The term Sciatica is used to describe leg pain, tingling, numbness or weakness that travels down the low back via the sciatic nerve to the back of leg. Sciatic nerve arises from each side of lower spine and passes deep in the buttock along the back of thigh and legs. The pain of Sciatica may be irregular/ infrequent or persistent causing severe agony to the patients. The pain of Sciatica may be confined to low back or hips or may extend up to toes. The pain of Sciatica can be excruciating and "not relieved by painkillers".

What causes Sciatica?

Pain in Sciatica is due to irritation or pinching of Sciatic nerve within the spine. This occurs most commonly due to prolapsed intervertebral disc (slip disc) causing nerve compression resulting in pain.

Is surgery the only treatment for Sciatica?

Most patients can be managed with medication/exercises. So surgery is not the only way out. Patients who have severe pain can also benefit from "Epidural Steroid Injection". This treatment has proven to be effective in avoiding spine surgery in such patients.

What is Epidural Steroid Injection?

Epidural Steroid Injection is a procedure done by a Specialist (Interventional Pain) in an Operation Theatre using X-Ray (Image Intensifier) to locate exact level of injection. A drug mixture consisting of Steroid with Local Anaesthetic is injected at the epidural space of affected nerve root. The steroid washes away inflammatory mediators from the epidural space which decreases the pain. Steroid also decreases the inflammatory response of body to the prolapsed disc. As a result the pain arising from nerve inflammation is decreased. This is a day care procedure i.e. the patients are discharged the same day.

How is the possibility of surgery ruled out?

Epidural Steroid Injection is a proven, safe and an effective treatment that works on the concept of Interventional pain management - to provide relief from persistent and chronic pain of Sciatica. Generally, a single injection is sufficient to relieve patients of the pain. The procedure can be repeated for a maximum 3 times in a year, depending on the patient's response. With effective pain relief, surgery is negated.

Non-Surgical Treatment For Sciatica

If you suffer from rheumatoid arthritis, you may be at a high risk of developing Carpal tunnel syndrome. This is a very painful condition in which the hands and wrists are affected. The Carpal tunnel refers to a structure which is formed by the bones present in the wrist and the surrounding connective tissues, through which the nerves and tendons controlling the thumb movement pass. Carpal tunnel syndrome occurs when the connective tissues get swollen because of inflammation and the nerves passing through the tunnel are crowded and squeezed.

Ways to get relief from Carpal tunnel syndrome:

Here are some common ways by which a patient with Rheumatoid arthritis can get relief from any discomfort caused due to Carpal tunnel syndrome:

Get your Rheumatoid arthritis treated. Carpal tunnel syndrome is commonly caused because of an underlying sickness such as rheumatoid arthritis. Medicines such as disease modifying anti-rheumatic drugs are used to manage the condition and for reducing inflammation which causes carpal tunnel syndrome.
Getting enough rest is also very important. You must avoid using that hand or wrist, which has been affected for some weeks. This will allow the inflamed tissue to heal. 
You may wear a wrist splinter. A splint is suggested for resting your wrist therefore, it is kept in a neutral position. It can be worn during the day or when you are sleeping.
You can take prescribed non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief. These also help in reducing the swelling of tissues within the carpal tunnel.
A Cortisone shot may also be effective for easing the carpal tunnel syndrome. These steroid injections are given directly into the carpal tunnel. You will be able to get temporary relief from pain.
A set of Carpal tunnel exercises have been developed by doctors. These are designed for stretching the wrists and for keeping them limber. You must perform these exercises on a regular basis for best results. Yoga is also effective for easing carpal tunnel syndrome. Performing regular yoga will help you to improve your wrist pain. The upper joints of the body are strengthened. 
Take breaks at work on a regular basis. By changing your position and taking short breaks, your Carpal tunnel symptoms are bound to improve. This is more essential for people who do a job where great stress is placed on the wrists. If you are into typing, you need to take breaks and stretch your wrists.
There are several alternative therapies for easing carpal tunnel syndrome, which  are being studied and researched on. They include the likes of acupuncture, chiropractic care, magnets, botox treatments and vitamin B6 supplements. 

Carpal Tunnel Syndrome - 7 Ways to Ease the Pain

Carpal tunnel syndrome is a painful one that is born from a strain on the median nerve, which loops through the wrist bone to connect it with the rest of the hand and fingers so as to promote motion. This condition can be a painful and debilitating one that usually starts at night, and affects the various fingers, especially the thumb and index finger. The symptoms include numbness, a tingling sensation, a weak grip, and the inability to do many tasks that involve the thumb and index finger. There are many ways of treating this condition with the help of physiotherapy, steroids and corticosteroids. There are easier ways of dealing with this issue on an everyday basis, as follows.

