Conditions Treated

Pain may not only limit you physically, but it can also affect your lifestyle and cause you to lose your independence. Properly treated pain can help you attain a better quality of life. We will carefully evaluate your pain problems and develop an individualized treatment plan for you. Some of the conditions that we treat are:

Neck/Back Conditions

  • Low Back Pain
    • Low Back Pain (LBP) affects about 40% of people sometime in their lives. This pain can vary from mild to severe. Acute or short-term low back pain generally last from a few days to a few weeks. Low back pain that persists for more than 3 months is considered chronic. Regardless of how long it lasts, it can make everyday activities difficult to do.

      The low back bears most of the body’s weight so it is pretty easy to hurt your back when you lift, reach or twist. In addition, as people age, bone strength, muscle elasticity and tone tend to decrease. The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae.

      Pain can occur when, for example, someone lifts something too heavy or overstretches, causing a sprain, strain, or spasm in one of the muscles or ligaments in the back. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the more than fifty nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain results.

      Depending on the cause, low back pain can cause a range of symptoms. The pain may be dull or sharp. It may be in one small area or over a broad area. You may have muscle spasms. Low back pain can also cause leg symptoms, such as pain, numbness, or tingling, often extending below the knee.

      Seventy percent of low back pain is thought to be due to muscle strain or injury to ligaments. We can provide a clear diagnosis and appropriate treatment.

  • Neck Pain
    • Neck pain is discomfort in any of the structures in the neck. These include the muscles, nerves, bones (vertebrae), and the disks between the bones. Neck pain may arise due to muscular tightness in both the neck and upper back, or pinching of the nerves emanating from the cervical vertebrae. Joint disruption in the neck creates pain, as does joint disruption in the upper back.

      The head is supported by the lower neck and upper back, and it is these areas that commonly cause neck pain. The top three joints in the neck allow for most movement of the neck and head. The lower joints in the neck and those of the upper back create a supportive structure for the head to sit on. If this support system is affected adversely, then the muscles in the area will tighten, leading to neck pain.

      When your neck is sore, you may have difficulty moving it, especially turning to one side. Many people describe this as having a stiff neck. If neck pain involves nerves, you may feel numbness, tingling, or weakness in your arm, hand, or elsewhere. Neck muscles can be strained from poor posture — whether it's leaning into your computer at work or hunching over your workbench at home. Wear-and-tear arthritis also is a common cause of neck pain. Causes of neck pain include:

      1. Abnormalities in the bone or joints
      2. Trauma
      3. Poor posture
      4. Degenerative diseases
      5. Tumors
      6. Muscle strain
  • Cervical & Lumbar Disk Herniations
    • The bones in the spinal column are separated by disks which provide a cushion between the vertebrae. The disks allow movement of the vertebrae for bending and reaching. When a disk moves out of place, pressure on the spinal nerves occurs. This can lead to pain, numbness or weakness. This type of disk herniation in your neck may cause pain when moving your neck, deep pain near or over the shoulder blade, or pain that moves to the upper arm, forearm and fingers. When the slipped disk or herniation occurs in the lower back, the pain may be in one part of the leg, hip, or buttocks, and numbness in other parts.

      Disc herniation is usually due to age related degeneration, or trauma, or lifting injuries. Slipped disks occur more often in middle-aged and older men, usually after strenuous activity.

      In many circumstances, disc herniations can be successfully treated with medication, physical therapy, and steroid injections performed by a pain management specialist.

  • Spinal Stenosis
    • Spinal stenosis is the narrowing of the open spaces within your spine, which can put pressure on your spinal cord and the nerves that travel through the spine. It is most commonly caused by wear-and-tear changes in the spine related to aging.

      It most often occurs in the neck and lower back. In the neck, narrowing in the upper spine can cause numbness, weakness or tingling in a leg, foot, arm or hand. Compressed nerves in the lower spine can cause pain or cramping in the legs when standing for long periods of time, or when you walk.

      Anesthetic injections, or nerve blocks, near the affected area or corticosteroid injections into the outermost membranes covering the spine and nerve roots can be used to alleviate the inflammation and acute pain that radiates from spinal stenosis.

  • Failed Back Syndrome
    • Failed back syndrome (FBS) is a general term that refers to chronic severe pain experienced after unsuccessful surgery for back pain. Surgery for back pain is conducted when there is an identifiable source of pain-usually to decompress a pinched nerve root or to stabilize a painful joint.

