Dr. Mingi Choi: Conditions Treated | Somerset Orthopedic and Sports Medicine

Dr. Mingi Choi: Conditions Treated

Herniated Disc:  ​Discs are pads that function as “cushions” between the vertebral bodies. They minimize the impact of movement on the spinal column. Each disc has a central softer component called a nucleus pulposus. When this is ruptured, the condition is referred to as a disc herniation. Herniated discs are most commonly found at the level between the fourth and fifth lumbar vertebrae, in the lower back. In severe cases, the disc tissue can press on the adjacent spinal nerves that exist the spine at the level of the disc herniation. In less severe cases, a patient might not experience symptoms and surgery may not be required. Either way, diagnosis can require a physical examination, imaging tests and electrical tests. Treatment may include physical therapy, muscle-relaxant medication, pain medication, anti-inflammation medication, epidural injections and surgical operations. Herniated discs can also occur in the Cervical spine and corresponding pain in the arms can occur.

Pinched Nerve:  ​The uncomfortable pain or numbness caused by damage to a peripheral nerve is the condition known to as a “pinched nerve.” It is usually associated with back pain or neck injury but a peripheral nerve is any nerve outside the brain and spinal cord. Anything which increases pressure around a nerve can cause a pinched nerve. The sensation is often described using words such as stabbing, prickling, burning, tingling or similar terms. Anyone susceptible to or experiencing disc herniation, arthritis in the spine, weight gain or water retention are at risk. The last two factors are also associated with pregnancy, so women who are expecting might also experience certain types of pinched nerves.  After reviewing your history of symptoms and performing a careful physical examination, a health care professional can usually diagnose the condition. An MRI or CT scan may be necessary if it is in the neck or back.  Depending on the location and the cause, treatment can be anything from prescribed rest to physical therapy and over-the-counter anti-inflammatory medications as well as spinal injection procedures.

Slipped” Disc:  ​This term comes from the action of the nuclear tissue when it is forced from the center of the disc. That tissue is soft and springy. It absorbs the shock of standing, walking, running, etc. Sometimes it can be placed under so much pressure that can cause the outer ring of the disc, known as the annulus, to rupture. The annulus consists of interwoven layers of fibrous tissue. It holds everything in place. If the disc herniates or ruptures, it may create pressure against one or more of the spinal nerves, rendering the corresponding area of the body weak or numb. The term “slipped disc” is often used interchangeable with “herniated disc”, but is also referred to as a prolapsed or ruptured disc.

Sciatica: The nerve pain caused by irritation of the sciatic nerve is called sciatica. This nerve winds its way from nerve roots in the lower back through the buttock area to send nerve endings down the lower limb. It is the largest nerve in the body. The pain is typically felt from the lower back to behind the thigh and can radiate down below the knee. It is most commonly caused by lumbar disc herniation, which presses directly on the nerve.  Other causes include irriation of the nerve from adjacent bone, tumors, muscle, internal bleeding, and infection in or around the lumbar spine. Irritation of the sciatic nerve during pregnancy can also trigger sciatica. Diagnosis can be achieved via a physical exam and medical history but X-rays and other tests could be necessary. Treatment depends on the underlying cause and the severity of the pain.  Chronic forms might require transcutaneous nerve stimulators, also known as TENS units. Otherwise, there are low back conditioning and stretching exercises, as well as medications that can help.

Carpal Tunnel Syndrome: Carpal tunnel syndrome is caused by irritation of the median nerve at the wrist. Any condition that exerts pressure on the median nerve is a possible cause. Symptoms include numbness and tingling of the hand. The wrist is supported by a band of fibrous issue. The space between this fibrous band and the wrist bone is called the carpal tunnel. All sensations from the thumb, index and middle fingers of the hand are received by the median nerve. The tingling and numbness is the result of any condition that causes swelling or a change in position of the tissue within the carpal tunnel that squeezes or irritates the median nerve. The most common cause is tendon inflammation resulting from repetitive work, such as uninterrupted typing. Symptoms are often more pronounced at night and can awaken people from sleep. Strength of grip can be affected, leading to frequent dropping of objects from the hand. More chronic cases might involve sharp shooting pains in the forearm or even atrophy of the hand muscles. A nerve conduction velocity test will measure the rate of speed of electrical impulses as they travel down a nerve. In carpal tunnel syndrome, those impulses will slow as they cross the carpal tunnel. Blood tests can identify medical conditions associated with carpal tunnel syndrome.

Peripheral Neuropathy: Any damage to the peripheral nerves that results in a tingling, painful or burning sensation in the extremities is known as peripheral neuropathy. More often than not, it occurs in the legs. Other symptoms include weakness and numbness. One of the most common causes is poorly controlled diabetes. Other causes include alcoholism, kidney failure, vitamin deficiency and shingles. Certain medications, including certain cancer chemotherapy drugs, can cause peripheral neuropathy. Sometimes, pressure on the nerve causes the nerve malfunction, rather than a disease. An example of this would be carpal tunnel syndrome. If there is no apparent cause, it is referred to as idiopathic peripheral neuropathy. A thorough medical history, along with a physical examination that includes certain tests, such as vibration and monofilament testing, will accurately detect certain types of peripheral neuropathy. Blood tests for exposure to toxins and electrodiagnostic studies are also effective. Small fiber neuropathy is better diagnosed through skin biopsies or quantitative sudomotor axon reflex testing (QSART).

