Nerve and General MSK Pain

What is physical medicine and rehabilitation?
Physical medicine and rehabilitation (PM&R), also called physiatry, involves the prevention, diagnosis and treatment of disorders, particularly related to the nerves, muscles and bones, that may produce temporary or permanent impairment.
What is a physiatrist?
Physiatrists are rehabilitation physicians that specialize in treating nerve, muscle and bone injuries or illnesses that affect how you move. Physiatrists treat a wide range of problems from sore shoulders and nerve compressions to spinal cord injuries. Their goal is to decrease pain and enhance performance without surgery.
What is a nerve entrapment?
A nerve entrapment, also known as a nerve compression, nerve impingement and pinched nerve, occurs when a nerve suffers from chronic compression by surrounding tissues.
What are the symptoms of a nerve entrapment or pinched nerve?
Symptoms from a nerve entrapment include numbness or weakness, tingling, a “pins and needles” or burning sensation, and pain radiating outward from the injured area.
What causes a nerve entrapment or pinched nerve?
A nerve entrapment may result from compression, constriction or stretching; ligamentous scarring from trauma; bony enlargement due to arthritis; or muscle enlargement from overuse.
Where can a nerve entrapment or pinched nerve occur?
A pinched nerve can occur in many places. For example, a herniated disk in your lower spine may put pressure on a nerve root, causing pain that radiates down the back of your leg (sciatica). Likewise, a pinched nerve in your wrist can lead to pain and numbness in your hand and fingers (carpal tunnel syndrome).
What are some common nerve compression or entrapment syndromes?
Common nerve compression syndromes include carpal tunnel syndrome, thoracic outlet syndrome, piriformis syndrome, cubital tunnel syndrome and radial tunnel syndrome.
How are nerve entrapments treated?
Treatment depends on the location of the entrapment. Typically, nerve entrapments are initially treated conservatively. Physical therapy and splinting are attempted for several weeks. If no improvement occurs, your doctor may consider a surgical procedure in which the structures that are compressing the nerves are divided or even removed, thus relieving the compression.
What is arthritis?
Arthritis is joint inflammation, and it can affect the knees, hands/wrists, hips, lower back, neck or any joint in the body. There are over 100 types of arthritis, and this number is growing. The most common types are osteoarthritis, which may affect the spine as well as the joints, and rheumatoid arthritis.
What is a herniated disk?
Disks are the rubbery, or jell-like cushions between the individual bones (vertebrae) that comprise your spine. A herniated disk, also known as a ruptured or slipped disk, occurs when some of the softer "jelly" pushes out through the outer harder part of the disk causing pain, numbness and/or weakness.
What are the symptoms of a herniated disk?
A herniated disk can irritate nerves and cause pain, numbness or weakness in an arm or leg.
How do you treat a herniated disk?
Treatments for herniated disks vary depending on the severity of the condition. The most common treatments include physical therapy, muscle-relaxing medications, pain or anti-inflammation medications, local injections of cortisone and surgical options. Many people with a disc herniation respond well to non-surgical measures that include rest and avoiding strenuous activity that can aggravate the condition.
What is shingles?
Shingles is a painful skin rash caused by the varicella zoster virus. The rash usually appears in a band, a strip or a small area on one side of the face or body. It is also known as herpes zoster.
What causes shingles?
Shingles occurs when the virus that causes chickenpox re-emerges in your body. Once you have had chickenpox, the virus is dormant in your nerve roots. In some people, it stays dormant forever. In others, the virus "wakes up" when disease, stress or aging weakens the immune system. Some medicines may also trigger the virus and cause a shingles rash.
What are the symptoms of shingles?
Shingles symptoms happen in stages. At first you may have a headache or be sensitive to light. You may also feel like you have the flu but not have a fever.

Later, you may feel itching, tingling or pain in a certain area. That's where a band, strip or small area of rash may occur a few days later. The rash turns into clusters of blisters that fill with fluid and then crust over. It takes two to four weeks for the blisters to heal, and they may leave scars.

Some people only get a mild rash, and others don’t get a rash at all. It's possible that you could also feel dizzy or weak, or you could have long-term pain or a rash on your face, changes in your vision, mental confusion or a rash that spreads.

Who gets shingles?
Shingles is most common in older adults and people who have weakened immune systems because of stress, injury, certain medications or other reasons. Most people who get shingles will get better and not experience it again.

Shingles is not a contagious disease, but there is a small chance that a person with a shingles rash can spread the virus to another person who hasn't had chickenpox or been vaccinated against the condition.

How is shingles treated?
Shingles is treated with antiviral and pain medications. If you think you have shingles, call your doctor to start the antiviral medicine right away. The sooner you start the medication, the faster and less painful your rash will be.

