Pain along the pelvis and groin region is known as osteitis pubis. Osteitis pubis develops through the inflammation of the pubic symphysis, or the joints of the major pelvic bones found at the front of the pelvis.
The pubic symphysis is a thin joint which generally provides very minimal motion. The joint retains the two sides of the pelvis together in the front, where they connect�at the sacrum in the rear side of the pelvis.
Contents
Osteitis Pubis Symptoms
Osteitis pubis is commonly characterized by pain in the front of the pelvis. Other causes of pelvic pain, such as a strain or a sprain, are frequently confused and diagnosed as osteitis pubis. While many patients report painful symptoms on one side, the�pain�typically occurs in the middle of the pelvis. Other symptoms of osteitis pubis include limping and weakness.
Osteitis Pubis Causes
For some patients, the pubic symphysis itself can become irritated and inflamed, causing the well-known symptoms of osteitis pubis. Other common causes of osteitis pubis comprise of: sports injuries, particularly from football, hockey, and soccer; pregnancy; gynecologic or abdominal surgical interventions; and trauma or injury from accidents.
�
Osteitis pubis is known as the inflammation of the pubis symphysis which causes various degrees of lower abdominal, pelvic, and groin pain. Symptoms of osteitis pubis include pain and discomfort in the region of the pelvis when engaging in physical activities, and loss of flexibility. A variety of causes, including sports injuries, can cause osteitis pubis. Fortunately, rest alone can help treat this painful health issue.
Dr. Alex Jimenez D.C., C.C.S.T.
Osteitis Pubis Diagnosis
Diagnosis of osteitis pubis generally involves x-rays which demonstrate an irregular pubic symphysis with sclerotic, or thick, bone borders as a result of chronic inflammation. An MRI test is generally not required, however, it will help demonstrate the inflammation of the bone and the joint.
Additional tests may be performed to ensure there’s no infection in the bone which could also be causing symptoms similar to osteitis pubis. This complication is more of a concern for those patients who have had recent surgery or for those who are more prone to suffer from infections.
Osteitis Pubis Management
The most recommended treatment for osteitis pubis is rest. Since inflammation is the problem, the human body often only requires the joint to rest in order to heal correctly. Other treatment, however, consists of:
Rest
An essential treatment for osteitis pubis is rest as this will permit the intense inflammation in the pelvis and groin to subside. For many patients, rest alone is the only treatment necessary for their�osteitis pubis. If the pain is severe, crutches or a cane may provide additional assistance.
Ice and Heat
Ice packs and heating pads are among the most commonly used remedies for inflammation. Make sure to follow the instructions of your healthcare professional before utilizing ice and heat for your osteitis pubis symptoms.
Chiropractic Care
Chiropractic care is a well-known, alternative treatment option for osteitis pubis. A doctor of chiropractic, or chiropractor, will utilize a variety of treatment methods and techniques, to help restore strength, mobility, and flexibility while rest is needed to subside the painful symptoms. Chiropractic care can also help correct any spinal misalignments which may be causing additional pain and discomfort for the patient.
Drugs and/or Medications
Nonsteroidal anti-inflammatory drugs and/or medications, commonly referred to as NSAIDs, are frequent prescriptions provided for patients with hip pain brought on by problems like arthritis, bursitis, and tendonitis.
Treatment of osteitis pubis may take some time to completely relieve the painful symptoms. The use of drugs and/or medications is demonstrated to be better than the other treatment options listed above, although attempts to heal osteitis pubis with cortisone injections have been tested.
Surgical interventions are generally not necessary for patients with osteitis pubis.�The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Acute Back Pain
Back pain�is the most prevalent cause of disability worldwide and the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
Ankylosing Spondylitis is a type of arthritis that typically begins during adolescence or in a person�s early twenties and occurs more often in men than in women. However, once experiences onset, they are affected for the rest of their lives. It is estimated that between 0.2% and 0.5% of individuals in the United States suffers from ankylosing spondylitis. �It can cause significant pain, discomfort, and immobility. While there is no cure for the condition, the symptoms can be treated, bringing some degree of comfort and mobility.
