolated and treatment can be offered that is directed towards that joint.

After Surgery

The main advantages of diagnostic injections are that it helps identify which of the joints are affected and which nerves need to be treated. By itself, a diagnostic injection is a treatment method.

The risks are minimal and can include just mild pain and swelling in the site of injection. If the joint identified is the wrong one, further injections may be required to isolate the nerve.

Read this article to learn about a procedure used to treat neck pain

Cervical Facet Radiofrequency Denervation

Cervical Facet Radiofrequency Denervation

What is Cervical Facet Radiofrequency Denervation?

Cervical Facet Radiofrequency Denervation is a procedure used to treat neck pain. The cervical facet refers to a part of the vertebra in the neck through which nerve fibers arise from the spinal cord. Radiofrequency denervation is a procedure similar to a nerve block but that utilizes radiofrequency and offers a long term solution to pain.

Who needs Cervical Facet Radiofrequency Denervation?

Wear and tear of the cervical facets occurs with advancing age and constant movement of the neck, which can lead to pain during movement of the neck joints. While painkillers may help relieve the pain, in some cases the pain can persist despite maximal medical treatment. In such cases, nerve blocks can be performed that block the conduction of pain signals through the nerves around the facet joints.

The aim of radiofrequency denervation is to provide long-term pain relief. These effects can last for a few months up to a couple of years but sometimes the pain can return as the nerve fibers grow again. In such cases, a repeat procedure may need to be performed.

What are the steps in Cervical Facet Radiofrequency Denervation?

Preparing for the Procedure

This procedure may take up to half an hour to perform. You may be offered mild sedation during the procedure.

Numbing the Skin

After isolating the cervical facet joint that is causing the pain using an x-ray, the skin that covers the area is numbed with a local anesthetic.

Inserting the Needle

Using X-ray or fluoroscopic guidance, your surgeon will insert a tiny needle through the numbed skin, all the way to the cervical facet joint.

Administering Radiofrequency Waves

Radiofrequency waves, in the form of a tiny electric current passed through the needle, are then administered. These waves generate heat and destroy the nerve fibers that are causing the pain.

Reducing Inflammation

Once the nerve fibers have been destroyed, a small amount of steroids may be injected to help reduce any inflammation that may occur.

After Surgery

Following the procedure, the patients are observed and subsequently discharged home. Patients may feel mild tingling or numbness in the area where the procedure was performed. This is normal and passes after a short while. It is advised that a family member or friend take the patient home as the sedation takes time to wear off and driving is a risky.

Patients may experience mild amount of bleeding and bruising at the site of the procedure. Allergic reactions are rare and usually towards the medication used rather than the procedure itself. Radiofrequency denervation should be avoided if patients are suffering from an active infection or are on blood thinning medication.

It can take anywhere between a month to 6 weeks to recover fully following the procedure. Patients are recommended to rest for at least a couple of days before embarking on any sort of physical activity. When doing so, activities should be light and easy to perform for a few days before attempting anything strenuous.

Post-thoracotomy Pain is a type of pain felt after a procedure called a thoracotomy

Post-thoracotomy Pain

Post-thoracotomy Pain

What is Post-thoracotomy Pain?

Pain in any part of the body is always distressing and a nuisance. Post-thoracotomy pain refers to pain that occurs following a surgical procedure on the chest wall called a thoracotomy.

A thoracotomy is a surgical procedure that is carried out to deal with medical conditions that affect the chest, such as tumors or cancer. The procedure involves making a deep incision in the chest wall that penetrates the skin, muscles and ligaments along with the requirement of resecting the ribs. Access is thus obtained to the structures within the lung so that surgery can be carried out.

Post-thoracotomy pain is a severe form of pain that can cause tremendous amount of distress to patients following a thoracotomy. As a result, patients can have a number of problems, such as difficulty coughing out infected secretions, development of pneumonia, and a general difficulty in managing any form of activities because breathing is painful.

What causes Post-thoracotomy Pain?

There are two main types of post-thoracotomy pain: acute and chronic. Acute post-thoracotomy pain refers to pain that occurs immediately after surgery. It can cause difficulty in breathing and coughing. Chronic post-thoracotomy pain refers to persistent pain at the site of surgical incision that lasts at least two months following a thoracotomy procedure.

The most common reason why post-thoracotomy pain may occur is damage to the intercostal nerves. These are the nerves that run in between the ribs and supply the muscles, called intercostal muscles, that connect the ribs. While care is always taken to prevent any damage to the intercostal nerves, unfortunately it can still occur due to mechanical injury that can be precipitated by rib resection. Pain usually occurs at the site of skin incision and damage of the intercostal nerve.

