Greetings again! This is Athena Jezik. We’re gonna work on some more tutorials and explain some things out. Sciatica seems to be a problem that many many people suffer from so i thought i would go through a little bit more sciatica work and explanation on how i deal with sciatica. There’s many different techniques that people have but for me this has been the most effective and i’m also learning that there’s different types of things that come from that area. Sciatica usually is pain coming from about here. When it’s real bad it will run down the leg. It’s a.
Nerve pain so it runs as though it’s a like a hot iron or a hot rod going down the leg. Very uncomfortable. Sometimes there’s pain though in other parts of the hip which isn’t really the classic sciatica but it does still involve things similar because there’s so many nerves that come out of this sacral area. So that’s another thing that i’ve been discovering. So not everything that happens with the pain and going down the leg is maybe the classic sciatica but it doesn’t matter because in my opinion naming a lot of things doesn’t really do anything except for.
Make it a disease and then a disease is only by law treatable by the western medical people. So that’s just names and labels. The thing is we want to get people out of pain. We want to move them into a space of being able to function well. So in that pain area of the hip impinging nerves and creating bad sensation or pain down the leg we’ll call that the sciatica pain and of course it comes from here and I find that it is always got a direct connection to the positioning of the sacrum.
That also has a direct connection to the position of the sphenoid bone at the occipital base and I’m gonna show you a little bit of this. I’ll just show it to you now. Excuse me it’s early in the morning and I’m kind of foggy today. So the sacrum is sitting here and in that sacral bone there is a lot of nerves that come out from here. These little holes are where they come out of so if that is position a little bit crooked on there, which happens quite a.
Bit then we’re gonna have this pressure. The nerves are not going to be coming out with the proper alignment and the nerves are gonna have pressure on them when they are twisted a little bit. sometimes this bone can be in a position that’s a little more like this or it can also be an a combination of that particular pattern so it’s important to be able to allow this bone to be able to lengthen down. This is something better done if the body can do it itself. If it’s forced into it, it doesn’t always mean that it’s going to hold.
Because there’s a bunch of stuff underneath there. The network of the facial structure, the membranes under that that will twist like a nylon stocking and so if it’s forced back it will go back but because of the underlying structures there it will pull it back into that odd position. This is translating up into the head and because I’m a cranial sacral therapist and I’ve been doing it for so many years I have a lot of understanding how these connections are made. So right in there where the.
Purple and the yellow come together is the sphenobasilar junction. The sphenoid bone is the yellow bone right here and so that bone touches all the other bones and it does relate directly to the sacrum at this joint. So if this sacral structure is sideways, crooked on there, that’s going to be placed and it’s going to be like so The same thing is gonna happen at at the head. This sphenoid bone is going to be out in a similar manner because it’s a counterbalance for what’s going on with the body. So it keeps.
Things balanced so that we feel somewhat straight. So that’s areas that I look for in work around low back pain particularly down in the sacral area. I do not like to do the hard pushing with the elbow. For one thing You can get through muscles that way but your elbows are not very sensitive as to what you’re really doing and what structures you’re on and i have found that when i’ve tried to work elbows even forearms the bones and the bony surfaces. it’s just too rough. I don’t feel good about it. It.
Doesn’t feel productive so I don’t use that method. Also sometimes when the nerve is affected there’s inflammation. So in my opinion the way that I see things is by driving yourself into that nerve, through those muscles with a bunch of inflammation going on is not really going to help the problem. So there’s little things like that that I pay attention to that I don’t know if many other people take a lot of that into account because we do get sort of a technique to loosen things up and.
It doesn’t always provide for us the thoughts of what’s happening at the subtle anatomy level. So I test this just by checking at the occipital base and at the sacrum to see the position of everything and once the position is established then I can go in and work with the sacrum in order to correct it. Sometimes this will be corrected quickly and sometimes it’s not corrected as quickly and I believe that a lot of that is because it’s maybe not a true quote sciatica but there’s other stuff going on maybe in the hip joint.
