Dr. Neelabh

A Herniated disc also known as a slip disc or prolapsed disc and it refers to the problem where one of the discs located in between the bones of the vertebrae(backbone) gets damaged and stacks itself upon the nerves. The tender inner portion of the disc gets protruded over the outer ring. Herniated disc causes severe neck pain and back pain. It occurs when the outer ring gets weak and tears down. The most common symptoms include pain and numbness, especially on one side of the body. The pain extends down to the arms and legs. It worsens during nighttime. The muscles become weak. Overweight people are likely to have this disease, as the discs carry extra weight. Old people are vulnerable to a slip disc.

Effects of Herniated Disc:

1. An untreated case of Herniated disc may cause permanent damage to the nerves.
2. In certain cases, a Herniated disc is capable of cutting off nerve impulses to the "caudal equine"nerves, present in the lower back and legs. This leads to loss of bladder control or bowel control.
3. Saddle anaesthesia is another long-term effect. Nerves are compressed by the slip disc, causing loss of sensation in the inner portions of your thighs, the back of your legs and surrounding the rectum region.
4. Symptoms may improve or worsen.

Diagnosis of Herniated Disc:

MRI of the spine is the investigation of choice. If patient has developed weakness or loss of sensation of the limbs, he might need EMG and NCV tests also.

Treatment

Treatment or diagnosis of Herniated disc or slipped disc can be either conservative or surgical in nature. The nature of treatment is determined according to your discomfort level and the kind of pain you are experiencing, or how much the disc has slipped out.

1. The pain caused by Herniated disc can be relieved by undertaking an exercise schedule, which includes stretching and strengthening the spine and its surrounding muscles.
2. A physiotherapist should be appointed for recommending the types of exercises.
3. Taking pain relievers also soothes the pain.
4. Stronger medicines prescribed by doctors include-muscle relaxants, narcotics to deal with the pain, medicines for nerve pain such as "gabapentin"  or "duloxetine".
5. In case of the symptoms not subsiding within a span of six weeks, a surgery may be recommended by your doctor. The surgeon may have to remove the damaged part of the disc. This surgery is called a microdiscectomy.

The most common reason is “high-grade osteoarthritis” due to wear and tear of the knee joint. The pre-hospital study of the Knee joint is mandatory and would decide what kind of replacement is suitable to the patient.

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.

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

*  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.

*  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.

*  Ice Pack: Use an ice pack or ice compress on your wrist for ten to fifteen minutes each every few hours to help in reliving unbearable pain.

*  Anti Inflammation 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. 

*  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.

What is Spinal Stenosis?

The narrowing of the gaps in the spine or the backbone is called as Spinal stenosis. This leads to pressure on the nerves and the spinal cord. 5% of cases of spinal stenosis are seen in the low back of the lumbar spine. In some cases the narrowing of the spine leads to the compressing of the nerve root, which leads to pain in the leg.

Causes of spinal stenosis: It can be caused by aging, arthritis, trauma to the spine, spondylolisthesis and tumor of the spine

Symptoms of spinal stenosis: There is constant pain in the back and legs as stenosis pinches the nerve responsible for sensation and muscle power. Other symptoms are numbness and tingling in the legs, frequent falling and pain while walking.

Treatment of spinal stenosis:

-  A routine program with exercises and physical therapy are the best treatment for spinal stenosis. The exercises are not a complete cure but they are beneficial in keeping the patient active. A physical therapy can be supervised and once the period of the same is over people easily transition to the exercise program. The key for exercise is starting slowly in order to build strength.

-  Generally, the patients are counseled not to perform strenuous activities as that might worsen the symptoms of spinal stenosis. In case of lumbar stenosis, patients find it comfortable when they are flexed forward. The doctor might recommend walking while being bent over and leaning when using a walker if not walking upright; sitting in recliners is also recommended instead of straight back chairs.

-  Injections of cortisone are usually given in the epidural space. This is believed to relieve the symptoms of spinal stenosis temporarily. Though there have been studies which question the use of these injections as they lead to the risk of osteoporosis related fractures. This is still being pondered over by the doctors as a suitable treatment option as it has its own benefits and risks.

-  Medications such as the antiinflammatory medicines like ibuprofen or aspirin are helpful in controlling the symptoms of spinal stenosis. Narcotic drugs might also prove to be helpful if used with care and for a short while. This is helpful for severe pain related to the nerves. Muscle relaxants like gabapentins might also be recommended. In some case anti depressants might also be given to provide relief from pain. 

Though side effects are a concern when using these medications and the patient should let the doctor knows about their allergies.