KNEE PAIN

Posted November 24, 2008 11:14 AM

Question:

Good Day, Dr. Veliz:

I have been having chronic pain in my left knee, for greater than one year, which has been driving me crazy.  The nurse practitioner examined me and said that she did not find anything wrong with my knee and that the MRI was completely normal.  What should I do at this point?

Answer:

Pain is commonly referred to the knee from the lumbar spine, hip and sacroiliac joint. Less commonly, pain can be referred to the knee from the ankle or foot. I recommend that you get a second opinion with an orthopedic surgeon, sports medicine specialist or pain management specialist.

Take care.

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FACET JOINT RADIOFREQUENCY OR RHIZOTOMY

Posted October 20, 2008 12:00 AM

Question:

Dear Dr. Veliz:

I’ve read about a procedure which involves burning nerves in the spine in order to decrease pain. I’m confused. If you burn a nerve, won’t this leave you paralyzed?

Answer:

Radiofrequency ablation or lesioning is also termed rhizotomy. In the case of facet joints, radio waves are used to produce heat in order to destroy a nerve. A needle is placed into the facet joint under x-ray guidance and radiofrequency waves are transmitted through the needle. The reason that paralysis should not occur is that the nerves being targeted are called sensory nerves and not motor nerves. They are called medial branch nerves and they carry pain signals from the facets joints to the spinal cord. In summary, heat is being used to destroy a sensory nerve, not a motor nerve. You are correct in your assumption that destroying a motor nerve can lead to weakness or paralysis. Your pain management specialist can minimize the risk of destroying a motor nerve by using x-ray guidance, understanding spinal anatomy and performing a test prior to the actual destroying of the nerve.

I hope this clarifies the issue for you.

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SCIATICA

Posted August 29, 2008 12:00 AM

Question:

Hello Dr. Veliz:

I was hoping that you could clarify something for me. My family physician told me that I had sciatica. On my way out of the office, I ran into his physician’s assistant who said that, actually, my S1 nerve root was being pinched. Can you please clarify why the physician’s assistant stated that my S1nerve root was being pinched and not my sciatic nerve, especially if my physician says I have sciatica?

Answer:

The sciatic nerve is formed by the nerve roots coming out of the spinal cord into the lower back. These branches of the sciatic nerve travel through the buttocks and down the back of each leg to the ankle and the foot. The definition of sciatica is numbness, tingling, or pain produced by inflammation of the nerve roots which eventually lead to the sciatic nerve. Your physician’s assistant was being more specific when he told you that your S1 nerve was being pinched. This is still consistent with the diagnosis of sciatica since the S1 nerve eventually leads to the sciatic nerve.

Best of luck.

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POSSIBLE HEART ATTACK

Posted July 14, 2008 12:00 AM

Question:

Dear Dr. Veliz:

Every once in a while, I have pain in my left shoulder that travels to my left hand. When this happens, I commonly feel short of breath and nauseated. Is it possible that the pain can be stressing me out and that stress can be causing me to be nauseated and short of breath?

Answer:

Even though you are not experiencing chest pain, shoulder pain traveling to your left hand, especially when associated with nausea and shortness of breath, can be originating from your heart. If you are currently experiencing those symptoms, I strongly suggest that you dial 911 immediately. If they are occurring sporadically, then you should quickly contact your primary care physician or cardiologist for further work up. It is very common for someone to be experiencing a heart attack without chest pain. This is even more common in persons with diabetes who have disorders of their autonomic nervous system.

Making sure that the pain is not originating from your heart takes precedence over determining whether or not the pain is originating from your shoulder or your neck. It is possible for a pinched nerve in one’s neck to result in shoulder pain and arm pain without any neck pain.

I wish you luck.

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