Conditions treated at VIROC

  • BACK PAIN
  • Sciatica, Herniated disc (Or slip disc)
  • Painful Degenerative Spine Disease
  • Lumbar Canal Stenosis
  • Piriformis   syndrome
  • Facet joint pain
  • Si joint disease
  • Meralgia paresthetica
  • Neck pain
  • Knee and Shoulder pain
  • Frozen shoulder
  • Myofacial Pain Syndrome
  • Complex regional pain syndrome (CRPS 1 & 2 )
  • Trigeminal Neuralgia
  • POST HERPATIC NEURALGIA
  • Neuropathic pain (Diabetic or other nerve injury)

BACK PAIN

Symptoms of Back Pain

  • Persistent aching or stiffness anywhere along your spine, from the base of the neck to the tail bone
  • Sharp, localized pain in the neck, upper back, or lower back — especially after lifting heavy objects or engaging in other strenuous activity
  • Chronic ache in the middle or lower back, especially after sitting or standing for extended periods
  • Back pain that radiates from the low back to the buttock, down the back of the thigh, and into the calf and toes
  • Inability to stand straight without having pain or muscle spasms in the lower back

back pain spine pain
Causes of Back Pain

Mechanical problems: A mechanical problem is due to the way your spine moves or the way you feel when you move your spine in certain ways. Perhaps the most common mechanical cause of back pain is a condition called intervertebral disc degeneration, which simply means that the discs located between the vertebrae of the spine are breaking down with age. As they deteriorate, they lose their cushioning ability. This problem can lead to pain if the back is stressed. Another cause of back pain is the wearing down of the facet joints, which are the large joints that connect each vertebrae to another. Other mechanical causes of back pain include spasms, muscle tension, and ruptured discs, which are also called herniated discs.

Injuries: Spine injuries such as sprains and fractures can cause either short-lived or chronic back pain. Sprains are tears in the ligaments that support the spine, and they can occur from twisting or lifting improperly. Fractured vertebrae are often the result of osteoporosis, a condition that causes weak, porous bones. Less commonly, back pain may be caused by more severe injuries that result from accidents and falls.

Acquired conditions and diseases: Many medical problems can cause or contribute to back pain. They include scoliosis, which causes curvature of the spine and does not usually cause pain until mid-life; spondylolisthesis; various forms of arthritis, including osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis; and spinal stenosis, a narrowing of the spinal column that puts pressure on the spinal cord and nerves. While osteoporosis itself is not painful, it can lead to painful fractures of the vertebrae. Other causes of back pain include pregnancy; kidney stones or infections; endometriosis, which is the buildup of uterine tissue in places outside the uterus; and fibromyalgia, which causes fatigue and widespread muscle pain.

Infections and tumors: Although they are not common causes of back pain, infections can cause pain when they involve the vertebrae, a condition called osteomyelitis, or when they involve the discs that cushion the vertebrae, which is called discitis. Tumors, too, are relatively rare causes of back pain. Occasionally, tumors begin in the back, but more often they appear in the back as a result of cancer that has spread from elsewhere in the body.
Although the causes of back pain are usually physical, it is important to know that emotional stress can play a role in how severe pain is and how long it lasts. Stress can affect the body in many ways, including causing back muscles to become tense and painful. Untreated depression and anxiety can make back pain feel much worse. Likewise, insomnia, or the lack of sleep, can also contribute to back pain.

 LUMBAR CANAL STENOSIS

LUMBAR CANAL STENOSIS (LCS) is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerves at the level of the lumbar vertebra.

This is usually due to the common occurrence of spinal degeneration that occurs with aging.
It can also sometimes be caused by spinal disc herniation, osteoporosis or a tumor. In the cervical (neck) and lumbar (low back) region it can be a congenital condition to varying degrees

Piriformis syndrome

  • Piriformis syndrome is an uncommon neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve. The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint. This muscle is important in lower body movement because it stabilizes the hip joint and lifts and rotates the thigh away from the body.
  • This enables us to walk, shift our weight from one foot to another, and maintain balance. It is also used in sports that involve lifting and rotating the thighs -- in short, in almost every motion of the hips and legs.
  • The sciatic nerve is a thick and long nerve in the body. It passes alongside or goes through the piriformis muscle, goes down the back of the leg, and eventually branches off into smaller nerves that end in the feet. Nerve compression can be caused by spasm of the piriformis muscle.

