Dr. Heller

Evaluation Procedures for Orthopedic Problems

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Picture: falmouthortho.com/

Adults – What are standard evaluation procedures?

Before a treatment or rehabilitation plan can be made, your orthopedist must first determine the reason for, and source of, your condition. This typically involves a complete physical exam and a review of your medical history profile, in addition to a description of your symptoms. Be sure to tell your healthcare providers of any other illnesses, injuries, or complaints that may be associated with the pain or condition. Also, tell him or her about any previous treatments or medicines prescribed. Initial tests may then follow.

Advanced evaluation procedures

If you need further evaluation you may have one of these tests:

  • X-ray. This test uses invisible electromagnetic energy beams to make images of tissues, bones, and organs onto film.
  • Arthrogram. This X-ray shows bone structures after an injection of a contrast fluid into a joint area. When the fluid leaks into an area that it does not belong, disease or injury may be considered, as a leak would provide evidence of a tear, opening, or blockage.
  • Magnetic resonance imaging (MRI). This test uses large magnets, radiofrequencies, and a computer to make detailed images of organs and structures within the body. It can often determine damage or disease in a surrounding ligament or muscle.
  • Computed tomography scan (also called a CT or CAT scan). This test uses X-rays and computer technology to make horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • Electromyogram (EMG). This test evaluates nerve and muscle function.
  • Ultrasound. This test uses high-frequency sound waves to create an image of the internal organs
  • Arthroscopy. This test is used to evaluate a joint. It uses a small, lighted, optic tube (arthroscope) that is inserted into the joint through a small incision in the joint. Images of the inside of the joint are projected onto a screen. It’s used to evaluate any degenerative or arthritic changes in the joint. It also detects bone diseases and tumors and may help determine the cause of bone pain and inflammation.
  • Myelogram. This test involves the injection of a dye or contrast material into the spinal canal. Next a specific X-ray study lets the healthcare provider evaluation of the spinal canal and nerve roots.
  • Radionuclide bone scan. This is a nuclear imaging technique. It uses a very small amount of radioactive material, which is injected into the patient’s bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
  • Blood tests. Other blood tests may be used to check for certain types of arthritis.

After the evaluative information is collected and reviewed, the orthopedist will discuss the treatment options with you to help you select the best treatment plan that promotes an active and functional life.

Children – What are standard evaluation procedures?

Children will be treated much like the adults are with a full physical exam and a detailed medical history. At this time, be sure to tell your child’s doctor of any other illnesses, injuries, or complaints that have been associated with the pain or condition, as well as any previous treatments or medicines prescribed. Some early tests may then be done, including:

  • Blood tests
  • X-rays.A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

Advanced evaluation procedures

Children who need further evaluation may undergo 1 or more of the following:

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  • Computed tomography scan (also called a CT or CAT scan).A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • EMG (electromyogram).A test used to evaluate nerve and muscle function.
  • Bone scan.A nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone inflammation.
  • This is becoming a common test for evaluating musculoskeletal complaints.

After the evaluative information is collected and reviewed, your child’s orthopaedist will discuss with you all treatment options and help you select the best treatment plan to enable your child to live an active and functional life.

Blue Ridge Orthopaedic & Spine Center has two convenient office locations in Warrenton (540) 347.9220 & Gainesville (703) 743.2814 to serve all of your Orthopaedic needs.  Call us today to schedule an appointment.  Same day/next day appointments available.  For more information on all comprehensive services we offer, visit www.broava.com.

Courtesy: Krames Staywell

Online Medical Reviewer: Ogiela, Dennis, MD
Online Medical Reviewer: Banerjee, Rahul, MD 

Injectable Corticosteroids

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Corticosteroid injections are powerful drugs used to decrease inflammation in the body’s tissues.  Corticosteroid injections can treat a range of muscular, skeletal, and spinal conditions.  This article from KRAMES STAYWELL shows us the most common uses of corticosteroid injections:

