Education

Procedures done in the office by:

Dr. Danushkodi, M.D.

 

EMG

 

What to Expect During Your EMG Test:
Electrodiagnostic medicine is the study of diseases of your nerves and muscles. Your doctor has recommended an EMG test to see if your muscles and nerves are working right. The results of the tests will help your doctor decide what is wrong and how it can be treated.

Why am I being sent to have an EMG?
You are being sent to get an electromyography (EMG), because you have numbness, tingling, pain, weakness or muscle cramping. Some of the tests that the EMG doctor may use to diagnose your symptoms are nerve conductions studies (NCS) and needle EMG. The EMG doctor will examine you to decide which tests to do.

What type of testing will be performed?
Nerve conduction studies – NCSs show how well the body’s electrical signals are traveling to a nerve. This is done by applying small electrical shocks to the nerve and recording how the nerve works. These shocks cause a quick, mild, tingling feeling. The doctor may test several nerves.

Needle EMG – For this part of the test, a small, thin needle is put in several muscles to see if there are any problems. It is used once for each patient and is thrown away after the test. There may be a small amount of pain during this part of the examination. The doctor tests only the muscles necessary to decide what is wrong. During the EMG test the doctor will be able to hear and see how your muscles and nerves are working by the electrical signals made by your muscles. The doctor then uses her medical knowledge to figure out what could be causing your problem

How long will these tests take?
The tests usually take 20 to 30 minutes. You can do any of your normal activities, like eating, driving and exercising, before the tests. There are no lasting side effects. You can also do your normal activities after the tests.

How should I prepare for the tests?
Tell the EMG doctor if you are taking Aspirin, blood thinners (like Coumadin or Plavix), have a pacemaker, or have hemophilia. Take a bath or shower to remove oil from your skin. Do not use body lotion or oils on the day of the test.

 

Therapeutic Botox

 

 

What is Botox?

Botox is a purified protein complex derived from bacteria, similar to the way that penicillin is derived from mold. It is manufactured under strict quality control standards by Allergan, and is administered in appropriate dilute dosages by licensed medical professionals. Botox has been approved for nearly 14 years and has been used in over 7 million treatment sessions. Botox therapy is approved by health authorities in 70 countries and has been endorsed by the National Institutes of Health since 1990.

How is a Botox Injection procedure performed?

Botox injections are performed in a comfortable room at our office. The trigger point or knotted muscle causing the pain is located and the area cleaned. The Botox is then injected into that trigger point or knot. The procedure only takes a few minutes.

It is important to remember that Botox treatment is not a cure. For many people, however, its effects have been beneficial. Typically, improvement with Botox is not immediate. It may take up to two weeks for its benefits to be noticeable, although it has noted complete relief for some patients in as little as two days time. After a Botox treatment, the nerve will take about three months to resume the release of acetylcholine, and the muscles may become overactive again. At that point, another Botox treatment may be needed to provide relief, as long as no allergic reactions or other significant side effects occurred and your condition responded to treatment.

Trigger Point Injections

Trigger points are very sensitive areas in muscles, causing them to be sensitive to touch. They can send pain toother areas of the body. For example, a trigger point in the neck may produce pain in the back, shoulder, or arm, but not in the neck. This pain usually comes from the trigger points in muscle groups and not from nerves in the body.

What is a trigger Point injection (TPI)?

A TPI is an injection that will help treat certain chronic pain conditions where muscle sensitivity and pain exist.

How long will the pain relief last?

The length of pain relief varies from person to person. In most cases, the pain may be lessened for a few days up to a few months

Back Pain:

 

Back pain is usually caused by an injury to the muscles or ligaments of  the spine.Sometimes the disks  that seperate each bone in the spine may bulge and cause pain by presenting on a nearby nerve. Back pain may also appear after a sudden twisting/bending force (such as in a care accident), or sometimes after a simple awkward movement. In either case, muscle spasm is oftern present and adds to the pain.

If you have low back pain, you may have tension, soreness or stiffness in your lower back area. This pain is often referred to as ‘non-specific’ back pain and usually improves on its own within a few days.

Back pain may be called either ‘acute’ or ‘chronic’ depending on how long your symptoms last. You may have:

  • acute back pain – lasting less than six weeks
  • sub-acute back pain – lasting six weeks to three months
  • chronic back pain – lasting longer than three months

Joint Injections

joint injection (intra-articular injection) is a procedure used in the treatment of inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendinitis, bursitis and occasionally osteoarthritis. A hypodermic needle is injected into the affected joint where it delivers a dose of anti-inflammatory agents

Facet joints are small joints at each segment of the spine that provide stability and help guide motion. The facet joints can become painful due to arthritis of the spine, a back injury or mechanical stress to the back. A cervical (neck), thoracic (upper back) or lumbar (lower back) facet joint injection involves injecting a steroid medication, which can anesthetize the facet joints and block the pain.