There might be some kind of misalignment in the pubic arch. There might be some kind of a rotation in the hip as well so other things have to happen. So here I’m just giving a little drag on the sacrum and letting it loosen up and letting it swim around and my other hand is at the occipital base. Just steadying the dural tube. And so there I just wait a little while and then I will soften the muscle area around there. I work really differently. It just kind of depends.
So much of my work is intuitive. There’s somewhat of a protocol that I follow but each person presents things differently. No two bodies are ever the same. No injury patterns are ever the same. So flexibility is important to be able to move from various techniques and not follow things too rigidly particularly in pain problems and issues Then the other thing that i will do is to get my finger at the base of the sacrum. Excuse me, at L5 S1, which is right in this area here L5 S1.
So try to put some distance between there because that’s where the jamming probably tends to be. Sometimes it’s at the coccyx. And I’ll show you that technique as well. So with that you just do a little stretching integrating in with the muscles integrating in with the tissues and then just waiting for it to move. This is going face down. There is a better way to do the sacral pull when they are on their back but this way will also open it up. Either way is fine and my other hand up here is also feeling some rotation and.
Some movement coming up the spine. So as one area of the spine is off every little vertebrae is affected to some degree. There’s a little bit of adjustment that they have to make in order to keep the misalignment aligned and the bodies just gonna do that it’s gonna work within the framework that it has and it’s gonna normalize whether a pattern is there. And so there now we’re getting it softened and now there’s a little bit of a stretch happening. I’m stretching downward with the hand that’s on the L5 S1.
And I am taking a little bit of a stretch upward. Just a little traction. No deeper than the fascial level. So we have skin, fluid, then fascia. So I’m three layers down and giving a little stretch there and i’m feeling quite a bit of rumbling going on and there is a separation happening between L5 S1 And it just swims around and the sacrum is trying right now to find its way back to the proper position. It’s a good idea, if you know cranial work to also balance it at the spenoid.
Level because the sphenoid bone, if not corrected, can pull this thing out. Sometimes this will correct the sphenoid bone but it’s a good idea to check both. She just had a couple pulses. There’s a lot of activity going on. Even though she’s not suffering from sciatica or any kind of hip serious pain problems there’s still a lot of activity going on, which is correcting little misalignments in there, which is a reason that we should be paying attention to maintenance. Even though we’re not hurting, we might wanna have.
Some kind of session just for tweaking. I see a number of people who come in regularly every four to six weeks just to be tweaked with cranial work And I myself have an hour and a half session with somebody once a month. And I love it when I get it. It took me a while to find somebody that I felt was at my capacity. Okay and then the other position is just to lay the hand on the sacrum here and curl the fingers at L5 S1 and give a little bit of traction this way.
This is a little tricky because you have to keep the palm of the hand pretty secure and the fingers have to bend so there’s quite a lot of technique in the hands in order to get the right feeling. And the hands have to work independently because I’m right at the sacral coccyx junction and I’m stretching downward on that while I’m allowing the movement, which is a little bit of a swaying motion at L5 S1. There’s a downward traction as well as this being loose to be able to align.
At the same time it’s being tractioned downward. Okay and there’s some movement happening. These techniques will usually give quite a bit of change to the pain. It doesn’t mean that one time is going to give total remedy to the problem but it does begin to correct that space. Once that’s corrected then we can go in and also work into the muscles, much deeper into the musculature. And the only reason i work into the musculature is to loosen the muscles so that they’re not sinching down around those nerves.
Because if they are sinching around those nerves then they are not gonna let go really easy even though the alignment happens so i just worked really deeply into these glutial muscles for the purpose of the muscle again, not the purpose of the nerve. And I’m careful if I go into the area where the sciatic is the main place where you can feel it. I do not go into that with a lot of deep pressure because again I don’t like going into the inflamed areas and I don’t like going into pain.