Contents
What is Ankylosing Spondylitis?
Ankylosing Spondylitis, or AS, is a type of arthritis that causes inflammation in the spine. While the vertebrae are primarily involved, it can also affect other joints as well, including the hips, shoulders, heels, ribs, and the small joints of the feet and hands.
In some cases, the heart, lungs, and even eyes can be involved. If left untreated, the condition can progress, causing chronic pain that can be severe as the spinal inflammation increases. More advanced cases can cause the spine to grow new bone formations so that it is immobile, or fixed, sometimes resulting in kyphosis, which is a bowed or forward-stooped posture.
What Causes Ankylosing Spondylitis?
While genetics is believed to be a key player in the development of Ankylosing Spondylitis, the exact cause has not yet been determined. The majority of people who have AS also carry a specific gene that has been linked to the condition.
This gene produces HLA-B27, a protein or genetic marker, that more than 95% of Caucasians with ankylosing spondylitis have. However, some people don�t have this protein who develop AS and many people do carry this marker yet never develop the condition.
Researchers theorize that there may be other genes that may be involved, as well as environmental factors that trigger the gene activation, such as a bacterial infection, causing people who are susceptible to AS to activate it. Scientists have identified more than 60 genes that are believed to be associated with AS with only about 30% that are linked to HLA-B27 regarding overall risk. Other genes that have been identified as key to AS include IL-23, IL-17, IL-12, and ERAP.
It is also believed that AS can be triggered when the intestinal defenses break down, allowing certain bacteria into the bloodstream. This can, in turn, cause an immune response.
How is Ankylosing Spondylitis Treated?
AS cannot be cured, but the symptoms can be treated to relieve stiffness and pain as well as delay or prevent spinal deformity and other complications. The damage that it does to the joints is irreversible, so it is best if treatment is started before that occurs. There are several ways that AS is treated:
Medication � Nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin (Indocin) and naproxen (Naprosyn) are commonly used to treat the symptoms of AS. They can be useful in relieving pain, inflammation, and stiffness but may cause some side effects, including gastrointestinal bleeding. This makes long-term use impractical and even unsafe. If NSAIDs do not help, other medications may be prescribed, including:
Golimumab (Simponi; Simponi Aria)
Certolizumab pegol (Cimzia)
Adalimumab (Humira)
Etanercept (Enbrel)
Infliximab (Remicade)
Physical therapy – PT is often recommended to help with flexibility, strength, and pain relief. It can help with posture and prevent some of the more debilitating symptoms.
Surgery � Most people with AS do not require surgery, but it may be recommended if there is severe joint damage or pain. In some cases, it can cause significant damage to hip joints, and they will need to be replaced.
Chiropractic � Many patients with AS have with outstanding results with chiropractic treatment. It is non-invasive and does not have the unpleasant side effects that many medications have.
Chiropractic Treatment for Ankylosing Spondylitis
Chiropractors strongly recommend chiropractic treatment for the non-acute inflammatory stage of AS. Once the condition has progressed to acute joint disease, there is a very high risk of injury or damage to the connective tissue. Adjustments and exercise are used to relieve symptoms, but some of the traditional spinal manipulation treatments are not performed.
A chiropractor will also make recommendations to the patient regarding lifestyle changes that can help with symptoms, such as stopping smoking. Tobacco use can increase inflammation and damage connective tissue. They may also advise increasing their intake of omega three fatty acids in their diet. Regular chiropractic care can help patients manage symptoms and prevent disease progression, improving their quality of life.
Sciatica is a collection of symptoms in the low back, which radiate down one or both legs. Sciatica is generally caused by the compression or irritation of the sciatic nerve, the largest nerve in the human body. One of the most common health issues that cause sciatic nerve pain is called piriformis syndrome. The piriformis muscle stretches from the front of the sacrum, the triangle-shaped bone between the hipbones on the pelvis.
The piriformis muscle extends to the top of the femur around the sciatic nerve. The femur, as previously mentioned, is the large bone in the upper leg. The piriformis muscle functions by helping the thigh move from side to side. A piriformis muscle spasm, or any other type of injury and/or condition along the piriformis muscle, can place pressure on the sciatic nerve and cause pain and discomfort. The result is piriformis�syndrome.
