Musculoskeletal Disorders:

Facet Joint Arthropathy

What is facet joint arthropathy?
The zygapophyseal (facet) joint is a common source of neck and back pain.  Facets joints function to stabilize and support the spine.  Facet joints, like all other joints in the body, are subject to degradation from years of repetitive stress and trauma, which can lead to painful arthritis.  In addition, intervertebral disc degeneration can lead to distortion of the normal spinal architecture and accelerate arthritis of the facet joints.

Symptoms
Facet joint arthropathy will often presents as neck, shoulder, back, and hip pain.  Cervical facet disease can also lead to headaches. The pain usually does not radiate significantly but often increases with spinal twisting or bending.

Diagnosis
To diagnose facet arthropathy, your healthcare provider will ask you questions about your symptoms and do a complete physical exam. During the physical exam your healthcare provider will look for signs of facet disease, such as tenderness in the paraspinal region and pain reproduced with spinal flexion and/or extension.

These tests help make a diagnosis:

  • Imaging tests. A CT scan or MRI scan can give a more detailed look at the spinal architecture and areas of significant arthritis.
  • Diagnostic facet joint blocks.  The “gold standard” for diagnosis of this disease is injection of local anesthetic to the affected facet joints or nerves to see if symptoms improve.  Often, insurance requires that two diagnostic injections be done before moving forward with radiofrequency ablation of the affected nerves, which can provide long-term relief from facet joint disease.

Treatment
Our team will help you deal with your disease through the following

  • Medicines may include nonsteroidal, anti-inflammatory medicines that relieve pain and swelling.
  • Pain procedures such as facet joint steroid injections are done to confirm the diagnosis before moving forward with long-term treatments such as radiofrequency ablation.
  • Physical therapy may include exercises to strengthen your spinal muscles and core.
  • Yoga.  Gradually increasing flexibility with gentle movement can help prevent facet joint arthropathy and improve quality of life.
  • Acupuncture, massage, and chiropractic care may also be helpful for some people.

What can I do to prevent facet arthropathy?
Because almost everyone has some osteoarthritis of the spine by age 50, you can’t really prevent facet joint disease. But you may be able to lower your risk. Here are some ways to keep your spine healthy:

  • Get regular exercise. Exercise strengthens the muscles that support your lower back and helps keep your spine flexible. Aerobic exercises like walking, swimming, cycling, and weight training are all good for your back.
  • Maintain good posture. Learn how to safely lift heavy objects. Also, sleep on a firm mattress and sit in a chair that supports the natural curves of your back.
  • Maintain a healthy weight. Excess weight puts more stress on your back and can contribute to developing symptoms of facet joint disease.

Spondylosis

Spondylosis is a type of degenerative disease that affects your neck or back. Normally, soft disks between your vertebrae, the bones in your spine, provide cushioning. With spondylosis, these disks become compressed.  When this happens, the cartilage that lines the vertebrae on each side of the disc, where they touch, can wear away. Once this protective cartilage is gone, spurs may develop on your vertebrae where they rub together. Nerves attached to your spinal cord may have less room to pass between the vertebrae on their way out of the spine.

Facts about spondylosis
This condition becomes more common with age. Many, however, don't have symptoms—you may not even be aware that these changes are going on in your neck.

Spondylosis usually doesn't lead to disability. But sometimes these changes in the spine can cause the spinal cord or nerve roots attached to it to become compressed. This can cause your legs or hands to feel weak or clumsy.

