Chester County Spine Care

A lumbar epidural steroid injection is a minimally invasive procedure for treating leg, buttock and lower back pain originating from the epidural space. The epidural space surrounds the dura, a membrane which protects the spinal cord and its nerves. The primary reasons for pain in this area are herniated or ruptured discs, stenosis, or sciatica all of which result in nerve compression. The pain may originate in any part of the lumbar region of the spine, including the coccyx, or tailbone, where it is referred to as caudal. A lumbar epidural steroid injection is usually administered in an outpatient surgical setting under local anesthetic. After the local anesthetic has numbed the skin, a small needle is inserted into the epidural space with the assistance of an imaging technique known as fluoroscopy. Once the targeted area is pinpointed, the medications, which include an anesthetic and a corticosteroid, are injected. After a lumbar epidural steroid injection, most patients return to work the next day. They normally experience immediate pain relief for a few hours after the procedure as a result of the injected anesthetic, although there may be some irritation at the injection site. In a few days, the original pain may worsen again as the anesthetic wears off. This is completely normal. In about a week, the corticosteroids will take full effect, reducing inflammation and significantly reducing pain. Depending on the patient's response, the doctor may administer as many as three epidural injections spaced several weeks apart. The effectiveness of a lumbar epidural steroid injection varies. Some patients experience long-term, or sometimes even permanent, pain relief after one injection, requiring no further treatment. Others may require additional treatment a few weeks or months later. The exact effectiveness of a lumbar caudal epidural steroid injection depends on the individual patient's condition.

Radiofrequency neurotomy is a treatment designed to provide relief from severe pain in the back or neck. It uses the heat generated by radiofrequency waves to interfere with the nerves' ability to send out pain signals. The heat generated by these waves is delivered to targeted nerve areas through special needles that are inserted, just above the spinal area, through the skin. Radiofrequency neurotomy does not usually provide permanent pain relief; its goal is to significantly decrease neck or back pain. Patients who have been previously unresponsive to more conservative methods of treatment, such as physical therapy or pain medication, are often candidates for this procedure. CANDIDATES FOR RADIOFREQUENCY NEUROTOMY People experiencing chronic back or neck pain are considered good candidates for radiofrequency neurotomy. Patients who are taking blood-thinning medications are generally not good candidates because blood thinners can cause adverse reactions when mixed with the medication that is administered during radiofrequency neurotomy. A series of diagnostic tests are performed to determine whether radiofrequency neurotomy will be beneficial for the patient. The diagnostic testing process begins with the injection of a small amount of numbing medication into the area where the pain is located. The areas of the body that have been numbed by the medication are the locations where the radiofrequency needles are placed. Once the needles have been inserted, the patient's pain level is tested. If the pain gradually lessens, the patient is a good candidate for radiofrequency neurotomy. THE RADIOFREQUENCY NEUROTOMY PROCEDURE Radiofrequency neurotomy is performed as an outpatient procedure in a doctor's office, and is usually completed within an hour. The procedure begins with the placement of an intravenous (IV) line into the patient's arm or hand. The IV is used to administer medication that keeps the patient comfortable and relaxed during treatment. A specialized X-ray machine, known as a fluoroscope, provides information that allows for the most accurate positioning of the radiofrequency needles. This ensures that only the targeted nerve tissues are affected, and that the healthy surrounding nerve tissues remain undamaged. RISKS OF RADIOFREQUENCY NEUROTOMY The risks of radiofrequency neurotomy vary. Some patients experience mild and temporary discomfort/reactions, while other patients experience serious and long-term pain or discomfort. Complications include the following: Temporary pain/numbness where the needles were placed Persistent numbness that cannot be resolved with medication Paralysis Another possible complication of radiofrequency neurotomy is bowel or bladder incontinence. RECOVERY FROM RADIOFREQUENCY NEUROTOMY Patients can return home immediately following radiofrequency neurotomy. The recovery process varies from patient to patient, though most patients need only a few days to recover. One of the most commonly reported side effects of the procedure is mild, temporary soreness throughout the body; it is typically treated with rest, or over-the-counter pain medication. RESULTS OF RADIOFREQUENCY NEUROTOMY Radiofrequency neurotomy is more successful in some patients than others. The relief the procedure provides is only temporary, and lasts anywhere from just a few months to up to 2 years. Radiofrequency neurotomy can be repeated if pain recurs.

