FREQUENTLY ASKED QUESTIONS

 
 
 
 

 

 
 

Should I apply ice or heat to an injury?

Ice should be used in the acute stage of an injury (within the first 24-48 hours), or whenever there is swelling. Ice helps to reduce inflammation by decreasing blood flow to the area in which cold is applied. Heat increases blood flow and may promote pain relief after swelling subsides. Heat may also be used to warm up muscles prior to exercise or physical therapy.

 

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What is physical therapy?

Physical therapy is the treatment of musculoskeletal and neurological injuries to promote a return to function and independent living. Physical therapy incorporates both exercise and functional training. Exercise restores motion and strength while functional training facilitates a return to daily activities, work, or sport.

 

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What is a tendon? ligament? cartilage?

A tendon is a band of tissue that connects muscle to bone. A ligament is an elastic band of tissue that connects bone to bone and provides stability to the joint. Cartilage is a soft, gel-like padding between bones that protects joints and facilitates movement.

 

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What is a cortisone/corticosteroid injection?

Cortisone is a steroid that is produced naturally in the body. Synthetically-produced cortisone can also be injected into soft tissues and joints to help decrease inflammation. While cortisone is not a pain reliever, pain may diminish as a result of reduced inflammation. In orthopaedics, cortisone injections are commonly used as a treatment for chronic conditions such as bursitis, tendinitis, and arthritis.

 

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What is an epidural injection?

An epidural injection is a method of injection a potent steroid inside of the epidural canal.  The epidural canal surrounds the spinal cord and spinal nerve roots.  Cortisone is injected directly into the epidural canal for pain relief from conditions such as herniated disks, spinal stenosis, or radiculopathy.  This often helps decrease the inflammation of compressed spinal nerves to relieve pain in the back, neck, arms or legs.  Some patients may need only one injection, but it usually takes two or three injections, given two weeks apart, to provide significant pain relief.

 

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What are NSAIDs and how do they work?

Non-steroidal anti-inflammatory drugs (NSAIDs) are non-prescription, over-the-counter pain relievers such as aspirin, ibuprofen, and naproxen sodium. They are popular treatments for muscular aches and pains, as well as arthritis.

NSAIDs not only relieve pain, but also help to decrease inflammation, prevent blood clots, and reduce fevers. They work by blocking the actions of the cyclooxygenase (COX) enzyme. There are two forms of the COX enzyme. COX-2 is produced when joints are injured or inflamed, which NSAIDS counteract. COX-1 protects the stomach lining from acids and digestive juices and helps the kidneys function properly. This is why side effects of NSAIDs may include nausea, upset stomach, ulcers, or improper kidney function.

 

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Do I need to do anything special the day or night before surgery?

  • Unless prior arrangements for conscious sedation have been made, you may eat/drink a light breakfast prior to your procedure   
    and take your normal medications unless otherwise instructed.
  • Follow your doctor’s orders regarding the taking of any medications the night before or the day of your procedure.
  • Refrain from smoking after midnight the day of your procedure.
  • Notify your physician if there is any change in your physical condition, such as a cold, fever or flu symptom.
  • If there is a chance you are pregnant, please notify your physician immediately.
  • If you are going to receive IV sedation for your procedure, you should be fasting for 8 hours prior to the procedure and must  have a driver to take you home.  Also, if you take an oral sedative prior to your procedure, you must have a driver.
 

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When should I arrive at the hospital/surgery center?

Arrive promptly at the time specified by the scheduler. If you are having a procedure at South Coast Medical Center, you will usually be asked to arrive a half-hour before your scheduled procedure.

 

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What should I wear the day of my procedure?

You may bathe or shower the morning of your procedure. Wear low heeled, comfortable shoes and loose, comfortable clothing such as t-shirts, button-down shirts, sweat pants or baggy shorts that will fit over bandages or dressings following the procedure.

 

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How long will surgery take?

The length of the procedure depends on the procedure(s) being performed.  Generally you may expect the procedure to last anywhere between 20 minutes to 1 hour.

