Pain clinic, Dr. Hossein Arjmand, physical medicine and rehabilitation specialist, pain specialist, Shiraz, spine specialist, Tavana pain clinic, back disc specialist, Dr. Hosein Arjmand, pain clinic

Cruciate ligament injury

What are the structures of the cruciate ligaments? Ligaments are rope-shaped structures that hold the bones together.
Each knee has two cruciate ligaments: anterior and posterior, which are placed crosswise. Keeping the thigh bones (femur) and leg bones (tibia) together during leg movements is next to each other.

How are these ligaments damaged?1. Twisting the knee
2. Hit on the knee
3. Excessive knee stretching
4. Jumping and landing on the ground with knee bending
5. Sudden stop while running
6. Sudden change and change of body weight created from one leg to another

Methods of diagnosis of cruciate ligament rupture : - Patient's history
- Clinical tests
- MRA
- Simple radiography is usually normal, unless it is accompanied by fractures in the articular surface of the tibia.

What are the consequences of cruciate ligament injury? If the injury is severe and leads to the rupture of any of the cruciate ligaments, knee instability may occur and the patient may experience so-called emptying of the knee during activity. Knee instability over time leads to Arthrosis or premature wear and tear of the knee joint

Treatments: In cases where the rupture is only in the cruciate ligament and there is no other injury in the knee, what kind of treatment the cruciate ligament injury needs depends on the severity of the injury, the age of the patient, his job, etc. A young person who has a complete rupture of the cruciate ligament and wants to continue active sports needs surgery. On the other hand, the treatment of an elderly person who lives a peaceful life is usually without surgery.

Non-surgical treatment methods for knee ligament injuries include drug therapy, physical therapy and exercise, PRP injection, ozone gas injection, steroid injection and prescription of special medical knee braces.

Prevention of knee cruciate ligament injury Preventing knee ligament injuries is a bit difficult, because these injuries usually occur during accidents, but doing the following can prevent these injuries a little.
1- Performing endurance and stretching exercises to increase the endurance of thigh muscles
2- Performing stretching exercises before and after sports activities
3- Gradually increasing the intensity of sports activities

suprascapular nerve block

Definition: It is a sensory and motor nerve that innervates parts of the scapula and shoulder muscles (supraspinatos and infraspinatus) and provides sensation to many parts of the shoulder joint.

In what cases is suprascapular nerve block performed? In cases where shoulder pain is caused by various diseases such as: severe abrasion (shoulder arthrosis), freezing or adhesion of the shoulder joint (frozen shoulder), severe pain after shoulder surgery, inflammation of shoulder bursae and tendons (subdeltoid bursitis, rotator cuff tendonitis), Shoulder pain caused by malignancy and...
By performing this procedure, the patient can participate better and more actively in rehabilitation and physiotherapy programs.

How is suprascapular nerve block performed? The best way to block this nerve is using ultrasound and under direct vision. With the help of ultrasound, the location of the nerve is determined, and the desired drugs, which may be steroid and anesthetic drugs, are injected around the nerve. This procedure can be done in the office and can only be done with local anesthesia.

Sometimes radio frequency (RF) is used to block for a longer period of time. Of course, we need a fluoroscope or radiology guide to perform RF

cervical headache

Definition: Pains that originate from the neck and the patient feels it in the head area.
These headaches start from the neck to the back of the head and then move to the front of the head.

signs: Usually, these patients feel headache along with neck pain and neck stiffness, and some neck movements aggravate their headache.
Usually these pains are one-sided and start from the neck and extend to the front of the head and sometimes even around the eyes.
Patients become sensitive to light and sound and may feel nauseous or even double vision.

Reasons: Usually, these headaches are caused by problems with the upper neck vertebrae, especially the second and third neck vertebrae (c2-c3)
Sometimes other causes such as tumors, fractured vertebrae, inflammation of intervertebral joints or neck injuries may cause such headaches.

