Category: Treatments

Temporomandibular joint disorder (TMJ) is defined by an aching in the chewing muscles of the jaw. It is often associated with limitations in the ability to move the jaw as well as with clicking or popping sounds in the jaw. The pain generally occurs around the temporomandibular joint in the jaw, the sides of the face and head, the back of the head and the neck and shoulders. The pain is usually described as intermittent, dull and aching, but can sometimes be constant. The pain is often made worse by chewing hard food or by yawning. Symptoms can continue for years. Some patients feel their jaw does not move correctly when opening or closing the mouth. Their teeth may not meet when the mouth is closed as well.

Diagnosis

Careful examination of the mouth and dental structures is usually undertaken as a first step. Additionally, careful examination of the muscular structures at the sides and back of the head, neck and shoulders helps to determine the extent of the problem. X-rays of the temporomandibular joint are sometimes used. MRI examinations can give additional detail and show if there is displacement of the disk or arthritis in the temporomandibular joint itself. Other diseases including rheumatoid arthritis, inflammation of the arteries at the sides of the head, infections and tumors can also cause these symptoms. Appropriate tests for these diseases are undertaken as necessary.

Treatment

Treatment of temporomandibular joint dysfunction (TMJ) often involves a team of specialists for best results. Dental specialists help with splints applied in the mouth. Injections of anesthetic medications around the muscles over the joint can be helpful in reducing the pain from TMJ dysfunction. Nerve block treatments to help reduce pain in regions of the head, neck and shoulders related to this disorder are also helpful in long-term treatment. Physical therapy methods to reduce muscle irritability in the jaw as well as in the neck and shoulders are also useful treatments for TMJ dysfunction. The utilization of biofeedback training and relaxation therapy in conjunction with these other measures can provide additional relief in selected patients.

Download the information sheet in pdf

Carpal tunnel syndrome is a disorder affecting the middle nerve of the wrist. This nerve is important because it helps operate our hand and supplies sensation to the skin of the hand. This nerve can get pinched where it passes over the bones of the wrist and underneath a strong ligament through an area called the carpal tunnel. The tunnel and surrounding tissues can get inflamed from repetitive use. This inflammation causes the tissues to swell, which puts pressure on the nerve and results in nerve damage. This compression of the median nerve is called carpal tunnel syndrome. Carpal tunnel syndrome is common in people who use their hands for repetitive activity, such as meat packers, computer keyboard operators, mechanics, carpenters and hairdressers. It is associated with diabetes, pregnancy and rheumatoid arthritis.

Diagnosis

The symptoms of carpal tunnel are numbness, pain and tingling in the hand, which is confined to the thumb, index finder and middle finger. This pain can occasionally shoot up the arm as far as the shoulder. The patient may also complain of weakness in the hand and decreased grip strength. There are certain physical signs the doctor will look for when he examines the patient with possible carpal tunnel syndrome.  These are called Tinels and Phalens. During both of these tests, the doctor will stress the median nerve by either tapping it or bending the hand. He will look for increased symptoms and pain. The diagnosis can be confirmed with a nerve conduction study, in which the electrical potential of the nerve is recorded with a fine needle. The neurologist will look for a decreased velocity of conduction in the median nerve. If this is present, the diagnosis is confirmed.

Treatment

The mainstay of treatment with carpal tunnel syndrome is to avoid the activities causing the disorder. In addition, splints are prescribed to keep the hand and wrist straight, especially during sleep because the middle nerve is compressed when we bend our wrist. Many of us bend our wrists unconsciously at night while we sleep especially when we grasp a pillow. That is why it is so important to wear the splint at night. Injections of anti-inflammatory drugs into the middle nerve can help as well. If it is impossible to change our daily activities or if carpal tunnel syndrome does not respond to injections and splinting, surgery becomes an option. During surgery, the doctor will splint the ligaments that are binding the nerves. This is called a carpal tunnel release, which is done as an outpatient procedure under local anesthetic. The patient can be back home within a few hours. Carpal tunnel syndrome can be readily treated if it is diagnosed early. The results of treatment are usually good. It is important to work closely with your doctor when managing carpal tunnel syndrome.

Download the information sheet in pdf

Constipation is defined as: Difficulty passing stool Incomplete passing of stool Infrequent passing of stool

Causes of constipation may include:

• Chronic use of medications
• Chronic use of enemas
• Diagnostic procedures
• Emotional stature Neuromuscular impairment
• Gastrointestinal lesions
• Immobility
• Inactivity
• Lack of privacy for personal habits
• Less than adequate intake of bulk
• Medication side effects
• Musculoskeletal impairment
• Obstructive lesions
• Pain on defecation
• Pregnancy
• Weak abdominal musculature fibers

Constipation in pain management is common as many patients receive opioids to manage their chronic pain. Opioids decrease the motility of the gastrointestinal tract, thereby delaying the passage of the stool. Tolerance does not develop to constipation as it does to the other side effects of opiates.