With a lot of pressure. I don’t think in my work it gives me the better results. Okay and then up front and there is many areas of the hip to take and loosen. And along the ridge of the hip as well coming from the sacrum. Working all that. And of course both sides are benefited. I won’t do too much on this side. Both sides have benefited by that. You can even go into the attachments of the hamstrings. In fact it’s a good idea to make sure that the.
Quadriceps and hamstrings are well stretched. With this there’s also some stretches that can be done with the leg, but I will show that at another time So basically what i do is corrected the position of the sacrum to alleviate the pain of the sciatic pain or hip pain. Thank you very much! This is Athena Jezik. Please subscribe to our channel and you should also visit our new website because we have over 1300 tutorials on our channel I know it can be a little difficult to navigate and find the tutorials that you want to see but if you visit us at.
Sciatica Leg Pain Relief
Rtf1ansiansicpg1252deff0deflang2057fonttblf0fnilfcharset0 Arialf1fnilfcharset0 Calibri generator Msftedit 126.96.36.1999viewkind4uc1pardsa200sl276slmult1qjlang9fs36 Hi, I’m Paula Moore The Chiropractor and I’m going to show you a sciatica leg pain relief exercise. It should be know that the majority of people who come to see me as patients who have been diagnosed with sciatica, don’t have true sciatica. They do have leg pain that is mimicking sciatica. In other words, it is running through the buttocks and down the thight, right down to the ankle but it stems from a different place. It’s not the sciatic nerve. It is from a tight muscle in the buttocks,.
Known as the piriformis muscle. It clamps down over the sciatic nerve giving you sciaticlike symtoms. par You chiropractor can tell the difference between these two. True sciatica and a piriformis muscle problem. I’m going to show you a stretch to get rid of the piriformis muscle problem and the resultant leg pain. If you do this stretch and notice your leg pain starting to decrease, you probably didn’t have true sciatica and that’s great, because sciatica is harder to treat. par So you want to sit fairly close to the wall and swing your legs up so your heels touch.
The wall. If you leg pain is on the left, then take your left ankle and place it over your left knee. Now some of you might find that this position is already very difficult to get into because your piriformis muscle has become very tight. If you want to increase the stretch, shuffle up closer to the wall with your buttocks. If you want to deepen the stretch yet again, slide your right foot down the wall so that your knee is bent. You can increase the stretch by gently bringing the left knee toward your opposite shoulder. That is the.
Lumbar Spine Selective Nerve Root Block Injection pain management movies
You will be lying on your front. Your skin will be cleaned. A small needle will be used to inject some local anesthetic to numb the skin. This may sting for a couple of seconds. The tip of a needle will be placed next to the spinal nerve. Fluoroscopy, an XRay TV, is often used to guide the needle to the correct location. Some contrast dye may be injected to check the exact position of the needle tip using fluoroscopy. Then the medication will be injected around the spinal nerve, the needle removed and a small bandage placed.
Cadaver Surface and Ultrasound Guided Anatomy of Nerve Blocks in Anesthesia Program
We’ll be talking about the interscalene block. The analgesia of the brachial plexus, which enervates the arms, is an example of a major nerve block. That is because two or more nerves are blocked that supply a large area. Types of surgeries that would benefit from interscalene block include the shoulder, arm, and forearm procedures. Injection at the interscalene level will block dermatomes C5 through C7 intensely, and dermatomes C8 through T1 less intensely. The interscalene groove lies at the cricoid cartilage, the level of the cricoid cartilage. It’s important to find the sternal notch and trace it over to the clavicle, and then.
Outline the sternocleidomastoid muscle. It is recommended that you also outline your carotid artery, internal jugular, and external jugular vein. You will also see the anterior scalene muscle, little scalene muscle, and the nerve roots of C5 through C7. There are several maneuvers that can accentuate the line marks while the patient is lying supine. First you have the patient turn their head to the contralateral side. This is when you will be able to see the external jugular vein cross the interscalene groove at the level of the cricoid cartilage.