Treatments:

1- Medicines such as pain relievers, muscle relaxants, anti-epileptic drugs.
2-Physiotherapy
3-RF (radio frequency) :In this method Special nerves of the occipital and cervical nerves may be burned or blocked.
4-Nerve block: Certain nerves may be blocked at the doctor's discretion. Nerves such as the occipital nerves.
5- Home remedies: treatments like yoga can be effective in pain control.

Abrasion of the facet joints

Definition: The spine consists of three main parts: vertebral body, intervertebral discs and facet joints.
Both upper and lower vertebrae are connected to each other through 2 facet joints.
These joints allow two vertebrae to move and rotate relative to each other.
Facet joints are among the synovial joints (with joint fluid). Therefore, like the knee joints, they may suffer wear and tear and then cause pain.

Symptoms:Dryness and pain in the back and neck may be symptoms of facet joint wear.
Pains caused by facet problems usually do not shoot to the limbs, and with warming up the body and some activity, the pain may decrease.

Epidemiology: Facet joint wear and tear, like other types of wear and tear, is more common in older people, obese people, multiple births, spine deviation (scoliosis) and among those who have done hard work for many years.

Treatments: In the first step of lifestyle modification, all kinds of painkillers, weight loss, physiotherapy, strengthening the back and abdominal muscles can be effective in controlling pain and symptoms.
In the next steps, according to discretion, the doctor may consider treatments such as intra-articular injections or block and RF of the nerves of the facet joints (radiofrequency)

Radio frequency of the nerves of the facet joints (Medial branch RF neurotomy): It is an effective method in the treatment and control of pain caused by wear and tear of the lumbar facet joints. In this method, the nerve fibers transmitting the pain message related to these joints are so-called burned.
This operation is performed on an outpatient basis in the operating room and does not require anesthesia and hospitalization of the patient, and the patient can resume daily activities the day after the operation.

Discogel

Discogel is one of the newest disc treatment methods that has received attention in recent years. This drug is a combination of a special type of alcohol gel and tungsten metal, which is guided by a fluoroscope or CT scan and based on radiology images in the nucleus. The disc is injected.

- Is Discogel suitable for all types of disc protrusions? Undoubtedly no. In cases where progressive weakness occurs in the patient, or urine and stool control is disturbed, or the disc is excessively dehydrated, or the slippage of the vertebra and spinal canal stenosis are the cause of the patient's pain and problems, this method may not be a suitable method for treatment.

How does this method treat the disc? After injecting discogel into the core of the disc, following chemical interactions, the water content of the disc gradually decreases after a while, as a result, the volume of the disc decreases and the protrusion of the disc recedes, and the compressive effects of the disc on the nerve roots. Also, with the penetration of this compound into the tears of the outer layer (annulus), the weak parts of the peripheral layer of the disc regain consistency and are strengthened.

Are the effects of Discogel permanent and does this treatment need to be repeated? no This injection is done only once in each disk and does not need to be repeated.

_Does this treatment method require hospitalization or anesthesia? No, this procedure is performed on an outpatient basis without the need for anesthesia, of course, due to the need for sterile conditions and a fluoroscope device, it is usually performed in hospitals or well-equipped medical centers.

_ How long after the operation can the patient resume his daily activities? From the day after the operation, the patient can return to his normal life, although it is better to avoid heavy activities for a while.
Dr. Hossein Arjamand

Knee pain and knee wear exercises

Soft number one:

While sitting on a chair, straighten one leg as shown in the figure and stay in the same position for five or ten seconds. Do this three times for each leg.

Soft number two:

Lie down and with your knees close to ninety degrees, place a pillow between your legs and press the pillow on both sides, press the pillow for ten seconds, then release. Do this three times.

Soft number three:

As shown in the picture while lying on your side, open and close your legs five times, then lie on the opposite side and repeat this movement. Repeat this for each side two or three times, depending on your ability.