Piriformis Syndrome Signs and Symptoms


  • Piriformis syndrome usually starts with pain,
  • tingling, or numbness in the buttocks.
  • Pain can be severe and extend down the length of the sciatic nerve (called sciatica).
  • The pain is due to the piriformis muscle compressing the sciatic nerve, such as while sitting on a car seat or running.
  • Pain may also be triggered while climbing stairs, applying firm pressure directly over the piriformis muscle, or sitting for long periods of time.
  • Most cases of sciatica, however, are not due to piriformis syndrome.

Facet joint

  • Facet joint, small stabilizing joints located between and behind adjacent vertebrae
  • To prevent excessive motion, over-twisting, or toppling over, the segments of the spine are stabilized by a number of structures that nonetheless preserve the flexibility needed to turn, look around and get around.
  • The facet joints, or joints with "small faces" are found at every spinal level (except at the top level) and provide about 20% of the torsional (twisting) stability in the neck and low back. The vertebrae of the chest area are normally far less mobile and permit a small amount of forward/backward and some side bending, and very little twisting.

Common Causes Of Facet Joint Pain

  • The cause of most lumbar facet pain is unknown. On occasion, the lumbar facet joints are affected by systemic inflammatory arthritides, such as rheumatoid arthritis and ankylosing spondylitis. The following is a more specific look at sources of low back pain (LBP).
  • Microtrauma
  • Synovial capsule distention and inflammation
  • Osteoarthritis
  • Rheumatoid arthritis
  •  
  • Sacroiliac joint dysfunction
  •  
  • Sacroiliac joint dysfunction, also called sacroiliac joint disordersacroiliac joint diseasesacroiliac joint syndrome or sacroiliac syndrome, or "sacroilliac dysfunction and instability", generally refers to pain in the sacroiliac joint region that is caused by abnormal motion in the sacroiliac joint, either too much motion or too little motion. It typically results in inflammation of the sacroiliac joint, and can be debilitating.
  • symptoms
  • lower back pain,
  • buttocks pain,
  • sciatic leg pain,
  • groin pain,
  • hip pain (for explanation of leg, groin, and hip pain, see referred pain),
  • urinary frequency,
  • "transient numbness,
  • prickling, or tingling
  • Pain can range from dull aching to sharp and stabbing and increases with physical activity.
  • Symptoms also worsen with prolonged or sustained positions (i.e., sitting, standing, lying).
  • Bending forward, stair climbing, hill climbing, and rising from a seated position can also provoke pain.
  • Pain is reported to increase during menstruation in women.
  • Patients with severe and disabling sacroiliac joint dysfunction can suffer from insomnia and depression.[15]

Meralgia paresthetica

Tight clothing, obesity or weight gain, and pregnancy are common causes of meralgia paresthetica. However, meralgia paresthetica can also be due to local trauma or a disease, such as diabetes.

In most cases, meralgia paresthetica can be relieved with conservative measures. In severe cases, treatment may include medications to relieve discomfort or nerve block or rarely, surgery.

Signs and symptoms

  • Pain on the outer side of the thigh, occasionally extending to the outer side of the knee, usually constant.
  • A burning sensation, tingling, or numbness in the same area
  • Multiple bee-sting like pains in the affected area
  • Occasionally, aching in the groin area or pain spreading across the buttocks
  • Usually more sensitive to light touch than to firm pressure
  • Hyper sensitivity to heat (warm water from shower feels like it is burning the area)

Neck Pain

  • Neck pain (or cervicalgia) is a common problem, with two-thirds of the population having neck pain at some point in their lives. Neck pain is also loosely referred to as cervical pain. Neck pain affects about 5% population and is more common in women than men. About one-half of episodes resolve within one year but remaining patients continue to suffer pain and associated disability.

Common causes of neck pain

  • Muscle strains: Overuse and poor posture , such as too many hours hunched over a steering wheel, laptops, mobile phones and other electronic gadgets often triggers muscle strains. Even such minor things as reading in bed or gritting your teeth can strain neck muscles.
  • Worn Joints: Just like all the other joints in your body, neck joints tend to undergo wear and tear with age, which can cause osteoarthritis in the neck.