 

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What kind of anesthesia will I receive?

Local anesthesia is used for every procedure.  Local anesthesia is an injection that provides numbness to a small area and is used primarily for minor procedures.   It is administered by the surgeon and does not require the presence of an anesthesiology provider.

If your physician deems it necessary, conscious sedation may be recommended.  Conscious sedation involves the administration of drugs to produce sedation and analgesia (insensibility to pain without loss of consciousness).  Your vital signs will be monitored closely for the duration of your sedation.  In addition, your surgeon will administer local anesthesia to the operative site.

Local anesthesia is an injection that provides numbness to a small area and is used primarily for minor surgery. It is often administered by the surgeon and does not require the presence of an anesthesiology provider.

 

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How long will I stay in the hospital/surgery center?

The time you spend in the surgery center will vary depending upon the type of procedure(s) performed, the type of anesthesia that was given, and your individual needs.  Most patients are discharged within 15 to 30 minutes after the procedure.

 

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What are the most common complications of my procedure?

Most patients will not encounter problems after the procedure.   As with any surgery, however, there are potential risks, including: reaction to anesthesia, bleeding, infection, blood clots, nerve damage, lack of full range of motion, development of arthritis, scar formation, or re-injury of the joint or soft tissue.

 

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What medications should I stop taking prior to my procedure?

You must NOT take any blood thinning medication for 1 week prior to your injection.  This includes Aggrenox (dipyridamole + ASA), Coumadin (warfarin) , Persantine (dipyramidole), Ticlid (ticlopidine), Agrylin (anagrelide HCl), Lovenox, Plavix (clopidogrel) and aspirin.  If another physician has prescribed any of these medications, let him/her know of the need to discontinue it for the week prior to your injection.

You must NOT take any anti-inflammatory medication for 3 days prior to your injection.  This includes ibuprofen, Motrin, Aleve, Advil, Celebrex, Naprosyn,etc. 

You MAY take Tylenol, Vicodin or other pain relief medication which is not anti-inflammatory. If you regularly take other prescribed medications for blood pressure or diabetes, you may take them prior to your injection with water.

 

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What happens after surgery?

You will be taken to the recovery room and monitored for a period of time.  After about 15 minutes you will be discharged as long as your condition is stable.  You may be monitored longer if necessary. 

Your nurse will review post-operative home care instructions with you, as well as explain any special instructions provided by your physician.

The first day of your injection you may use an ice pack to the area 3-4 times at 20 minute intervals as needed for comfort.

The second day of your injection you may use either a low-heat warming pad or an ice pack to the area 3-4 times as needed for comfort.

When you follow up with your doctor after your series of injections has been completed, she will discuss additional post-operative instructions such as physical therapy, when stitches may be removed, when you can return to work, how long you should take pain medications, and more.

 

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What is the difference between a sprain and a strain?

A strain occurs when a muscle is stretched or torn. A sprain occurs when a ligament is stretched or torn.

Strains are often the result of overuse or improper use of a muscle, while sprains typically occur when a joint is subjected to excessive force or unnatural movements (e.g., sudden twists, turns, or stops).

Sprains can be categorized by degree of severity:

  • A first-degree sprain stretches the ligament but does not tear it. Symptoms include mild pain with normal movement.
  • A second-degree sprain is characterized by a partially torn ligament, significant pain and swelling, restricted movement, and mild to moderate joint instability.
  • In a third-degree sprain, the ligament is completely torn with mild to severe pain, swelling, and significant joint instability.
 

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What is sciatica?

In the low back, nerves join to form the sciatic nerve, which runs down into the leg and controls the leg muscles. Sciatica is a condition that may cause radiating pain, numbness, tingling, and/or muscle weakness in the leg but originates from nerve root impingement in the lower back. Nerve impingement is most often caused by a herniated disk or spinal stenosis.

 

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What is spinal stenosis?

