Dr. Jeffrey R. Carlson

Disc herniation usually has 3 treatment options. Medications to decrease pain and inflammation to make you more comfortable while the body heals. Injections are an option within this medication treatment. The next treatment option includes physical therapy to help take the disc pressure of the nerve root. The last treatment option would be surgery. Surgery is the quickest way to remove the pressure of a disc herniation from the nerve root. Usually we start with non-operatve treatments unless the nerve is severly compressed and causing weakness.

I believe you are talking about a "disc herniation" in the lumbar spine. A herniation of a disc in the lower back is when a portion of the disc exit its normal position and in most cases enters the spinal canal. If the disc material is large enough it can compress the nerves in the spinal canal and cause pain. The nerves in the lower back are the ones that convey information to and from the legs, so when they become compressed the nerve pain is present in the same pattern of the nerve tract down the leg. So, yes a disc herniation can produce leg pain.

Sciatica is a term that is used to mean several diagnoses that include any pain that affects the lower back and hip, or pain down the leg. It is very important to have a doctor provide a definitive diagnosis as this determines the treatment options. Specifically for the diagnosis of disc herniation that is compressing a portion of the sciatic nerve, surgery can be very helpful

Braces are meant to support boney structures and joints. They assist in the muscle and tendons roles to hold bones stable. In the case of a herniated disc, the cartilage has been moved out of position and is compressing the nerve, it is not a bone alignment disorder. The braces will support the muscles that hold the bones and can help with the symptomatic muscle spasm but the nerve will still be compressed and the nerve pain will persist.

Yes, it is possible. Of course, it depends on what you mean be "normal life" and what kind of surgery. Simple disc surgery should leave you with the ability to do any activity you would like, while more complex reconstruction of the spine will allow you to function in normal daily life but would limit you ability to perform contact sports. I would encourage you to have a discussion with your surgeon about the expectations of the surgery.

Generally bulging disc surgery is meant to remove the pressure from the nerve root. This surgery may be called a discectomy or a laminectomy. Usually these surgeries are done on an outpatient basis with the patient going home the same day. There will be some back pain related to the surgery itself, but the leg pain should get better in 24-48 hours. Usually by 2 weeks most patients are ready to get back to their normal activities.

Back adjustments can help relieve discomfort, improve posture and remind us to care for our spines. The most important aspect of spine adjustments is learning from the practitioner how to keep your spine flexible and strong. Developing a spinal care routine that will prevent dysfunction and sticking to that routine will be the most valuable tools from any spine adjustment.

Unfortunately the only way to know if it is broken is an x-ray. You do have about 2 weeks before the bones get set enough that they need to be rebroken, so you can wait 1 week and see if it gets better. If not, you should get an x-ray.

Yes. Spinal anesthesia can be used to proceed with hip replacement surgery, The anesthesiologist will need to be familiar with techniques that will allow the patient to be ambulatory right after surgery. Spinal anesthetics, in general, will cause paralysis of both legs which will prevent the patient from moving their legs and prevent walking until the anesthetic wears off. With controlled spinal anesthesia, the pain control and motor function can be adjusted to allow the patient motor function to return and proceed with ambulation.

That pain can be from a tendon that attaches to the top of the pelvis. This tendon is part of the "core" that keeps the spine and the pelvis together. Usually, it is treated symptomatically with anti-inflammatories (ibuprofen, naproxen) or Tylenol as well as local applications of creams (Voltaren Gel) or BenGay, Icey-Hot. There are also some stretches that can be done to improve the strength of the tendon attachment and prevent this from continuing or coming back.

You should have a follow-up visit with an orthopedic surgeon. Fractures may not show for 2 weeks after the initial injury, so a second X-ray 2 weeks after the injury will help clear that concern. It also may be a soft tissue-related injury, which your orthopedic surgeon would be efficient at diagnosing.

Jeffrey R. Carlson, MD

There are several things this may be. The most common are pinching of the nerves in the neck that increases with the change in position of the neck. With neck extension, the nerves can become more compressed and increase the pain in the shoulder and arm. Muscular weakness around the shoulder girdle may also be a reason for an increase in shoulder and neck pain with a change of position. As we move from upright to lying, the shoulder blade will move and if the musculature is not strong enough, there may be pain associated with that.
Best to have this evaluated by a physician.

