Neck Pain

Pain Conditions

At Bay State Pain Management, Our Expert Pain Management Specialists Provide Effective Treatments for Head, Shoulder, Arms and Neck Pain.

Neck Pain

  • Overview
  • What Is it?
  • Diagnosis
  • Causes
  • Common Symptoms
  • Treatment Guidelines
  • Key point about neck pain

Neck Pain

What is neck pain?

Due to its location and range-of-motion, your neck is often left unprotected and at risk for injury. Neck pain can range from mild discomfort to disabling, chronic pain.

CT scanHow is neck pain diagnosed?

Along with a complete medical history and physical exam, diagnostic procedures for neck pain may include:

  • Blood tests. These tests can help diagnose underlying inflammatory disease.

  • Electromyogram (EMG) and nerve conduction studies. These tests are done together to evaluate nerve function.

  • X-ray. This is a test that uses electromagnetic energy beams to make images of bones onto film.

  • MRI. This procedure uses large magnets and a computer to make detailed images of organs and structures within the body. MRI can often identify damage or disease of internal structures within our joints or in a surrounding ligament or muscle.

  • CT scan. This is an imaging procedure that uses X-rays and computer technology to make images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

neck pain What causes neck pain?

Many different things can cause neck pain including injury, age-related disorders, and inflammatory disease. Causes of neck pain and problems may include:

  • Damage to the muscles, tendons, or ligaments

  • Herniated disk in the neck

  • Arthritis such as osteoarthritis or rheumatoid arthritis

  • Cervical (neck) disk degeneration

  • Problems of the vertebrae and bones present at birth (congenital)

  • Tumors

What are the symptoms of neck pain?

Neck pain may feel: 

  • Tender

  • Sharp

  • Stiff

  • Spasmodic

  • Burning or tingling

Sometimes other symptoms occur along with neck pain such as weakness in your arm or hand, or headaches. Pain can also spread to your back.

cervicalHow is neck pain treated?

Treatment may include:

  • Medicine to reduce inflammation and control pain

  • Rest

  • Physical therapy

  • Osteopathic manipulation

  • Neck brace or immobilization

  • Exercise

  • Massage therapy

  • Surgery

 

When should I call my healthcare provider?

Treatment for neck pain is recommended when the pain starts to prevent any future injury or damage. 

Key points about neck pain

  • Neck pain can range from mild discomfort to disabling, chronic pain.

  • Neck pain can result from many different causes, from injury to age-related disorders or inflammatory disease.

  • Seeking medical advice as soon as possible after the injury will minimize future damage and inflammation.

  • Once you have been treated for the initial injury, a program of physical rehabilitation may be necessary. It is important to follow through with your program and exercises to both strengthen and build muscles to support your activities.

  • Using good body mechanics may prevent future injury.

CAUSES OF NECK PAIN

  • Torticollis
  • Whiplash Injury

Torticollis

What is torticollis?

Torticollis, also known as wryneck or twisted neck, is a twisting of the neck that causes the head to rotate and tilt at an odd angle.

What causes torticollis?

The exact cause of torticollis is unknown.

Congenital muscular torticollis is a condition you are born with. It is more likely to happen in firstborn children. This may also be accompanied by a congenital hip dislocation. The cause is likely from the baby’s position in the uterus which leads to injury to the neck muscles.

Acquired torticollis may be caused by irritation to the cervical ligaments from a viral infection, injury, or vigorous movement. Additional causes may include:

  • Sleeping in an awkward position

  • Neck muscle injury at birth

  • Burn injury

  • Any injury that causes heavy scarring and skin or muscle shrinkage

  • Neck muscle spasm

Torticollis may also be a condition that results from the following:

  • Slipped facets (2 small joints on the side of the spine)

  • Herniated disk

  • Viral or bacterial infection

What are the symptoms of torticollis?

The following are the most common symptoms of torticollis. However, each person may experience symptoms differently. Symptoms may include:

  • Neck muscle pain or pain down the spine

  • Head tilts to one side

  • Inability to turn the head, usually holding it twisted to one side

  • Spasm of the neck muscles

  • Awkward position of the chin

The symptoms of torticollis may look like other conditions and medical problems. Always talk with your healthcare provider for a diagnosis.