A bursal sac is filled with fluid that provides a cushion between muscles/tendons and bones to decrease friction and irritation. There are bursal sacs around most of the body's joints. When a bursal sac gets infected or inflamed, it can lead to a painful condition called "bursitis." Although often caused by repetitive movement or overuse of a joint during sports or intense physical activity, bursitis can also result from injury, or arthritis of a joint. The most common symptoms of bursitis are pain, stiffness, swelling and tenderness, usually in the joints of the elbow, shoulder, hip, knee or ankle. The heel and Achilles tendon can also be affected. Pain, which can develop gradually or be sudden and severe, may be accompanied by decreased mobility of the joint. If conservative treatment methods are unsuccessful in treating the pain and discomfort caused by bursitis, bursal sac injections can be an effective way of reducing inflammation and diminishing pain. Anti-inflammatory steroid medication is injected directly into the bursal sac; as inflammation decreases, pain and discomfort subside, often for a few weeks or months. In some cases, one injection may be sufficient to alleviate symptoms.

By reducing inflammation, epidural steroid injections (ESIs) are used to temporarily relieve lumbar (lower back), cervical (neck), thoracic (mid-spine) and sciatic-nerve pain. ESIs contain cortisone and an anesthetic, and are delivered directly to the epidural space, which is the area between the spinal cord and the outer membrane that covers the brain and spinal cord (the dura). As a result, they provide more effective and faster pain relief than oral medications. CANDIDATES FOR EPIDURAL STEROID INJECTIONS Candidates for epidural steroid injections have back pain, and/or pain radiating down the arms and legs. Pain relieved by ESIs can be the result of many conditions, including the following: Lumbar-disc herniation Degenerative disc disease Lumbar spinal stenosis Vertebral compression fractures Cysts in a facet joint or nerve root Annular tears Epidural steroid injections can be used alone to provide pain relief, or given as part of a rehabilitation program to help a patient perform physical therapy exercises with less discomfort. Relief from a single injection can last from 1 week up to 1 year; a typical positive response lasts for 1 month. If helpful, injections can be repeated at 2-week intervals, but usually no more than 3 or 4 times per year. ESIs can also be of diagnostic value in pinpointing the source of the pain and determining its severity, which can assist a physician in developing an appropriate treatment plan. THE EPIDURAL-STEROID-INJECTION PROCEDURE Epidural steroid injections are administered by many types of physicians, including anesthesiologists, orthopedists, physiatrists, pain-management specialists and neurologists. Typically, they are administered in an outpatient facility, under the guidance of fluoroscopy, to verify that the medication is reaching the inflamed nerve root. Because the injection contains a local anesthetic as well as a corticosteroid, the injection is not usually painful, although a patient may feel pressure at the injection site. The injection procedure takes only a few minutes. In most cases, the patient experiences immediate pain relief due to the anesthetic, but the relief is temporary and wears off in a few hours. During the next day or two, however, as the corticosteroid works to reduce inflammation, the patient should feel a significant, if not total, alleviation of pain. The patient can usually resume normal activities the day after the procedure. RISKS OF EPIDURAL STEROID INJECTIONS Epidural steroid injections are a safe form of treatment, although, in rare instances, they can cause headaches, bleeding, infections, nausea or vomiting, allergic reactions or nerve damage. Patients who are pregnant, have infections, or suffer from chronic bleeding disorders are not candidates for epidural steroid injections. ESIs can temporarily elevate blood pressure and blood sugar, and cause mood swings, so patients with hypertension, diabetes or mood disorders should be monitored before, during and after treatment.