Symptoms
Symptoms of spondylosis can include:

  • Pain in the neck that may travel to your arms or shoulders
  • Pain in the back that may travel to your hips or legs
  • Headaches
  • A grinding feeling when you move your neck
  • Weakness or numbness in your shoulders, arms, or hands
  • Weakness or numbness in your legs or feet
  • Stiffness in the neck
  • Trouble keeping your balance
  • Trouble controlling your bladder or bowels

Diagnosis
Your healthcare provider will give you a physical examination to see if you have this condition. You will probably discuss any spine injuries you've had and describe your symptoms. The healthcare provider will probably check your neck, shoulders, arms, and legs to see how well they're working. Other tests that may help make a diagnosis include:

  • Imaging tests. X-rays, MRIs, and CT scans all provide images of the structures in your spine for the healthcare provider to see. These can show the bones, disks, muscles, and nerves in and around your neck or back, as well as your spinal cord.
  • Myelography. During this test, the healthcare provider injects a dye into the fluid around your spinal cord and then does a CT scan to see how the bone spurs and disks are interacting with the individual nerves.
  • Electromyography. This test shows how well your nerves are passing along signals from your spinal cord to your muscles.

Treatment
Your healthcare provider can recommend a variety of treatments for pain relief from spondylosis, depending on your needs. These may include:

  • Medications. Nonsteroidal anti-inflammatory medicines, like ibuprofen or aspirin, and muscle relaxants may help.
  • Physical therapy. A physical therapist can teach you stretching and strengthening exercises that may ease symptoms.
  • Ice or heat. Cool your neck with an ice pack or heat it with a warming pad as directed by your healthcare provider or physical therapist.
  • Injections. A healthcare provider can inject steroid medicine into the painful joints of your neck or back.
  • Surgery. In most cases, surgery is not needed. But surgeons can do different procedures to relieve pressure on the spinal cord or the nerves leaving your spine, if necessary.

Prevention
You may not be able to prevent spondylosis, but these steps may reduce your risk:

  • Stay physically active.
  • Use good posture.
  • Prevent injuries by always using the right equipment and the right form when exercising or playing sports.
  • Avoid trauma to your neck or back.

Herniated Discs

Disk Disease (Herniation)
What is disk disease?

Disk disease is caused by a change in the structure of the normal disk. Most of the time, disk disease happens as a result of aging and the normal break down that occurs within the disk. Sometimes, severe injury can cause a normal disk to herniate. Injury may also cause an already herniated disk to worsen.

  • Bulging disk. With age, the intervertebral disk may lose fluid and become dried out. As this happens, the spongy disk (which is located between the bony parts of the spine and acts as a “shock absorber”) becomes compressed. This may lead to the breakdown of the tough outer ring. This lets the nucleus, or the inside of the ring, to bulge out. This is called a bulging disk.
  • Ruptured or herniated disk. As the disk continues to break down, or with continued stress on the spine, the inner nucleus pulposus may actually rupture out from the annulus. This is a ruptured, or herniated, disk. The fragments of disc material can then press on the nerve roots located just behind the disk space. This can cause pain, weakness, numbness, or changes in sensation.

Most disk herniations happen in the lower lumbar spine, especially between the fourth and fifth lumbar vertebrae and between the fifth lumbar vertebra and the first sacral vertebra (the L4-5 and L5-S1 levels).

What are the risks for disk disease?
Although age is the most common risk, physical inactivity can cause weak back and abdominal muscles, which may not support the spine properly. Back injuries also increase when people who are normally not physically active participate in overly strenuous activities. Jobs that require heavy lifting and twisting of the spine can also cause back injuries.

What are the symptoms of disk disease?
The symptoms of disk disease vary depending on where the disk has herniated, and what nerve root it is pushing on. These are the most common symptoms of lumbar disk disease:

  • Intermittent or continuous back pain. This may be made worse by movement, coughing, sneezing, or standing for long periods of time
  • Spasm of the back muscles
  • Sciatica – pain that starts near the back or buttock and travels down the leg to the calf or into the foot
  • Muscle weakness in the legs
  • Numbness in the leg or foot
  • Decreased reflexes at the knee or ankle
  • Changes in bladder or bowel function

How is disk disease diagnosed?
In addition to a complete medical history and physical exam, you may have one or more of the following tests:

  • X-ray. A test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Magnetic resonance imaging (MRI). A procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  • Myelogram. A procedure that uses dye injected into the spinal canal to make the structure clearly visible on X-rays.
  • Computed tomography scan (also called a CT or CAT scan). An imaging procedure that uses 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.

