Click on a topic below:
- Extremity Pain Overview
- Carpal Tunnel Syndrome
- Complex Regional Pain Syndrome (CRPS)
- Ilio-Tibial Band Syndrome
- Peripheral Nerve Injury
- Shoulder Pain
Extremity pain involves the arms, legs, wrists, ankles, shoulders, or even the neck. Whether these are directly related to injury of the nerves or joints due to an inflammation, surgery, arthritis, or muscular strain, it is important to know whether the cause of pain is irritation of the nerve roots in the spine. Appropriate evaluation might reveal the pain source, and allow specific treatment.
The bursae are pads filled with fluid that provide extra cushioning for joints, and bursitis is when the bursae become inflamed. Inflammation typically occurs in the bursae near joints that perform repetitive movements. Rarely, the cause is due to infection. Symptoms include pain near the involved joint and stiffness of the joint. Treatments include ice, rest, NSAID’s, physical therapy, steroid injections into the bursa, and possible surgical removal.
Carpal Tunnel Syndrome
The carpal tunnel is a small area in the wrist created by ligaments that protects the nerves that travel through the tunnel and provide sensation and movement into the hand. The median nerve goes through the tunnel to give sensation and movement to the thumb, index, and middle finger. When the nerve is pinched, it causes pain, numbness, and weakness into these fingers. The nerve is typically pinched due to inflammation from repetitive movements like typing, injuries to the wrist, hormonal changes, and in certain diseases like diabetes, obesity, and hypothyroidism.
Symptoms include pain, numbness, and weakness in the hand and thumb, index finger, and middle finger. Treatment includes rest, a wrist splint, taking frequent breaks if due to repetitive activity, NSAIDs, steroid injections into the carpal tunnel to decrease inflammation, or surgery.
Complex Regional Pain Syndrome
(CRPS, also known as Causalgia)
Complex Regional Pain Syndrome, previously known as Causalgia or Reflex Sympathetic Dystrophy (RSD), is caused by abnormal activity in the sympathetic nervous system. This syndrome most often results from an injury or surgery to an extremity, particularly the hand or foot. As the injury or surgery heals, the pain persists, intensifies, and can spread. The skin around the affected area can change color and be cold to touch. It is typically a burning, itching kind of pain, and almost any stimulus to the affected area is painful. There can also be changes to hair and nail growth patterns. It is usually treated first with medications and physical therapy. If these treatments do not bring relief, the next step may be a series of nerve blocks. A treatment option for refractory pain includes spinal cord stimulation, i.e. placing electrical stimulators in the spinal canal to send tingling sensations into the painful extremity. If you believe you are suffering from Complex Regional Pain Syndrome, see your doctor for a full evaluation and possible referral to a pain specialist. The earlier Complex Regional Pain Syndrome is identified and treated, the better the response to treatment.
Ilio-Tibial Band Syndrome (ITBS)
The iliotibial band stretches from the pelvis to just below the knee and provides stability to the knee when moving. Iliotibial Band Syndrome occurs when this band becomes inflamed which typically occurs in athletes who perform repetitive activities that involve knee movement. Symptoms include lateral knee pain when running or going up or downhill, tenderness right above the lateral knee joint, and may progress to pain at rest. Treatment includes physical therapy, stretching, non-steroidal anti-inflammatory drugs (NSAIDs), and rest.
Peripheral Nerve Injury
The peripheral nerves are the nerves outside of the brain and spinal cord. They relay messages from the brain and spinal cord to the limbs and internal organs. These nerves are not as durable as those in the central nervous system and are easily damaged. When injury occurs to these nerves, you may feel numbness or weakness in the area the nerve typically supplies. Treatment includes protecting the surrounding area of the nerve such as a sling or splint, physical therapy, and muscle stimulation.
Shoulder pain can occur due to injury, infection, tumor, but most commonly, arthritis. The pain can arise from the bones that make up the shoulder, cartilage, menisci, or could be due to injury in a cervical spinal nerve. Symptoms include pain in the joint, decreased range of motion, stiffness, swelling, and redness. Treatment depends on the underlying cause but typically involves rest, NSAIDs, heat and ice, physical therapy, steroid injections, and possibly surgery.