Contents
Piriformis Syndrome Causes and Symptoms
Sciatic nerve pain,�or sciatica, is one of the most prevalent�symptoms of piriformis syndrome. The pain and discomfort, however, may be felt in another part of the body. This is known as referred pain. Other common symptoms of piriformis syndrome include tingling sensations and numbness; tenderness;�difficulty sitting along with�pain while sitting and pain in the buttocks and thighs with physical activities.
The piriformis muscle can easily become damaged or injured from periods of inactivity or an excessive amount of exercise. Some common causes of piriformis syndrome include overuse; repetitive movements involving the legs; sitting for lengthy periods of time; lifting heavy objects; and extensive stair climbing. Sports injuries or automobile accident injuries can also harm the piriformis muscle and cause it to compress the sciatic nerve.�
�
Piriformis Syndrome Diagnosis
A doctor appointment for diagnosis of piriformis syndrome may include a review of the patient’s health history, their symptoms, and other probable causes of their pain and discomfort. If you recall straining a muscle during physical activity, be sure to share that information with your doctor. The�doctor may also perform a physical exam. The patient will participate in a series of range of movements to determine the cause of symptoms.
Some imaging tests may also be essential to help rule out other causes of piriformis syndrome. A CT scan or an MRI scan may help the healthcare professional determine whether even a herniated disc or arthritis is causing the patient’s pain and discomfort. An ultrasound of the piriformis muscle may also be helpful in diagnosing the problem if it seems that piriformis syndrome is causing the patient’s overall symptoms.
�
Piriformis syndrome is a health issue associated with the compression or impingement of the sciatic nerve around the piriformis muscle. Symptoms may include pain and discomfort, tingling sensations and numbness along the low back, or sciatica. Chiropractic care is a well-known alternative treatment option which can help reduce the compression of the sciatic nerve and improve piriformis syndrome.
Dr. Alex Jimenez D.C., C.C.S.T.
Piriformis Syndrome Treatment
Piriformis syndrome may often not need any treatment to�relieve its symptoms. Just avoiding the physical activities which caused the pain and discomfort to manifest and rest can help improve the health issue. If symptoms do persist, however, alternating between ice and heat can help decrease pain. Apply ice for 15 to 20 minutes then use a heating pad on the affected area. Try that every couple of hours to help relieve symptoms.
Over-the-counter painkillers�may also help decrease pain and discomfort. The symptoms associated with piriformis syndrome can go away with no additional treatment, however, if it doesn’t, the patient might benefit from alternative treatment options, such as chiropractic care or physical therapy. Chiropractic care is a treatment approach which utilizes spinal adjustments and manual manipulations to treat a variety of injuries and/or conditions.
A chiropractor,�or doctor of chiropractic, may also provide piriformis syndrome relief through the use of transcutaneous electrical nerve stimulator, or TENS, treatment. A TENS device is a handheld unit which sends electrical charges directly to the affected region of the piriformis muscle. The nerves are then stimulated by the electric energy, which interferes with pain signals being transmitted to the brain.
The chiropractor or physical therapist may also recommend a series of lifestyle modifications, including physical activity guidance and nutritional advice. Various stretches and exercises can help improve the strength, flexibility, and mobility of the�piriformis muscle. In severe cases of piriformis syndrome, corticosteroid injections or even surgical interventions may be required to help alleviate the symptoms.�The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Chiropractic for Athletes with Back Pain
Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain is the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
Roberto Varela was always actively involved with chores at home before he started to experience neck, shoulder and leg pain. Due to his symptoms, Mr. Varela had difficulties engaging in regular physical activities, such as driving. However, after being recommended by his wife, he first received chiropractic care with Dr. Alex Jimenez, and Roberto Varela experienced tremendous relief from his neck, shoulder and leg pain, regaining his quality of life. Mr. Varela highly recommends Dr. Alex Jimenez and his staff for their services.