1. Wrist splint: it is a good idea to wear a wrist splint at night which will keep the bones and muscles stationary as the pain in this condition usually starts at night. This will also prevent further damage to the median nerve. 

2. Activity: keep your activity to a minimum to give your hand and rest, in particular, some much needed rest from the pain, numbness and tingling. Further, you need to avoid activities that cause too much pain and numbness. Also, take care to keep your thumb and wrist straight during other activities so that there is less strain on the median nerve.

3. Strength and flexibility: many times, the pain from the wrist and fingers can spread towards the arm as well. In order to prevent this and to treat the pain on a more long term basis, it is important to turn to some mild exercise which can make the area more flexible and strong. This can include wrist twists which can be done ten times for each hand. One can also try yoga to strengthen the joints in the upper body.

4. Ice pack: use an ice pack or ice compress on your wrist for ten to fifteen minutes each every few hours to help in relieving unbearable pain.

5. Anti-inflammatory medication: patients suffering from this condition can also turn to non steroid medication that will help in bringing down the inflammation. This inflammation is usually responsible to a great extent for symptoms like numbness and pain which can halt various activities. These drugs may include aspirin, ibuprofen, and even naproxen sodium. 

6. Taking breaks: one must take regular breaks at work and flex the fingers and the wrist so that the painful bending posture does not make matters worse.
 
Ensuring that you manage your everyday functioning despite carpal tunnel syndrome is a matter of balancing your activities with rest.

Easy Ways to Deal With Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition that causes numbness or tingling in the hands and arms besides other symptoms. Carpal tunnel is basically a narrow passage on the palm side of the wrist. This condition is caused when a nerve in the carpel tunnel is compressed. Since this median nerve runs up through the hands to the forearm, it affects the arms as well. Not only does it cause nerve pain, but also results in limited functionality of the thumb.

To prevent this syndrome, one needs to understand its causes. We have discussed some of the primary causes below:

Issues with the thyroid hormone: Hypothyroidism, an imbalance or lack of thyroid hormones in the body, can create problems that lead to issues with the overall musculoskeletal system. An over-active pituitary gland can also cause issues that affect mobility and motor skills. This can lead to or exacerbate the carpal tunnel syndrome.
Arthritis: Arthritis causes swelling and inflammation of joints and tendons, which tend to increase the symptoms of carpal tunnel. Eventually, arthritis can also lead to compression of the median nerve and other structures in the wrist, thereby leading to carpal tunnel syndrome.
Pregnancy or menopause: During pregnancy as well as menopause, women experience tingling or numbness in their hands, which is believed to be caused by carpal tunnel. Experts say that when a fluid called oedema builds up in the tissues around the wrists and other parts of the body, it puts a pressure on the median nerve, leading to pain.
Work pressure: Experts believe that behaviours can increase the risk of carpal tunnel. The other instances which cause this syndrome include physical labour, using mechanical tools and repeated stress to the wrist. However, various studies suggest that there isn t any direct association between using a computer and carpal tunnel syndrome. It may just cause different forms of hand pain.
Imbalance of body fluids: Fluid retention in the body increases the pressure within the carpal tunnel, which irritates the median nerve. This is common during pregnancy and menopause as discussed earlier.
Obesity: One of the significant risk factors for this syndrome is being obese. So be careful about gaining excess weight.
Other conditions: Certain conditions like hormonal imbalance, diabetes and kidney failure may increase the chances of carpal tunnel syndrome. It also occurs in people who usually have narrow carpel tunnels. In some cases, it is inherited and is passed from one generation to the next.
Inflammatory conditions: Illnesses that end up in inflammation, such as rheumatoid arthritis, can affect the lining around the tendons in the wrist and put pressure on the median nerve.
Fractures: A fracture in the wrist can cause narrowing of the carpal tunnel and irritate the nerve. 

Carpal Tunnel Syndrome - Most Common Causes

Spinal fractures are extremely painful and usually happen when an external force applied to the spine exceeds the vertebral column s ability to bear the load. Many times, the bone fragments pinch and damage the spinal cord, which leads to an injury or dislocation of the bony vertebra. Although spinal fractures can develop anywhere along the spine, the most common site is the lower back.

What causes spinal fractures?