      Multiple factors can contribute to the onset or development of FBS. Contributing factors include but are not limited to residual or recurrent disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue (fibrosis), depression and spinal muscular deconditioning. An individual may be predisposed to the development of FBS due to systemic disorders such as diabetes, autoimmune disease and peripheral blood vessels (vascular) disease. Smoking is also a risk for poor recovery.

      The treatments of FBS include physical therapy, minor nerve blocks, transcutaneous electrical nerve stimulation (TENS), behavioral medicine, non-steroidal anti-inflammatory (NSAID) medications, membrane stabilizers, antidepressants, spinal cord stimulation, and intracathecal morphine pump. Use of epidural steroid injections may be minimally helpful in some cases.


Upper Extremity Conditions

  • Shoulder, Wrist, Elbow & Hand Pain
    • Pain in the shoulder, wrist, elbow and hand could be genetic, or acquired through many years of strain on certain areas of the joints, or possibly brought about by an occurrence through daily life. There are numerous possible causes of this pain. Among them are carpal tunnel syndrome, tendinitis, bursitis, and arthritis. Arthritis is the inflammation of the joints. Bursitis is the inflammation of the fluid filled sacs (bursae) found in your joints. These sacs surround the areas where tendons, skin and muscle meet bones. This inflammation causes pain, discomfort and can limit movement. Tendinitis is the inflammation or irritation of the tendons – the thick cords that join your muscles to your bones. It results in acute pain, tenderness and limited mobility.

      These are only a few of the causes of shoulder, wrist, elbow and hand pain. We will provide a clear diagnosis and appropriate treatment for your shoulder, wrist, elbow and hand pain.

  • Rotator Cuff Tears
    • A rotator cuff tear is a tear of one or more of the tendons of the four rotator cuff muscles. A rotator cuff injury can include any type of irritation or damage to the rotator cuff muscles or tendons.

      There are two main causes of rotator cuff tears: injury & degeneration. You can tear your rotator cuff if you fall down on your outstretched arm or lift something too heavy with a jerking motion. Or this type of tear can occur with other shoulder injuries, such as broken collarbone or dislocated shoulder.

      Chronic tears however, are the result of a wearing down of the tendon slowly over time, usually occurring as we age. You have a greater chance of degenerative rotator cuff tears when the same shoulder motion is repeated again and again in a job, routine chores, or most frequently in sports activities. Lack of blood supply as we age can ultimately lead to a tendon tear.

      The pain with a sudden tear after a fall or injury is intense and is often accompanied by weakness of the shoulder and arm. Chronic rotator cuff tears include a gradual worsening of pain, weakness and stiffness or loss of motions. Over time, the pain and other symptoms become much worse.

  • Carpel Tunnel Syndrome
    • The carpal tunnel is a space at the base of the wrist formed by eight carpal bones on the back of the wrist and a ligament along the palm side. Traveling through the carpal tunnel are wrist and hand tendons and the median nerve. The median nerve is responsible for sensation to the thumb, index finger, middle finger, and half of the ring finger. The median nerve also supplies sensation to the thumb muscles, which is very important in pinching or gripping actions.

      When someone experiences pain in the wrist, numbness and tingling in the hands or fingers, decreased feeling of touch in the thumb, index finger or middle finger, reduced dexterity of the hands or fingers, or reduced grip strength, they may be suffering from Carpel Tunnel Syndrome.

      Carpel Tunnel Syndrome can be caused by highly repetitive hand or finger movements. The tendons in the wrist become inflamed and apply pressure on the median nerve. We will be able to determine if your pain is due to Carpel Tunnel syndrome and provide the appropriate treatment.

  • Tennis Elbow & Golfer’s Elbow
    • When the tendon on the outside of the elbow joint that directs wrist and hand movements becomes inflamed, it is called Tennis Elbow. Repetitive movements involving gripping and twisting, such as playing tennis or turning a screwdriver will cause pain, particularly on the outside of the elbow.

      When the tendon on the inside of the elbow joint becomes inflamed, it is called Golfer’s Elbow. Pain will be pronounced with repetitive movements involving gripping and carrying loads, or when a force is directed upwards, as occurs with golf.