How is torticollis diagnosed?

Diagnosis of torticollis usually is confirmed with a medical history and physical exam.

How it torticollis treated?

Specific treatment for torticollis will be determined by your healthcare provider based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medicines, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Treatment may include:

  • Neck collar

  • Heat therapy

  • Ultrasound therapy

  • Physical therapy

  • Surgery

When should I call my healthcare provider?

If your symptoms have not improved within the time frame suggested by your healthcare provider, you should let them know. Also, if your symptoms get worse or you get new symptoms, tell your healthcare provider.

Key points about torticollis

  • It is a twisting of the neck that causes the head to rotate and tilt at an odd angle.

  • The exact cause is unknown. It can be congenital or acquired.

  • Diagnosis is usually confirmed by history and physical exam.

Whiplash Injury

What is whiplash?

Whiplash is an injury to your neck. It is caused by your neck bending forcibly forward and then backward, or vice versa. The injury, which is poorly understood, usually involves the muscles, disks, nerves, and tendons in your neck.

What causes whiplash?

Most whiplash injuries result from a collision that includes sudden acceleration or deceleration. Many whiplash injuries occur when you are involved in a rear-end automobile collision. They also happen as a result of a sports injury, particularly during contact sports.

What are the symptoms of whiplash?

These are the most common symptoms of whiplash:

  • Neck pain

  • Neck stiffness

  • Shoulder pain

  • Low back pain

  • Dizziness

  • Pain in your arm or hand

  • Numbness in your arm or hand

  • Irritability

  • Sleeplessness

  • Tiredness

The symptoms of whiplash may look like other health problems. Always see your healthcare provider for a diagnosis.

CT scanHow is whiplash diagnosed?

Along with a complete medical history and physical exam, tests for whiplash may include:

  • X-ray. Electromagnetic energy beams make images of internal tissues, bones, and organs onto film. But many whiplash injuries include damage to soft tissue that can't be seen on X-rays.

  • MRI. Large magnets and a computer make detailed images of organs and soft tissue structures in your body.

  • CT scan. X-rays and computer technology make detailed images of any part of your body, including your bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

 

How is whiplash treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment may include:

  • Ice applications for the first 24 hours

  • Cervical (neck) collar

  • Gentle, active movement after 24 hours

  • Nonsteroidal anti-inflammatory medicines such as ibuprofen)

  • Muscle relaxing medicines

  • Physical therapy

  • Osteopathic manipulation

  • Topical gels or shots into the neck to ease pain

What are possible complications of whiplash?

While most people who have a whiplash injury recover within a few weeks to a few months, some have persistent pain for several months or longer.

When should I call my healthcare provider?

If your symptoms have not improved within the time frame your healthcare provider suggested, let him or her know. Also, if your symptoms get worse or you get new symptoms, tell your provider.

Key points about whiplash

  • Whiplash is poorly understood, but it usually involves the muscles, disks, nerves, and tendons in your neck.

  • It is caused by the neck bending forcibly forward and then backward, or vice versa.

  • Many whiplash injuries occur if you are involved in a rear-end automobile collision.

  • Your healthcare provider will determine specific treatment for your whiplash.

SEEKING HELP FOR NECK PAIN

  • Chiropractic Medicine
  • Acupuncture
  • Chronic Pain

Chiropractic Medicine

Chiropractic medicine focuses on the link between the body's structure and function. A key part of chiropractic medicine is the belief that the body can heal itself with the right support.

Chiropractic medicine believes a person's health can be improved through hands-on treatments (called adjustments or manipulations) and tools. These are used to create better structure and alignment. Providers find structural and functional problems by doing a physical exam and taking X-rays. They may also do lab tests and other testing. Some chiropractors offer nutritional advice and do complementary medicine. They also often advise exercises to do at home.

Chiropractic treatments may help ease lower back pain, muscle pain, and other bone pain. During treatment, you may lie down on a special table. The provider then uses their hands and elbows to realign your spine.