This also tenses the sternocleidomastoid muscle. You may also ask the patient to reach to the ipsilateral knee. This maneuver flattens the neck and makes the identification of the scalene muscles easier. Some complications that occur include incidental block of the phrenic nerve, recurrent laryngeal nerve, and stellate ganglion due to close proximity. Dyspnea may occur from the nerve, the phrenic nerve, causing hoarseness, and from the recurrent laryngeal nerve. Since the area is very vascular, there is potential for inadvertent intravascular injection. First, this is the clavicle. Here is the sternocleidomastoid muscle.
Common carotid. Internal jugular. External jugular. Anterior scalene muscle. And middle scalene muscle. And the three trunks for the brachial plexus superior, middle, inferior. This is the left arm, and the branches of the brachial plexus are the musculocutaneous nerve, the median nerve, the ulnar nerve, the radial nerve, and the axillary nerve. Here we have an ultrasound view of the interscalene block. We are looking at the right side of the neck. This is medial, and this side of the ultrasound is lateral. We have the carotid artery here, we have the right IJ here, and Shane’s doing a Valsalva maneuver right now.
We have the anterior scalene muscle here, the middle scalene muscle here, and our sternocleidomastoid on top. The nerve bundle is located between the anterior scalene muscle and the middle scalene muscle here, and here’s our nerve bundle, right in there. Here we have the surface anatomy for a femoral block. First you want to identify the anterior superior iliac spine and the pubic tubercle, and draw a line connecting these structures. This is the inguinal ligament. Midline on the inguinal ligament, you’ll palpate to find the femoral pulse. And using.
Your VAN acronym, you can see the femoral vein, femoral artery, and femoral nerve. To find the femoral nerve from the femoral pulse, you’ll go two centimeters distal and two centimeters lateral. I will use the width of my finger to approximate this distance. Two centimeters distal, two centimeters lateral, and you will end up right over the femoral nerve. This is your injection point. Here we have a cadaver dissection of our upper thigh area, where we will be performing our femoral nerve block. Landmarks that you are looking for, for the femoral nerve block,.
Are your anterior superior iliac spine and your pubic tubercle. You’ll draw a line connecting these two structures, I have a dotted line here, to display that. When you’re doing the block, you’ll palpate for the femoral artery pulse along that line. It’s approximately midline. Once you’ve located the pulse, you’ll move two centimeters distal and two centimeters lateral for your injection site. You can just approximate that with a finger, your index finger. Two centimeters distal, two centimeters lateral, and as you can see, we’re right over the femoral nerve. As you.
Can see, if you use your VAN acronym, which is vein, artery, nerve, from medial to lateral we have the femoral vein, femoral artery, and femoral nerve. One of the possible complications to this block, which is very rare, is intravascular injection, because of the close proximity of the femoral nerve to the femoral artery. Okay, you are looking at the view of the femoral nerve block. On our screen, we have medial and lateral. You can see the femoral vein, which is compressible, and the femoral artery. And if we scan down, we can see it bifurcate.
And lateral to the femoral artery is the femoral nerve complex. It is below the fascia lata and the fascia illiaca. So below there is the femoral artery and femoral nerve complex. Here we’re doing the surface anatomy of a popliteal block. I have drawn out the popliteal fossa, starting with the tendon of the semitendinosus and then the tendon of the biceps femoris at the popliteal crease, drew a flat line in the middle. Measured, it was actually 6 centimeters, so at 3 centimeters I measured, drew a line, and then outlined the popliteal.
Fossa. I then bifurcated the triangle and then measured up 5 centimeters, and went lateral one centimeter. Popliteal injection on surface anatomy generally will be right here, inside your popliteal triangle. Here we are looking at the posterior left leg. The sciatic nerve splits into the tibial nerve and the common peroneal nerve in the popliteal fossa. The nerves are superficial to the popliteal artery and vein. We are doing the ultrasound of the popliteal block. Currently, we’re at the popliteal crease, and we are medial and lateral. We have our semitendinosus muscle, our semimembranosus muscle, and our biceps.