For many years, the medical community has been acutely aware of the body’s natural regenerative qualities. Physicians across all fields, including orthopedics, dentistry, and sports medicine, have implemented protocols that work synergistically with the body. The use of platelet-rich plasma (PRP) is common for promoting joint recovery and managing degenerative disease. It was only a matter of time before science discovered the value that PRP held for the body’s largest organ: the skin. We are pleased to offer PRP treatments to help our patients address their cosmetic concerns. WHAT IS PRP? PRP, or platelet-rich plasma, is an organic substance that has long been advocated for its ability to facilitate tissue regeneration and wound healing. The substance exists in every person’s blood, which makes it safe and convenient. PRP is obtained through a simple blood draw and centrifuge (spinning) process. Centrifugation of the blood separates nutrient-rich platelets from red blood cells and other product. Platelets are valuable because they contain a large number of growth factors. These include epithelial and vascular epithelial growth factors as well as fibroblast and connective tissue growth factors. Each type of growth promotes vital processes such as inflammatory response, blood vessel regeneration, tissue remodeling, and cell proliferation. WHAT ARE THE BENEFITS OF PLATELET-RICH PLASMA INJECTIONS? The growth factors contained in platelet-rich plasma are involved in almost every regenerative process in the body. When PRP is injected just beneath the skin, it stimulates collagen proliferation through which a number of benefits occur. PRP injections add volume to areas of the face that have begun to droop or atrophy. The cheeks can be rounded out and under eye hollows that cause dark circles and bags can be softened. Due to ongoing collagen remodeling, PRP injections also promote softer, smoother, tighter skin over time. Injections of platelet-rich plasma are also beneficial because they are safe for all skin types and tones. The organic nature of treatment, using your own blood product, significantly reduces the potential for side effects such as allergic response. HOW DOES PRP WORK FOR AESTHETIC REJUVENATION? Platelet-rich plasma is used in two ways to improve the appearance and overall vitality of the skin. The product may be injected beneath wrinkles, hollows, and areas of deflation and it may also be applied topically in a gentle microneedling procedure. The way that PRP improves texture, volume, and radiance is by inducing numerous regenerative processes. The various growth factors that exist within blood plasma provide essential proteins, electrolytes, hormones, and other nutrients to the skin. Proteins are integral to the formation of fibrin polymer which lays a strong foundation for firm, youthful tissue. Platelets within the plasma naturally respond to injuries in the body, prompting accelerated tissue regeneration through vascular and cellular regrowth. HOW LONG DO PRP INJECTIONS TAKE? PRP treatment with injections takes only slightly longer than an average injectable treatment. We begin with a standard blood draw. If desired, a topical numbing cream can be applied to the treatment area while blood is processed in the centrifuge. This takes just a few minutes. The provider carefully observes the face and may mark areas where injections are recommended. The entire process is typically complete within 15 to 20 minutes. Microneedling with PRP is also brief, taking approximately 30 minutes from start to finish. WHAT HAPPENS AFTER THE PRP PROCEDURE? Patients can resume normal activity immediately following their PRP procedure. Slight redness and swelling should be expected. Some patients notice minor bruising. These side effects typically disappear within the first day after treatment. HOW LONG WILL IT TAKE TO SEE RESULTS? Patients who undergo microneedling with PRP may notice an immediate boost in the radiance and softness of their skin. PRP injections work beneath the surface to restructure the collagen matrix in superficial tissue, so results from injections alone become more noticeable after a few weeks. As healing mechanisms increase, patients notice improvements such as: Smoother texture due to improved collagen formation. More radiance due to new blood vessel formation. Fresher, younger-looking skin due to the influx of vital nutrients. WHAT ARE THE ADVANTAGES OF PRP VS. OTHER INJECTABLES? Studies have indicated that patients treated with platelet-rich plasma facials and facelifts find that their results continue to improve over time. Several months after treatment, the effects of cellular regeneration may be even more noticeable than they are right after microneedling or injections. This is because plasma stimulates cellular activity in which collagen and elastin are remodeled.