 

  • Nerve compression: Herniated disks or bone osteophytes (abnormal growth) in the vertebrae of the neck can take up too much space and press on the nerves branching out from the spinal cord.
  • Injuries: Rear-end automobile collisions often result in whiplash injuries, which occur when the head is jerked backward and then forward, stretching the soft tissues of the neck beyond their limits.
  • Diseases: Neck pain can sometimes be caused by diseases, such as rheumatoid arthritis, tuberculosis, meningitis or cancer Neck pain can also come from conditions directly affecting the muscles of the neck, such as fibromyalgia

Common Symptoms

  • Neck pain is commonly associated with dull aching. Sometimes pain in the neck is worsened with movement of the neck or turning the head. Other symptoms associated with some forms of neck pain include numbness, tingling, tenderness, sharp shooting pain, fullness, difficulty swallowing, pulsations, swishing sounds in the head and dizziness or light-headedness.
  • Neck pain can also be associated with headache, facial pain, shoulder pain and arm numbness or tingling (upper extremity paresthesias). These associated symptoms are often a result of nerves getting pinched in the neck. Depending on the condition, sometimes neck pain is accompanied by upper back and/or lower back pain, as is common in inflammation of the spine from ankylosing spondylitis.

neck 2


When to seek medical advice


  • In case of injury, one should seek medical advice immediately without any delay.
  • If there has not been an injury, you should seek medical care when neck pain becomes:
  • Continuous and persistent
  • Severe
  • Accompanied by pain that radiates down the arms or legs
  • Accompanied by headaches, numbness, tingling or weakness

neck 3

KNEE PAIN

About the Knee

Knee is the largest joint in your body. It is a complex joint made of bone, cartilage and ligaments. The cartilage in the knee acts as a cushion and gliding surface. When healthy, the cartilage keeps the bones in the joint from rubbing together. However, when the joint is affected by arthritis, the bones make contact and cause pain. Injuries, aging and degenerative conditions such as arthritis can cause the cartilage to break down

Common Causes of Knee Pain

Osteoarthritis: Arthritis is a chronic condition that causes joint inflammation. Symptoms include redness, warmth, swelling, tenderness and pain.

Up to 40 percent of the population may have knee osteoarthritis, or “wear and tear” arthritis. This is the gradual breakdown of the cartilage in the knee. Also called degenerative joint disease, osteoarthritis usually develops over years and often is found in patients who have had a knee infection or injury and those who are overweight/

osteoarthritis

As cartilage wears away, the bones around it can grow thicker and develop bony spurs. This can lead to increased friction between the bones and disrupted movement in your knee. This also can lead to problems with the synovium, a membrane in your knee that produces a liquid to keep your cartilage slippery. This membrane can become inflamed and make too much fluid. This results in swelling, or “water on the knee.” In the most severe cases, the knee can become deformed as the continued friction wears away the bone. Common symptoms of osteoarthritis include pain, stiffness, tenderness, a limited range of motion and a grating sensation when you bend your knee. The pain is usually worse after activity.
Rheumatoid arthritis: Rheumatoid arthritis can affect joints on both sides of the body (both knees, both hands and/or both wrists). In rheumatoid arthritis, your body’s cells attack your own tissues. Rheumatoid arthritis affects three to five times more women than men and often presents between the ages of 20 and 50.

Over time, rheumatoid arthritis can cause cartilage to wear away, swelling in the synovium, and excess fluid in the knee. In later stages, bones can rub against each other.

Bursitis: Bursitis is the inflammation of any of the fluid-filled sacs (bursae) protecting the body’s joints. This is usually caused by repetitive motions or by a stress such as kneeling. Sometimes, a sudden injury can cause bursitis.
knee3

Tendonitis: The tendons – rope-like tissues connecting muscles to bone at the knee and other joints – can become painfully inflamed by repetitive and strenuous movement. Tendonitis is a common sports injury, caused by overuse of the same parts of the body. Patellar tendinitis, or “jumper’s knee,” is an inflammation or irritation of the tendon between the knee cap and the shin bone.

Patellofemoral pain syndrome (PFPS): Knee pain or discomfort while walking up and down stairs, jumping or squatting may be symptoms of patellofemoral pain syndrome. This common knee problem is felt toward the front of the knee. It can cause a grinding sensation when bending or straightening your leg, and can cause the knee to occasionally buckle. Sometimes called “runner’s knee,” patellofemoral pain syndrome may be caused by a kneecap that is not aligned properly, overuse, injury, excess weight or when the cartilage in the knee cap is worn significantly.

Injuries: Knee injuries can be the result of sports, falls or trauma. They typically involve the ligaments that hold two of the bones of the knee – the femur and tibia – together eg-ACL,MCL,& Meniscal injuries.

