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.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The symptoms of a herniated disc depend
on the exact level of the spine where the disc herniation occurs and whether or
not nerve tissue is being irritated. A disc herniation may not cause any
symptoms. However, disc herniation can cause local pain at the level of the
spine affected.
If the disc herniation is large enough, the disc tissue can
press on the adjacent spinal nerves that exit the spine at the level of the disc
herniation. This can cause shooting pain in the distribution of that nerve and
usually occurs on one side of the body. For example, a disc herniation at the
level between the fourth and fifth lumbar vertebrae of the low back can cause a
shooting pain down the buttock into the back of the thigh and down the leg.
Sometimes this is associated with numbness and tingling in the leg. The pain
often is worsened upon standing and decreases with lying down.
If the disc
herniation is extremely large, it can press on spinal nerves on both sides of
the body. This can result in severe pain down both lower extremities. There can
be marked weakness of the lower extremities and even incontinence of bowel and
bladder. This is medically referred to as cauda equina syndrome.
How is a herniated disc diagnosed?
The doctor will suspect a herniated disc when symptoms described above are
present. The neurologic examination can reveal abnormal reflexes. Often pain can
be elicited when the straight leg is raised when lying or sitting. This is
referred to as a "positive straight leg raising test." There can be abnormal
sensation in the foot or leg.
A variety of blood tests are frequently done to determine if there are signs
of inflammation or infection.
Plain film X-rays can indicate "wear and tear" (degeneration) of the spine.
They do not, however, demonstrate the status of discs. In order to determine
whether or not a disc is herniated, an MRI scan or CT scan is performed for
diagnosis.
An electromyogram (EMG) can be used to document precisely which nerves are
being irritated by a disc herniation.
Sciatica pain, caused by irritation of the sciatic nerve, typically radiates from the low back to behind the thigh to below the knee. Disc herniation is usually the cause of sciatica. Medication to alleviate pain, physical therapy, and bed rest are treatments for 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.
Degenerative disc disease makes the disc more susceptible to herniation (rupture) which can lead to localized or radiating pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises and medications to relieve pain, muscle spasm and inflammation.
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.
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.
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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