      When rest of the arm, use of cold packs or using a brace does not alleviate the pain after 6 to 8 weeks, corticosteroid injections can be used. Ultrasound therapy is another option to help the tendon heal and stop pain.

  • TMJ / TMJD
    • Temprormandibular joint disorders (TMJD) occur when there are problems with the jaw, jaw joint and surrounding facial muscles that control chewing and moving the jaw. The temporomandibular joint (TMJ) is the hinge joint that connects the lower jaw to the temporal bone of the skull, which is immediately in front of the ears.

      The cause of TMJD is not clear but generally thought to arise from problems with the muscles of the jaw or with the parts of the joint itself. For example, injury to the jaw or the TMJ, or muscles of the head and neck, such as from a heavy blow or whiplash can cause TMJD. It can also be caused by grinding or clenching teeth, presence of arthritis in the TMJ, dislocation of the disc between the ball and socket, or stress.

      People with TMJD can experience severe pain and discomfort that can be temporary or last for many years. More women than men experience TMJD, and TMJD is seen most commonly in people between the ages of 20 and 40.


Chronic Pain Syndromes

  • Osteoarthritis Pain
    • Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions that can affect people of all ages, races and genders. Arthritis is not just a disease of old age. Two-thirds of people with arthritis are under the age of 65, including 300,000 children.

      Osteoarthritis (OA), the most common form of arthritis, is a progressive degenerative joint disease characterized by the breakdown of joint cartilage associated with risk factors such as obesity, joint injury, overuse of the joint, weak thigh muscles, genetics and age.

      OA is a chronic condition in which the material that cushions the joints, called cartilage, breaks down. This causes the bones to rub against each other, causing stiffness, pain and loss of joint movement. The cause is not fully understood. Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can slow the progression of the disease, relieve pain and improve joint function.

  • Neuropathy
    • Neuropathy, also known as peripheral neuropathy, is damage to the peripheral nervous system. Neuropathy is a complication of a number of different underlying conditions including physical trauma, repetitive injury, infection and metabolic problems. It often causes pain, weakness and numbness, usually in hands and feet but can be in other areas of the body.

      Diabetic neuropathy is a complication of the metabolic disorder diabetes. Over a number of years, the excess blood glucose in people with diabetes can injure the walls of tiny blood vessels supplying nerves, especially those in the legs. While diabetes is the most common cause of neuropathy, other medical conditions that can also lead to neuropathy include:

      1. Chronic liver disease
      2. Chronic kidney disease
      3. Cancer - lymphoma or multiple myeloma
      4. Lyme disease, a tick-borne bacterial infection
      5. Long-term excessive alcohol intake
      6. Vitamin B deficiency and other nutritional deficiency
      7. HIV infection and AIDS
      8. Guillain-Barré syndrome

      One goal of treatment is to manage the condition causing the neuropathy. If the underlying cause is corrected, the neuropathy often improves on its own. Another goal of treatment is to relieve the painful symptoms.

  • Cancer Pain
    • Pain is common in people with cancer, with 30% to 50% of people experience pain while undergoing treatment. The percentage rises among people with advanced cancer. Cancer pain may be dull, achy or sharp. It could be constant, intermittent, mild, moderate or sharp. Cancer related pain may arise from the disease itself or by the treatment of the disease. Most cancer pain is caused by the tumor pressing on bones, nerves or other organs in your body. Sometimes pain is related to your cancer treatment. For example, some chemotherapy drugs can cause numbness and tingling in your hands and feet or a burning sensation at the place where they are injected. Radiation therapy can cause skin redness and irritation.

      Cancer pain can be acute or chronic. Acute pain is due to damage caused by an injury and tends to only last a short time. For example, surgery can cause acute pain but the pain subsides as the wound heals. Chronic pain is pain caused by changes to nerves. Nerve changes may occur due to cancer pressing on nerves or due to chemicals produced by a tumor. It can also be caused by nerve changes due to cancer treatment. The pain continues long after the injury or treatment is over and can range from mild to severe. It can be there all the time and is also called persistent pain.

      We will formulate a pain treatment plan for pain control that best suits your individual situation.

  • Fibromyalgia
    • Fibromyalgia pain causes you to ache all over. You may have painful "trigger points," places on your body that hurt no matter what medication you take. Your muscles may feel like they have been overworked or pulled even though you haven't exercised. Sometimes, your muscles will twitch. Other times they will burn or ache with deep stabbing pain. Some patients with fibromyalgia have pain and achiness around the joints in their neck, shoulders, back, and hips. This kind of pain makes it difficult to sleep or exercise.