Good care at home can help you feel better faster. Take care of any skin sores and keep them clean. Take your medicines as directed. If you are bothered by pain, tell your doctor. He or she may write a prescription for pain medicine or suggest an over-the-counter pain medication.

What is Electrodiagnostic (EMG/NCS) Medicine?
Electromyography (EMG) and nerve conduction studies (NCS) are electrodiagnostic tools that help identify the source of muscle weakness, pain or numbness.

EMG and NCS tests evaluate the electrical activity of muscles and peripheral nerves in the upper and lower limbs. Doctors with specialized training in electrodiagnosis interpret the muscle and nerve responses to determine the most effective treatments.

Who requires an EMG/NCS?
Patients who require an EMG/NCS generally need a diagnosis relating to some type of neuromuscular disorder. EMG and NCS tests help find the cause of a variety of conditions relating to muscles, such as paralysis, pain, spasms, numbness and tingling, and weakness. Results can also help to pinpoint the location of the problem, whether it is in the muscles themselves or is originating from the spinal cord or nerves.

EMG and NCS aid in diagnosing:
  • Carpal tunnel syndrome
  • Focal nerve injuries
  • Muscle disorders, such as multiple sclerosis and ALS (Lou Gehrig's disease)
  • Nerve injuries in the neck and back
  • Neuromuscular diseases
  • Peripheral neuropathies, such as muscular dystrophy
What are sports injuries?
The term “sports injury,” in the broadest sense, refers to injuries that most commonly occur during sports or exercise. Some sports injuries result from accidents; others are due to poor training practices, improper equipment, lack of conditioning or insufficient warm-up and stretching.

Although virtually any part of your body can be injured during sports or exercise, the term is usually reserved for injuries that involve the musculoskeletal system, which includes the muscles, bones and associated tissues like cartilage.

What are some common sports injuries?
Common sports-related injuries include sprains, strains, knee injuries, compartment syndrome, shin splints, Achilles tendon injuries, fractures and dislocations.
How do you treat a sports injury?
It’s best to start the RICE (rest, ice, compression and elevation) treatment immediately after a sports injury. If the injury is not severe, you may continue treatment at home. For more serious or chronic injuries, contact your doctor for a specialized treatment plan.
What is anti-aging medicine?
Anti-aging medicine is a clinical/medical specialty and field of scientific research aimed at the early detection, prevention, treatment and reversal of age-related decline.
What is regenerative medicine?
Regenerative medicine optimizes the body's endogenous mechanisms of self-repair and adds exogenous treatments and technologies.
What causes lower back pain?
For most people, a specific cause of lower back pain is never found. It’s estimated that a clear explanation can be identified in only about 10 to 15 percent of cases. Among the common causes, however, are the following:
  • Muscle or ligament strain
  • Degenerative joint disease
  • Disk disease
  • Spinal stenosis
  • Spondylolisthesis
  • Osteoporosis with compression
When is lower back pain considered chronic?
Lower back pain is considered chronic if it has been present for greater than three months.
Is lower back pain ever life threatening?
Fortunately, life-threatening causes are rare, representing less than one percent of all cases of back pain. Of these rare causes, infection and cancer top the list.
How is lower back pain treated?
Lower back pain can be treated in a number of ways and depends on the cause.

Conservative treatment is usually tried first and may include physical therapy, stretching and massage. Acetaminophen, anti-inflammatory drugs (such as naproxen sodium or ibuprofen) or a muscle relaxant may be helpful. Rest is recommended only as required by the severity of pain; activity, if tolerated, is encouraged. If a life-threatening cause of pain is not suspected, you can consider alternative and complementary therapies, including acupuncture, chiropractic care or homeopathy.

Any life-threatening cause needs to be directly addressed by your doctor.

Is neck pain common?
Yes. Neck pain is a common complaint and is usually not severe. Rarely, neck pain can be a symptom of a more serious problem. Seek medical care if your neck pain is accompanied by numbness or loss of strength in your arms or hands or if you're experiencing shooting pain in your shoulder or down your arm.
What causes neck pain?
Some common causes of neck pain include:
  • Abnormalities in the bone or joints
  • Trauma
  • Poor posture
  • Degenerative diseases
  • Tumors
  • Muscle strain
What is interventional pain management?
Interventional pain management refers to minimally invasive procedures to help treat pain and related disorders.
What kinds of symptoms are treated?
Many different types of pain problems are treated with interventional pain medicine but the most common are chronic lower back pain, sciatica, neck pain and joint pain.
What types of procedures are used?
The most common procedures are X-ray guided injections to deliver corticosteroids to relieve inflammation in spinal structures caused by herniated discs, spinal stenosis or arthritis. These procedures include epidural steroid injections, facet joint injections and sacroiliac injections.