Jeffrey R. Carlson, MD

With long-lasting swelling and decreased ROM, you should be seen by a physician. Getting an X-ray will help determine if there is a fracture. A physical exam can evaluate the ligaments and ensure they are not torn. If deemed necessary on the physical exam, the doctor may want to order an MRI to look at the other soft tissues.

Jeffrey R. Carlson, MD

Yes, you need to get an X-ray and a physical examination of your foot to insure you do not have a fracture.

Jeffrey R. Carlson, MD

A bone bruise on the patella from a dislocated knee cap has very different symptoms than a meniscal tear. The knee cap (patella) when recovering from a dislocation will have pain in the front of the knee. The torn soft-tissue around the knee cap will also be sore or painful as it heals on the inner side of the knee cap. The bone bruise and healing from the dislocation may take several months to recover.

Meniscal tears will be felt on the joint line of the knee, usually towards the back of the knee. They can move at times to make it difficult to walk or cause locking of the joint where it would be difficult to bend the knee. MRI's are very sensitive for both injuries. The MRI will show both injuries if they are there and not be hidden from view. I would consult with your doctor about the injury and your progress. Your physician's physical exam may be able to distinguish between these injuries and give you a path forward.

Jeffrey R. Carlson, MD

Hip fractures can be very debilitating in the elderly population. Sometimes the fracture and its consequences can lead to worsening of the patients condition. The options are limited due to the importance of the hip bone being needed to walk. Stability of the hip is needed to allow us to stand and ambulate. Fractures of the hips can be treated with surgery or non-surgically. Both methods have risks and benefits.

Surgically, complications can include infection, bleeding, loosening of the hardware; and anesthetically, fluid overload, brain fog or reactions to the medications provided. Surgery will allow the patient to get out of bed and ambulate more quickly than non-surgical care, which will limit other risks including bed sores, pneumonia and blood clots.

Non-surgically, it becomes very difficult to manage pain related to the hip fracture without having immobility. This may mean complete bedrest or possibly traction in bed that provide stability of the bone while it heals. This may last 6 weeks to 3 months. Even young, healthy patients staying in bed have a high risk of bed sores, pneumonia, and blood clots.

It is a difficult decision, so your doctor can guide you through the risk/benefit ratios. Most commonly, surgery is the best option.

Jeffrey R. Carlson, MD

Numbness has several causes and should be brought to the attention of your surgeon. There may be surgical reasons for numbness, anesthetic reasons for the numbness or surgical dressing reasons for the numbness. Your surgeon will be able to give you some answers concerning this.

Jeffrey R. Carlson, MD

Herniated discs can heal on their own. Our bodies have tremendous ability to heal, reconstruct and remodel injuries in bone, muscle, tendons and discs. The disc material itself that herniates comes from the central portion of the disc and ruptures through the covering of the disc, called the annulus. The annulus has significant vascular and nerve innervations. As the annulus tears, it will create a hole that allows the central disc material to herniate through the hole and compress the nerve.

The vascular supply of the annulus will begin to send healing factors to the hole and these factors will also help to resorb or heal the herniated disc. The time frame for healing is the more difficult issue. The healing may take 5-7 years for the disc herniation, so with patients that have severe pain, this may not be a reasonable course of action.

Jeffrey R. Carlson, MD

This X-ray shows a significantly displaced distal phalageal fracture that seems to run through the nail bed. This should be evaluated by a hand surgeon as it may need surgery to allow proper positioning and long-term function of the finger.

Jeffrey R. Carlson, MD

It seems like your clavicle has not healed. I would suggest you get evaluated by your PCP for potential reasons for the bone not healing. These medical reasons can include smoking, use of NSAID's or other medications that can prevent bone healing, low calcium metabolism, low vitamin D, osteopenia, osteoporosis or other endocrine disorders. These are correctable medical issues that should be addressed prior to expecting the bone to heal. When these have been determined and improved, it sounds like you will need another surgery which would include removing any tissue that is not allowing the bone to heal, adding bone graft and a plating technique that allows for strength while the bone heals.

Jeffrey R. Carlson, MD