      Fibromyalgia pain is felt over the entire body. The pain can be a deep, sharp, dull, throbbing, or aching and is pain that's felt in the muscles, tendons, and ligaments around the joints. The Arthritis Foundation describes the muscle and tissue pain as tender, aching, throbbing, sore, burning, and gnawing. For some people with fibromyalgia, the pain comes and goes. The pain also seems to travel throughout the body.

      Along with the deep muscle soreness and body aches, people with fibromyalgia may have painful tender points or localized areas of tenderness around their joints that hurt when pressed with a finger. It's the tissue around the joints rather than the joints themselves that hurts. These tender points are often not areas of deep pain. Instead, they are superficial, located under the surface of the skin.

      It is thought that fibromyalgia pain results from neuro-chemical imbalances including activation of inflammatory pathways in the brain which results in abnormalities in pain processing.

  • Shingles Pain
    • Shingles is an infection caused by the same virus that causes chickenpox. It occurs in people who had chickenpox previously when the inactive virus becomes active again. The symptoms include a rash on the side of the body or face which develop into small blisters that dry out and scab over within several days. When the rash is at its peak, you can experience anywhere from a mild itching to extreme and intense pain.

      When the pain of shingles remains after the rash is gone, it is Post Herpetic Neuralgia (PNH). PNH typically occurs in the area where the shingles occurred. The pain can be intermittent or constant and a range of mild to extreme. Just touching the skin can set it off. It can last weeks, months and even years. While the cause of PNH is unknown, it may be due to residual damage or inflammation in the nerve after shingles resolves.

      Post Herpetic Neuralgia treatment aims to soothe and quiet the misfiring nerves that are creating the pain.


Lower Extremity Conditions

  • Hip, Knee, Ankle & Foot Pain
    • There are several possible causes to hip, knee, ankle and foot pain, in some cases related to one another. Lower extremity pain is a common and often painful problem which can begin with an injury, accident or from long-term habits. When your upper body is not aligned with your lower body, weight bearing is not balanced and you put uneven pressure on your lower extremity when you move.

      The nerves which control your lower extremities begin in the low back and lower spine which is why low back posture problems are a common cause of pain radiating to the hip, thigh, knee, leg, ankle and foot. When structural distortions in the low back caused by chronic poor posture or trauma cause a spinal distortion and compress delicate nerves, pain, numbness, tingling, and weakness traveling down the lower extremity often result.

      Sciatica is pain caused by compression somewhere along the sciatic nerve, which runs from the lower back to the feet. This compression may be caused by disc herniation, disc disease, bone spurs on the hips or vertebrae, and spinal stenosis, among other causes. When any of these happen, pressure may be put on the sciatic nerve or spinal cord, causing pain in the hips, lower back, legs, or even the feet. Pain may be present anywhere along the nerve.

      These are only a few of the causes of hip, knee, ankle and foot pain. We can provide a clear diagnosis and appropriate treatment for your hip, knee, ankle and foot pain.

  • Sacroiliac Joint Pain
    • The sacroiliac (SI) joints are formed by the connection of the sacrum and the right and left iliac bones. The sacrum is located at the base of the spine. It is made up of 5 vertebrae or backbones that are fused together. The iliac bones are the two large bones that makeup the pelvis. The sacroiliac joints support the entire weight of the upper body. When these joints are stressed it can cause wearing of the cartilage of the SI joints.

      Symptoms of sacroiliac joint dysfunction include:

      1. Pain in the lower back, usually on one side
      2. Hip pain
      3. Discomfort with bending over or standing after sitting for long periods
      4. Diminishing pain when lying down

      Any condition that alters the normal walking pattern can put undue stress on the SI joints and can lead to pain. There are many other disorders that can cause sacroiliac joint inflammation and pain including gout and arthritis.

      Chronic sacroiliac joint pain may be helped with corticosteroid injections.

  • Osteoarthritis of the Knee
    • Osteoarthritis of the Knees:

      Simply described it is a chronic (usually insidious onset) arthritic condition affecting one or more joints. It causes a loss of cartilage which is the main shock absorber. Other names for this condition include degenerative joint disease (DJD).