Chiropractors have different training than licensed medical doctors. It's extensive and highly focused on the correct structure of the body. A Doctor of Chiropractic (DC) has had at least 3 years of college. There is a focus on biology or basic sciences. They also have at least 4 years of training at an accredited chiropractic college that includes classroom, lab, and clinical courses. To practice, they must also pass a comprehensive licensing exam. Many states require yearly continuing education credits to keep the license.

When considering chiropractic treatment:

  • Ask if chiropractic treatment could help your condition.

  • Ask how long treatments may take and how many treatments you may need.

  • Check your insurance coverage.

  • Find out if there are out-of-pocket costs.

  • As with any healthcare treatment, discuss the risks and benefits of the treatment with the chiropractor.

Tell the chiropractor about any medicines you take. If any vitamins or supplements are advised, ask about possible interactions with the medicines or supplements you are now taking.

Tell all of your healthcare providers (conventional or complementary) about the health approaches, supplements, and medicines you use. This will give them a full picture of your health. It will help ensure safe, effective, and coordinated care.

Acupuncture

What is acupuncture?

Acupuncture is the practice of putting thin needles into the skin on certain parts of the body. These are then activated by gentle and specific movements of the provider's hands. Or through electrical stimulation. 

Acupuncture is part of the ancient practice of Traditional Chinese medicine (TCM). TCM providers believe the human body has more than 2,000 acupuncture points. The points are linked by pathways called meridians. Meridians create an energy flow called Qi (pronounced "chee") all over the body. Qi is responsible for overall health. Disrupting the energy flow can cause disease. Using acupuncture on certain points is believed to improve the flow of blocked or nonmoving Qi. This restores energy movement and improves health.

Studies have shown that acupuncture works well for many conditions that are discussed below

Acupuncture is not for everyone. If you choose to see an acupuncturist, talk with your healthcare provider first. Find an acupuncturist who is licensed and has the right training and credentials.

What does acupuncture feel like?

Acupuncture is done using hair-thin needles. Most people report feeling little pain as the needle is put into certain points. Needles are only inserted to a point that gives a feeling of pressure or ache. Needles may be heated during the treatment. Mild electric current may also be applied to the needles. Some people say acupuncture makes them feel energized. Others say they feel relaxed.

Needles must be sterilized to prevent infection. And incorrect needle placement can cause pain during treatment. So it's important to find an experienced, well-trained provider who uses sterilized needles. The FDA regulates acupuncture needles just as it does other medical devices.

Sometimes other forms of stimulation are used over the acupuncture points instead of needles. These include:

  • Heat (moxibustion)

  • Pressure (acupressure)

  • Friction

  • Suction (cupping)

  • Electromagnetic energy impulses

How does acupuncture affect the body?

Acupuncture points are believed to stimulate the central nervous system. This releases chemicals into the muscles, spinal cord, and brain. These biochemical changes may stimulate the body's natural healing abilities. They may promote physical and emotional well-being.

Studies have shown that acupuncture is effective alone or used with conventional therapies to treat these conditions:

  • Upset stomach (nausea) caused by surgical anesthesia and cancer chemotherapy

  • Dental pain after surgery

  • Addiction

  • Headaches

  • Menstrual cramps

  • Tennis elbow

  • Fibromyalgia

  • Myofascial pain

  • Osteoarthritis

  • Low back pain

  • Carpal tunnel syndrome

  • Asthma

It may also help with stroke rehabilitation.

What conditions may be helped by acupuncture?