Shoulder Pain Treatment
Shoulder pain or leg pain is common; however, sometimes these problems don’t originate in the location of the symptoms. Shoulder and leg pain may also occur due to health issues in the neck or cervical spine. A variety of injuries and conditions can have their roots in improper posture, sports injuries or automobile accident injuries, causing misalignments, or subluxations, in the cervical spine or neck. Many healthcare professionals will discuss how damage to the cervical spine can be an underlying cause for shoulder pain and leg pain, among other symptoms.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused on treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and we have helped you in any way, please feel free to subscribe and recommend�us.
The hips are some of the most flexible structures in the human body, providing the necessary amount of strength and stability needed to support the human body when walking, running or jumping. However, the hip joint can also be vulnerable to damage or injury, resulting in debilitating hip pain. Trochanteric bursitis is hip pain brought on by the inflammation of the fluid-filled sac, or bursa, found on the outer border of the hip.
Contents
Trochanteric Bursitis Overview
There are about 160 bursae located around the entire body. Bursae act as a sort of “cushion” between soft tissues and bones, preventing bones from rubbing against tendons, ligaments, and muscles. Trochanteric bursitis can affect any of the bursae inside the human body. Trochanteric bursitis affects the outer part of the thighbone, or the femur, at the edge of the hip. This bony point is best known as the greater trochanter.
Another bursa, called the iliopsoas bursa, can be found on the inside of the hip. Inflammation of the iliopsoas bursa also triggers pain in the groin. Bursitis is considered to be one of the top causes of hip pain. Repetitive physical activities, such as climbing stairs, or even surgical interventions to the hip may cause inflammation in the bursa. Many doctors commonly refer to trochanteric�bursitis as greater trochanteric pain syndrome.
Signs and Symptoms of Trochanteric Bursitis
The main characteristic of trochanteric bursitis involves pain in the outer area of the hip or pain when laying on the affected side of the hip. The painful signs and symptoms will also generally become worse through certain physical activities, such as walking or climbing stairs. Pain may also�radiate down the�thigh and into the feet, or it may disperse. Pain can be sharp and fade into an ache, accompanied by swelling in the legs.
Causes of Trochanteric Bursitis
Common causes of trochanteric bursitis include�slip-and-fall accidents, strong blows to the hip, or lying on one side of the body for an extended period of time. Sports injuries involving�overuse from repetitive physical activities like running, bicycling, or climbing stairs, a ripped tendon or even standing may cause trochanteric�bursitis. Health issues, such as�bone spurs in the hip or thighbone, may consequently cause trochanteric bursitis.�
A variety of conditions and disorders may also lead to trochanteric bursitis, including spine problems, such as scoliosis or arthritis of the lumbar spine, even rheumatoid arthritis, and gout as well as thyroid disease. Moreover, legs of two different lengths,�hip surgery or prosthetic implants can create problems in the hips. Trochanteric bursitis is most common in middle-aged or elderly people and it is most prevalent in women than men.
�
Trochanteric Bursitis Treatment and Chiropractic Care
Avoiding the physical activities which caused trochanteric bursitis will allow time for the body to heal. After seeing a healthcare professional for diagnosis, the doctor may often recommend nonsteroidal anti-inflammatory drugs, or NSAIDs to help control pain and inflammation. The recommended amount should be used to avoid side effects. Some doctors may also use steroid injections to control pain and inflammation.
Many healthcare professionals may also recommend alternative treatment options,�such as chiropractic care and physical therapy to help improve trochanteric bursitis signs and symptoms. A chiropractor may utilize spinal adjustments�and manual manipulations to reduce pressure from the spine while a physical therapist may teach the patient exercises to maintain strength. A cane or crutches can also take the weight off a patient’s hip.
If pain relievers or alternative treatment options, such as chiropractic care or physical therapy, do not work for the patient, the healthcare professional might recommend surgery to remove the bursa. This procedure can be accomplished through very small incisions with a camera. Other treatment approaches should be considered before following through with surgery.� The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
�
�
Additional Topics: Acute Back Pain
Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain is the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
If you are considering going upright in your workplace or workspace, you are not alone. Companies large and small are recognizing the benefits of this healthy, spine-friendly way of working and they are incorporating it into their employees� workstations. It places the body in an optimal position, between standing and sitting to provide an ergonomic solution to working at a desk that saves space too. Even home offices are getting in on the movement. These case studies tell the stories of four companies that incorporated upright workspace technology for their organizations.