Spinal stenosis: is a narrowing of the spine. People are either born with this condition or develop it later in life. It is a natural part of aging for most who have it. The natural process of degeneration is called spondylosis. This is made worse by arthritis of the bone that is felt in the joints, also known as osteoarthritis. With the loss of bone mass, there is less space between your individual vertebrae. Your back is put under extra stress and, as a result, your body’s facet joints begin to grow. These are the joints that allow you to bend over and twist from side to side. The end result is even less space for the nerve roots that flow through your spinal cord and down your spine. Symptoms tend to creep up gradually as the bones degenerate. The two main types are lumbar and cervical stenosis. Symptoms of lumbar stenosis include pain, numbness of weakness in the lower back, legs and/or buttocks. Tingling, pain or weakness in one or both legs can result from walking or standing for some duration. Loss of function of lumbar nerve roots of the spinal canal can result in loss of bladder and bowel control. Cervical stenosis can cause clumsiness in the arms or hands. Other symptoms include numbness of the hands, difficulty balancing and bladder or bowel incontinence.

Lower Back Pain: The lower back is also known as the lumbar area. Its functions include structural support, movement and protection of certain body tissues. Pain in this area is caused by conditions that affect the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, internal organs of the pelvis and abdomen, and the skin that covers the lumbar area. Common causes of lower back pain include lumbar strain, nerve irritation, lumbar radiculopathy, bony encroachment, and conditions of the bone and joints. Lumbar strain occurs when stretching of the ligaments, tendons and/or muscles of the lower back leads to injury, which results in microscopic tears of varying degrees in these tissues. Diagnosis is based on the history of the injury, the location of the pain, and exclusion of nervous system injury. Treatment of lower back pain depends on the diagnosed or suspected cause. The use of epidural steroid injections, however, is common.

Neck Pain:  Neck pain is also known as cervical pain. It is a common medical condition that can come from a number of disorders and disease. It can involve any of the tissues in the neck. Common causes are degenerative disc disease, neck strain, whiplash, a herniated disc, or a pinched nerve. Common infections also cause neck pain. Sometimes neck pain is caused by conditions directly affecting the muscles of the neck, such as fibromyalgia and polymyalgia rheumatic, or simply from uncomfortable positioning of the neck while sleeping with the head on a pillow. Neck pain can be associated with headaches, tingling in the arms, muscle pain, fever, stiff neck, throat pain, tenderness, and weakness of the arms. After reviewing the history of symptoms, a doctor will note the location, intensity, duration and radiation of the pain. The neck is examined at rest, as well as in motion. The neck is also palpated to detect tenderness. The nervous system is examined in order to determine whether nerve involvement is present.  Further testing can include X-rays, CT scan, bone scan, MRI scan, myelogram, and electrical tests such as electromyography (EMG) and nerve conduction velocity test (NCV) Depending on the cause, treatment options include rest, heat or cold applications, traction, soft-collar traction, physical therapy, local injections of cortisone or anesthetics, topical anesthetic creams, topical pain-relief patches, muscle relaxants, analgesics and surgical procedures. Chronic neck pain sometimes responds to alternative treatments such as acupuncture.

Degenerative Disc Disease: Degeneration or deterioration of the discs of the spine makes them more susceptible to herniation, which can lead to localized or radiating pain. Ruptured discs are also the cause of sciatica. What causes degenerative disc disease? The simple answer would be age. Cartilage gets weaker, thinner and more fragile. The discs and joints that stack the vertebrae are partly composed of cartilage, so those areas tend to get worn down over time. This gradual deterioration is referred to as degenerative disc disease, or DDD for short. Degenerative disc disease can also result from traumatic injury to the spine. Signs of irritated nerves can sometimes be detected by a doctor during the examination. Nerve testing of the lower extremities can also be used. MRI or CT Scan testing is often necessary for detecting disc herniation. Treatment ranges from medical management to surgery. Medical management is non-invasive and mostly includes patient education, medications to relieve pain and muscle spasm, cortisone injections, physical therapy, and rest. Surgery is necessary in cases of unrelenting pain, severe impairment of function or incontinence.

Lumbar Radiculopathy: Lumbar radiculopathy is caused by the compression or irritation of a spinal nerve in the lower back. It causes pain that exits the spinal column and goes down the leg. Symptoms include pain, numbness, tingling, or weakness in the arms or legs. Most patients with radiculopathy show a positive response to conservative treatment such as medications, physical therapy and chiropractic treatment within 6 weeks to 3 months. Activities that place an excessive or repetitive load on the spine are risk factors for radiculopathy. This means that anyone involved in heavy labor or contact sports is more likely to be a patient than someone leading a sedentary lifestyle. Symptoms include pinched or compressed nerves. Localized neck or back pain is also common.  Some patients report a sensitivity to light touch that feels painful in the affected area.  Physicians diagnose lumbar radiculopathy by asking questions in order to determine the exact location of the symptoms, which helps them localize the nerve that is responsible. Muscle strength, sensation and reflexes will be checked for abnormalities. Most people can obtain good relief of their symptoms with anti-inflammatory medications, physical therapy. Avoiding activity that strains the neck or back is also recommended. Surgery only becomes necessary when compression needs to be removed from the affected nerve. This is accomplished via a laminectomy or a discectomy. A laminectomy creates space by removing a small portion of the bone covering the nerve. A discectomy relieves the compression by removing the portion of the disc that has herniated out.

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