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  • 23
  • Jun
Nerve Root Impingement
ps Lower Limb,Neck and Back,Spine Comments Off on Nerve Root Impingement

A variety of conditions can cause pressure on one or more nerves as they leave your vertebral column in the middle and lower back. And, depending on the cause, the severity of symptoms, also known as “radiculopathies,” can vary.

Symptoms for Nerve Root Impingement

Pressure on the nerve roots often causes what is known as “radicular pain” – that is, pain that seems to come from some distance away from the site of the original problem. This is because the nerves that emerge from your spine form the link between your brain and you outlying tissues: if they are pinched or damaged, you’ll feel pain in the areas that they supply.

The symptoms of nerve root trouble in the middle and lower back can vary from back pain and numbness to nerve pain. Bending forward or sitting tends to relieve the pain of spinal stenosis because this flexed position enlarges the space available for the spinal cord or cauda equina, a bundle of nerves at the end of the cord. There may no symptoms until the condition has been present for some time. In other cases, there’s an immediate onset of pain.

What Causes Impingement on the Nerve Roots?

There are a number of ways a nerve root can become compressed in this area:

Spinal Stenosis

Spine Anatomy
Spine Anatomy

A narrowing of the canal and bony openings (foramina) through which the spinal cord travels and the nerve roots emerge, spinal stenosis can cause a number of nerve root problems in the lumbar spine. The lower part of the lumbar region is more often affected than the upper part.

Spinal stenosis is usually the result of the aging process, when osteoarthritis sets in and your discs become drier and shrink. The growth of bony projections – spurs, called osteophytes, that protrude into the canal and foramina can also contribute to nerve root problems.

Other causes of the spinal stenosis are a herniated or bulging disc, inflamed facet joints, a vertebra that has slipped forward (spondylolisthesis), trauma (such as road accident or fall from a ladder), scoliosis, bone disease, a tumour of the spine, or a congenital defect of the spine, such as a narrower that usual spinal column that has been present from birth.

Slipped Disc and Disc Bulges

Herniated Disc

Unfortunately poor movement patterns, such as bending with your back rather than your legs o pick up things, can damage the innermost rings of your vertebral discs. The damage gradually spreads to the outer rings, allowing the gel-like fluid in the center to leak out. If the outermost rings are still mainly intact, the fluid causes a bulge, which can press into the central spinal canal or into the space where the nerves leave your spine, and pinch them – causing, for example, problems such as sciatica. If all the rings are damaged, and the fluid seeps out of it, the disc ruptures and “slips” – what doctors call a “prolapse” or “herniation.”

Facet Joint Problems

These tiny joints are located at the back of the vertebrae. They are the joints at which the upper part of each vertebra joins the lower part of one above it, and the lower part joins the upper part of the one below. But if, for example, the lumbar spine loses stability, as a result, say, of poor lifting technique, the fibrous tissue surrounding the facet joints can thicken in an effort to regain stability and protect the area. This can not only pinch nerves as they leave the vertebral column, it can encourage the growth of bony spurs called osteophytes that will also pinch the nerves.

Proper Posture in Lifting Heavy Load

Figuring Out Nerve Root Impingement

Back pain should always be investigated by your doctor. In particular, if you experience bowel and bladder incontinence, severe numbness down the legs, muscle weakness, poor balance, or paralysis, seek immediate medical attention. Following a physical examination, and listening to an account of your symptoms, your doctor will probably be able to make a preliminary diagnosis. An X-ray, CT scan, or MRI of the spine may confirm the precise cause.

Fixing Nerve Root Impingement

Many cases of nerve root inflammation get better without treatment. If this doesn’t happen, the treatment options your doctor may consider include:

  • Physiotherapy
    This usually involves stretching and strengthening exercises. Posture and movement training are also likely to be included.
  • Medication
    NSAIDs, and injections may be helpful.
  • Surgery
    May be an option to relieve pressure on your spinal cord and/or nerve roots.

Nerve Root Impingement Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

Book Appointment Online for Nerve Root Impingement Treatment

  • 23
  • Jun
Neck Injuries
ps Neck and Back,Spine Comments Off on Neck Injuries

Minor neck injuries may result from tripping, falling a short distance, or excessive twisting of the spine. Severe neck injuries may result from whiplash in a car accident, or sports-related injuries.

“Burners” and “Stingers”

If you’ve played contact sports and suffered a burner or a stinger, you remember it. The pain shoots from the shoulder to the hand “like an electric shock or lightning bolt down the arm”. A burner or stinger is an injury to the nerve supply to the upper arm, either at the neck or shoulder, often following a fall onto the head – for example, following a tackle in football.

What Happens?

When the head is forced sideways and downward, it bends the neck and pinches the surrounding nerves. As a result, you may feel numbness or weakness in the arm and possibly a feeling of warmth.