Many people in the U.S. get acupuncture treatment to ease long-term (chronic) pain. This includes arthritis and low back pain. But acupuncture has other uses around the world. Before getting acupuncture, talk with your healthcare provider. Conditions that may be helped by acupuncture include:

Digestive

Emotional

Gastritis

Irritable bowel syndrome

Hepatitis

Hemorrhoids

Anxiety

Depression

Insomnia

Nervousness

Neurosis

Eye-Ear-Throat

Gynecological

Rhinitis

Sinusitis

Sore throat

Menstrual pain

Infertility

Musculoskeletal

Neurological

Arthritis

Back pain

Muscle cramping

Muscle pain and weakness

Neck pain

Sciatica

Headaches

Migraines

Neurogenic bladder dysfunction

Parkinson's disease

Postoperative pain

Stroke

Respiratory

Miscellaneous

Allergic rhinitis

Sinusitis

Bronchitis

Irritable bladder

Prostatitis

Male infertility

Some forms of impotence

Addiction

Things to think about when choosing acupuncture

Scientific studies have not fully explained how acupuncture works in the framework of Western medicine. So acupuncture is still disputed. It's important to be safe when deciding about acupuncture.

  • Talk about acupuncture with your healthcare provider first. Acupuncture is not for everyone. Talk about all the treatments and medicines you are taking. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. If you have a pacemaker, are at risk for infection, have chronic skin problems, are pregnant, or have breast or other implants, tell your provider. Acupuncture may be risky to your health if you don't talk about these things.

  • Don't rely on a diagnosis of disease by an acupuncture provider. If you were given a diagnosis by a healthcare provider, ask him or her if acupuncture might help.

  • Choose a licensed acupuncture provider. Talk with your healthcare provider, friends, and family members. They may be able to refer you to a licensed or certified provider. You don't have to be a doctor to practice acupuncture or be a certified acupuncturist. About 30 states have set training standards for certification in acupuncture. But not all states require acupuncturists to get a license to practice. Not all certified acupuncturists are doctors. But the American Academy of Medical Acupuncture can give you a list of doctors who do acupuncture.

  • Think about costs and insurance coverage. Before starting treatment, ask the acupuncturist about the number of treatments needed. Find out how much they will cost. Some insurers cover the cost. But others don't. It's important to know before you start treatment if it is covered by your insurance.

Chronic Pain

What is pain?

Pain starts in receptor nerve cells found beneath the skin and in organs throughout the body. When you are sick, injured, or have other type of problems, these receptor cells send messages along nerve pathways to the spinal cord, which then carries the messages to the brain. Pain medicine may be needed to reduce or block these messages before they reach the brain.

Pain can be anything from slightly bothersome, such as a mild headache, to something excruciating and emergent, such as the chest pain that comes with a heart attack or the pain of kidney stones. 

What are the different types of pain?

Two major types of pain include the following:

  • Acute pain. This pain may come from inflammation, tissue damage, injury, illness, or recent surgery. It usually lasts less than a week or two. The pain usually ends after the underlying cause is treated or has been resolved.

  • Chronic pain. This is pain that lasts for months or even years.

What is chronic pain?

Chronic pain is long standing pain that persists beyond the usual recovery period or occurs along with a chronic health condition, such as arthritis. Chronic pain may be “on” and “off” or continuous. It may affect people to the point that they can’t work, eat properly, take part in physical activity, or enjoy life.

Chronic pain is a major medical condition that can and should be treated.

Chronic pain is one of the most costly health problems in U.S. Increased medical expenses, lost income, lost productivity, compensation payments, and legal charges are some of the economic consequences of chronic pain. Consider the following:

  • Low back pain is one of the most significant health problems. Back pain is a common cause of activity limitation in adults.

  • Cancer pain affects most people with advanced cancer.

  • Arthritis pain affects more than 50 million Americans each year.

  • Headaches affect millions of U.S. adults. Some of the most common types of chronic headaches are migraines, cluster headaches, and tension headaches.

  • Other pain disorders such as the neuralgias and neuropathies that affect nerves throughout the body, pain due to central nervous system damage (to the brain and spinal cord), as well as pain where no physical cause can be found (psychogenic pain) increase the total number of reported cases.

What causes chronic pain?

There are many causes of chronic pain. It may start from an illness or injury, but remain long after recovery from other symptoms. Or there may be an ongoing cause of pain, such as arthritis or cancer. Many people suffer chronic pain in the absence of any past injury or evidence of illness.

What is the effect of chronic pain?