Shape Up
Rhode Island-based start-up company, ShapeUp, is a health and technology-centered small business with just employees. It manages the design and implementation of socially activated wellness programs in the workplace. They were looking for furniture that was high quality and sturdy enough to withstand a workforce that was very active. At the same time, it needed to promote good health to remain consistent with the company�s health-oriented ideals.
Their first step moving in that direction was to purchase several community upright workstations. This would allow employees to get upright at various points during the day. The feedback from employees was so great that upright workstations were placed in each employee�s work area.� They reported reduced back pain and increased energy, attributing it to the simple act of going upright.
FLUX
FLUX, based in San Francisco, is a small tech company with fewer than 50 employees. The venture-backed start-up created software that �reimagines sustainable building design.�
In 2012, Nicholas Chim, the company�s founder, began searching for body-friendly workstations that would help keep his energy level up and help him maintain his focus. He purchased an upright station for himself to�use in his work area. Many of the employees expressed great interest in this new workstation. Once, Chim came home from a business trip and found that one of the employees had taken over his upright station.
It was then that Chim realized he needed to purchase upright stations for all of his employees if he was going to keep them happy and healthy. He now offers upright workstations to all of his employees; all they have to do is request it.
Katie Rowe Mitchell
Katie Rowe Mitchell has a home office where she runs her start-up, Unfold Yoga + Wellness with her friend and partner Nicole Elipas Doherty. The company brings meditation practices and accessible yoga to organizations as a wellness measure for the companies� employees. She left a�longtime corporate job that left her feeling physically uncomfortable, overstressed, and overworked due, in part, to her sedentary work style.
She recognized the link between yoga and having more energy and better focus so she left her corporate job to start her own company that would bring yoga to be stressed out workers. In her own home office, Katie wanted a more active work style, and an upright workstation was the answer. It keeps her engaged in mind, body, and spirit. She has a newfound sense of freedom that sitting behind a desk for hours every day did not provide. Going upright opened a whole new world for Katie.
Wikimedia Foundation
Tech non-profit Wikimedia Foundation is based in San Francisco and has 200 employees. It powers several collaboratively edited projects including Wikimedia. When the company decided to redesign their office space, they decided that they wanted to create a work environment that empowered and encouraged employees to work together. They chose a dynamic environment with an open floor plan � and they included several upright stations. These workstations were grouped so that all of the employees would have an opportunity to use the stations at different times. The standing desks also proved to be space saving and took up less room in the work area than traditional desks and chairs.
Athletic pubalgia is a debilitating health issue which affects the groin. The injury commonly happens through sports that use sudden changes of direction or intense twisting motions. Also referred to as a sports hernia, athletic pubalgia is characterized as a tear or strain in any soft tissue (muscle, tendon, ligament) of the abdominal or lower abdomen region.
Contents
Physiology of Athletic Pubalgia
The soft tissues most often affected by athletic pubalgia are the oblique muscles found in the lower abdomen, especially in the tendons that attach the oblique muscles to the pubic bone. In many instances, the joints that connect the thigh muscles to the pubic bone,�known as the adductor muscles, are also stretched or torn as a result of athletic pubalgia.
Physical activities which involve planting the feet and twisting with maximum exertion can cause athletic pubalgia. A sports hernia is most prevalent in vigorous sports, such as hockey, soccer, wrestling, and football. Athletic pubalgia�causes pain and discomfort in the groin region which typically gets better with rest but comes back with physical activity.
A sports�hernia does not result in a visible bulge in the groin, such as the well-known inguinal hernia does. As time passes, athletic pubalgia can lead to an inguinal hernia, and abdominal organs can push against the diminished cells to form a visible bulge. Without treatment, this sports injury could lead to chronic, disabling pain and other symptoms.