 

 

 

 

 

Cervical Pain:


The cervical spine is a marvelous and complex structure. It is capable of supporting a head weighing 15 or more pounds while moving in several directions. No other region of the spine has such freedom of movement.

 

This combination however, complexity and mobility, make the neck susceptible to pain and injury.

 

This complex structure includes 7 small vertebrae, intervertebral discs to absorb shock, joints, the spinal cord, 8 nerve roots, vascular elements, 32 muscles, and ligaments.

The nerve roots stem from the spinal cord like tree branches through foramen in the vertebrae. Each nerve root transmits signals (nerve impulses) to and from the brain, shoulders, arms, and chest. A vascular system of 4 arteries and veins run through the neck to circulate blood between the brain and the heart. Joints, muscles, and ligaments facilitate movement and serve to stabilize the structure.

The Spine:

 

The spinal column consists of 33 vertebrae:

  • 7 cervical (neck)(figure 1B)

 

  • 12 thoracic (each connects to 1 pair of ribs)

 

  • 5 lumbar (low back)

  • 5 sacral (in an adult they are joined together as one bone called the sacrum and do not contain discs)

  • 4 coccygeal (joined to form the single coccyx)

 

Cervical disc degeneration, tear and prolapse

 

Anatomy

The cervical (neck) spine has 7 pieces (vertebrae) whose bodies are stacked like building blocks.

Between each vertebra there are three joints - the disc between the bodies at the front, and two smaller facet joints at the back. The spinal cord runs down inside the spinal canal between the discs at the front and facet joints behind, and then at each level sends off a pair of nerves which leave the bony spine through holes called the intervertebral foramina (single = foramen, meaning window). Outside the spine, the cervical nerves join together to form the brachial plexus, which sends nerves into the upper limb.

The cervical bodies are separated by cushions called discs. A disc is made of special cartilage and acts like a shock absorber between the bodies. The disc is made of two parts - the outer layers form the annulus (meaning "belt"), which is like layers of onion rings and makes up 75% of the disc. In the centre of the disc is the nucleus, which makes up 25% of the disc and is like crab meat. The facet joints are like tiles on a roof, overlapping one another. Problems with a disc or facet joint can cause pressure on the adjacent nerve.


Pathology

The disc dries out with degeneration, meaning "wear and tear" that occurs with getting older and which may be accelerated by injury. With disc dehydration the disc gets smaller and loses its shock absorbing capacity.

Disc degeneration is best seen on magnetic resonance imaging (MRI) but usually doesn't cause any symptoms. However, sometimes disc degeneration can cause pain which can be due to annulus tear, mechanical failure or toxic ("poisonous") chemicals caused by breakdown of the disc. Disc degeneration may occur with or without reduction of disc height. Rupture of the annulus with outpouching of the nucleus is referred to as a "ruptured disc", "herniated disc", "disc prolapse" or "slipped disc". The fresh prolapse is initially well hydrated (like a grape) but with time it usually shrinks due to dehydration (like a sultana). This is why most disc prolapses improve without surgery. As we get older the spine often forms bony spurs (called osteophytes). This condition is called osteoarthritis, osteoarthrosis or spondylosis and is the commonest form of arthritis in our community. Surprisingly, these bony spurs do not usually cause any neck pain but they can grow and press on a nerve in the spine to cause arm pain (brachial neuralgia), or on the spinal cord to cause weakness and/or numbness in the arms and legs, as well as difficulty with bladder control

    Disc tear

A disc tear occurs in the annulus and is one of the most common causes of acute (rapid onset) neck pain, often causing pain in the middle or just to one side of the neck or into a shoulder blade, or between the shoulder blades. This pain is often mistakenly attributed to a "torn muscle". A disc tear can be notoriously slow to heal because discs have a relatively poor blood supply. Therefore, pain from a disc tear can take a frustratingly long time to settle - weeks to months - and sometimes remains for years.

    Disc rupture

Outpouching of the disc nucleus through an annulus tear is referred to as a "ruptured", "herniated", "prolapsed" or "slipped" disc. When a disc fragment extrudes to press on a nerve, the patient experiences a condition called brachalgia or brachial neuralgia, meaning nerve pain radiating into the upper limb.