Stenosis refers to a narrowing of the spinal canal, usually in the lower back (lumbar) region. This narrowing is often a result of the normal degenerative aging process. It occurs as the disks of cartilage that separate the spine’s vertebrae lose water and the space between the vertebrae become smaller, causing friction between the bones. The loss of water in the disks makes them less flexible and unable to act as shock absorbers in the spine. Daily wear and tear on the spine becomes more significant without these shock absorbers.

As the disks degenerate, vertebrae may shift, causing the spinal canal to narrow. In some cases, the nerves that travel through the spinal column to the legs become squeezed. This can cause back and leg pain, and even leg weakness. Arthritis and falls also contribute to the narrowing of the spinal canal, compressing the nerves and nerve roots and causing pain and discomfort.

 

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What is degenerative disk disease?

Degenerative disk disease is a general term applied to back pain that has lasted for more than three months. It is caused by degenerative changes in the intervertebral disks in the spine and can occur anywhere in the spine: low back (lumbar), mid-back (thoracic), or neck (cervical).

Under the age of 30, these disks are normally soft, and they act as cushions for the vertebrae. With age, the material in these lumbar disks becomes less flexible and the disks begin to erode, losing some of their height. As their thickness decreases, their ability to act as a cushion lessens. The less dense cushion now alters the position of the vertebrae and the ligaments that connect them. In some cases, the loss of density can even cause the vertebra to shift their positions. As the vertebrae shift and affect the other bones, the nerves can get caught or pinched and muscle spasms can occur.

Degenerative disk disease is primarily a result of the normal aging process, but it may also occur as a result of trauma, infection, or direct injury to the disk. Heredity and physical fitness may also play a part in the process.

 

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What is a torn rotator cuff?

The rotator cuff is a group of tendons and their related muscles that help keep the shoulder and upper arm bone securely placed in to the socket of the shoulder blade. The rotator cuff stabilizes the shoulder joint and helps you to raise and rotate your arms.

There are three stages of rotator cuff tears:

  • A stage 1 tear is a partial tear less than 1 cm in size. It is accompanied by some pain following overhead arm movements, but range of motion is not limited.
  • A stage 2 tear is a partial tear greater than 1 cm but less than 5 cm in length. Pain is common during and after overhead arm movements, as well as at night. It may be accompanied by a slight decrease in range of motion.
  • A stage 3 tear is a full tear greater than 5 cm in size. Stiffness, weakness, and pain occur during and after overhead arm movements and during sleep. There may be a slight to severe decrease in range of motion in the shoulder.
 

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What is shoulder impingement?

Impingement syndrome is a common disorder of the shoulder that refers to an improper alignment of the bones and tissues in the upper arm. Inflammatory conditions such as tendinitis, bursitis, and arthritis are all closely related to impingement syndrome, as are tears to the rotator cuff tendons.

If the rotator cuff becomes inflamed from overuse or there is a bone deformity or spur on the end of the shoulder blade, then the space between the upper arm bone and tip of the shoulder blade is narrowed, causing the rotator cuff and its fluid-filled bursa to be squeezed or pinched. This impingement causes irritation and pain to the rotator cuff when the shoulder is raised.

 

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What is frozen shoulder?

Frozen shoulder (adhesive capsulitis) is a condition in which the tissues around the shoulder joint stiffen, scar tissue forms, and shoulder movements become difficult and painful. It can develop when you stop using the joint normally because of pain, other injury, or a chronic health condition, such as diabetes. Any shoulder problem can lead to frozen shoulder if you do not work to maintain its full range of motion.

 

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What is a separated shoulder?

A shoulder separation (acromioclavicular joint injury) occurs when the outer end of the collarbone separates from the end of the shoulder blade because of torn ligaments. This injury occurs most often from a blow to the shoulder or a fall on a shoulder or outstretched hand or arm.

 

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What is a dislocated shoulder?

A shoulder dislocation (shoulder instability) occurs when the upper end of the arm bone pops out of the shoulder joint. This injury may be caused by a direct blow to the shoulder, a fall on an outstretched hand or arm, or an exaggerated overhead throwing motion.