When pain becomes such a problem that it interferes with your life’s work and normal activities, you may become preoccupied with the pain, and feel depressed and irritable. Depression and irritability often lead to insomnia and weariness, leading to more irritability, depression, and pain. This state, in turn, can lead to suffering, sleeplessness, and sadness. The urge to stop the pain can lead some people to use multiple drugs and may drive others to have repeated surgeries, or resort to questionable treatments. The situation can often be as hard on the family as it is on the person suffering with the pain.

How is chronic pain treated?

Chronic pain affects all parts of your life. The most effective treatment includes symptom relief and support. A multidisciplinary approach to pain management is often required to provide the needed interventions to help manage the pain. Pain management programs are usually done on an outpatient basis. Many skilled professionals are part of the pain management rehabilitation team, including:

  • Neurologists and neurosurgeons

  • Primary care providers

  • Orthopedists and orthopedic surgeons

  • Anesthesiologists

  • Oncologists

  • Physiatrists

  • Nurses

  • Physical therapists

  • Occupational therapists

  • Psychologists/psychiatrists

  • Social workers

  • Case managers

  • Vocational counselors

Special pain programs are located in many hospitals, rehab facilities, and pain clinics.

The pain management rehab program

A pain management rehabilitation program is designed to meet your needs. The program will depend on the specific type of pain, disease, or condition. Active involvement by you and your family is vital to the success of the program.

The goal of a pain management program is to help you return to the highest level of function and independence possible, while improving your overall quality of life—physically, emotionally, and socially. Pain management techniques help reduce your suffering.

To help reach these goals, pain management programs may include:

  • Medical management of chronic pain, including medicine management:

    • Over-the-counter (OTC) medicines may include nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, or acetaminophen.

    • Prescription pain medicines, including opioids, may be needed to provide stronger pain relief. However, these drugs are reserved for more severe types of pain, as they have some potential for abuse. They may also have unpleasant and potentially dangerous side effects.

    • Prescription antidepressants can help some people. These medicines increase the supply of the naturally produced neurotransmitters, serotonin and norepinephrine. Serotonin is an important part of a pain-controlling pathway in the brain.

    • Adjuvant medicines may be advised to help control the side effects or to help increase the pain-relieving effects of pain medicines.

  • Heat and cold treatments to reduce stiffness and pain, especially with joint problems such as arthritis

  • Physical and occupational therapy such as massage and whirlpool treatments

  • Exercise to prevent further problems and reduce spasticity, joint contractures, joint inflammation, spinal alignment problems, or muscle weakening and shrinking

  • Local electrical stimulation involving application(s) of brief pulses of electricity to nerve endings under the skin to provide pain relief

  • Injection therapies, such as epidural steroid injection

  • Emotional and psychological support, which may include:

    • Psychotherapy and group therapy

    • Stress management

    • Relaxation training

    • Meditation

    • Hypnosis

    • Biofeedback

    • Behavior changes

The philosophy common to all of the psychological approaches to pain management is the belief that you can do things on your own to control pain. This includes changing your attitudes, your perception of being a victim, your feelings, or your behaviors associated with pain. It also may include understanding how unconscious forces and past events have contributed to your pain. These goals may be accomplished with:

  • Patient and family education and counseling

  • Alternative medicine and therapy treatments, as appropriate

In addition, treatment may include the following:

  • Surgery may be considered. But although surgery can bring release from pain, it may also destroy other sensations or become the source of new pain. Relief is not necessarily permanent and pain may return. There are a variety of operations to relieve pain. Consult your doctor or more information.

  • Acupuncture, a 2,000-year-old Chinese technique of inserting fine needles under the skin at selected points in the body, has shown some promise in the treatment of chronic pain. Needles are manipulated by the practitioner to produce pain relief.

PREVENTING AND TREATING NECK PAIN

  • The Orthopedic Treatment Team
  • Evaluation Procedures for Orthopedic Problems
  • Musculoskeletal Rehabilitation
  • Put a Stop to Nerve Injuries Called Stingers

The Orthopedic Treatment Team

What is orthopedics?