Femoris muscle. We have the popliteal vein, which is compressible, and then our popliteal artery, that you can see here pulsating. We then have our common peroneal nerve, and then also our tibial nerve. As we scan the leg, they are coming together to form our sciatic nerve. Right before the bifurcation is going to be the ideal site for your popliteal nerve block. All right, I just want to point out some landmarks here for placing an epiduralspinal, that we have our coccyx, our sacrum, and then we have our fifth lumbar, our fourth, third,.
Second, and first lumbar vertebrae. And also here we have our iliac crest on both sides, and as you can see here, our iliac crest comes approximately at L4. Now this imaginary line right here is called the intercristal line or the Tuffier’s line. These iliac crest are going to be the landmarks that you’re actually going to be feeling on your patient to feel for your L4 lumbar. Now placing an epidural or a spinal, you can go below or above the L4. This is generally. Now, the patient is generally going to be sitting in.
An upright position, bent over, opening up the access to get to inside the vertebrae or also on a lateral side, hunching in more of the fetal position. As I said here, just pointing over again, you have the iliac crest coming in line here with L4, placing an epidural or a spinal below L4 or above L4. Here I’m going to show you the proper positioning here for placing an epidural andor spinal. You’ll want to have the bare back exposed here, and you’ll have the patient that’ll want to get into a C position that’s going to help open up the spinal processes. So the.
Patient here will go and almost push up against my hand here, forming a backwards C. Now I’ve predrawn out right here the iliac crest. The iliac crests form an imaginary line, intercristal line, and at the intercristal line is going to be your L4 spinal process. And I’ve already premarked here the L5, L3, and L2. So here are our spaces here between our spinal processes, between L2 and L3, L3 and L4, L4 and L5, and L5 and sacrum. Epidurals and spinals can be placed anywhere in between these spaces here,.
Generally, as your conus medullaris of your spinal cord will typically land between your L1 space. So as I said before, typical placements here are going to be between L2, L3 for spinals and epidurals, and between your L3, L4 or even going down to your L4, L5. But typically, you could actually put an epidural anywhere along the entire continuum of the spinal column, but if you ever have to do a spinal, do not go above your L2, as you could hit that conus medullaris. What I’m holding here is a lumbar vertebra. As you can see, right inside here is going.
To be the vertebral foramen. This is where the spinal column is going to be sitting, the spinal cord will be sitting right in the vertebral foramen. A laminectomy was performed here on this cadaver here to reveal our sites here for inserting an epidural, spinal, andor doing a spinal tap for withdrawing cerebral spinal fluid here. I just want to point out here, after the laminectomy is done, we have the dura mater. The dura mater is what surrounds the spinal cord and withholds cerebral spinal fluid. The spinal cord right here actually floats within that.
Cerebral spinal fluid, and the spinal cord comes from your medulla oblongata, all the way down to approximately at L2. At the end of L2, it becomes your conus medullaris. The conus medullaris is actually the coneshaped process of the spinal cord and the continuation on with the filum terminale internum, which will then anchor itself into the sacral hiatus at the end of the dura mater sac. Now also, coming off the spinal cord here is going to be your cauda equina, also known as horsetail. As you can see here, these tail fibers coming off, these are going.
To originate off the spinal cord at approximately L1 all the way down to the S5, your sacral, your fifth sacral is where they’re going to go off. Now, some may wonder, when we do a spinal, aren’t we going to end up making contact with the conus medullaris, and could form what is, say, a total spinal, as if you injected directly into the spinal cord. Well, these, actually the equina, will be freefloating within the spinal column here, so when you insert the needle, they should actually theoretically move out of the way. Now as you can see here,.
