Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
What are radiculopathy and sciatica? What are the symptoms?
Radiculopathy refers to nerve irritation caused by damage to
the disc between the vertebrae. This occurs because of degeneration
("wear and tear") of the outer ring of the disc or because of
traumatic injury, or both. Weakness of the outer ring leads to disc
bulging and disc herniation. As a result, the central softer portion of
the disc can rupture through the outer ring of the disc and abut the
spinal cord or its nerves as they exit the bony spinal column.
When nerves are irritated in the neck from degenerative disc
disease, the condition is referred to as cervical radiculopathy.
This can lead to painful burning or tingling sensations in the arms.
When nerves are irritated in the low back from degenerative disc
disease, the condition is called lumbar radiculopathy, and it often
causes the commonly recognized "sciatica" pain that shoots down a lower
extremity. This condition can be preceded by a localized
low-back aching. Sciatica pain can follow a "popping" sensation at onset and
be accompanied by numbness and tingling. The pain commonly increases
with movements at the waist and can increase with coughing or
sneezing. In more severe instances, lumbar radiculopathy can be
accompanied by incontinence of the bladder and/or bowels.
How are degenerative disc disease, radiculopathy, and sciatica diagnosed?
Degenerative disc disease, radiculopathy, and sciatica are suspected when the symptoms described above are noted. The doctor
can sometimes detect signs of irritated nerves during the examination.
For example, increased radiating pain when the lower extremity is
lifted supports the diagnosis of lumbar radiculopathy. Nerve testing
(EMG/electromyogram and NCV/nerve conduction velocity) of the lower extremities
can be used to detect the nerve irritation. The actual disc herniation can be
detected with radiology testing, such as CAT or MRI scanning.
Degenerative Disc Disease & Sciatica - Effective TreatmentsQuestion: What treatments have been effective for your degenerative disc disease or sciatica?
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
A pinched nerve can be caused of a variety of conditions, for example, carpal tunnel syndrome, herniated disc, sciatica, arthritis, spinal stenosis, trauma, and more. Common symptoms of a pinched nerve include pain, numbness, tingling, and weakness. Treatment of a pinched nerve depends on the cause of the pinched nerve.
Neck pain (cervical pain) may be caused by any number of disorders and diseases. Tenderness is another symptom of neck pain. Though treatment for neck pain really depends upon the cause, treatment typically may involve heat/ice application, traction, physical therapy, cortisone injection, topical anesthetic creams, and muscle relaxants.
Osteoarthritis is a type of arthritis caused by inflammation, breakdown, and eventual loss of
cartilage in the joints. Also known as degenerative arthritis. Osteoarthritis
can be caused by aging, heredity, and injury from trauma or disease.
A herniated disc may be caused by injury or degeneration from age. Symptoms depend on the location of the herniation and whether nerve tissue is being irritated. An MRI or CT scan is performed to diagnose a herniated disc. Treatment may involve physical therapy, cortisone injection, pain medications, antiinflammatory medications, muscle relaxants, and surgery.
Lumbar stenosis can be caused by degenerative arthritis (the most common cause), tumor, infection, or metabolic disorders (Paget's disease of the bone). Symptoms include low back pain, weakness, pain, numbness, and loss of sensation in the legs. Other conditions may cause similar symptoms of lumbar stenosis, including diabetic neuropathy, claudication, and peripheral vascular disease. Diagnosis, is a medical history and imaging studies. Lumbar stenosis may be treated with medication or surgery.
Radiculopathy, a condition in which a nerve or nerves along the spine are compressed causing pain, numbness, weakenss, and tingling along the nerve(s). Some causes of radiculopathy include bone spurs, disc hernation, osteoarthritis, tumors, infection, and neuropathy. Treatment depends on the are of nerve compression. Surgery is generally not required.
The five types of spondylolisthesis include 1) dysplastic, 2) isthmic, 3) degenerative, 4) traumatic, and 5) pathologic. The most common symptom of spondylolisthesis is lower back pain. Treatment depends on the type and severity of spondylolisthesis. Surgery is required in some cases of spondylolisthesis.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Diffuse idiopathic skeletal hyperostosis (DISH or Forestier's disease) is a form of degenerative arthritis. It is characterized by calcification along the sides of the vertebrae of the spine. Symptoms include stiffness and pain in the upper and lower back. Anti-inflammatory medications are used to treat DISH.
Cauda equina syndrome is a medical emergency condition that is caused by the uncommon compression of the nerves at the end of the spinal cord. Symptoms of cauda equina syndrome include lower back pain, tingling and/or numbness in the buttocks and lower extremities, bowel or bladder incontinence, and weakness in the legs. Causes of cauda equina syndrome include herniated discs, hematomas, or infection. Treatment is generally prompt surgery.
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