Diagnosis

Patients with constipation complain of:

• Abdominal pain
• Appetite impairment
• Abdominal pressure
• Back pain
• Feelings of fullness
• Hard formed stool
• Headache
• Inability to defecate
• Nausea
• Pain with defecation

Along with attaining the patient’s history, the health care provider can further determine constipation by noting the lack of bowel sounds, palpating the rectal mass, and palpating the abdomen for a mass. If the problem has been noted and addressed for a couple of days without resolve, the physician may order an abdominal x-ray to view the blockage and the cause of the blockage if visible.

Treatment

Constipation can be treated with a liberal diet of fruits, vegetables, and plenty of water.         These tend to increase the hydration in the stool allowing it to move more readily through the system. Exercise helps the colon to initiate movement to move the stool through the system. Stool softening medications may be recommended and/or prescribed by the physician.

Download the information sheet in pdf

Spinal stenosis is defined as the narrowing of the spinal column around the spinal cord or nerve roots. The spinal column is composed of a number of structures. The most delicate of these is the nerves that make up the spinal cord and branch out into nerve roots. These nerves are protected by a combination of bones, disks and ligaments. The bones have a number of joints, called the facet joints, at every level of the spine. Studies show that spinal stenosis occurs when degenerative arthritis of these facet joints leads to calcium deposits on the interior spinal ligaments. When this is coupled with a bulging disk, the result can lead to compression of a nerve root, which then causes pain and irritation. Patients may limp as a result of the pain and the reduced blood flow to the nerves. Patients may notice these symptoms occur after they walk a short distance. Resting may help relieve the symptoms. Patients will also find themselves leaning forward or flexing the lower spine to help relieve irritation of the affected nerves. Sitting for a time may also help relieve the pain. Research shows that the pain from spinal stenosis can mimic pain brought about by other spinal disorders. For most patients the condition develops slowly over time. It is quite rare for the condition to be brought about by a single incident.

Diagnosis

Doctors will often find during a physical examination that a patient with spinal stenosis will have an abnormal gait pattern. There is usually tenderness over the affected portions of the spine, with restrictions in range of motion at the waist. Doctors will often utilize X-rays, such as a CT scan, to better study the joints and bony structures in the spine. For patients who may be facing surgery, a MRI or myelogram is sometimes used to better study the nerve structures within the spine.

Treatment

Nerve block treatments or injections of anesthetic medication with anti- inflammatory medications can be quite helpful in treating the pain. These are epidural injections and are usually given in a series of three treatments over a two to three week period. If the epidural injections are not helpful, the doctors may use a nerve block designed to reduce irritation from the joints of the back that can be contributing to the symptoms. The use of oral nonsteroidal anti-inflammatory medications in conjunction with pain medications may be useful as well.

Doctors may prescribe physical therapy exercises that will initially address flexibility and proceed to strength training exercises for the surrounding muscles in order to provide support for the affected parts of the spine. For some patients with spinal stenosis, surgery is a last resort to relieve pressure on the effected nerves in the spine. This is usually reserved for patients with neurologic weakness in the affected extremities.

Behavioral interventions, including biofeedback and muscle relaxation training, in conjunction with counseling are used for patients with recurring pain when all other methods fail.  The goal is to develop coping mechanisms to live more productively with the residual pain.

Download the information sheet in pdf

The piriformis, located deep within the buttocks, is a large muscle with two large sections. The sciatic nerve is a large nerve running from the base of the spine down through the back of the leg and passes through the two piriformis muscle bundles. If the muscular tissue or the connective tissue around this muscle becomes inflamed or swollen, it can irritate the sciatic nerve and cause pain that reaches from the buttocks down through the leg. Some patients will complain of lower back pain as well. Typically pain is worse while sitting and especially while driving a car.

Diagnosis

During a physical examination the piriformis muscle is tender. Stretching the muscle will often cause a painful reaction. The neurologic exam is usually normal.  Symptoms of piriformis syndrome can be similar to symptoms for spinal disorders that affect the sciatic nerve such as a ruptured disk. X-ray studies of the spine such as a CT scan and a MRI are used to insure there is not a spinal pathology causing the pain. MRI scanning of the piriformis area itself can sometimes show enlargement of the piriformis muscle with compression of the sciatic nerve. An injection of anesthetic medications around the piriformis muscle and sciatic nerve helps confirm the diagnosis. A biomechanical screen performed by the physical therapist can also help confirm the diagnosis.

Treatment

Many patients will find relief  from  the pain with injection therapy around the piriformis muscle and sciatic nerve. Physical therapy is also very important in treating this syndrome. Patients with piriformis syndrome will be asked to perform exercises to stretch and condition the large muscles in the gluteal region. This will help reduce the number of muscle spasms and irritation of the connective tissue around the sciatic nerve. For some patients the use of behavioral therapy, including biofeedback techniques, helps control some of the excess muscle irritability and reduces the pain. This permits the patient to progress more efficiently through their course of physical therapy. In extreme cases of piriformis syndrome, surgery is considered, but only after conservative measures have failed.

Download the information sheet in pdf