Cortisone is a chemical produced by the body to counter inflammation. Cortisone produced by the body is short-acting, and has only a temporary impact on inflammation, so is not very effective in helping to heal acne cysts or nodules. Cortisone injections, however, use highly concentrated cortisone, so are more effective in immediately reducing redness and inflammation, and providing long-lasting results. Although cortisone is a steroid, it is not an anabolic steroid, which is commonly used to increase strength and muscle size, and known to have harmful side effects. Cortisone injections are used to treat severe and sustained deep-tissue acne. Severe acne may include cysts or nodules that develop on the face or other areas. Nodules are large, painful, solid lesions lodged deep within the skin. Cysts are deep, painful, pus-filled lesions. They are often difficult to clear up with common acne treatments such as topical medications. Deep-tissue acne can be painful and last for months. If left untreated, it can cause permanent scarring. Cortisone injections provide fast and effective relief. BENEFITS OF CORTISONE INJECTIONS ACNE Injected cortisone penetrates more deeply than just the top layer of skin, making it much more effective than topical solutions in treating cystic acne infection, and preventing scars from forming. SCARS Treatment with cortisone injections improves the look of keloid and hypertrophic scars that have formed as a result of acne. Keloid scars are overgrown areas of scar tissue that form at the site of a previous injury such as an incision, wound or pimple. Hypertrophic scars are red, raised scars filled with excessive amounts of collagen. Cortisone injections make these types of scars less noticeable by reducing their redness and inflammation. THE CORTISONE INJECTION PROCEDURE When used to treat acne, cortisone is injected directly into the affected area, where it starts to reduce inflammation right away. Healing of deep-tissue acne begins immediately after injection. The cortisone injection itself can hurt when placed into an already painful cyst or nodule. In those cases, a local anesthetic may be applied to numb the skin before giving the injection. Multiple treatments of the same area are not needed because cortisone produces results immediately. SIDE EFFECTS OF CORTISONE INJECTIONS The side effects of cortisone injections are minimal. The most common side effect, atrophy of the fatty tissue around the injection site that results in a slight depression in the skin, is temporary. In some cases, skin takes several months to return to normal. Immediately following an injection, the skin may swell slightly, but this quickly goes away. In dark-skinned people, a small white spot may appear at the injection site, but this, too, disappears soon afterward. There is almost no risk of allergic reaction because cortisone is naturally produced by the body. Cortisone injections for cystic acne and nodules are performed in a doctor's office.

Facet-joint injections are both a minimally invasive treatment for back pain caused by inflamed facet joints, and a diagnostic tool for determining whether facet-joint inflammation is a source of pain. Four facet joints connect each vertebra to the vertebra above and below it. A facet-joint injection, administered into either the joint capsule or its surrounding tissue, combines a long-lasting steroid and a local anesthetic. Although the anesthetic provides only temporary pain relief, the steroid reduces inflammation, and can relieve pain for anywhere from a few days to a few years. Lasting pain relief is diagnostically significant because it confirms that the pain originated in the joint that received the injection. Facet-joint injections can be repeated up to 3 times a year for those who have successful but short-term pain relief. CANDIDATES FOR FACET-JOINT INJECTIONS Patients with back pain (or pain thought to originate in the back) are candidates for facet-joint injections. Facet-joint pain can be the result of injury, spinal stenosis, sciatica or osteoarthritis. Although pain typically appears in the lumbar region, it can occur anywhere in the spine. When facet joints are inflamed, depending on the location of the inflammation, pain can be experienced in the following regions: Groin Buttocks Hips Shoulders or neck Legs or arms Facet-joint injections are often recommended after anti-inflammatory medication, a back brace or other conservative methods have failed to alleviate symptoms. A patient who is pregnant, has an infection, or suffers from a chronic bleeding disorder is not a candidate for facet-joint injections. THE FACET-JOINT-INJECTION PROCEDURE During the procedure, the injection site is first numbed with an anesthetic. The needle is then inserted directly into the facet joint through the back; fluoroscopy, an imaging technique, is used to ensure precise placement. Once the needle is correctly positioned, a combination of anesthetic and cortisone is injected into the targeted joint. The procedure takes less than 30 minutes to perform. There is immediate pain relief from the anesthetic used in the injection, but it takes several days to determine whether the cortisone has had an effect. There may be mild pain at the injection site; it can be managed by taking Tylenol and applying ice. RECOVERY FROM FACET-JOINT INJECTIONS A patient can return home shortly after receiving an injection(s), and can resume regular activities the next day. A follow-up visit to the doctor takes place in about a week; an evaluation is made of how effective the injection has been in lessening symptoms. RESULTS OF FACET-JOINT INJECTIONS Results of facet-joint injections vary widely. Some patients experience long-term, even permanent, pain relief after one injection, whereas others may need additional treatment within a few weeks or months. RISKS OF FACET-JOINT INJECTIONS Although considered safe, there are risks involved with facet-joint injections. In rare cases, they can cause infection, allergic reaction, bleeding or nerve damage.