Usually the symptoms subside quickly – within seconds or minutes – but in up to 10 percent of cases, the unpleasant sensations can last hours, days, or longer.

What Should be Done?

You should immediately get checked by a doctor. An examination will confirm the type of injury. If the symptoms pass, you will probably need no treatment. But you may need further medical attention if you experience weakness lasting more than a few days, neck pain, symptoms in both arms, or if you have a history of recurrent stingers or burners. Having a narrow spinal canal – spinal stenosis – may make you more prone to burners and stingers.

Whiplash

When your head is jerked violently and unexpectedly backward or forward – typically in a car accident or during contact sports – the resulting injury is known as whiplash. It can also be called cervical sprain (or strain) or hyperextension injury.

Whiplash Injury
Whiplash Injury

What Happens in a Whiplash Injury?

The pain is caused by the soft tissues (muscles, tendons, and ligaments) of the neck being forced to the very limit of their range of motion. If the ligaments are torn, there will be internal bleeding bleeding between them and the vertebrae. You may start to feel pain and experience stiffness in the neck within minutes or it make take several hours for symptoms to be felt. Further symptoms that result from whiplash may include neck spasms, dizziness, and headache.

What Should be Done?

It’s important to seek medical help as soon as possible. Modern surgical treatment with internal fixation (screws, plates, rods) has eliminated the need for cast treatment in all but the most unusual circumstances. A plastic collar may be used for a short period.

Subject to your doctor’s advice, anti-inflammatories and physiotherapy may help relieve discomfort in the early stages the recovery process.

You can expect a full recovery within a couple of weeks, although some people have problems for longer.

Neck Injury Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

Book Appointment Online for neck injury specialist Treatment

  • 20
  • Jun
Cervical Spondylosis
ps Neck and Back,Spine Comments Off on Cervical Spondylosis

As we age, the joints in our necks show signs of wear and tear and this can lead to changes in the neck vertebrae as the body adapts to joint damage. Another term for osteoarthritis of the neck is known as cervical spondylosis.

Cervical Spondylosis

Symptoms for Cervical Spondylosis

The symptoms of cervical spondylosis are variable. If you have this condition, you may find your neck has gotten stiffer over time, though the onset of symptoms can also be quite sudden. The pain may be in the neck itself, between or over the shoulder blades. If a nerve is pinched, pain and / or pins and needles can be felt from the shoulder down as far as the fingers.

You may feel numbness in your shoulders and arms and rarely, the legs – in which case you need to seek medical advice promptly. Sometimes symptoms are worse after standing or sitting (especially in a draft), or in the morning if you slept in an awkward position, when you sneeze, cough, or laugh, or bend your neck backward.

Discomfort can be mild, or you may have pain so severe that you cannot move your head. You may have attacks of vertigo if you move your head quickly. The symptoms can be constant, or you may have flare-ups. In all cases get medical advice.

Some people in whom X-rays reveal the presence of cervical spondylosis exhibit no symptoms at all.

What Causes Cervical Spondylosis?

Age is not the only cause of wear on the bones and soft tissues of the neck. Years of regular sporting activities or doing a physical job that has placed stress on the neck can have the same effect.

There are several other risk factors for cervical spondylosis. These include being overweight and lack of exercise, a past neck injury – sometimes many years before – previous spinal surgery, a damage intervertebral disc, and the effects of osteoporosis.

Prevention to Cervical Spondylosis

It’s hard to avoid the stresses and strains of everyday life that contribute to the development of cervical spondylosis. But you can reduce the impact by paying attention to the posture and lifestyle.

Fixing Cervical Spondylosis

It’s important to keep your neck gently moving so it does not stiffen up. Oral anti-inflammatories may help and the doctor may give you something more powerful on an occasional basis for flare ups.

Your doctor may recommend physiotherapy which can bring relief of symptoms to some people.

Cervical Spondylolisthesis

Sometimes a condition called spondylolisthesis can be a complication of cervical spondylosis. When it occurs in the neck, the condition is often termed subaxial subluxation. One of the vertebrae slips forward (if it slips backward the condition is called retrolisthesis) so it’s out of line with the rest of the spine. This may happen because of progressive degeneration or due to trauma such as a motor vehicle collision. If the slippage is slight, you may not experience any symptoms. But if the misaligned vertebra presses against a nerve, the pain can be severe and you may have tingling or numbness in the arms and / or legs.

What is the Treatment for Cervical Spondylolisthesis

The treatment for spondylolisthesis is initially the same as for cervical spondylosis. But if things do not settle down, you may need a surgery. Fusion of the vertebrae around the area of slippage is an option that if often recommended, especially when there are symptoms of nerve compression. In some cases the vertebrae are fused where they are after the slip.