Spinal fractures can occur due to both minor trauma/falls and major accidents. The following are the probable causes of such fractures-

  Injuries sustained while playing a sport
  A traumatic injury
  Spinal instability
  Injuries sustained after falling from a height
  A whiplash
  Injuries sustained in an accident
  An underlying condition such as Osteoporosis, which causes the spinal bones to weaken

Symptoms observed:

Spinal fractures are characterized by the following symptoms-

  Muscle spasm and swelling
  Numbness
  Acute pain that worsens when you walk or stand for a long time
  A tingling sensation
  Restricted mobility of the spinal column
  Spinal deformity/disability
  Sudden onset of pain in the lower back region

What are the various types of spinal fractures?

Spinal fractures primarily fall into four categories, namely the following-

  Compression - Compression fractures are quite common in people with osteoporosis or bone cancer. The bones become fragile and brittle. If sudden force is applied with extreme pressure, the vertebra may not be able to support the load and that may result in a fracture.

  Burst - Severe trauma, such as a car accident can cause burst fractures. The external pressure is so much that the vertebra gets crushed. As a result, the bony fragments spread out and cause spinal cord injury. Unlike a compression fracture, where only a part of the vertebra is damaged, a burst fracture leads to multiple fractures in the vertebra.

  Flexion-distraction - This type of fracture is likely to happen if you are involved in a car accident. Normally, the spine is made to flex forward. However, a sudden jerk that pushes your body forward can put a lot of pressure on the spine and cause the vertebrae to break.

  Fracture-dislocation - This debilitating condition results from a torn ligament and broken bone.

What is the treatment for spinal fractures?

Treatment options for spinal fractures include both non-surgical and surgical methods.

  Non-surgical treatment - Most cases of spinal fractures can be treated with immobilization in a corset or brace for up to 10-12 weeks. Bracing will help prevent deformity and reduce pain.

  Surgical treatment - The doctor may recommend surgery in severe cases. The two standard surgical procedures are-

Vertebroplasty - The surgeon will insert a tube, known as a catheter, into the compressed vertebra. Through the catheter, he/she will inject bone cement into the fracture site. This will harden and stabilize the vertebral column. Vertebroplasty has proved to be an effective procedure to reduce pain. The surgery restores mobility and prevents loss of bone due to bed rest.

Kyphoplasty - During this procedure, the surgeon inserts a catheter into the spinal column under the guidance of an X-ray. Next, he/she makes small incisions along the back and inserts an inflatable bone stamp. The tamp, once inflated, bring back the vertebral body to its original height. It also creates a cavity to be filled with bone cement, which seals the cracks. The bone cement stops the vertebra from collapsing again. After the whole procedure, the surgeon will remove the catheter and stitch the incisions.

Following surgery, you will need to wear a brace for about 6-12 weeks. Physical therapy is strongly recommended initially to help you get back to your daily activities in a week or two.

Spinal Fractures - All You Should Know!

A Tennis elbow is a painful condition that affects the tendons due to a condition known as tendinitis, which causes inflammation. This condition will end up restricting the free movement of the elbow and the arm due to the pain and stiffness that it causes. This is due to the fact that these tendons are the tough band of connective tissues that hold the muscles and the lower arm with the bone. Repeated gripping motions and continued tugging as well as activities like weight lifting, tennis, squash and other like carpentry, painting writing and typing, can lead to this condition. 

Here are a few methods of treatment and the questions that revolve around them.

Do I have to restrict my movements: Yes, when you have tennis elbow, the very first thing you must do is to give rest to the tendons by curbing those activities that have caused the condition or those which can aggravate the pain and stiffness. Lifting heavy objects, gripping things for prolong periods, other physical pursuits like tennis and other games and more will need to stop so that you do not stretch, strain or pull the tissue.
Can I take pain killers: Yes, you can take pain killers like ibuprofen and acetaminophen in case the pain is unbearable? Always ensure that an orthopaedic specialist takes a look at your arm before prescribing the medicines to you.
Is an ice compress good for this pain: You can use the RICE method for acute pain that is less than 72 hours old. For more persistent pain, you must see a doctor. The RICE method refers to Rest, Ice, Compression and Elevation. In this method, you can keep your arm elevated and give it rest. You can also use an ice compress and keep it tightly wound with an elastic bandage so as to avoid swelling.
Can I take injections for this condition: Corticosteroid injections may be used for very severe cases. This contains the cortisol hormone and can give good results in the short run.
Are there any non invasive methods for treatment: You can try non-invasive procedures like shock wave therapy which will help in fixing the pain and promote motion gradually. This procedure is usually conducted with the help of shock waves that are passed to the skin.
Is exercising a complete no no: In this case, many orthopaedic surgeons and doctors will ask you to go through physiotherapy so that you can get used to movements and motion after prolonged pain. These exercises will also strengthen the muscles of the area.
Talk to your doctor if the pain is particularly debilitating and discuss surgery for the same.

Common FAQs on Tennis Elbow Treatment

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