Orthopedics is a medical specialty that deals with the treatment of bones and muscles. Orthopedic surgery is the branch of medicine concerned with diseases, injuries, and conditions of the musculoskeletal system relating to the body's muscles and skeleton. This includes the joints, ligaments, tendons, and nerves.

Who treats orthopedic conditions?

Orthopedic conditions may be treated by your doctor or other medical specialists and healthcare providers. Several doctors from different medical specialties may be involved in the treatment at the same time. This approach is important to manage the symptoms of an orthopedic condition, especially as many symptoms are long-term (chronic) and change over time. Some of the more common medical professionals who take part in treating orthopedic conditions may include:

Primary care doctor

A primary care doctor has specialized education and training in general internal medicine, family practice, or another first-level-of-care area. Primary care doctors provide people with any of the following:

  • Routine healthcare (including yearly physical exams and immunizations)

  • Treatment for acute medical conditions

  • Initial care for conditions that may become more serious or chronic in nature

Your primary care doctor may treat and diagnose your disease. They may also refer you to a specialist for more specialized treatment of certain aspects of a disease.

Orthopedic surgeon

This doctor specializes in orthopedic surgery. They may also be called an orthopedist. Orthopedists are educated in the workings of the musculoskeletal system. They can diagnose bone, muscle, joint, tendon, or ligament conditions. They can also treat an injury, provide rehabilitation (rehab), and advise on how to prevent further damage to a diseased area.

The orthopedist may have completed up to 14 years of formal education. After becoming licensed to practice medicine, the orthopedic surgeon may become board-certified by passing both oral and written exams given by the American Board of Orthopaedic Surgery. Many orthopedic surgeons choose to practice general orthopedics. Others specialize in certain areas of the body such as the foot, hand, shoulder, spine, hip, or knee. Others specialize in an area of orthopedic care such as sports medicine or trauma medicine. Some orthopedists may specialize in several areas and may collaborate with other specialists, such as neurosurgeons or rheumatologists, in caring for patients.

Primary care sports medicine doctor

This is a primary care doctor who has extra fellowship training in musculoskeletal injuries and other problems that affect athletes. This type of doctor can manage many orthopedic problems while also recognizing which cases need surgery.

Rheumatologist

A rheumatologist is a doctor who specializes in the treatment of arthritis and other rheumatic diseases that may affect joints, muscles, bones, skin, and other tissues. Most rheumatologists have a background in internal medicine or pediatrics and have received additional training in rheumatology. Rheumatologists are specially trained to identify many types of rheumatic diseases in their earliest stages. This includes arthritis, many types of autoimmune diseases, musculoskeletal pain, and disorders of the musculoskeletal system. In addition to 4 years of medical school and 3 years of specialized training in internal medicine or pediatrics, a rheumatologist has had an additional 2 or 3 years of specialized training in the field of rheumatology. A rheumatologist may also be board certified by the American Board of Internal Medicine.

Physical therapist

Physical therapy is the health profession that focuses on the neuromuscular, musculoskeletal, and cardiopulmonary systems of the human body, as these systems relate to human motion, health, and function.

Physical therapists ( PTs) are very important members of the healthcare team. They evaluate and provide treatment for people with health problems resulting from injury, disease, or overuse of muscles, ligaments, or tendons. PTs have an undergraduate degree in physical therapy. Many have a master's degree or doctorate. All graduates must be licensed by their state by passing a national certification exam before they can practice. PTs work in many settings, including:

  • Hospitals

  • Rehab centers

  • Home health agencies

  • Schools

  • Sports facilities

  • Community health centers

  • Private practice

For orthopedic conditions, PTs provide comprehensive training such as:

  • Functional mobility

  • Balance and gait retraining

  • Soft-tissue mobilization

  • Body mechanics education

  • Wheelchair safety and management

  • Neuromuscular re-education

  • Exercise programming

  • Family education and training

  • Help with pain relief and management

  • Instruction in walking safely

  • Pre- and post-surgical rehab

Occupational therapist

Occupational therapy is a healthcare profession that uses "occupation," or purposeful activity, to help people with physical, developmental, or emotional disabilities lead independent, productive, and satisfying lives. An occupational therapist often coordinates these areas of care for a person with a debilitating condition, such as an orthopedic condition:

  • Evaluating children and adults with developmental or neuromuscular problems to plan treatment activities that will help them grow mentally, socially, and physically

  • Helping children and adults learn how to carry out daily tasks

  • Conducting group or individual treatment to help children and adults in a mental health center learn to cope with daily activities

  • Advising changes in layout and design of the home or school so that children and adults with injuries or disabilities have greater access and mobility

Occupational therapists work in many different settings, including:

  • Hospitals

  • Rehab centers

  • Schools

  • Home care agencies

  • Private practice

  • Government agencies

Physiatrist

Physical medicine and rehabilitation, also known as physiatry, is a medical specialty that helps to restore lost abilities for a person who has been disabled due to disease, disorder, or injury. Physiatry provides integrated, multidisciplinary care aimed at recovery of the whole person. It does this by addressing the person's physical, psychological, medical, vocational, and social needs. The doctor who specializes in physical medicine and rehab is called a physiatrist.

Podiatrist

A podiatrist specializes in foot care and is licensed to prescribe medicine and do some surgery.

Nurses, nurse practitioners, and physician assistants

Other providers who specialize in the care of orthopedic conditions may help your doctor to provide care.

Other providers

Depending on the specific condition, other doctors and healthcare professionals, such as pain specialists, may be involved in treating orthopedic conditions. For instance, a neurologist or neurosurgeon may help treat problems affecting the spine because of involvement of the spinal cord. Occupational therapists may be involved in treating conditions that require rehab. Occupational therapists often work with physical therapists.

Evaluation Procedures for Orthopedic Problems

What are standard evaluation procedures?

Before a treatment or rehabilitation plan can be made, your orthopedist must first find what is causing your condition. This typically involves a physical exam and a review of your health history. The healthcare provider will also look at your symptoms. Tell your provider about any other illnesses, injuries, or complaints that may be causing the pain or condition. Also tell him or her about any treatments or medicines that you have had. You may have testing after this first exam.

Advanced evaluation procedures

If you need more evaluation you may have one of these tests:

  • X-ray. This test uses invisible electromagnetic energy beams to make images of tissues, bones, and organs on film.

  • Arthrogram. This X-ray shows bone structures after an injection of a contrast fluid into a joint area. When the fluid leaks into an area where it does not belong, disease or injury may be considered. A leak would mean there is a tear, opening, or blockage.

  • MRI. This test uses large magnets, radiofrequencies, and a computer to make detailed images of organs and structures within the body. It can often determine damage or disease in a surrounding ligament or muscle.

  • CT scan. This test uses X-rays and computer technology to make horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

  • Electromyogram (EMG). This test evaluates nerve and muscle function.

  • Ultrasound. This test uses high-frequency sound waves to create an image of the internal organs

  • Arthroscopy. This test is used to evaluate a joint. It uses a small, lighted, optic tube (arthroscope). This tube is inserted into the joint through a small cut or incision in the joint. Images of the inside of the joint are projected onto a screen. It's used to evaluate any degenerative or arthritic changes in the joint. It also detects bone diseases, ligament or cartilage tears, or tumors and may help determine the cause of bone pain and inflammation.

  • Myelogram. This test involves the injection of a dye or contrast material into the spinal canal. Next, a specific X-ray study lets the healthcare provider evaluate the spinal canal and nerve roots.

  • Radionuclide bone scan. This is a nuclear imaging test. It uses a very small amount of radioactive material, which is injected into the bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.

  • Blood tests. Other blood tests may be used to check for certain types of arthritis or other disorders.

After the healthcare provider has collected and looked at the test results, they will discuss the treatment options with you. Together you can choose the best treatment plan for you.

What is musculoskeletal rehabilitation?

A musculoskeletal rehabilitation (rehab) program is supervised by a team of medical professionals. It is designed for people with impairments or disabilities due to disease, disorders, or injury to the muscles, tendons, ligaments, or bones. These programs can often improve a person's ability to function and reduce their symptoms. They can also improve their well-being.