As was previously mentioned, a thoracotomy may be conducted to remove a tumor within the lung. A recurrence of this tumor can result in pain. Finally, post-thoracotomy pain may occur due to damage that occurred inadvertently to surrounding muscles during the surgical procedure. While there are clearly a few causes of post-thoracotomy pain, there still remains debate as to what the exact cause for it is.

Symptoms and Diagnosis

The most common symptom of post-thoracotomy pain is pain at the site of surgery. Upon examination, the patient will complain of tenderness at the site of incision and occasionally may complain of altered sensation at the site.

How is Post-thoracotomy Pain treated?

The decision as to what treatment is best is decided by the doctor based on the patient's presentation and their response to symptomatic treatment.

  • Symptomatic treatment This refers to the application of hot or cold packs at the area of the incision to help relieve pain.
  • Painkillers This is probably the first-line of treatment that the doctor may recommend. Commonly used drugs include paracetamol and non-steroidal anti-inflammatory drugs. On occasion, stronger painkillers may be required and the doctor will decide this on a case-by-case basis.
  • Antidepressant medications such as tricyclic antidepressants are known to be extremely strong painkillers and may be offered to the patient.
  • Specialist treatments These include injecting the painful area with a combination of a local anesthetic along with a steroid compound. This numbs the area and reduces the inflammation.

This procedure is used to treat trigger points, or painful knots in the muscle. Learn more about Trigger Point Injections here:

Trigger Point Injection

Trigger Point Injection

What are Trigger Point Injection?

Trigger point injections are a common procedure performed in clinical practice. Here we discuss this procedure in a bit more detail. Muscle tightening, or knot formation, can occur due to constant stress. These knots, which are easily felt and painful when touched, are called trigger points.

A trigger point injection is a procedure that is performed to loosen these tightened muscles and to reduce pain. It usually involves injecting the site with a local anesthetic agent to help numb the pain. Sometimes, the local anesthetic agent may be injected along with a steroid injection to help reduce the inflammation. The entire procedure is completed within a few minutes.

Who needs Trigger Point Injection?

Sometimes, muscle tightening can occur due to excessive activity and stress. Certain conditions such as fibromyalgia and myofascial pain can also be treated using trigger point injections.

What are the steps in Trigger Point Injection?

Preparing for the Injection

Once the areas where the trigger point injections need to be administered have been identified, the skin of these areas is cleaned with an antiseptic solution.

Administering the Injection

The injection, containing either local anesthetic or a combination of a local anesthetic with a steroid, is then administered into the muscle.

After Surgery

The procedure is performed on an outpatient basis and does not require admission to a hospital. Following the completion of the procedure, the area of injection will be covered with a bandage, and the patient will be observed for a short period of time. If all is well, the patient is discharged home.

Since the procedure is fairly straightforward and simple, the risks and side effects are only very few and are rare. A mild amount of pain at the site of injection and occasional bruising may be seen. Patients who are injected with steroids may have altered blood sugar levels and changes in weight if they receive multiple injections throughout the year.

Trigger point injections do provide significant relief from pain due to muscle tightening. However, it must be kept in mind that while these injections reduce pain, they are not a cure. Once the procedure is complete and the patient is discharged home, they are often reviewed in clinic or in the outpatients department after 4 or more weeks.

Sacroiliac Joint Injections may help your lower back pain. Find out more about this nonsurgical procedure here:

Sacroiliac Joint Injections

What are Sacroiliac Joint Injections?

The sacroiliac joint can sometimes be the cause for lower back pain. In such cases, sacroiliac joint injections may be performed to relieve the pain.

Who needs Sacroiliac Joint Injections?

The sacroiliac joint is a faceted joint that connects the lower end of the spine, called the sacrum, to the hip bone. There are two sacroiliac joints, and they are under constant stress from movement of the hips. As a result, it is no surprise that they can be subject to injury or arthritis and can become quite painful. Those suffering sacroiliac joint pain may benefit from this procedure.

What are the steps in Sacroiliac Joint Injections?

Identifying the Injection Area

Is important to recognize that sacroiliac joint injections are performed primarily to reduce pain and improve movement of the hip and lower back. The procedure begins by identifying the area where the injection needs to be administered. This may be done by performing an x-ray or a special test called fluoroscopy.

Positioning the Patient

Consent for the procedure is obtained and the patient is placed in the required position to gain access to the sacroiliac joint. This is usually the patient lying on their chest. The skin over the sacroiliac joint is cleaned with antiseptic solution.

Administering the Injection

Local anesthetic may be injected into the skin, all the way down to the surface of the joint. Once this is done, the injection, containing a local anesthetic along with a steroid drug, is injected into the joint. The purpose of the local anesthetic is to help reduce the pain, while the purpose of the steroid is to reduce both inflammation and pain. The entire procedure takes only a few minutes to perform.

After Surgery

Following the procedure, the patient will be monitored for a short period of time and will then be discharged home. They will be advised to take a rest for a day or two and can resume normal activities after that.