Healthcare Professional Diagnosis
During the first consultation, a doctor will discuss the individual’s symptoms and how the injury happened. To�diagnose athletic pubalgia, the healthcare professional will look for tenderness in the groin or above the pubis. Although a sports hernia may be related to an inguinal hernia, the doctor may not find any hernias during a physical examination.
Furthermore, to help determine the presence of athletic pubalgia, the healthcare professional will probably ask the patient to perform a sit-up or to�bend the trunk against resistance. If you have a sports hernia, these tests will be painful. The doctor may also require�x-rays or magnetic resonance imaging (MRI) to help determine whether you have athletic pubalgia.�The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Acute Back Pain
Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain attributes to the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
The vast majority of clinically suspected bone Mets are found in the axial skeleton and proximal femurs/humeri
Radiography is the most cost-effective and readily available initial imaging tool to investigate bone Mets but often fails early metastatic detection
Tc99 bone scintigraphy is the most sensitive and cost-effective imaging modality to demonstrate metastatic foci
MR imaging may help� regional identification of bone Mets especially if x-radiography is unrewarding
Significant limitations of MRI: inability to perform a whole-body MRI scan
Cost and other contraindications such as cardiac pacemakers and cochlear implants may be another limiting factor
Contents
Marrow Based Neoplasms
Malignancy originating from the marrow cells are often referred to as “round-cell tumors.”
Multiple Myeloma (MM)
Lymphoma
Ewing’s sarcoma
The last two are less frequent than MM
Red marrow in adults is in the axial skeleton and proximal femurs/humeri d/t gradual marrow “retraction” following the childhood
Note bone marrow biopsy histopathology specimen of MM with abnormal plasma cells replacing regular marrow residents (above image)
Multiple Myeloma (MM) is the most common primary bone neoplasm in adults>40s. Etiology is unknown, but many theories exist (e.g., genetic, environmental, radiation, chronic inflammation, MGUS)
MM: malignant proliferation of plasma cells >10% of red marrow, with subsequent replacement of normal marrow cells by myeloma cells and overproduction of monoclonal antibodies paraproteins (M protein) with heavy chains IgG (52%), IgA (21%), IgM (12%) and light chains kappa or lambda aka Bence-Jones proteins
Clinical Presentation of MM
MM is occasionally detected as unexplained anemia on routine blood studies for unrelated complaints
Common MSK symptoms: Bone pain/Pathologic fractures
Diagnostic imaging plays an essential role during the Dx of MM
Bone marrow aspiration biopsy, blood tests, and serum protein electrophoresis may be used
Imaging approach: bone pain is investigated with initial x-radiographs if radiographs are unrewarding MR imaging may help to reveal bone marrow abnormality. MRI is recommended as myeloma survey
Currently, MRI protocol known as “whole body myeloma scan” consisting of T1, T2-fat suppressed, and T1+C coronal sequences can detect MM in the skull, spine, pelvis, ribs and femurs/humeri. This technique is much more superior to radiographic “skeletal myeloma survey.”
Tc99 bone scintigraphy is not typically used for MM because over 30% of MM lesions are “cold” or photopenic on radionuclide bone scan d/t highly lytic nature of MM with osteoclasts outpacing osteoblasts.