Soft number four:

Place a band around your foot, at the point where the toes join the sole of the foot, and hold both sides of it with both hands, so that you feel tension and stretch in the back of the thigh, under the knee, and in the sole of the foot. Hold the leg for ten seconds and then release. Repeat this for the opposite side.

Do all the exercises according to the instructions three times a day.
If any of the exercises aggravate your pain, remove it.

Neck pain and neck disc exercises

The number one sport

Put your right or left hand above your ear and put pressure on your head, on the other hand, resist the pressure with your head, so that the force of the head and hand neutralize each other and neither of them move. . Press the head and hands together for 10 seconds. Repeat this movement for the opposite side. Do this three times for each side

Sport number two

Place the palms of both hands on your forehead and apply force to your forehead, on the other hand, resist the pressure with your head. The head and hands apply pressure to each other for ten seconds. Repeat this movement three times.

Sport number three

Stand completely straight and place the palms of both hands behind the head. The head should be completely straight and the elbows should be as far back as possible. In this case, the palms of both hands put pressure on the back of the head, while the head shows resistance. This pressure should continue for 10 seconds. Repeat this movement three times.

Exercise number four

Put your chest forward and raise your shoulders. Stay in this position for 10 seconds. Repeat this movement three times.

Exercise number five

According to the shape or one hand, pull your head to the same side, so that you feel the stretch in the muscles on the opposite side of the neck. Maintain this position for 10 seconds. Repeat this exercise three times and do it for the opposite side as well.

Repeat all the above exercises in three meals: morning, noon and night.

Meniscus

What is the meniscus? Menisci are horseshoe-shaped and flexible structures that are placed in the knee joint like a rubber gasket between the femur and lower leg bones, and provide smooth and smooth movement of the knee joint, and on the other hand, strengthen this joint and provide a proportional distribution of force. They perform in the knee joint. Each knee has two meniscus, one on the outside of the knee and one on the inside of the knee.

What causes a meniscus tear?Sudden rotation or twisting movements of the knee when the knee is bent, for example during exercise or lifting heavy objects, can lead to meniscus tear.

Meniscus tear symptoms: Depending on the severity of the meniscus injury, the patient may experience different symptoms. In cases of mild injury, only pain and swelling of the knee may occur, and after two to three weeks, the symptoms will disappear. In cases of moderate damage, in addition to pain and swelling, the patient may experience a decrease in the ability to bend and straighten the knee, although the patient will still be able to walk. At this stage, the symptoms may disappear after a few weeks, but as soon as the knee is exposed to pressure, the symptoms will return and these symptoms will continue until the patient goes through the treatment steps correctly. In severe cases, it is possible. A piece of the torn meniscus enters the joint space and the so-called locking of the knee occurs. A state in which the patient will not be able to bend and straighten the knee and walk.

Diagnosis: Based on physical examination, disease history and if necessary, MRI is performed. Plain radiography has no role in the diagnosis of meniscus tear.

treatment:Depending on the severity of the injury, various treatments may be considered, such as: ice compress, rest and avoiding movements that put pressure on the meniscus, such as sitting and standing, anti-inflammatory drugs, knee braces, physiotherapy, laser therapy, using Ozone gas and in extreme cases surgery to repair or remove a part of the meniscus.

Sciatica

What is sciatica? The thickest nerve in the body, which is formed by the fusion of several nerve roots at the end of the spine, and after passing through the pelvis and the back of the thigh, it is divided into smaller branches when it reaches the knee, and along its path, it reaches the corresponding muscles and part of the skin of the body. The lower one is innervated.
The shooting pain that usually starts from the back and affects the hips and may continue to the lower leg and also the leg itself is called sciatica pain. This pain may be accompanied by numbness and weakness.
Sciatica pain is rarely seen in people under 20 years of age and is usually more common in middle age and around 40 to 50 years of age. Researchers believe that approximately 43% of the world's population suffers from sciatica. This disease does not appear suddenly, but develops over time.

Reasons: Sciatica is actually a symptom and not the name of a disease. It is a sign of other problems that manifest as sciatica pain.