      Contrary to popular belief, this is NOT an inevitable part of aging. It does however affect hands, feet, back, hips, knees, and neck. The KNEE is one of the most commonly affected joints and can often make moving around difficult.

      Causes of osteoarthritis are many and can include: joint injuries, obesity, inactivity, genetics, ethnicity, and aging. The inflammation in the joint can lead to bony changes and can also affect the muscles, ligaments and lining of the joint. This can give the joints a knobby appearance, causing decreased range of motion, and lead to weakness of the limb.

      Osteoarthritis Questionnaire

      1. Does knee or joint pain keep you from enjoying the activities you love or getting the exercise you need?
      2. Do you Have knee or joint stiffness in the morning or after sitting and does it tend to improve once you are moving. Do you have knee pain when climbing stairs?
      3. Do you have trouble fully moving your knees (flexing and extending) due to pain or fluid in the joint?

      If you answered YES to one or more of the questions above, you may have osteoarthritis of the knee. The good news is that your level of pain and discomfort can usually be improved through the use of Hyalgan.

      Day after day patients share with me how their lives have improved because of the care they have received here in my office. They are people who have gone from suffering with daily pain to celebrating full, pain free lives again. That is exactly the relief I want my patients to have.

      Help for Osteoarthritis of the Knee

      Hyalgan is a natural substance normally found in the joint. It is not a drug. It is used as a healthy alternative to corticosteroid injections. Knee pain relief while using Hyalgan is usually longer than that provided by steroids. Several Injections given weekly can provide long lasting relief. The majority of patients (90%) report improvement and for some it seems miraculous. Hyalgan doesn’t interfere with other medications you are taking. Treatments can be given safely for a long period of time.

  • Plantar Fascitis
    • Plantar Fasciitis occurs when the plantar fascia becomes strained, weak swollen and inflamed. The plantar fascia is the ligament, or flat band of tissue, that connects your heel bone to your toes and supports your arch. When it becomes strained, your heel or bottom of your foot hurts when you stand or walk. Plantar fasciitis is common among middle aged people and can occur among younger people who are on their feet a lot. Plantar fasciitis is one of the most common causes of heel pain.

      Pain from plantar fasciitis occurs most often after being off your feet for a long time and stiffness in your foot is prevalent. But the pain will return as the day goes on and a lot of time is spent on your feet and when you climb stairs. Someone is more likely to get plantar fasciitis if they:

      1. Have either flat feet or high arches
      2. Are a long distance runner
      3. Have a sudden weight gain or obesity
      4. Wear shoes with poor arch support or soft soles

      Local injections of corticosteroids often give temporary or permanent relief.

  • Achilles Tendonitis
    • Achilles Tendonitis is the inflammation of the tendon that connects the calf muscle to the heel bone. This tendon is used when you walk, run or jump and therefore, can withstand great stress. When repetitive stress is placed on the tendon, tendonitis can occur. There are two types of achilles tendonitis, depending on where it occurs. When the middle portion of the tendon begins to degenerate, that is non-insertional Achilles tendinitis. When the tendinitis involves the lower portion of the heel, where the tendon attaches to the heel bone, it is insertional Achilles tendinitis.

      Achilles tendonitis results from repetitive stress to the tendon such as a sudden increase in the amount or intensity of exercise activity. Achilles tendonitis will result in the pain and stiffness in the back of the leg after running or exercising.

      If ignored Achilles tendonitis can lead to tendon tearing or rupturing, and therefore, it is important to treat it when it occurs.

  • Tarsal Tunnel Syndrome
    • Tarsal Tunnel Syndrome is a painful foot condition caused when the tibial nerve which provides sensation to the bottom of the foot, becomes compressed. The tibial nerve, artery and tendons together run through the tarsal tunnel found along the inner leg behind the bump on the inside of the ankle. They provide the movement and flexibility to the foot.

      When the tarsal nerve is compressed, it causes pain, a burning sensation and tingling on the sole of the foot, in and around the ankles and sometimes the toes. Tarsal tunnel syndrome may be caused by an injury or disease, or can be due to the natural shaping of the foot. For example, flat feet, fallen arches or swelling caused by an ankle sprain can cause tarsal tunnel syndrome.

      Tarsal tunnel syndrome can be treated with corticosteroid and anesthetic injections.

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