A radiographic skeletal survey is considered more sensitive than bone scintigraphy in MM
PET-CT scanning of MM is gaining popularity due to the high level of detection of multiple sites of MM
Radiographic Dx of MM: consists of identification of characteristically localized focal osteolytic “punched out” or “moth-eaten” lesions of variable sizes following the distribution of adults red marrow
Note rad abnormality is known as “raindrop skull” is characteristic of MM
Radiographic appearance of MM may vary from “punched out” round radiolucencies to “moth-eaten” or permeating osteolytic lesion producing endosteal scalloping (yellow arrow)
Pelvis and femurs are commonly affected by MM and present radiographically as round lytic punched out or moth-eaten lesions
N.B. Occasionally MM may pose radiographic dilemma by presenting as generalized osteopenia in the spine that can be difficult to differentiate from age-related osteoporosis
MR imaging of MM reveals� marrow changes with low signal on T1, a high signal on fluid-sensitive sequences and bright contrast enhancement on T1+C gad d/t increased vasculature and high activity of� MM cells
Example of full-body MRI of “whole body myeloma scan” with T2-fat suppressed (A), T1 (B) and T1+C (C) pulse sequences produced in coronal slices
Note multiple foci of bone marrow changes in the spine pelvis and femurs
Miscellaneous Neoplasms of the Spinal Column
Chordoma: is relatively uncommon but considered the m/c primary malignant neoplasm that only affects the spine. D/t slow growth is often misdiagnosed for a considerable length of time as LBP
Pathology: derives from malignant transformation of notochordal cells presented as mucoid, gelatinous mass containing physaliphorous cells
Demo:�M: F 3:1 (30-70S). 50%-sacrococcygeal, 35% spheno-occipital 15%-spine
Clinically: asymptomatic for a long time until non-specific LBP, changes in bladder & bowel, neurological signs are less common d/t midline “outward” growth & inferior to S1. Local invasion worsens prognosis. 60%-survive 5-years, 40%-10-years, Mets are delayed, poor prognosis d/t local invasion. >50% can be id. on DRE.
Imaging:�x-rays often tricky d/t overlying gas/feces. CT is >sensitive to id the bone mass and internal calcifications. MRI: T2 bight signal, T1 heterogeneously low and high d/t mucus/blood decomposition, MRI best detects local invasion and essential for care planning. Rx:� complete excision is often impossible d/t local vascular invasion.
Giant cell tumor (GCT):�2nd most common primary sacral tumor. It is a histolgically benign neoplasm containing multinucleated Giant cells of Monocyte-Osteoclast origin
Imaging Dx:�x-radiography is the 1st step usually in response to complaints of LBP. Often challenging to id on x-rays d/t bowel gas/feces
Key rad feature: osteolytic expansile lesion noted by destruction of sacral arcuate lines. CT may id the lesion better. MRI is the modality of choice following x-rays. MRI: T1 low to intermediate signal. Heterogeneously high d/t edema with areas of low signal on T2 d/t blood degradation and fibrosis. Characteristic fluid-fluid levels may be noted especially if ABC develops within a GCT. Rx: operative. Prognosis is less favorable than GCT in long bones d/t lung Mets (deposits) in 13.7%
Aneurysmal Bone Cysts (ABC) are benign expansile tumor-like bone lesions (not a true neoplasm) composed and filled with numerous blood-filled channels. Thus the term “blood sponge.” ABC is m/c id in children and adolescents
Unknown etiology: trauma and pre-existing bone neoplasm (e.g., GCT) often reported. Clinically: pain that may be progressive d/t rapid nature of ABC expansion. In the spine, ABC m/c affects posterior elements and presented as expansile, soap-bubbly or lytic lesion.
DDx: can be broad, but Osteoblastoma and GCT are the top DDxs.
Imaging: x-rays demo expansile mass in posterior elements, CT is more sensitive than x-rays, MRI will demo characteristic fluid-fluid levels and mixed high and low signal d/t edema and blood decomposition/aging with some septations.
N.B. MRI fluid-fluid levels are not exclusive to ABC, and DDx includes GCT, osteoblastoma, telangiectatic osteosarcoma.
Rx: operative curettage and bone grafting, fibrosing agents. Recurrence 10-30%.
Athletic pubalgia, also known as a hockey hernia,�hockey groin, Gilmore’s Groin,�sports hernia, or groin disruption, is a health issue of the pubic joint. It is a condition characterized by chronic groin pain in athletes and identified by a dilated ring of the inguinal canal. Soccer and ice hockey players are the athletes most commonly affected by athletic pubalgia, and both recreational and professional athletes can be impacted.
Contents
Athletic Pubalgia Symptoms
Symptoms of athletic pubalgia�generally manifest as pain following physical activity, most frequently through hip extension, and twisting and turning movements. The painful symptoms usually radiate into the adductor muscle region and the testicles, although it is often difficult for the individual to pinpoint the exact location of the�symptoms. Athletes with athletic pubalgia�experience soreness and stiffness after physical activity.
