If you have suffered an injury at work or during work related activities, it is very important to take the right steps when seeking medical treatment. Having appropriate medical care is very important for your health and recovery with the main goal to gain your function and life back.

Our main goal is to help you to have an access to all possible available resources to help with medical care you need and all the support available to return your function and life back.

United States Department of Labor

Occupational safety and health administration

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9636

If you have suffered an injury after a motor vehicle accident, it is very important to take the right steps when seeking medical treatment. Having appropriate medical care is very important for your health and recovery with the main goal to gain your function and life back.

Our main goal is to help you to have an access to all possible available resources to help with medical care you need and all the support available to return your function and life back.

CDC: Injury prevention and control: Motor vehicle safety

https://www.cdc.gov/motorvehiclesafety/states/index.html

Complex regional pain syndrome is a devastating chronic pain condition usually affecting an arm or leg. The pain usually follows an injury, surgery, stroke or heart attack. However, the pain is out of proportion in severity comparing to the initial injury.  There are two types of the complex regional pain syndrome.

Type I.  This type of complex regional pain syndrome is also known as reflex sympathetic dystrophy syndrome. The condition occurs after an injury or illness without known damage to the nerve of the affected limb.  The absolute majority of the complex regional pain syndrome is Type I.

Type II.  This type of complex regional pain syndrome is also known as causalgia and the pain follows a distinct nerve injury.

The majority of the cases of complex regional pain syndrome occur after a crush injury, fracture, surgical procedure or amputation. Emotional stress could be as predisposing factor.  The treatment of the complex regional pain syndrome is more effective and successful if started early.

The management and treatment of the complex regional pain syndrome is very challenging. Patient can benefit from taking pain relievers, antidepressants and anticonvulsants, corticosteroids medications, bone loss medications and sympathetic nerve block and medications.  Several therapies such as applying heat and cold, topical analgesics, physical therapy, transcutaneous electrical nerve stimulation (TENS), biofeedback and spinal cord stimulation placement can help patients with this condition.

Living with chronic painful condition is very challenging especially when your family and friends don’t believe you could have such devastating pain as described. Family support is very important, also sometimes participation in support groups activities where patients can share experience and feelings with other people can provide significant help.

Fibromyalgia is a generalized chronic pain syndrome with a presentation of a widespread pain and tenderness to palpation at multiple soft tissue body sites. This condition is usually accompanied by depression, anxiety, insomnia, cognitive dysfunction, chronic fatigue, irritable bowel syndrome, endocrine dysfunction and dysfunction of the autonomic system.  Fibromyalgia could be also be accompanied by rheumatoid arthritis, lupus and hypothyroidism. The pain could be symmetric and asymmetric in presentation.

Fibromyalgia Tender Points

Fibromyalgia is distinct from the myofascial pain by having a very low threshold of the pain at the tender spots of the body.  Myofascial pain is generally a soft tissue injury which could be self-limited and usually not a long-term condition, also fatigue and morning stiffness is uncommon for myofascial pain.

Common symptoms of fibromyalgia syndrome are widespread pain, chronic insomnia, depression, anxiety, physical fatigue from regular daily activities, prolonged morning stiffness, lightheadedness, dizziness, syncope, irritable bowel, abdominal pain, diarrhea, urinary frequency, urgency, pain with urination and other.

The treatment of fibromyalgia should be emphasized on patient’s education and reassurance. There are available techniques of conservation of energy, following routine daily activities, low impact graded aerobic exercises.  Treatment modalities as biofeedback, tender point injections, combination therapy and acupuncture are usually effective.  Patient’s also benefit from the treatment using tricyclic antidepressants, pregabalin, SSRIs, muscle relaxants and tramadol.

Arm, elbow, wrist and hand pain could be related to arthritis, osteonecrosis, nerve injury or infection. Patient needs to seek a specialist’s assessment if the pain is consistent, severe or progressively worsening and self-care measures failed to provide with pain relief.

Arm, elbow, wrist and hand pain conditions:

Acromioclavicular joint sprains

Shoulder joint injuries

Inpatient syndrome

Rotator cuff tear

Degenerative joint disease of the shoulder

Biceps tendinitis and rupture

Adhesive capsulitis or frozen shoulder

Scapular winging

Scapular fractures

Clavicular fractures

Medial epicondylitis

Lateral epicondylitis

Elbow bursitis

Dislocation of the elbow

Biceps tendinitis

Triceps tendinitis

Ligament sprain

Pronator syndrome

Cubital tunnel syndrome

De Quervain’s tenosynovitis

Ganglion cyst

Scaphoid fracture

Trigger finger

Jersey finger

Mallet finger 

Hip pain is usually caused by arthritis, osteonecrosis, infection or labral pathology and generally localized to the groin and anterior thigh area. Pain is worse with weightbearing, climbing steps, or squatting to seat at a lower level.  The pain is associated with antalgic gait and painful, limited range of motion of the hip joint.