  • Lower back pain – Lower back pain from strains, spinal stenosis, ruptured disks, and other common conditions may be treated with injectable corticosteroids to provide some reprieve from pain. Lumbar radiculopathy is pain in the buttocks, hips, or legs that stems from a pinched nerve in the lower back.  This kind of pain can usually be treated with corticosteroid injections near the pinched nerve.  If a patient is having excruciating pain, the injection may target the spinal cord area through a catheter.  Sometimes other drugs such as local anesthetics or narcotics are given in conjunction with the corticosteroid.
  • Osteoarthritis – Osteoarthritis suffers often develop inflammation and pain in their joints. An injection of corticosteroids into the affected joint can provide temporary pain relief for several weeks or even months.  After the treatment, you will need to rest the joint for at least 24 hours for the best results.
  • Carpal tunnel syndrome – Carpal tunnel syndrome may occur when a nerve in the wrist becomes compressed or pinched, causing pain and weakness in the hand. Infecting a corticosteroid in the wrist can provide immediate relief.
  • Cervical radiculopathy – This is neck pain that radiates to the shoulder and arm. It occurs when the vertebrae in the spine moves closer together, pinching a nerve in the neck.  Injecting corticosteroids near the pinched nerve may reduce pain and swelling allowing for time to heal .

Blue Ridge Orthopaedic & Spine Center has two convenient office locations in Warrenton (540) 347.9220 & Gainesville (703) 743.2814 to serve all of your Orthopaedic needs. Call us today to schedule an appointment. Same day/next day appointments are available. For more information on all comprehensive orthopaedic services we offer visit www.broava.com.

Does the Epidural always work for Pain?

 

When Do Epidural Steroid Injections Work for Back Pain?

by: Sylvia Marten  spine-health.com

For most people suffering from back pain, surgery is scheduled only after all other options have been exhausted.

One non-surgical approach to pain relief is epidural steroid injections. They are only intended for temporary pain relief, but steroid injections coupled with therapeutic exercise may allow patients to postpone or even avoid surgery altogether.

Epidural injections deliver steroid medication directly to the source of pain.

Epidural steroid injections are most often used to treat low back and leg pain associated with sciatica, which is pain caused by a pinched nerve in the low back that radiates down the leg.

  • Sciatica can result from a number of conditions, including a herniated disc, degenerative disc disease, or spinal stenosis.

Epidural Steroid Injections Video

Many Spine-health readers have had epidural steroid injections and have shared their results with us:

  • There were many people who did experience relief, if only temporarily.
  • In several instances, injections helped our readers reduce their pain while they waited for their scheduled surgery.
  • There was also indication among our readers that a series of 3-4 shots provided the most relief, while anything more than that had little effect, or even made pain worse.
  • A select few were awarded complete relief and were able to return to normal activities.
  • For as many of our readers who have had success, there were just as many who experienced little to no relief from epidural steroid injections.

Fluoroscopy, or live X-ray, has been shown to be the most effective way to deliver the medication most accurately to the epidural space.

The most common reader complaints were centered on the side effects associated with steroids. Many reported significant weight gain and bloating, swelling of the face, feet and ankles, and headache and nausea.

Another concern for some readers, especially those with diabetes, was the rise in blood sugar associated with steroids.

Efficacy of epidural steroid injections

There is no conclusive evidence that epidural steroid injections work better for one condition than another. Success rates are different for each individual. For those hoping to postpone surgery, injections may provide enough temporary relief.

Steroid injections may also effect enough pain relief to allow you to begin a physical exercise program. Many people have gained enough pain relief through an exercise program to avoid surgery.

The most important thing is to find a doctor that you trust, and who will adequately answer any questions you may have regarding your condition or the injection procedure.

 

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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

Stiff Neck Causes and Symptoms

Stiff Neck Causes, Symptoms and Treatment
Richard A. Staehler, MD, www.spine-health.com

A stiff neck is typically characterized by soreness and difficulty moving the neck, especially when trying to turn the head to the side. A stiff neck may also be accompanied by a headache, neck pain, shoulder pain and/or arm pain, and cause the individual to turn the entire body as opposed to the neck when trying to look sideways or backwards.

Symptoms typically last for a couple of days or a week and may prompt neck pain that ranges from mildly painful but annoying to extremely painful and limiting. While there are a few instances in which neck stiffness is a sign of a serious medical condition, most episodes of acute neck stiffness or pain heal quickly due to the durable and recuperative nature of the cervical spine.

Neck Strains and Sprains Video

The most common causes of a stiff neck include, but are not limited to, the following:

Muscle Strain or Sprain
By far the most common cause of a stiff neck is a muscle sprain or muscle strain, particularly to the levator scapula muscle. Located at the back and side of the neck, the levator scapula muscle connects the cervical spine (the neck) with the shoulder. This muscle is controlled by the third and fourth cervical nerves (C3, C4).