Diseases like:Lumbar disc herniation, spondylolisthesis and spinal canal stenosis

In addition to the mentioned common diseases, the following causes can also cause sciatic nerve involvement:Pregnancy, adhesions, muscle strain or spasm, spinal tumors, infection, lower back fracture

Common symptoms of sciatica pain: Chronic pain on one side of the hip or leg, bilateral pain is very rare
Pain that starts from the lower back or hips and extends to the thigh and leg
Pain that eases when sleeping or walking and worsens when standing or sitting
Feeling of numbness and tingling and weakness in the legs
Feeling of weakness and numbness when moving the legs
Back pain is weaker than leg pain
Sciatica pain is aggravated by sudden movements such as coughing, sneezing and Or changing the state, for example, when getting up

Treatments:1. Conservative treatments:
The aim of this type of treatment is to improve symptoms and pain caused by pressure on the nerve. There are many treatments to improve sciatica symptoms, some effective ones are mentioned here
2. Physiotherapy: In the early stages of severe sciatica pain, the use of hot or cold packs is usually effective in improving the pain. Usually, an ice pack is used first and then a hot water bag. The intervals of using this treatment should be every two hours. If using an ice pack, a cloth or towel should be placed between the skin and the ice pack. Also, the use of physiotherapy modalities such as TENS and ultrasound can help relieve symptoms.
3. Painkillers: Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen are usually prescribed to relieve sciatica pain. Muscle relaxants may also be effective in the short term (from a few days to a maximum of two weeks).
4. Interventional treatments: In case of non-response to the previous treatments, the next step can be the use of interventional treatments. Treatments such as epidural injections or ozone nucleolysis. Of course, the amount of disc herniation and the condition of the patient are important for using these methods.
Usually, sciatica pain improves over time, and the time of severe involvement usually lasts from a few days to a maximum of 12 weeks. After the pain is improved, the patient must undergo physiotherapy and exercise therapy to prevent the pain from returning. Also, the conditions of the working environment or the lifestyle of the patient should be changed in such a way that with the correct way of moving and lifting objects, the least pressure is placed on the spine.
5. Effective exercises for sciatica pain, depending on the type of sciatica factor and the amount of pain of the patient, all kinds of exercises are prescribed

Strengthening movements: The purpose of this type of exercise is to strengthen muscles, tendons and ligaments. Strengthening the muscles of the back, abdomen and hips is one of the main goals of strengthening exercises

warm-up exercises Stretching exercises are effective in reducing pain. Most people do not do this type of movement. It is very important to stretch the muscles of the back of the thighs, from the waist to the knees. Another effective movement is to bend on both knees and hands and stretch one arm and the opposite leg and repeat the other arm and leg after a few seconds.

Low-risk aerobic exercise Low-risk movements such as walking, swimming or hydrotherapy are very effective in improving sciatica symptoms. Aerobic movements have the property that the body releases endorphins during these activities, which is a natural pain reliever and relieves sciatica pain.
The patient can do these exercises alone and alternately. Sports such as yoga, tai chi and pilates are also useful if there is a trainer who knows the condition of the patient.

Surgical treatments If the severe pain in the leg lasts for more than 4 or 6 weeks, if the patient does not respond to non-surgical treatments, and if the patient is unable to perform daily activities due to the severity of the problem, the next option may be open surgery.

laser

Laser is a part of the spectrum of light. Light is an electromagnetic energy. Electromagnetic energy is usually measured by wavelength. Visible light has a wavelength between 380 and 740. Each color in visible light has its own wavelength. Different types of lasers are placed in a part of this spectrum according to their wavelength.

In terms of wavelength, lasers used in physiotherapy are placed after infrared or infrared waves. In other words, their wavelength is slightly longer than infrared waves.
The laser device is actually a kind of light amplifier. In fact, the laser device produces homogenous light waves in a concentrated manner, and this concentration and convergence causes a lot of energy to be generated in It becomes a surface unit, so it can be used in cutting metals and diamonds.
The waves of a beam of light emitted from a laser device are coherent, monochromatic, and have the same polarization.