How is disk disease treated?
Typically, conservative therapy is the first line of treatment to manage lumbar disk disease. This may include a mix of the following:

  • Bed rest
  • Education on proper body mechanics (to help decrease the chance of worsening pain or damage to the disk)
  • Physical therapy, which may include ultrasound, massage, conditioning, and exercise programs
  • Weight control
  • Pain injections/procedures, such as epidural steroid injections
  • Use of bracing
  • Medicine to control pain and relax muscles

Can disk disease be prevented?
Maintaining a healthy weight, participating in regular exercise, and using good posture can lessen your risk for disk disease.

Spinal Stenosis

What is spinal stenosis?
Your spinal cord is a bundle of nerves that runs through a tunnel formed by your vertebrae. The tunnel is called the spinal canal.  Spinal stenosis is a narrowing of the spinal canal. Stenosis which means narrowing, can cause pressure on your spinal cord or the nerves that go from your spinal cord to your muscles.  Spinal stenosis can happen in any part of your spine but is most common in the lower back, the lumbar area.   If you have lumbar spinal stenosis, you may have trouble walking distances or find that you need to lean forward to relieve pressure on your lower back. You may also have pain or numbness in your legs. In more severe cases, you may have difficulty controlling your bowel and bladder. There is no cure for lumbar spinal stenosis, but you have many treatment choices.

What causes spinal stenosis?
The most common cause of spinal stenosis is osteoarthritis, the gradual wear and tear that happens to your joints over time. Spinal stenosis is common because osteoarthritis begins to cause changes in most people’s spines by age 50. That's why most people who develop symptoms of spinal stenosis are 50 or older. Women have a higher risk of developing spinal stenosis than men.

Besides osteoarthritis, other conditions or circumstances can cause spinal stenosis:

  • Narrow spinal canal
  • Injury to the spine
  • Spinal tumor
  • Certain bone diseases
  • Past surgery of the spine
  • Rheumatoid arthritis

What are the symptoms of spinal stenosis?
Early spinal stenosis may have no symptoms. In most people, symptoms develop gradually over time. Symptoms may include:

  • Pain in the back or neck
  • Burning pain going into the buttocks and down into the legs (sciatica)
  • Numbness, tingling, cramping, or weakness in the arms or legs
  • Loss of sensation in the hands or feet
  • A weakness in a foot that causes the foot to slap down when walking ("foot drop")
  • Loss of sexual ability

Pressure on nerves in the lumbar region can also cause more serious symptoms known as cauda equine syndrome. If you have any of these symptoms, you need to get medical attention right away:

  • Loss of bowel or bladder control
  • Severe or increasing numbness between your legs, inner thighs, and back of the legs
  • Severe pain and weakness that spreads into one or both legs. This makes it hard to walk or get out of a chair

How is spinal stenosis diagnosed?
To diagnose spinal stenosis, your healthcare provider will ask you questions about your symptoms and do a complete physical exam. During the physical exam your healthcare provider will look for signs of spinal stenosis, such as loss of sensation, weakness, and abnormal reflexes.

These tests help make a diagnosis:

  • X-rays of your spine. These may show bone growths called spurs that push on spinal nerves and/or narrowing of the spinal canal.
  • Imaging tests. A CT scan or MRI scan can give a more detailed look at the spinal canal and nerve structures.
  • Other studies. Your healthcare provider might order a bone scan, myelogram (a CT taken after injecting dye), and EMG (an electrical test of muscle activity).