Knee and ankle joints pain could be related to arthritis, osteonecrosis, nerve injury or infection as well.  Patient needs to seek a specialist's assessment if the pain is consistent, severe or progressively worsening and self-care measures failed to provide with pain relief.

Hip, knee, ankle and foot conditions:

Hamstrings strain

Piriformis syndrome

Iliopsoas bursitis and tendinitis

Snapping hip syndrome

Groin strain

Greater trochanteric bursitis

Posterior hip dislocation

Hip fractures

Slipped Capital Femoral Epiphysis (SCFE)

Avulsion fractures

Meniscal injuries

ACL and PCL injuries

Ligament tears

Iliotibial band syndrome

Patellae related injuries

Patellofemoral pain syndrome

Medial tibial stress syndrome

Stress fractures

Ankle sprains

Ankle and foot fractures

Plantar fasciitis

Morton’s neuroma

Hammer toe

Claw toe

Mallet toe

Radicular leg pain and feeling of numbness and tingling is caused by irritation of the lumbosacral nerve roots. Acute onset of the radicular pain could be a result of a disc herniation in young adults.  Patient’s can describe subjective weakness and sciatica pain as a pain with numbness and tingling traveling from the low back and buttock into the thigh, calf and foot.  Patients report that sitting is more bothersome than standing or walking.

Sciatica pain usually goes away over time. Patient needs to seek a doctor's advise and evaluation if self-care measures failed to relieve symptoms of pain or the pain lasts longer than a week, became severe or progressively worsening.  Also immediate help is needed if the pain is sudden, severe in the low back and affected leg, after a violent injury such as motor vehicle accident, also with difficulty to control bladder or bowels.

Headache is a pain in any region of the head. Patient can experience sharp pain, throbbing sensation or a dull ache.  Headaches can be different in duration lasting from several minutes to several days, also developed gradually or suddenly.

Headaches could be primary as cluster headaches, migraines, tension headaches and trigeminal autonomic cephalalgia, also chronic daily headaches, cough headaches, exercise headaches and sex headaches.  There are several lifestyle factors that can trigger primary headaches as alcohol consumption, certain foods consumption, changes in sleep patterns, poor posture, skipped meals and stress.

Secondary headaches are usually related to infection, vascular trauma or dysfunction, blood clots, malignancy, cervicogenic, concussion, hangovers, high blood pressure, overuse of pain medications, panic disorders, stroke, brain of vascular pathology.

Headache can be a presentation for serious condition and needs to be evaluated by a specialist. Patient needs to seek doctor's immediate advice if severe headache is accompanied by confusion, slurred speech, fainting, high fever, numbness, weakness or paralysis, stiff neck, visual disturbance, difficulty with ambulation, nausea or vomiting, difficulty to manage bowel or bladder.

Neck pain is a source for a discomfort that almost every adult will experience during her on his life. The most common causes for the acute neck pain are soft tissue injury or inflammation, benign or malignant mass formation, ligamentous strain, aggravation of underlying degenerative conditions sometimes even without preceding trauma.  Neck pain is usually self limited and associated with limited motion but not radicular symptoms.  Occasionally, pain will radiate to the shoulders and sometimes down to the affected arms and hands.  This pain can provoke anxiety for patients, but it is generally resolved within several weeks.  This mechanical type of the neck pain is usually relieved with anti-inflammatory medications, heat packs and short-term immobilization.  When such localized acute neck pain persists for longer periods of time or true radiculopathy is present, the patient should be evaluated by a specialist for the presence of a more serious conditions.

Acute cervical strain (whiplash) with neck pain and stiffness is often a result of the motor vehicle accident and typically rear end collisions.  Patients can complain about the pain initially, however, the onset of the pain usually occurs one day later.  Whiplash pain is usually accompanied by neck and upper back pain, upper shoulder pain, headache, sensation of tingling and numbness and persistent stiffness.  Cervical x-ray is the first step to evaluate the condition.  Patients should be assessed by a specialist and more advanced studies could be necessary if the severe neck pain persists, or true radiculopathy or other neurologic abnormalities are present.

Patients with persistent and progressively worsening in severity neck pain, associated muscle pain, weight loss and soft tissue atrophy need to be assessed by a specialist for possible infection, inflammation or malignancy.

Cervical radiculopathy

Radicular arm pain is most commonly caused by nerve root compression at the cervical spine. The cause for the acute radiculopathy is generally a result of soft disc herniation.  Also acute foraminal disc herniation can cause severe nerve root compression with severe radiating to the chest pain that can be confused with the cardiac or pulmonary condition.  Chronic cervical radiculopathy is generally caused by spondylosis or degenerative spine arthritis, with osteophyte complexes (extra bone formation) that cause various degrees of central and neuroforaminal stenosis.  Chronic radiculopathy usually accompanied by neck pain and limited motion.  Facet arthropathy and degenerative disc disease may also contribute to headaches as a frequent symptom of the patients with chronic radiculopathy.