Frozen shoulder

  • Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years.
  • Your risk of developing frozen shoulder increases if you're recovering from a medical condition or procedure that prevents you from moving your arm — such as a stroke or a mastectomy.
  • It's unusual for frozen shoulder to recur in the same shoulder, but some people can develop it in the opposite shoulder.
  • It is more common in diabetic patients.

Frozen shoulder typically develops slowly, and in three stages. Each stage can last a number of months.

  • Freezing stage. Any movement of your shoulder causes pain, and your shoulder's range of motion starts to become limited.
  • Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and using it becomes more difficult.
  • Thawing stage. The range of motion in your shoulder begins to improve.

For some people, the pain worsens at night, sometimes disrupting sleep.

Myofacial pain syndrome

  • Myofascial pain syndrome is a chronic pain disorder. In myofascial pain syndrome, pressure on sensitive points in your muscles (trigger points) causes pain in seemingly unrelated parts of your body. This is called referred pain.
  • Myofascial pain syndrome typically occurs after a muscle has been contracted repetitively. This can be caused by repetitive motions used in jobs or hobbies or by stress-related muscle tension.
  • While nearly everyone has experienced muscle tension pain, the discomfort associated with myofascial pain syndrome persists or worsens. Treatment options for myofascial pain syndrome include physical therapy and trigger point injections. Pain medications and relaxation techniques also can help.

Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy, is a chronic neurological syndrome characterized by:

  • severe burning pain
  • pathological changes in bone and skin
  • excessive sweating
  • tissue swelling
  • extreme sensitivity to touch

[For a complete description of CRPS symptoms, please read the Diagnosis section of the Clinical Practice Guidelines section of this website.]

There are Two Types of CRPS - Type I and Type II

  • CRPS Type I (also referred to as RSD) - cases in which the nerve injury cannot be immediately identified
  • CRPS Type II (also referred to as Causalgia) - cases in which a distinct "major" nerve injury has occurred
  • CRPS is best described in terms of an injury to a nerve or soft tissue (e.g. broken bone) that does not follow the normal healing path
  • CRPS development does not appear to depend on the magnitude of the injury. The sympathetic nervous system seems to assume an abnormal function after an injury.
  • Since there is no single laboratory test to diagnose CRPS, the physician must assess and document both subjective complaints (medical history) and, if present, objective findings (physical examination).

Trigeminal Neuralgia: 

  • This type of neuralgia is associated with pain from the trigeminal nerve, which goes from the brain to the face. The particular cause of pain is believed to be a blood vessel pressing down on the trigeminal nerve where it meets with the brainstem. Trigeminal neuralgia causes pain in the face, usually on one side, and is most common in the elderly.

trigeminal neuralgia
Postherpetic Neuralgia: 

This type of neuralgia occurs as a complication of shingles and may be anywhere on the body. Shingles is a viral infection characterized by a painful rash and blisters. Neuralgia can erupt wherever the outbreak of shingles occurred and can be mild or severe, persistent or intermittent, and can last for months or years.

Causes of Neuralgia

The underlying cause of any type of neuralgia is damage to a nerve. Each nerve in your body is protected by a coating called the myelin sheath. When the myelin is damaged or wears away from the nerve, the stabbing, severe, shock-like pain of neuralgia results. There are many different factors, including old age, which can cause damage to the myelin. Unfortunately, in many cases of neuralgia, a cause can never be found.

Infection: The cause of postherpetic neuralgia is shingles, an infection caused by the chickenpox virus. The likelihood of having this infection increases with age. Lyme disease, HIV, and syphilis can also cause neuralgia.

Multiple Sclerosis: Multiple sclerosis (MS) is a disease that is caused by the degradation of myelin. Among the many symptoms that result from MS is neuralgia, often in the face.

Pressure on Nerves: The myelin on nerves can be worn away by pressure. The pressure may come from a bone, ligament, blood vessel, or a tumor that is pressing on the nerve. The pressure of a swollen blood vessel is a common cause in trigeminal neuralgia.

Diabetes (Diabetic Neuropathy): Many people with diabetes will suffer from some type of neuralgia because excess glucose in the bloodstream can lead to myelin damage.

Less Common Causes: If the cause of neuralgia cannot be blamed on an infection, MS, diabetes, or pressure on the nerves, it may be from one of many less common factors. These include:

  • chronic kidney disease
  • porphyria (a rare blood disease)
  • medications like cisplatin, paclitaxel, or vincristine (prescribed to cancer patients)
  • trauma, such as that caused by surgery
  • chemical irritation
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