In most cases, following sacroiliac joint injections, patients may experience immediate relief. This is usually due to the local anesthetic component of the injection. The steroids may take a day or two to begin affecting the pain, but the effects are longer lasting, often lasting for up to a few months. Sometimes, once the effects of the steroids are worn off, the pain may return, and repeat injections may be required.

The treatment is relatively safe and has very few risks. The most common risk is that of mild bruising and pain at the site of injection. This usually passes after a few hours. The other risks include persistent pain and allergic reactions to the drugs. Joint infection is a rare side effect, as absolute sterility is observed during the procedure.

Epidural blood patches are a treatment option for managing spinal headaches. Learn more here:

Epidural Blood Patch for Spinal Headaches

Headaches can occur due a variety of reasons. One of them is leakage of spinal fluid. This is called the spinal headache. Epidural blood patches are a treatment option for managing spinal headaches.

What is an Epidural Blood Patch?

When headache occurs due to leakage of spinal fluid, is essential that this process be stopped in order to relieve the headache.An epidural blood patch involves injection of blood into the spinal space (epidural space) which then closes the opening through which the leakage is occurring. This is a surgical procedure and can provide fast and effective relief.

When is an Epidural Blood Patch Offered to the Patient?

Spinal headaches can occur after procedures such as a lumbar puncture where a small hole is made in the lining of the spinal-cord with a fine needle in order to obtain a small amount of fluid that circulates around the spinal-cord (cerebrospinal fluid) for analysis. Normally, after the lumbar puncture procedure is complete, the hole that is created by a needle automatically closes.However, in certain cases small amounts of fluid may continue to leak out of this hole causing spinal headache. In such a situation an epidural blood patch may be offered to the patient.

How is an Epidural Blood Patch Procedure Performed?

The process involves autologous blood injection. This means that a small amount of blood is taken out of the veins of the patient and is then injected into the epidural space in close proximity to the site of lumbar puncture or where the hole is present. The blood that is injected clots and causes an increase in pressure which compresses and seals the hole shut. Further leakage of spinal fluid is this prevented and the headache is relieved.

The entire procedure does not take long to perform and patients can be discharged home the same day after a short period of observation. Patients may be requested to lie flat on their back for up to 4 hours following the procedure to allow for healing to begin.

How Safe is a Procedure?

The procedure is relatively safe. However it must be borne in mind that blood injected into a space where it does not belong can be an irritant. As a result, patients may experience mild back pain of leg pain. The chances of any infections occurring as a result the procedure are low as it is performed in sterile conditions.

Is it Effective?

Patient reports have varied but in most of the cases spinal headaches seem to resolve effectively following an epidural blood patch. In fact, in many cases this treatment can help avoid the requirement for surgery.

This bone condition affects millions all over the world. Do you know what it is?

Osteoarthritis

What is Osteoarthritis?

Osteoarthritis is a disease of the bone and joints where there is breakdown of the joint tissue and structure, resulting in pain in the joints and reduced joint movement. As it involves joint breakdown, or degeneration, it is a degenerative joint disease. It is the most common type of joint disease seen across the world.

Osteoarthritis is commonly seen in individuals over the age of 50. It is also more common in women. Millions of people all over the world suffer from osteoarthritis, with the American College of Rheumatology reporting that over 27 million people in the United States suffer from it.

What causes Osteoarthritis?

There are many causes of osteoarthritis, but the most common cause is aging. As one gets old, it is natural for the joints to get weaker and the tissues to lose their strength. This results in degeneration of the bone and joint tissue, resulting in osteoarthritis. In addition, there is also inflammation of the bone and joints that causes pain.

However, osteoarthritis can occur in younger patients, especially those who place their joints under a lot of stress every day. These can include athletes, as well as people involved in occupations that commonly stress the back and joints, such as builders or painters.

People who have a family member who suffers from osteoarthritis can also develop this condition. Also, patients who are overweight or obese are at a higher risk of developing osteoarthritis.

Symptoms and Diagnosis

There are a number of symptoms that patients can experience when suffering from osteoarthritis. These can include joint stiffness and reduced movement, pain upon movement and swelling of the affected joints. As a result of these, the patient may have trouble performing their daily tasks, prompting them to see a doctor. When examined, patients may have tender, swollen joints with limited capability of movement.

Osteoarthritis commonly affects the hips, knees, lower back and the small joints of the hands and feet. Among these, the knee is the most common joint affected.

In most cases, osteoarthritis can be diagnosed from clinical history and examination of the patient. In some cases, x-rays will reveal damage to the joint with changes specific to osteoarthritis, such as irregular bone margins and narrowed joint spaces. In some cases, an MRI scan may need to be performed.

How is Osteoarthritis treated?