 

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What are muscle spasms?

When muscles become inflamed, they can also spasm, or contract tightly, as a response to injury. While they are the body’s way of protecting itself from further injury, they often produce excruciating and often debilitating pain. Muscle spasms are common in the low back (lumbar) muscles.

 

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What is tendinitis?

Tendinitis is inflammation of a tendon, a band of tissue that connects muscle to bone. It is most commonly the result of overuse during physical activities. Repetitive motions can stretch and irritate the tendon, causing pain and swelling. Tendinitis occurs around joints such as the elbow, shoulder, wrist, ankle, or knee.

 

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What is bursitis?

Bursitis is inflammation of a bursa or bursae (more than one bursa), small fluid-filled sacs that cushion areas of friction around joints. Bursae contain synovial fluid that lubricates the joints. Bursitis typically occurs as a result of overuse during physical activities or infection of the synovial fluid. If a bursa becomes infected or irritated from repetitive stress, it will cause pain and limited movement. Bursitis is most common in the shoulder, knee, hip, elbow, or heel.

 

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What is arthritis?

The most common form of arthritis, osteoarthritis, can affect any joint in the body, but most often afflicts the knees, hips, and fingers. Most people will develop osteoarthritis from the normal wear and tear on the joints through the years. Joints contain cartilage, a rubbery material that cushions the ends of bones and facilitates movement. Over time, or if the joint has been injured, the cartilage wears away and the bones of the joint start rubbing together. As bones rub together, bone spurs may form and the joint becomes stiff after long periods of activity or inactivity.

 

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What is a stress fracture?

A stress fracture is a microscopic crack in a bone that occurs from overuse. Muscles normally absorb the shock of physical activities, but when they become too fatigued to do so, they transfer the stress to the bones which results in a hairline-sized fracture.

Stress fractures usually develop in the weight-bearing bones of the feet and lower legs, often after a rapid increase in the duration or intensity of exercise or from wearing improper or worn out athletic shoes.

 

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What is carpal tunnel syndrome?

Carpal tunnel syndrome is the term used to describe a specific group of symptoms (tingling, numbness, weakness, or pain) in the fingers or hand and occasionally in the lower arm and elbow. These symptoms occur when there is pressure on a nerve (median nerve) within the wrist (carpal tunnel). Carpal tunnel syndrome develops over time because of repetitive hand motions that damage muscle and bone in the wrist area.

 

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What is a bulging/ruptured/herniated disk?

The spinal vertebrae are separated by flexible disks of shock absorbing cartilage. These disks are made of a supple outer layer with a soft jelly-like core (nucleus). If a disk is compressed, so that part of it intrudes into the spinal canal but the outer layer has not been ruptured, it may be referred to as a “bulging” disk. This condition may or may not be painful and is extremely common.

Herniated disks are often referred to as “slipped” or “ruptured” disks. When a disk herniates, the tissue located in the center (nucleus) of the disk is forced outward. Although the disk does not actually “slip,” strong pressure on the disk may force a fragment of the nucleus to rupture the outer layer of the disk.

If the disk fragment does not interfere with the spinal nerves, the injury is usually not painful. If the disk fragment moves into the spinal canal and presses against one or more of the spinal nerves, it can cause nerve impingement and pain.

If the injured disk is in the low back, it may produce pain, numbness, or weakness in the lower back, leg, or foot. If the injured disk is in the neck, it may produce pain, numbness, or weakness in the shoulder, arm, or hand.

 

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What is radiculopathy/nerve impingement?

Radiculopathy refers to a condition in which the spinal nerve roots are irritated or compressed. Many people refer to it as having a “pinched nerve.” Lumbar nerve impingement indicates that the nerve roots in the lower spine are involved, while cervical radiculopathy is associated with nerve roots in the neck. Nerve impingement is most often caused by a herniated disk or spinal stenosis.

 

If you have a question that is not addressed in this section, please call our office, or email it to info@pacificcoastspineandpain.com.

 

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