Laser is obtained by combining the beginning of the words of the opposite term:
Light Amplification by Stimulate Emission of Radiation

Types of lasers used in physical therapy- Class 3 or LLLT with a power of less than 500 milliwatts mw (cold laser)
- Class 4 or HPLT with a power of more than 500 milliwatts mw

Diseases and injuries that laser can be very effective in treating and healing: -Types of sports injuries such as damage and inflammation of tendons, ligaments, muscles (tendonitis, ligament sprain, muscle strain)
- Peripheral neuropathy, inflammation of joint capsule and bursae (capsulitis, bursitis) br />- spinal canal stenosis
- wear and arthritis of joints
- chronic pains
- open wounds
-...

Mechanisms of laser operation- Reducing pain
- Reducing inflammation
- Increasing the speed of recovery of damaged tissues
- Relaxing muscles
- Stimulating the speed of regeneration in damaged nerves
- Increasing the activity of blood vessels in the area Treated
- Reduction of fibrosis tissue formation
- Increase in the number of stem cells in the treated area
Many neuromusculoskeletal problems respond much better to HPLT.
Many patients realize the effects of the treatment in the first sessions, although in many cases, due to the severity and chronic nature of the damage, multiple treatment sessions may be needed.
Capable pain clinic equipped withGiga high power diode laser It is one of the selected lasers in the field of medicine, with a power of 30 watts and a wavelength of 980 + 1470 nm. One of the features of this laser is receiving the FDA certificate from the United States, which is a confirmation of the device's effectiveness and safety.
In addition to being used in a physiotherapy clinic, this device can also be converted into a surgical laser and can be used in disc laser operations. Also, having a special probe, it can be used in the treatment and elimination of spider veins caused by varicose veins.

Post Herpetic Neuralgia

Herpes zoster virus is the cause of shingles and chicken pox. After contracting chicken pox, the virus hides in the sensory nerve ganglia, and in the case of a weak immune system, the virus may reactivate and appear as shingles (mostly in the elderly). Axons enter the relevant dermatomes and symptoms such as chicken pox appear locally. Due to the inflammation of the involved sensory nerves, the person experiences severe pain along with burning and numbness in the affected areas, which may last for a long time. It can be prolonged and sometimes even affects the person for years. The painful stage after shingles is called post-shingles neuralgia.

Treatment: Medicinal:Various drug groups such as antivirals, corticosteroids, anticonvulsants such as gabapentin, tricyclic antidepressants such as nortriptyline, pain relievers such as diclofenac, even opioids and topical medications such as capsaicin may benefit.

Interventional treatments :1. Epidural injectionand paravertebral steroid
2. Sympathetic nerve block
3. Spinal cord stimulator may be used in very severe and resistant cases

ozontherapy

Using ozone gas in therapeutic concentrations to treat joint wear, sports injuries, disc herniation (ozone nucleolysis). Ozone gas exerts its therapeutic effects by having analgesic and regenerative (restorative) properties and activating the immune system. Compared with other treatment methods, there are few side effects.

- Disc herniation: Certain types of discs can be treated by injecting ozone into the disc. Of course, this procedure is performed in completely sterile conditions, in the hospital and with the help of the c-arm device on an outpatient basis (without anesthesia and only local anesthesia).
After injecting ozone into the disc, it takes 2 to 4 weeks for the protruding part of the disc to gradually recede.

- Abrasion of the joints: Another use of ozone is its intra-articular injection, of course, in order to achieve the greatest therapeutic effect in these cases, the injection sessions must be repeated between 3 and 5 times with specific time intervals.

Back pain and lumbar disc exercises

1. As shown in the figure, we gather both legs in the stomach and stay in this position for ten seconds. Then we return to the normal position and put our feet on the ground. We repeat this movement three times.