The levator scapula muscle may be strained or sprained throughout the course of many common, everyday activities, such as:

  • Sleeping in a position that strains the neck muscles
  • Sports injuries that strain the neck
  • Any activity that involves repeatedly turning the head from side to side, such as swimming the front crawl stroke
  • Poor posture, such as slouching while viewing the computer monitor
  • Excessive stress, which can lead to tension in the neck
  • Holding the neck in an abnormal position for a long period, such as cradling a phone between the neck and shoulder.

Meningitis / Infection
A stiff neck, in conjunction with a high fever, headache, nausea or vomiting, sleepiness and other symptoms, may be indicative of meningitis, a bacterial inflection that causes the protective membranes of the brain and spinal cord to be inflamed. Other infections can also cause stiff neck symptoms, such as meningococcal disease, an infection in the cervical spine. Any time a stiff neck is accompanied by a fever, it is advisable to seek immediate medical attention to check for these possibilities.

Cervical Spine Disorders
Many problems in the cervical spine can lead to neck stiffness. The stiffness can be a reaction to the underlying disorder in the cervical spine. For example, a cervical herniated disc or cervical osteoarthritis can lead to neck stiffness, as the structures and nerve pathways in the cervical spine are all interconnected and a problem in any one area can lead to muscle spasm and/or muscle stiffness.

Stiff Neck Treatment

As a general rule, it is advisable to seek medical attention if the stiff neck symptoms do not subside after one week. Immediate medical attention is recommended if neck stiffness is noted after a traumatic injury, or if there are additional troublesome symptoms, such as a high fever.

In the vast majority of cases, a stiff neck may be treated within a few days.

 

 

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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

Take 2 aspirin & call me in the morning doesn’t cut it with chronic pain

5 Realities of Living with Chronic Pain
by Stephanie Burke  spine-health.com

Living with chronic pain is challenging enough because of the obvious reason—the pain—but there are other factors that go along with this condition that make life even more difficult.

If you live with chronic pain, consider sharing this blog with your loved ones so they can better understand what your daily life is like.

Chronic pain may persist even after a condition, such as spinal stenosis, is addressed through surgery.

  1. Pain is rarely “all in your head.”

People in pain are often treated as if their pain is actually made up or greatly exaggerated. While it is true that pain is subjective (people simply perceive pain differently) and some people may report pain because they have other agendas, for the vast majority the pain is real and present. It is not made up. The problem is that chronic pain is often caused by anatomical problems that are difficult or impossible to diagnose using standard medical tests, and pain cannot be diagnosed like other medical problems (such as a broken bone that can be seen on an X-ray).

Fortunately, most in the medical community are now trying to understand and appreciate that chronic pain is real and needs to be treated and managed differently.

  1. Pain is not the only problem—it breeds other health problems.

Thoughts and emotions related to chronic pain also can both aggravate and alleviate the pain. For example, depression, which is a serious disease, can worsen the pain. Sleep problems, again caused by the pain, can also make the pain worse. And increased pain usually leads to increased sleep problems.

Often all conditions related to the pain need to be treated concurrently in order for the patient to get any relief.

 

  1. Pain is deeply personal.

Everyone experiences and expresses pain differently. Any two people with the exact same health condition are likely to feel and express their pain in unique ways depending on a number of factors. Newer chronic pain theories now have physiological explanations for how and why people experience pain differently.

When it comes to back pain, this is especially true. Two people can have the same type of herniated disc, but one feels only slight discomfort and the other feels intense burning pain that is unresponsive to conventional treatment. It is also not uncommon that no anatomical cause of the pain can be detected.

Why is this point important? It means that chronic pain often needs to be treated as the primary problem, which is different than the conventional medical approach of identifying and treating the underlying problem causing the pain.

  1. Chronic pain is its own beast.

Unlike acute pain, which functions as a warning signal (e.g. I just stepped on a nail—better move my foot!), chronic pain does not have any useful function. It just is.

Often, chronic pain is caused by nerves that continue to send pain signals to the brain. When dealing with chronic pain, one of the most frustrating things is that there is nothing to “fix.” It just exists in your body.

  1. Chronic pain is LONELY.

After awhile, many people with chronic pain—especially pain that is caused by a condition that cannot be seen—begin to feel isolated. Here the Internet has done a world of good helping people in pain connect with others in similar situations and find a supportive peer group through online communities of people in similar situations.

Having a clearer understanding of how chronic pain works, as well as the central role that the mind plays in the experience of chronic pain, is becoming more mainstream in the medical community. Patients who start to gain more understanding of their own chronic pain may also benefit in terms of gaining increased emotional support, more effective and sustainable pain management, and even possibly harnessing the power of their minds to assist in coping with the pain.

 

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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

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