How is spinal stenosis treated?
If you have spinal stenosis, many types of healthcare professionals can help you, such as pain specialists, surgeons, and physical therapists. Treatment can include physical therapy, injections, medicine, and sometimes surgery. Except in emergencies, such as cauda equina syndrome, surgery is usually the last resort.

  • Physical therapy may include exercises to strengthen your back, stomach, and leg muscles. Learning how to do activities safely, using braces to support your back, stretching, and massage may also be helpful.
  • Medicines may include nonsteroidal, anti-inflammatory medicines that relieve pain and swelling
  • Pain injections/procedures, such as epidural steroid injections, may offer some temporary relief.
  • Surgical treatments include removing bone spurs and widening the space between vertebrae. The lower back may also be stabilized by fusing together some of the vertebrae.
  • Acupuncture and chiropractic care may also be helpful for some people.

What can I do to prevent spinal stenosis?
Because almost everyone has some osteoarthritis of the spine by age 50, you can’t really prevent spinal stenosis. But you may be able to lower your risk. Here are some ways to keep your spine healthy:

  • Get regular exercise. Exercise strengthens the muscles that support your lower back and helps keep your spine flexible. Aerobic exercises like walking, swimming, cycling, and weight training are all good for your back.
  • Maintain good posture. Learn how to safely lift heavy objects. Also, sleep on a firm mattress and sit in a chair that supports the natural curves of your back.
  • Maintain a healthy weight. Excess weight puts more stress on your back and can contribute to developing symptoms of lumbar spinal stenosis.

Lumbar Radiculopathy (Sciatica)

What is sciatica?
Lumbar radiculopathy, also called sciatica, is a pain that originates along your sciatic nerve. This nerve extends from the back of your pelvis down the back of your thigh. Your sciatic nerve is the main nerve in your leg. It is also the largest nerve in your entire body.

What causes sciatica?
Usually, sciatica is caused by a herniated (or bulging) disk in your spine that presses on your sciatic nerve.  Other reasons for pressure on your sciatic nerve may include:

  • Obesity
  • Poor posture
  • Tumor
  • Abscess
  • Blood clot
  • Awkward sitting position
  • Any nerve disorders

Sometimes, the cause for your sciatica cannot be identified.

What are the symptoms of sciatica?
These are the most common symptoms of sciatica:

  • Lower back pain that radiates or spreads down your buttock and the back of one thigh
  • Pain that extends from your buttock down to your foot
  • Numbness (in severe cases)
  • Weakness (in severe cases)

How is sciatica diagnosed?
Along with a complete medical history and physical exam, tests for sciatica may include:

  • X-ray. Electromagnetic energy beams make images of internal tissues, bones, and organs onto film.
  • Magnetic resonance imaging (MRI). Large magnets, radiofrequency energy, and a computer make detailed images of organs and structures in your body.
  • Electromyography and nerve conduction study (EMG and NCS). A procedure done together to record and analyze electrical impulses in your muscles. During the EMG, thin needles are placed in your muscle to record electrical activity. The NCS is often done along with the EMG to determine if a nerve is working normally. Electrodes are then placed in various locations on your skin along the nerve pathway. When stimulating the nerve at various places, your healthcare provider can then determine the specific site of your injury.

What is the treatment for sciatica?
Sciatica usually heals on its own with rest and time. To help relieve the pain, treatment may include:

  • Nonsteroidal anti-inflammatory (NSAIDS) medicines such as ibuprofen
  • Heat or cold applied to the sore muscles
  • Movement (keeping your body in motion minimizes inflammation)
  • Pain relieving procedures, such as epidural steroid injections
  • Spinal manipulation
  • Surgery (to repair your herniated disk, if the condition persists)

Compression Fractures of the Spine

What are compression fractures?
A compression fracture is a type of fracture or break in your vertebrae. The vertebrae are the bones in your back that are stacked on top of each other to make your spine. Your spine supports your weight, allows you to move, and protects your spinal cord and the nerves that go from it to the rest of your body.  Compression fractures can cause the vertebrae to collapse, making them shorter in height. This collapse can also cause pieces of bone to press on the spinal cord and nerves, decreasing the amount of blood and oxygen that gets to the spinal cord.