Cervical Spondylolisthesis Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

Book Appointment Online for cervical spondylosis Treatment

  • 16
  • Jun
Wry Neck
ps Neck and Back Comments Off on Wry Neck

You will certainly know if you’ve had the temporary disabling condition called wry neck, known medically torticollis.

Symptoms of Wry Neck

Torticollis

You can go to bed feeling just fine and wake up in the morning hardly able to straighten your head and neck. As well as looking lopsided, you may also experience headache, head tremors, or neck pain. Your neck muscles will feel stiff and tender and one shoulder may be raised. See a doctor at once if you believe you may have suffered a neck injury.

What Causes Wry Neck?

The cause is usually soft-tissue damage or irritation. Common triggers include exposure of the neck muscles to cold – for example, by sleeping in a drafty room – sitting or sleeping in an unusual position without proper neck support or with too many pillows, poor posture in front of a computer screen, or carrying a heavy, unbalanced load.

A tendency to wry neck can run in families – when it is known a spasmodic torticollis – and usually starts with muscle spasms in middle age. Without treatment, the condition can become permanent. Babies can be born with wry neck if their head is in the wrong position in the womb or if the muscles or blood supply to neck are damaged.

Figuring Out What’s Wrong With Your Wry Neck

Your doctor will probably be able to make a diagnosis by taking a history and examining you. To rule out more serious causes of your problem, he or she may send you for further tests like an X-ray or MRI.

Fixing Wry Neck

The good news is that torticollis usually passes within a day or two, though you may still have some symptoms after a week or more. Applying heat may ease the stiffness. You could also try a soft neck collar.

Oral anti-inflammatories may be helpful. Or your doctor may prescribe something stronger such as a muscle relaxant or a drug used to treat muscle spasm – orally or by injection. In a few cases surgery may become necessary.

In children who are born with torticollis, the aim is to stretch their shortened neck muscles; treatment is usually successful, if started early.

Wry Neck Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

Book Appointment Online for Wry Neck Treatment

  • 14
  • Jun
Rheumatoid Arthritis
ps General Comments Off on Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a “rheumatic disease”, that can affect the organs and systems of the whole body. It is a serious, long-term, and progressive condition, but one in which there are often periods in which the disease does not cause any symptoms. Fortunately, modern treatment can prolong these symptoms-free periods and slow the disease process.

Rheumatoid arthritis is an autoimmune condition, in which the body’s defense mechanism attacks its own tissues. It affects about three times more women than men. It can strike at any stage of life, but it usually becomes apparent between ages 40 and 60.

Symptoms

In RA, joints lubricated by synovial fluid become inflamed – and a large number of the joints in your body, including the facet joints of the vertebrae, are synovial. This inflammation leads to a reduction in mobility and damage to bones and cartilage. In the spine, the cervical (neck) vertebrae are most commonly affected by this condition.

The symptoms of RA tend to come and go, often being inactive for months or even years. This makes the condition difficult to diagnose early. The hands and wrists are often the first to be affected, leading over time to severe deformities.

The disease often affects the cervical vertebrae, leading to pain at the base of the neck as the vertebrae become unable to support the weight of the skull, and so slip bit, leading to deformities and the serious risk of spinal cord compression at the base of the skull.

Compression in other areas of the spine may first become apparent if your gait starts to change. You may also experience weakness and problems in keeping your balance. When the condition is active, there is muscle and joint stiffness, frequently accompanied by tiredness, a raised temperature, and a loss of appetite.

RA can also affect other organs and systems of the body, such as the lungs, kidneys, heart, liver (“Felty’s syndrome), and the eyes (“Sjogren’s syndrome), which often become dry and inflamed.

Rheumatoid Arthritis

What Causes Rheumatoid Arthritis?

Nobody knows for sure. What is clear is that a family history of RA predisposes to it, and there is strong evidence that cigarette smoking, stress, and obesity are all risk factors.

It is thought that, especially when risk factors are present, a viral or bacterial infection may trigger an autoimmune response in which your body’s defensive immune system starts to target your body’s own tissues.

Figuring Out What’s Wrong

A doctor may first suspect RA after looking at your joints to see whether they are swollen, twisted in any way, or tender; stiffness (characteristically in the morning) and decreasing mobility are also key indicators. The relative numbers of small and large joints affected are an important part of the diagnosis. Blood samples are also taken. In about 80 percent of people who have RA, an antibody – that is, a protein that destroys material identified as foreign – called “rheumatic factor” is found, but some people who have this antibody in their blood do no have RA.

Fixing Rheumatoid Arthritis

The earlier a diagnosis is made and treatment can start the better in order to reduce the risk of irreversible joint damage.

The pain of RA can be relieved by oral medication, physiotherapy or injection.

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