Intra-articular hip injections are a common treatment for hip pain. Hip pain is usually due to inflammation of an arthritic or traumatized hip joint. Placing an anti-inflammatory solution into the hip joint may reduce inflammation and decrease or relieve pain. The procedure is performed in an injection suite in the office or in a surgery center. While lying face up on X-ray table the skin over the groin will be marked, cleaned and then numbed with lidocaine. After the skin is numb, a needle is directed into the hip using fluoroscopic (X-ray) guidance. During administration of the numbing agent, you may feel a slight pinch and burn sensation lasting only a few seconds. Next you may feel some pressure as the needle is advanced into the hip joint. Most patients receive benefit from the injection within the first week. Sometimes the relief is delayed, and benefit is realized the second week.

Sacroiliac-joint steroid injections help to diagnose and relieve lower-back pain caused by problems with one or both of the sacroiliac joints, which connect the spine's base (sacrum) to the pelvis's ilium bones. If one or both of the sacroiliac joints is inflamed (sacroiliac-joint dysfunction), a patient can experience pain in the buttocks and lower back that worsens when running or standing. Sacroiliac-joint dysfunction can be caused by osteoarthritis, traumatic injury, pregnancy, inflammatory joint disease, or underlying structural abnormalities. REASONS FOR SACROILIAC-JOINT STEROID INJECTIONS A sacroiliac-joint steroid injection is used to confirm a diagnosis of sacroiliac-joint dysfunction. If the injection provides pain relief, it establishes the joint as the pain's source, and, at the same time, acts as a treatment. Corticosteroids, along with a local anesthetic and saline solution, are injected directly into the sacroiliac joint, reducing swelling and pain for, possibly, several months. As with other spinal blocks, a sacroiliac-joint injection can be repeated up to 3 times a year. Spinal injections only provide temporary relief from pain; they are not a cure. For that, surgery may be necessary. THE SACROILIAC-JOINT-STEROID-INJECTION PROCEDURE To make sure the injection is placed in the correct spot, the procedure, which takes less than half an hour, is performed using imaging guidance and a contrast dye. The patient lies facedown on a surgical table, and the skin on the lower back is cleansed with an antiseptic solution. A local anesthetic is given to reduce discomfort from the injection, which contains steroid medication, saline solution and anesthetic. When the procedure is complete, the injection site is covered with a small bandage. The anesthetic in the injection provides immediate pain relief, and the steroid medication reduces inflammation within 24 to 48 hours. RECOVERY FROM SACROILIAC-JOINT STEROID INJECTIONS In some cases, a patient's legs are affected by the anesthetic, causing numbness or weakness that can make walking difficult until the anesthetic wears off. Injection-site tenderness and swelling can occur, but they are usually mild, and can be minimized by applying ice. Normal activities can be resumed the next day. Only moderate exercise is allowed, but it can be increased in duration and intensity during the following 1 to 2 weeks. RISKS OF SACROILIAC-JOINT STEROID INJECTIONS Although sacroiliac-joint steroid injections are considered safe, there are risks; they include infection, excessive bleeding, adverse reaction to medication, and damage to adjacent tissue. Post-injection, a diabetic patient may have temporary spike in blood sugar levels, and a patient with bipolar disorder may have a manic episode, making careful monitoring essential in these instances.