Low back pain is a very common condition and ranks second only to upper respiratory infection. According to the public data, approximately 80% of adult population will experience at least one episode of low back pain.  The source of the pain is usually related to musculoskeletal components of the spinal column.  The pain is originated from soft tissue structures, paraspinal musculature, ligaments, facet joints, bone structures, intervertebral discs and nerves.

The most common origin of the acute low back pain is from the soft tissue structures. Muscle strain and ligament sprain can result from overuse and produce severe pain with restriction of mobility.  The pain is usually self-limiting and improves with conservative and nonoperative care within the first 6 weeks.

Sometimes acute low back pain becomes chronic with frequent flares. Among the causes for the chronic pain is radiculopathy which is generally associated with mechanical low back pain.  The true radicular pain is the pain with a sensation of numbness and tingling traveling below the buttock area down to the upper or lower leg area.

One of the other causes for the chronic intermittent low back pain is an aggravation of lumbar spondylosis (arthritis of the spine). Exacerbation of nonradicular low back pain is usually frequent and associated with overuse or minor injury to the arthritic lumbar facet joints (main joints of the spine).

Low back pain can also be discogenic (related to the intervertebral disc pathology) in etiology. The presentation of the pain has symptoms that overlap with the pain produced by lumbar facet joints pathology. The discogenic pain is usually more intense and severe, also producing more significant restriction in mobility.

There are other causes for the low back pain that include infection, tmalignancy, spinal stenosis and specific musculoskeletal pathology.

Neurogenic claudication

Lumbar spinal stenosis produces leg pain and fatigue with ambulation which called neurogenic claudication.  This pain occurs most commonly in older patients who complain of severe leg pain becoming intolerable after ambulating varying distances.  The pain is a generally relieved after sitting or leaning forward while flexing the lumbar spine.

Vascular claudication

Vascular claudication pain caused by arterial insufficiency of the lower extremity. This condition can produce severe leg pain with ambulation, however, often relieved by stopping and standing. Also, patients can have leg pain at night which requires sitting and dangling the legs at the bedside. The risk factors for vascular claudication are tobacco smoking, diabetes, hypertension, and vascular disease.

Lumbar radiculopathy

Radicular leg pain and feeling of numbness and tingling is caused by irritation of the lumbar sacral nerve roots. Acute onset of the radicular pain could be a result of a disc herniation in young adults.  Patients can describe subjective weakness and sciatica pain as a pain with numbness and tingling traveling from the low back and buttock into the thigh, calf and foot.  Patients report that sitting is more bothersome than standing or walking.

Coccydynia

Coccydynia is localized pain in the coccyx area that is usually chronic and severe. The pain is aggravated after prolonged sitting on firm surfaces.  Radiation of the pain is not present but the pain can travel to the buttock or ischial tuberosity with both sides possibly involved.

Piriformis syndrome

Piriformis syndrome represents the pain originated from inflamed piriformis muscle with also sciatica nerve pain after sciatic nerve been directly compressed by the piriformis muscle. Patients report buttock and leg pain with numbness and tingling that is exacerbated after prolonged sitting.  Patients also report localized buttock tenderness with palpation in the piriformis muscle area.

Sacroiliac joint dysfunction or sacroiliitis

Sacroiliac joint is an L-shaped articulation between the sacrum and the ileum. The joint pain usually is related to hyper or hypo-mobility for the joint, repetitive overloads, trauma and injury to the capsule of the joint.  The pain can be instant or gradual in the low back area, buttock, leg or groin area with tenderness over the joint.  Patients report abnormal sacroiliac joint motion patterns and increased discomfort with changing positions. The pain also involves associated muscles such as quadratus lumborum, erector spinae and piriformis muscles.

Hip pathology

Hip pain caused by arthritis, osteonecrosis, infection or labral (joint capsule) pathology is generally localized to the groin and anterior thigh area. Pain is worse with weightbearing, climbing steps, or squatting to seat at a lower level.  He pain is associated with antalgic gait and painful limited range of motion of the hip joint.

Chronic low back pain

Chronic low back pain without radicular component is commonly caused by degenerative conditions. The evolution of spondylosis or arthritis usually begins in the third decade of life and progresses with aging.  The degenerative processes start with the intervertebral disc dehydration and subsequent loss of the disc height.  The collapse of the disc space promotes osteophyte formation in the parallel of facet arthritis and ligamentum flavum hypertrophy and cause spinal stenosis.

Facet syndrome

Facet syndrome is associated with low back pain caused by inflammation of facet joints with resultant discrete pain associated with radiation into the buttock area. This pain could travel further down to the posterior thigh on the affected side.

Risks for the chronic low back pain often obesity, limited muscle mass, poor aerobic conditioning, tobacco smoking and medical comorbidities. Degenerative changes are not reversible, however, patient’s can have significant beneficial effect on chronic low back pain by addressing this aggravating factors.