What causes compression fractures?
Osteoporosis is the most common cause of compression fractures. Osteoporosis is a type of bone loss that causes bones to break easily.  Other causes include injuries to the spine (such as from car accidents and sports injuries) and cancer tumors in the spine (the cancer may start in the vertebrae, but, more commonly, it spreads there from another part of the body to the bone).

Who is at risk for compression fractures?
Osteoporosis is the most common cause of compression fractures. Preventing and treating osteoporosis is the best way to decrease your risk for compression fractures. Most compression fractures linked to osteoporosis are found in women, especially after menopause, but older men develop osteoporosis and compression fractures, too.

People who have had one compression fracture related to osteoporosis are at a higher than average risk for having another one.

What are the symptoms of compression fractures?
When compression fractures first start developing, they may not cause symptoms. A doctor may discover them on an X-ray that you had done for other reasons. Later symptoms may include:

  • Slowly worsening back pain — lying on your back may relieve the pain and standing may make it worse
  • A decrease in your height
  • Limited movement in your spine (unable to bend or twist)
  • A stooped-over posture, called kyphosis (Often, the front side of the vertebra loses height, but the rear side doesn't. As a result these fractures can cause your posture to stoop forward over time.)
  • Numbness or tingling, weak muscles, problems walking, and possible trouble controlling your bowels or bladder because of nerve damage

If the fracture happens rapidly, you may feel sudden, severe, disabling back pain.

How are compression fractures diagnosed?
Your doctor may will talk to you about your medical history and recent injuries and do a physical exam. He or she will check to see where you have pain and whether your upper spine is hunched forward. The doctor may also want to get pictures of your spine using X-rays, CT, or MRI scans.

How are compression fractures treated?
If your compression fractures are related to osteoporosis, your doctor will want to treat the osteoporosis. You may need to take bone-strengthening medicine and calcium and vitamin D supplements. Physical therapy and exercises may be recommended too. These things help make your bones stronger and can help prevent other fractures.

Other types of treatment include:

  • Pain medicine to relieve your back pain
  • Wearing a back brace
  • Physical therapy to help you move better and strengthen the muscles around your spine

Different types of surgery are available and may be needed if other treatments aren't helping:

  • Vertebroplasty: Using an X-ray for guidance, your pain doctor uses a small needle to inject special quick-setting cement into your fractured vertebra. The cement provides support for the broken vertebra, strengthens the area, and usually results in pain relief.
  • Kyphoplasty: This procedure is a lot like vertebroplasty, but before the cement is injected, small balloons are used to expand the fractured space to help make the vertebra taller. The balloons are removed, and then the empty space is filled with cement.

If cancer is causing your symptoms, you may need radiation therapy as well as surgery to remove some of the bone and treat the tumor. If an injury has caused the fracture, you may need surgery to repair the bone and join vertebrae together, a procedure called fusion.

Whiplash Injury

What is a whiplash?
Whiplash is an injury to your neck. It is caused by your neck bending forcibly forward and then backward, or vice versa. The injury, which is poorly understood, usually involves the muscles, discs, nerves, and tendons in your neck.

What causes a whiplash?
Most whiplash injuries result from a collision that includes sudden acceleration or deceleration. Many whiplash injuries occur when you are involved in a rear-end automobile collision. They also happen as a result of a sports injury, particularly during contact sports.