Lumbar facet-joint injections are both a minimally invasive treatment for lower-back pain caused by inflamed facet joints, and a diagnostic tool to determine whether facet-joint inflammation is the source of the pain. Facet joints connect each vertebra to the vertebra above and below it. A facet-joint injection, administered either into the joint capsule or its surrounding tissue, combines a long-lasting corticosteroid with a local anesthetic. Although the anesthetic provides only very temporary pain relief, the corticosteroid reduces inflammation and can relieve pain for up to a few years. Enduring pain relief from the injection is diagnostically significant, indicating that the pain originates in the facet joint that received the injection. Lumbar facet-joint injections can be repeated up to 3 times a year for those who experience successful but short-term pain relief. While this treatment is very helpful for certain patients, it is not effective in all cases. CANDIDATES FOR LUMBAR FACET-JOINT INJECTIONS Patients with pain in the lower back, hips or buttocks, or radicular pain that radiates down the legs, are likely candidates for facet-joint injections. Facet-joint pain can be the result of injury, spinal stenosis, sciatica or osteoarthritis. Facet-joint injections may be administered after anti-inflammatory medications, a back brace or other conservative methods have failed to alleviate symptoms. Although lumbar facet-joint injections can be effective in relieving pain and determining its point of origin, they are not considered safe for a patient who is pregnant, or has an infection or chronic bleeding disorder. THE LUMBAR FACET-JOINT INJECTION PROCEDURE Prior to the administration of a facet-joint injection, the injection site is numbed with an anesthetic. The needle is then inserted, using fluoroscopy (an imaging technique) to ensure precise placement, through the back and directly into the facet joint. Once the needle is correctly positioned, a combination of anesthetic and corticosteroid is injected. This procedure takes less than 30 minutes to perform. The patient typically experiences immediate pain relief because of the anesthetic used in the injection, but measurable results of the corticosteroid may take several days to appear. Mild, temporary pain can occur at the injection site, but it can be managed by taking acetaminophen (Tylenol) and applying ice. RECOVERY FROM LUMBAR FACET-JOINT INJECTIONS After receiving a facet-joint injection, the patient is able to return home shortly thereafter, and resume regular activities the next day. The corticosteroid used in a facet-joint injection may take up to a week to fully relieve pain. During a follow-up visit in about a week, an evaluation is made of how effective the injection has been in lessening symptoms. A patient is often encouraged to become involved in an exercise program that involves both stretching and strengthening exercises, which can enhance the effects of the facet-joint injection. Some patients experience long-term, sometimes even permanent, pain relief after one injection and require no further treatment; others may need additional treatment a few weeks or months later. RISKS OF LUMBAR FACET-JOINT INJECTIONS Although considered safe, there are risks involved with facet-joint injections. In rare cases, they can cause infection, allergic reaction, bleeding or nerve damage.

Trigger-point injections treat pain in areas that have developed trigger points, which are knots of muscle that form when muscles contract and but cannot relax. Trigger points are caused by injury to or overuse of the affected muscle; they can also be caused by stress and anxiety. They can irritate the nerves around them, which causes pain in other areas of the body. The chronic pain brought on by trigger points can also decrease the affected muscle's range of motion. CANDIDATES FOR TRIGGER-POINT INJECTIONS Trigger-point injections are typically used to treat pain in the neck, lower back, arms and legs. They can also be effective for tension headaches, temporomandibular joint (TMJ) pain or fibromyalgia, and for myofascial pain syndrome, a chronic pain condition in which trigger points develop in certain muscles, and cause pain when touched. Patients with this condition often experience deep, aching pain in the affected muscle that worsens over time, as well as muscle and joint stiffness, and difficulty sleeping. Symptoms can significantly affect a person's quality of life, and should be addressed if they do not subside. Over time, patients with untreated myofascial pain syndrome can develop muscle weakness or fibromyalgia. THE TRIGGER-POINT INJECTION PROCEDURE A needle containing a local anesthetic, and, sometimes, a corticosteroid to reduce inflammation, is inserted into the trigger point to make it inactive and, therefore, alleviate the pain. The procedure typically takes between 15 and 20 minutes, and is done in a doctor's office. If necessary, multiple sites can receive trigger point injections in one appointment. RISKS OF TRIGGER-POINT INJECTIONS Trigger-point injections are considered safe, and have few side effects. The patient may feel sore around the injection site for up to 2 days, but applying ice usually helps. In most cases, normal activities can be resumed the next day. Trigger-point injections not only relieve pain, they loosen the muscles that are responsible for the pain, which facilitates the rehabilitation process.