2. As shown in the figure, we gather one of the legs in the stomach and stay in this position for ten seconds. Then we put that foot on the ground and do the same movement with the opposite foot. We repeat this movement three times for each leg.

3. As in the figure, we stick the two legs together and move to one side, then return to the normal position and move to the opposite side. We repeat this movement ten times for each side.

4. As shown in the figure, we lift the pelvis off the ground and hold it in the air for ten seconds, then lower the pelvis to the ground. We repeat this three times.

5. As shown in the figure, lift the leg and pull it towards you while wrapping both hands around the thigh and stay in this position for five to ten seconds, so that you feel a stretch on the back of the thigh. We repeat the same movement for the opposite side. We repeat this exercise three times for each leg.

-- Pay attention to do the exercises carefully and if any of these movements increase your pain, remove that movement.
-- Do all the exercises three times a day.
-- The condition for these exercises to be effective is to repeat and continue doing them.
-- Even if you feel better, continue these exercises.

orthosis & prosthesis

Prescribing all kinds of orthoses and prostheses:

• Muscular and skeletal disabilities in order to increase the patient's performance and become more independent from the surrounding people, such as artificial limbs and wearable braces (long leg brace, AFO, KAFO,...)

• Correcting biomechanical anomalies such as using different types of insoles (wedge, arch support, pads, ...) or knee braces (knee cage, ...) and belts (Milwaukee, chair back, ...) and...

• To reduce movement in order to reduce inflammation and improve damaged tissue, such as knee braces, wrist braces, neck braces, etc.

Botox

Botox (clostridium botulinum toxin):

By acting on the place where the nerve connects to the muscle (synapse) and preventing the passage of the nerve message to the muscle, Botox causes a part of the treated muscle to become disabled. This feature has led to the widespread use of this drug in various fields. including in the treatment of wrinkles and wrinkles on the face and beauty application by disabling the muscles that cause wrinkles and wrinkles. But what is done in this center is the use of this medicine in the treatment of various diseases, including:

migrain headache:

Most of the pain caused by migraine occurs due to the spasm of various muscles around the skull, which can be controlled by injecting Botox in the muscles responsible for these severe spasms and treating the headache. From three to six months, we need to repeat the injection.

Spasticity caused by stroke (CVA) or traumatic brain injury (TBI):

Treatment of continuous muscle contraction (spasticity) in the organs due to the mentioned diseases, which causes abnormal conditions in the appearance and function of the organs.

cerebral palsy:

Following a brain injury (with different severity and weakness) during the embryonic period or at birth, we may witness spasticity in different parts of the body in the later stages of life (depending on the damaged area and its extent in the brain), which we can use Botox to treat. to control

cervical dystonia:

Abnormal neck conditions that occur due to the occurrence of spasticity in various neck muscles. The cause of this phenomenon is still unknown. We can help treat this disease by injecting Botox into the responsible muscles.

stellate ganglion block

This ganglion is actually an extension of the sympathetic chain that is located throughout the spine on both sides of the vertebrae.
Its location is on the outer side in front of the C6 or C7 vertebrae (bilaterally).
We may block it in the treatment of sympathetically related painful conditions in the head and neck and upper limbs and upper thoracic dermatomes. As:
1. (Post herpetic neuralgia) (PHN)
2. (Complex regional pain syndrome) (CRPS)
3. Cancer pains of upper limbs and head and neck
4. Painful conditions related to the vascular system such as: vascular insufficiency, vasospasm, arterial embolism
5. Chest pain caused by angina pectoris
6. Excessive sweating of the hands (along with thoracic sympathetic block)

The block may be performed under the guidance of fluoroscope or sonography and with local anesthesia. For long-term block, RF can be used.