There are a number of different treatment options that your doctor may offer you. These can include:

  • Pain killers: These may be offered to reduce the inflammation and to reduce pain. Drugs such as non-steroidal anti-inflammatory drugs, or NSAIDs, are often used.
  • Physical therapy: Sometimes, doctors may refer patients to a physical therapist, who may prescribe a treatment plan that will help reduce pain and increase joint movement. They may even offer certain aids to help walk about and manage tasks at home.
  • Steroid injections: These may be offered by the doctor in case pain is severe and is not reduced by the above measures. It reduces pain and inflammation significantly when injected into the joint, but repeated injections may be required.

Back and neck pain don’t have to seem overwhelming. Read today’s article to learn more:

Back and Neck Pain Overview

What are Back and Neck Pain?

We don't usually think about our necks or backs, so when pain or irritation begins, it can seem overwhelming. That pain can last for hours, days, or years, depending on the cause.

This article refers to acute and chronic pain. Acute pain is sudden, sharp, and related to tissue damage. Acute pain can subside instantly or last three to six months. If acute pain isn't relieved, it can lead to chronic pain. Chronic pain continues even after an injury has healed and lasts more than three to six months. The source of chronic pain can be something identifiable, like an ongoing injury, or something unidentifiable, like when no injury is present. Chronic pain is described as an aching, deep, burning or dull feeling that carries into the extremities.

What causes Back and Neck Pain Overview?

Most pain in the back and neck is caused by issues with muscles. This is often more mild pain, caused by muscle tension, cramps, or sprains. Poor posture can cause back and neck pain by forcing the spine into an incorrect position. This position causes weight to be distributed incorrectly. Pain can also be caused by wear-and-tear from aging or overuse through conditions like arthritis. This can cause degeneration that leads to nerve compression. Traumatic injury can also causes neck pain. This can be through a sudden impact or blow and can cause conditions like herniated disc.

What are the Vertebral Discs?

Your spine is made of different sections of vertebral discs. The cervical section of the spine is in your neck, the thoracic section is in your upper back, and the lumbar section is in your lower back. Vertebral discs separate the vertebrae in your spine, acting as shock absorbers for the spinal column by providing a cushion between the vertebrae. These discs are made of tough, elastic material that allows the spine to bend and twist naturally. The tough outer wall of the disc is called the annulus fibrosis, while the soft material contained inside the disc wall is called the nucleus pulposis.

Vertebral Disc Wall Weakness

Despite their strength and elasticity, vertebral discs can be damaged by injury or everyday wear-and-tear from aging. Often, this damage starts with cracking and weakening of fibers in the disc's annulus fibrosis. Radial tears can form in the disc wall, in or near sensitive nerve fibers.

Nucleus Pushing Through The Vertebral Disc Wall

As the outer wall weakens, the nucleus pulposis will push through the wall's tear to the edge of the disc wall. This additional pressure creates back pain at the level of the affected disc.

Pressure Against Nerve Roots

If the nucleus pulposis pushes through and out of the disc wall's outer edge, it's called a herniation or a rupture. This herniated disc material may put pressure against the nerve roots near the disc, which can cause radiating pain to travel down one or both of the legs.

How are Back and Neck Pain Overview treated?

Treatment of any back or neck pain will vary depending on the severity and location of the condition. Your doctor may recommend conservative treatment methods like physical therapy, injections, rest, activity modification, medication, or others. In some cases, surgery may be necessary.

Don’t miss this article if you want to know the warning signs of a bone infection

Osteomyelitis

What is Osteomyelitis?

Osteomyelitis is condition where the bone cells or marrow are infected, which can cause the death of tissue in the bone. Treatment of osteomyelitis is necessary to prevent the infection from spreading to other areas in the body. Osteomyelitis in adults generally affects the feet, pelvis, and spine, but in children, it affects the ends of the longer bones in the legs and arms.

What causes Osteomyelitis?

Osteomyelitis can be caused by a bacterial or fungal infection where microorganisms are able to invade bone tissue by migrating through the bloodstream or nearby tissues. Infection may also occur from trauma or surgical complications. Some people with more compromised immune systems are more likely to get this condition. This can include those with diabetes and those who abuse drugs intravenously.

Symptoms and Diagnosis

Symptoms of osteomyelitis can include fever, chills, pain, tenderness, and chronic fatigue. Redness, swelling, and tenderness may also be present, in addition to warmth in the area of infection. Because infection can interrupt the flow of blood to the area, some bone tissue may die and some new growth may occur in the area. In severe cases, an open, draining wound near the infection may be present.

How is Osteomyelitis treated?

Osteomyelitis requires treatment in order to avoid serious complications. Treatment methods may include oral or intravenous administration of antibiotics. In some cases, surgical treatment may be required to clean the infected bone and insert antibiotic-impregnated beads into the area. If the condition is very severe, amputation may be necessary.