Osteopathy is an alternative system of medicine that combines elements of conventional medicine with an alternative therapy known as osteopathic manipulative treatment (OMT). Using OMT, a doctor physically moves muscles and joints to improve alignment and restore balance to the musculoskeletal system, which, in turn, is said to help all the body's systems function optimally. OMT is performed on many areas of the body, and is even used to manipulate joints of the cranium (cranial osteopathy). Osteopathic care encourages a natural form of self-healing. Osteopathic care is sometimes compared to chiropractic care, because both use hands-on physical manipulation to treat problems. The principles of osteopathic care were established in 1874 by Dr. Andrew Taylor Still, who believed that effective medical care should promote the body's ability to heal itself. Using this principle, osteopathic care focuses on treating the patient as whole, rather than simply treating specific symptoms of an illness or condition. Doctors of osteopathic medicine (DOs) work in partnership with their patients to break down barriers that inhibit quality healthcare. DOs also stress the importance of preventative care. APPLICATIONS FOR OSTEOPATHIC CARE Osteopathic care combines medicine in its conventional forms, such as prescription medications and surgery, with techniques, such as OMT and nutritional counseling, to alleviate pain, prevent illness and restore strength. Osteopathic care may be helpful for treating various conditions, including the following: Lower-back pain Neck pain Ankle injury Asthma Tennis elbow Fibromyalgia Postoperative pain Temporomandibular joint disorder (TMJ) Bronchitis Chronic obstructive pulmonary disease (COPD) Irritable-bowel syndrome (IBS) Menstrual pain Chronic migraines Carpal tunnel syndrome Sinus disorders Spinal problems (such as spinal disc injuries) Osteopathic care is also used to treat trauma caused by car accidents or sports injuries. BENEFITS OF OSTEOPATHIC CARE The physical-manipulation techniques used in osteopathic care may be effective in reducing pain and restoring strength. Osteopathic care may also provide patients with the following benefits: Reduced tension within the body Healthy flow of bodily fluids Restoration of muscle and tissue balance Relief from chronic migraines Relief from back and spinal problems Increased range of motion in the joints Decrease in stress placed on the joints Improved mobility of the cranial bones Osteopathic care may also increase blood circulation and lower blood pressure. RISKS AND COMPLICATIONS OF OSTEOPATHIC CARE Osteopathic care methods usually have few risks or side effects, although not every patient is helped by them. Patients with broken or dislocated bones, joint or bone infections, damaged ligaments, osteoporosis or bone cancer should avoid osteopathic care methods, especially OMT. Osteopathic care methods are also not recommended for patients who are pregnant or taking blood-thinning medications, or who have recently had joint surgery. Following osteopathic care treatment, a patient may experience a slight headache, fatigue or mild discomfort, although these side effects are temporary and usually disappear within 24 hours. Stroke and spinal injuries have been reported following OMT performed for neck pains, although such complications are considered extremely rare. OUTCOMES OF OSTEOPATHIC CARE The outcome of osteopathic care depends on the specific therapy used and the needs of the patient being treated. Many patients have reported successful results from osteopathic care, although scientific evidence of its efficacy is lacking. Patients often prefer osteopathic care to conventional treatment because it is usually less invasive, and less likely to cause serious side effects or complications.

When should a patient be referred for an EMG/NCS? The most frequent symptoms for a referral for an electrodiagnostic study involve numbness, tingling, weakness, fatigue, radiating and burning pain, muscle cramping and muscle atrophy. The most common neuromuscular disorders tested include nerve entrapments such as carpal tunnel and cubital tunnel syndromes, lumbar or cervical radiculopathies, polyneuropathy, plexopathy, myopathy or neuromuscular junction disorders such as myasthenia’s gravis. The study is considered to be most accurate once three weeks have passed since the symptoms first occurred, however it can be done at anytime. What is an electrodiagnostic study and how is it done? Electrodiagnostic studies are usually performed by either a Physiatrist or a Neurologist and consist of two parts, the nerve conduction study (NCS) and the electromyogram (EMG). The nerve conduction study consists of recording the nerve production and velocity by applying several small shocks to a peripheral nerve with electrodes attached to skin. This records important information such as the amplitude and conduction velocity of a nerve at several locations along its path. This can provide information to diagnose nerve entrapments as well as axonal loss of a nerve. The electromyogram is the second part of the test and is usually much shorter in duration than the nerve conduction portion of the study. This involve using a fine needle (27 gauge needles are used in our office) to analyze the electrical activity of the muscle in resting state and activated states. What occurs during an electrodiagnostic consultation? A complete history and physical examination will be performed to determine whether the study is appropriate to perform and if so which nerves and muscles should be studied. In essence the electrodiagnostic study is considered to be an extension of the history and physical exam. A differential diagnosis is considered based on the symptoms. For example, a patient presents with hand weakness and 4th & 5th digit numbness and tingling. Specific nerves and muscles will be tested to determine if this is a focal entrapment of the ulnar nerve, a lower trunk brachial plexopathy or a C8/T1 radiculopathy. Moreover, the test can localize an ulnar neuropathy to either the elbow or the wrist and determine the severity. The nerve conduction portion of the study is typically performed first followed by the electromyogram portion of the study. The test is not usually considered to be painful but at times may cause a little temporary discomfort. When the study is finished, we generally will discuss the results with you.