Any exertion which increases intra-abdominal pressure, such as sneezing or�coughing, as well as physical activity, can lead to pain. While pain in the stomach and pelvis can occur due to a variety of health issues, including injuries to the low back, or lumbar spine, the hip joint, the sacroiliac joint, and the abdomen, along with the genito-urinary system, diagnosis of athletic pubalgia demands skillful differentiation and evaluation.
Clinical Presentation of Athletic Pubalgia
The diagnosis of athletic pubalgia is based on the patient’s history, where healthcare professionals may also depend on the use�of magnetic resonance imaging,�or MRI. Symptoms can frequently be reproduced by certain movements, such as performing crunches or sit-ups. Pain associated with athletic pubalgia may also be elicited with the patient in a “frog posture,” in which the individual is supine with knees bent and heels together.
Many athletes experience concomitant fatigue or tearing of the�adductor muscles or labral tears of the hip. If there is stiffness in the adductor muscles post-injury, painful symptoms can manifest. Alternative treatment options should be to restore normal movement after the adductor has begun to heal, normally 6 to 8 weeks post-injury. Moreover, sleeping in a prone position with the hip on the affected side flexed and externally rotated can offer relief to some athletes with athletic pubalgia.
The precise prevalence of this health issue is unknown. Conservative therapies,�such as gentle stretching, may temporarily alleviate painful symptoms, however, definitive treatment options should be considered for long-term relief.�The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Acute Back Pain
Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain attributes to the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
Sleeping. New parents chase it, Type A personalities fight it, but everyone needs it. The thing is, most people don�t get enough of it. According to the National Sleep Foundation, 45 percent of adults in the United States report that in a seven day period lack of sleep affected their daily activities.
Sleep quantity is not as much of a problem as sleep quality. Around 35 percent of people who said they slept for 7 or 8 hours a night still reported that their sleep quality was �only fair� or �poor� and 20 percent said that they did not feel refreshed upon waking. When a person is dealing with pain, such as lower back pain, it can make it even more difficult to get a good night�s sleep.
Contents
The Importance of Sleeping
Sleep is vital for good health. The Centers for Disease Control (CDC) cites insufficient sleep as a contributing factor to a variety of conditions including obesity, diabetes, depression, and cardiovascular disease. It is also a significant contributing factor in many machine related crashed, worksite accidents, and automobile accidents, leading to injury, disability, and even death.
Sleep allows your body to heal and the spine to rejuvenate. It helps you handle stress better and manage pain more effectively. It is an essential part of good health so making sure that you get good quality sleep should be a priority � and it is possible. These are the best sleep positions to get your best sleep when you have lower back pain.
Stomach Position
Sleeping on your stomach is usually the least back friendly sleep position, but some people can�t sleep any other way. Take the strain off of your back by supporting it with a pillow under your lower abdomen and pelvis. Using a pillow may put too much stress on your back, so you might need to try to sleep without one. Another alternative is to use a flatter, less fluffy pillow. Try different positions, such as drawing one leg up or splaying your legs more until you find on that is right for you.
Back Position
If you sleep on your back, you likely won�t be comfortable just lying flat. Try different positions such as placing a rolled towel under your knees or the small of your back to provide added support. Use a good pillow to support your neck. Some pillows are made specifically for people who sleep on their backs; you may want to give it a try.
Side Position
Many people with lower back pain find sleeping on their side to be the most comfortable sleep position. If you sleep on your side, pull your knees up slightly so that they are almost perpendicular from your body. You may have to make some adjustments to how bent your legs are before you find a position that takes the pressure off of your back. Place a pillow between your thighs and knees. You may want to use a body pillow to provide even more support all along your legs.
A Word about Your Pillow and Your Bed
The position that you sleep in can help relieve your back pain, but getting good quality sleep will help you manage your pain much better so it should be your goal to get a�good, restful sleep every night. You should change out your pillow on a regular basis.
Pillows can get worn and no longer deliver the support they once did. If you are waking up with neck or back pain or headaches, it could be your pillow. Additionally, studies show that making your bed every day improves your quality of sleep. Make sure that the temperature is comfortable and avoid electronic devices for about an hour before bedtime. Be kind to your body; make sleep a priority.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