The dura mater, in order to do a spinal you actually have to penetrate the dura mater, but now in doing an epidural, you are actually instilling medication above this dura mater. And as you can see here, this is very, very thin, so the precise distance of performing an epidural versus a spinal is a very, very small distance. And once again, we have our spinal cord, the conus medullaris, and then the cauda equina, all of the spinal cord. Now a great acronym to actually remember for the placements of the needle for an epiduralspinal.
Is SSSILDA. These are the layers, or levels, that you’re going to be going through to place your epiduralspinal. SSSILDA. S for skin. S for subcutaneous layers. So here we have our skin layer, which has been removed, and then you enter the subcutaneous fatty layer. The next, third S is your supraspinous ligament. So you can remark right here, which actually is going to be the ligament that actually traverses across the tip of your spinous process. Your next letter, I, is going to be your interspinous ligament, which will.
Actually be a ligament that connects the spinous processes to the superior and inferior together. And this is if you’re doing a midline approach. And now your next layer is going to be your ligamentum flavum, which is actually going to, as soon as you break through that, is going to be your potential epidural space. That is where you are going to be placing your epidural drug, andor epidural catheter. The next level that you’re going to break through, which I pointed out before, is your dura mater. Now the dura mater is what, inside,.
Is going to house your cerebral spinal fluid. And then your next layer is going to be the arachnoid mater. The arachnoid mater is what actually surrounds your spinal cord, spinal process, which is where you’re going to be having, giving your spinal. Now just remember, spinals are not given directly into the spinal cord, as that will give a total spinal and can be very, very detrimental to your patient. So always avoid any injection directly into the spinal cord. And this way, if you’re doing any spinal, you want to be going below L2,.
As the conus medullaris is, in general, housed at L2. So by going at between above and below L3, L4, and L5, you should avoid any total spinals. Okay, so here we are showing a midline approach of a sagittal plane of the lower back. And I just want to point out here that we actually have a spinal process here, and a spinal process here. So for us to be placing an epidural andor spinal, we actually have our interspinous here, in between our two spinal processes. So this is a great advantage you can use in.
BLOQUEO INTERPECTORAL. INTERPECTORAL NERVE BLOCK
INTERPECTORAL NERVE BLOCK FOR BREAST SURGERY The sensory innervation of the chest wall including the breast is subsidiary of the intercostal nerves. Mammary gland also receives innervation via the same lines The skin of the breast and breast glandular tissue receive innervation via the lateral and medial branches of each intercostal nerve T2T6 however there are deeper structures not receive their innervation through the same nerve branches The pectoral mayor and minor muscles have their own motor and sensitive innervation through branches of brachial plexus This branches are the medial pectoral nerve.
And lateral pectoral nerve. after his release, will be divided into upper, middle and lower primary trunks. Primary trunks are gruped into secundary trunks or fascicles The medial and lateral pectoral nerves arising from the brachial plexus at the level of secondary trunks fascicles that give them their name lateral and medial standing through the pectoralis minor, and between this one and mayor to give its distal branches The medial and lateral pectoral nerves gets into the clavipectoral fascia with the acromiothoracic artery, good reference for this block One of the most common surgeries.
For cosmetic breast surgey is breast augmentation The prosthesis implanted by the surgeon may be introduced below the glandular breast tissue or under the pectoralis major muscle The position of the prothesis is vital for planning postoperative analgesia. Paravertebrar, epidural and intercostal block have been successfully employed, specialy paravertebral block has been presented by many authors as the goldstandar for analgesia in breast surgery but produce metameric block including only skin and glandular breast tissue leaving the pectoral muscles without block. TAP block approach is based in a interfascial compartment block.
Using high volumes of local anesthetic achieves no visible nerves using ultrasound techniques Using the same concept, the pectoralis nerves not visible with ultrasound could find benefits on this kind of technics These nerves are not visible, but the interpectoral space and clavipectoral fascia can be visualice with ultrasound therefore using large volumes of local anesthetic would be possible to block them. We will star our situating the ultrasound probe parallel to the clavicle and below it we can clearly identify the major pectoral muscle surface and minor pectoral deeply. We can perform the approach fron craneal to caudal,.
