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 patient's physician will start with a complete medical history and physical examination to get clues to the diagnosis of lumbar spinal stenosis. During the medical history, the patient will be asked questions regarding symptoms, including how long they have been present, what makes them better or worse, what prior treatment the patient has had, and what other medical conditions they have. These questions can also help the doctor distinguish lumbar spinal stenosis from other disorders that may produce similar symptoms.
The physical examination often consists of testing the range of motion in the back and feeling for areas of tenderness in the back. The legs may be examined for range of motion, strength, sensation, reflexes, and pulses. The hips and knees may also be examined because problems with these joints can often causes symptoms similar to those of lumbar spinal stenosis.
After the examination, the physician may order imaging studies to detect anatomic signs of lumbar spinal stenosis. This often begins with plain X-rays of the back. The doctors may also order an X-ray of the patient's hips depending on findings from the physical examination. The X-rays can show the doctor various signs associated with spinal stenosis, including loss of the normal intervertebral disc height, the presence of bone spurs (osteophytes), and spinal instability (abnormal motion between the vertebrae). The ultimate diagnosis of lumbar spinal stenosis is made by an MRI scan (magnetic resonance imagining scan) or CT scan (CAT scan or
computerized axial tomography). These are more advanced tests that show the nerves in the lower back and can show if they are being compressed from lumbar spinal stenosis.
In some cases, special nerve tests including electromyogram (EMG) or nerve conduction studies
may be ordered. These tests can identify damage to or irritation of the nerves
caused by long-term compression from lumbar spinal stenosis. These tests can also help
determine exactly which nerves are involved.
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.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
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.
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.
A common form of short stature, achondroplasia (dwarfism) is a genetic condition causing a disorder of bone growth. Complications of achondroplasia that need monitoring include (this is not all inclusive) stenosis and compression of the spinal cord, a large opening under the skull, lordosis, kyphosis, spinal stenosis, hydrocephalus, middle ear infections, obesity, and dental crowning. Achondroplasia is caused by mutations of the FGFR3 gene.
Bowel or fecal incontinence refers to the loss of voluntary control of stool, or bowel movements. The condition can include partial incontinence, in which a person loses only a small amount of liquid waste, to complete incontinence, in which the entire bowel movement cannot be controlled. Diet changes and elimination of certain medications can help patients to regain bowel control. Treatment involves a combination of medication, biofeedback, and exercise.
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