What conditions can benefit from musculoskeletal rehab?

Some of the conditions that may benefit from this type of rehab may include:

  • Amputation

  • Tendon tears, such as Achilles tendon injuries and tears of the rotator cuff in the shoulder

  • Trauma injuries, such as sprains, strains, joint dislocations, and breaks (fractures)

  • Back pain

  • Osteoporosis

  • Arthritis

  • Bone tumors

  • Repetitive stress injuries, such as tendonitis and carpal tunnel syndrome

  • Joint injury and replacement

The musculoskeletal rehab team

These programs can be done on an inpatient or outpatient basis. Many skilled professionals are part of the rehab team, such as:

  • Orthopedist or orthopedic surgeon

  • Neurologist or neurosurgeon

  • Physiatrist

  • Internist

  • Other specialty doctors

  • Rehabilitation specialists

  • Registered dietitian

  • Physical therapist

  • Occupational therapist

  • Social worker

  • Exercise physiologist

  • Psychologist or psychiatrist

  • Recreational therapist

  • Case manager

  • Chaplain

  • Vocational counselor

The musculoskeletal rehab program

The program is designed to meet the needs of each person, depending on the specific problem or disease. It's vital that both the person and their family are actively involved.

The goal is to help the person return to the highest level of function and independence possible. It's also to improve their quality of life—physically, emotionally, and socially.

To help reach these goals, programs may include:

  • Fitting and care for casts, braces, and splints (orthoses), or artificial limbs (prostheses)

  • Exercise programs to improve range of motion, increase muscle strength, improve flexibility and mobility, and increase endurance

  • Gait (walking) retraining and safely using a walker, cane, or crutch

  • Help with buying assistive devices that promote independence

  • Patient and family education and counseling

  • Pain management

  • Stress management and emotional support

  • Nutritional counseling

  • Ergonomic assessments and work-related injury prevention

  • Vocational counseling

Put a Stop to Nerve Injuries Called Stingers

Body-slamming moves are part of the game for football players, wrestlers, and others who play contact sports. They're also the most common cause of stingers. A stinger is a burning pain or a feeling like an electrical shock that spreads through one of the arms. These painful injuries affect the nerves in the neck and shoulders. Or they can affect nerves in the neck that branch off from the spinal cord.

Stingers occur when the shoulder and head go in opposite directions, the head is moved quickly to one side, or the area above the collarbone is hit. The injury occurs when a spinal nerve in the neck is squeezed (compressed) as the head is forced backward and the neck is forced toward the affected side. Stingers may also be caused when the head is forced sideways, away from the shoulder. This overstretches the nerves in the neck and shoulder region. 

You may feel a sudden burning or stinging pain in your arm or between your neck and shoulder. Your shoulder or arm may be tingly, weak, or numb. It also may feel like an electrical shock is spreading down one of your arms. Symptoms rarely last more than a few seconds or minutes.

If you have any of these symptoms, see your healthcare provider right away. Untreated stingers can get better, but nerve damage and muscle weakness can remain. After you have a stinger, another similar injury is more likely. Multiple stingers cause long-lasting (permanent) nerve damage and weakness. 

Typically, stingers affect only one side of the body. But multiple injuries can affect both sides. Pain that occurs at the same time in both arms after a neck injury may mean there is damage to the spinal cord. These symptoms need further medical evaluation to address the extent of injury.

The pain and muscle weakness caused by stingers typically is treated with ice, then with anti-inflammatory medicine and heat. You also need to rest until symptoms go away. If the pain lasts more than a few weeks, your healthcare provider may order more tests to assess nerve damage. You may need a cervical collar to prevent more nerve irritation, traction to relieve pressure on nerves, or injections of cortisone to reduce inflammation.

You shouldn't play sports again until:

  • Your healthcare provider has evaluated your spine and neck and clears your for activity.

  • The pain is gone

  • You have full range of motion in your neck

When playing sports, your technique and equipment should be reviewed to see if improvements can protect you from further injury. Strengthening your neck muscles or correcting long-lasting (chronic) problems with your posture is the best way to help prevent future injury.