What are the symptoms of a whiplash?
These are the most common symptoms of whiplash:

  • Neck pain
  • Neck stiffness
  • Shoulder pain
  • Low back pain
  • Dizziness
  • Pain in your arm or hand
  • Numbness in your arm or hand
  • Ringing in your ears
  • Blurred vision
  • Concentration or memory problems
  • Irritability
  • Sleeplessness
  • Tiredness

How is a whiplash diagnosed?
Along with a complete medical history and physical exam, tests for whiplash may include the following:

  • X-ray. Electromagnetic energy beams produce images of internal tissues, bones, and organs onto film.
  • Magnetic resonance imaging (MRI). Large magnets and a computer make detailed images of organs and soft tissue structures in your body.
  • Computed tomography (CT) scan.  X-rays and computer technology make horizontal, or axial, images (often called slices) of your body. A CT scan shows detailed images of any part of your body, including your bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

How is a whiplash treated?
Treatment may include:

  • Ice applications for the first 24 hours
  • Cervical (neck) collar
  • Gentle, active movement after 24 hours
  • Nonsteroidal anti-inflammatory medicines (NSAIDs such as ibuprofen)
  • Muscle relaxing medicines
  • Physical therapy
  • Pain injections
  • Osteopathic manipulation

Sacroiliac Joint Pain

What is sacroiliac joint pain?
The sacroiliac joint (“SI joint”) is a common source of pain in the buttocks and lower lumbar area.  The SI joint is formed where the pelvis and tail bone come together.  The joint is designed for stability but age-related changes and injuries to the supporting bones, ligaments, and tendons commonly lead to chronic pain.

Symptoms
SI joint arthropathy presents with pain and tenderness over the SI joint, which may be referred to the buttocks, lower lumbar region, and the back of the leg.  Prolonged sitting or standing may exacerbate the pain.

Diagnosis
To diagnose SI joint arthropathy, your healthcare provider will ask you questions about your symptoms and do a complete physical exam. During the physical exam your healthcare provider will look for signs of SI joint disease, such as joint tenderness or restricted motion.

These tests may also help make a diagnosis:

  • Imaging tests. A CT scan or MRI scan can give a more detailed look at the spinal architecture and potential causes of SI joint disease.
  • Diagnostic SI joint injection.  The most reliable means of diagnosing this disease is injection of local anesthetic and steroid into the affected joint, which can often provide long-term relief and be repeated as necessary.

Treatment
Our team will help you deal with your disease through the following:

  • Physical therapy may include exercises to strengthen your pelvic muscles and core.
  • Medicines may include nonsteroidal, anti-inflammatory medicines that relieve pain and swelling.
  • Pain procedures such as steroid injections into the SI joint.  This simple and effective procedure can often provide long-term relief from SI joint disease.
  • Yoga.  Gradually increasing flexibility with gentle movement can help prevent arthritis and improve quality of life.
  • Acupuncture, massage, and chiropractic care may also be helpful for some people.

What can I do to prevent facet arthropathy?
Because almost everyone has some osteoarthritis of the spine by age 50, you can’t really prevent SI joint disease. But you may be able to lower your risk. Here are some ways to keep your spine healthy:

  • Get regular exercise. Exercise strengthens the muscles that support your lower back and helps keep your spine flexible. Aerobic exercises like walking, swimming, cycling, and weight training are all good for your back.
  • Maintain good posture. Learn how to safely lift heavy objects. Also, sleep on a firm mattress and sit in a chair that supports the natural curves of your back.
  • Maintain a healthy weight. Excess weight puts more stress on your back and can contribute to developing symptoms of facet joint disease.

Piriformis Syndrome

Piriformis syndrome is a disorder that occurs when the piriformis muscle compresses or irritates the sciatic nerve. This occurs when the piriformis muscle becomes tight or spasms and places pressure on the sciatic nerve, which causes pain in the buttocks and along the back of the leg/foot. The pain may worsen as a result of sitting for a long period of time, climbing steps, walking, or running.

Other Disorders

  • Degenerative Disc Disease
  • Cervical Radiculopathy
  • Post-Laminectomy Syndrome (Failed Back Surgery Syndrome)
  • Coccydynia (Tail Bone Pain)
  • Tendonitis