From medial to lateral or lateral to medial. Lateral to medial should be better to promote medial diffusion of local anesthetic Ultrasonography is very easy to see the local anesthetic diffusion along the fascia needle progression being possible to improve the distribution of anesthetic For breast augmentation should be noted that the point cutaneous prothesis insertion either Periareolar or submammary probably not be covered by the block so advise local infiltration in these points separately Also, can be performed as a continuous technique with a conventional epidural system and depending of surgery.
Neural Glides for Ulnar, Median Radial Nerves Ask Doctor Jo
Hey everybody, it’s Dr. Jo! Today we’re going to talk about neural glides or neural flossing. That is to get your nerves moving if you’ve had damage to them, if you’ve had surgery and maybe have some scar tissue around them. So let’s get to it. You probably were wondering why I was making funny faces just a minute ago. You have three different nerves main nerves in your arm, which is your ulnar nerve, your median nerve, and your radial nerve. So with your ulnar nerve, to stretch that one out, you’re gonna put your pointer finger.
And your thumb together making an okay sign. You want to flip it up and come back down. Some people are only going to be able to get to about right here before they feel that stretch in the nerve on the outer part of their arm. So if you can only get to here, that’s fine. You can do that, and do that about 10 times. Then eventually you are going to go a little bit further, coming up and down. And hopefully you will be able to get all the way up so you can make bird man face. Alright, the next one is your median nerve.
That one is in the middle. You can put your arm straight out to the side, and you want your palm to be up. You’re going to keep your fingers as straight as you can, and then move at your wrist bringing your fingers down. Now some people going just straight down will be enough stretch. If that’s not enough stretch for you, then you can take your head and to the opposite shoulder, and go down and up. Same thing, just do about 10 of these at a time because if you do too many, you can also irritate the nerve. Now if you get 10 of these.
And you still don’t feel a stretch, you can take it back a little, turn your head, and then stretch. Little pause at the end, and come on back up. The last one is going to be your radial nerve on top because it’s rad. You’re going to put your arm out again, but now you are going to put your hand and palm down, and repeat the same way, going down and up. If that’s not enough for you, then you can turn your head to the side, and go.
Down and up. If that’s still not enough, go back just a little bit, and go down and up. The last thing I am going to show you is actually doing some neural glides in your leg. A lot of people will do this for their sciatic nerve. So I’m going to hop up here and show you. So if you’ve been diagnosed with nerve damage in your leg, you’re going to want to sit up in a chair or on your couch, just where you are comfortable. Now stick out your leg, and.
Pull your toes toward you. Now some people might feel a pull as soon as the pull their toes towards them. If you feel a pull with that, then you’re just going to point your toes and and flex your toes back and forth. That’s moving that nerve up and down. It’s gliding it back and forth. If that’s not enough, then you’re going to slump your back down, pull your chin towards your chest and then do the same thing. Pulling your toes towards you and pointing away from you. It’s simple as that. Make sure you just do about 10 to.
Coding Continuous Nerve Blocks
This nerve block follow up care, I had to call my friend Diana that went to Orlando with me just to confirm some information about this. Q The question was When coding continuous nerve blocks and that’s the listing for different nerve blocks how do you code for the follow up when the patient is sent home with the catheter and the follow up is being done via telephone by the anesthesiologist A Now for one, in her background, she said she didn’t think this was done very often.
But that doesn’t mean, obviously, it doesn’t happen because someone wouldn’t be asking this question. For an answer, this is what information she had given me. She said, it all depends, and this is what you need to know. First of all, you don’t have enough information given to just say if these nerve blocks are used. You need to know why the nerve block was being given. What you need to know is if there’s a global period with the condition. Let’s say someone had back surgery and they had spurs cut off of their spine and they more or less slit them from C1 to L5, and.
There’s a lot of pain involved but they don’t necessarily need to be in the hospital, they just need pain control. So, they give him a pain pump and they send them home. That’s kind of what I’m thinking that this is. Now, on that surgery if it’s a major surgery, there’s going to be a global period that goes along with that. Now, if it’s not a major surgery, and for whatever reason, it’s a pain control issue, maybe they have a little back pain and they’re trying this, that’s not going to have a global period with it. You need.
To know what was the procedure that was done to the patient that had them need this catheter to be placed and the pain to be taken care of. Now, that being said, now that you’ve got that information, let’s say you do have a global period, you still need to check with the payer because if it’s in the global period, then you’re not going to get paid. Then, if you call the payer and they’re on Medicare, chances are Medicare doesn’t pay for telephone visits as far as I know. You can’t use it.
What you would do is, you would just document that the anesthesiologist called and did a check on the patient and you can’t turn it in. If you can turn it in, you still have to document it and you would use a telephone EM and I think I have those listed at the bottom. I don’t know. I’m not sure. I think I did. No go up, go back up. I thought I listed them. Well, okay, it’s true. I gave a range. Go down just a little bit. There it is, 9944199443, those are EM codes for telephone services.
Treating Sciatic Pain Dr. Daniel Yadagar, Interventional Pain Management Physician
Hi, I’m Doctor Daniel Yadegar,I’m an Interventional pain management specialist with the Orlin and Cohen Orthopedic Group. More often than not people ask me what exactly is interventional pain management Interventional pain management is a discipline of medicine devoted to the diagnosis and treatment of pain related disorders. Our goal is to relieve, reduce, or manage pain and improve a patient’s overall quality of life. This is accomplished by utilizing a multidisciplinary approach,in which a team of health care professionals worktogetherto provide a full range of treatment optionsand services for patients suffering from chronic andor acute pain.
Common musculoskeletal pain disorders include Back, Hip, and Leg Pain Neck, Shoulder and Arm Pain Whiplash Injuries Work Related Injuries Sports Injuries Failed Back Surgery and Other Post Surgical Pain Syndromes Myofascial Pain Facet Syndrome Sacroiliac Joint Pain Today I will be briefly talking about back pain with sciatica or pain radiating down the leg. This is a common complaint that we encounter on a daily basis. Sciatic pain results when injury or pressure have compressed the spinal roots or nerves that branch off the spinal cord in the lower region of the spine.
Sciatic paincan be described as sharp, dull, burning, tingly, numb, continuous, or intermittent and usually affects only one side of the body. There may be associatedweakness in the affected limb as well. Sciatic pain is most often the result of aherniated disc,spinal stenosis, ornarrowing of the spinal canal associated with arthritis or bony overgrowth, or in extremely rare cases, infection or tumor. An initial work up including a detailed and comprehensive history and physical examis the first step in diagnosis. Further work up may be needed such as imaging studies which.
Include xrays, MRIs CT scans and or nerve study testing. Once the diagnosis of the cause of sciatica has been determined, a treatment plan is then established. Most cases of back pain resolve with nonsurgical treatment. Some of the most common nonsurgical treatment options that we utilize are physical therapy and exercise, medication management and spinal injections. As an interventional pain physician, I am trained through the use of xray guidance or flouroscopy to deliver potent medications targeted specifically to the affected site of inflammation in the spine. The use of.
Flouroscopy allows the medication to be placed safely and precisely. These procedures are done as an outpatient in our accredited flouroscopy suite, which is fully staffed with certified personnel and licensed anesthesiologists. Other common procedures that we are trained to administer for appropriate musculoskeletal problems include Cervical, thoracic, and caudal Epidural Steroid Injections Facet Joint Injections Medial Branch or Nerve Blocks Radiofrequency Ablation SacroiIiac Joint injections Hip Injections Trigger Point Injections Bursa Injections Lumbar Discography Spinal Cord Stimulation Percutaneous Disc Decompression For more information on musculoskeletal conditions you can visit our patient education section.