Roundup: Dr. Hossein Arjamand

sphenopalatine ganglion block

A set of sympathetic and parasympathetic, motor and sensory nerves are involved in the formation of this ganglion.
This ganglion is located behind the nose.
Sphenopalatine ganglion block indications
1. Sphenopalatine neuralgia
2. Migraine and cluster headaches(cluster)
3. Unspecified pink pains(Atypical facial pain)
4. Shingles involving the ophthalmic branch of the trigeminal nerve(Herprs zoster ophthalmicus)
5. Trigeminal neuralgia(Trigeminal neuralgia)

The block of this ganglion may be done initially through the nose and with local anesthetic, and if a suitable response is observed, it can be done in the next stage by RF for a longer period.
To perform this procedure, it is necessary to use a fluoroscope to ensure the correct position of the needle tip.
It does not require anesthesia and is performed only with local anesthesia.

Author: Dr. Hossein Arjamand

Sympathetic nerve block

Among the interventional treatments in the control and relief of pain are diseases in which the hyperactivity of this system has caused problems for the patient or this system plays a role in pain transmission.

1. Sphenopalatine ganglion or the sphenopalatine ganglion located behind the nose

2. Stellate ganglion Or the stellate ganglion located in the neck.

3. Lumbar sympathetic chain which is located in the waist.

4. Impar ganglion which is located in the pelvis.

Intraarticular injections

Performing intra-articular injections in various diseases such as abrasion, inflammatory diseases and trauma to treat or control pain and inflammation such as: interphalangeal joints, ankle and hand, knee and elbow, shoulder and hip, sacroiliac ), facet, acromioclavicular, sternoclavicular, temporomandibular

In some cases, to ensure the injection in the target joint, we need to perform an injection under the guide, such as the hip joint, SI, facet, TM joint. In these cases, we may use fluoroscopy or ultrasound guidance.

Soft tissue injections

Types of soft tissue injections such as:

• Injection of trigger points(trigger point)
• Stock market injection(bursa) In all types of bursitis: pes anserine, subdeltoid, ischial, trochanteric و...

• Injection around the tendon in all types of tendinitis (tendonitis) As: De Quervain, tennis elbow, golf elbow و ...

• Injections around injured ligaments in all types ligament sprain As: ankle sprain و ...
• Intramuscular injection under fluoroscopic guidance in muscles such as : psoas, piriformis, quadratus lumbrum

ozone nucleolysis

The use of ozone in medical science is relatively new and its use in various fields is increasing day by day. One of the cases where the therapeutic effects of ozone have recently been noticed is in the treatment of lumbar disc prolapse.

Of course, this method may not be suitable for all types of disc protrusions. The patient should be properly selected based on physical examination and MRI features.

اNucleolysis is a minimally invasive method. Due to the importance of observing sterility conditions and the need to use a fluoroscope, it is performed in the operating room. Of course, the patient is fully awake during the operation and this operation is performed with local anesthesia. Before the operation, the patient receives a dose of prophylactic antibiotics to prevent infection in the disk (diskitis).

The procedure usually takes between half an hour and an hour. After that, the patient is observed in the hospital for two hours and after confirming the patient's condition, he is discharged. The patient can return home on his own foot, although it is better to have a patient with him. After the patient is prepared and lies on his stomach, under the guidance of the fluoroscope, special needles are sent into the target disc and after ensuring At the right place of the needle, a mixture of oxygen and ozone prepared by a special ozone generator is injected into the disc (nucleus) using contrast injection. Also, a part of ozone is injected around the damaged nerve root.

Mechanism of action: By denaturing the core of the disc, ozone reduces the volume of the disc and then the pressure caused by the protrusion of the disc on the nerve root is removed and the desired result is achieved. Of course, it takes between two to four weeks for the effect of ozone and the appearance of its results. After the operation, the patient can carry out his daily activities to the extent that it does not lead to pressure on the spine, and there is no need for absolute rest.

Author: Dr. Hossein Arjamand

Radiofrequency neurotomy

In the field of pain, it is widely used as an effective and efficient method to control pain in patients with pain that is resistant to other treatments. In this method, the radiofrequency probe is placed next to the nerve, and it causes changes in the nerve through heat and electromagnetic waves. It says that it ultimately controls and inhibits the transmission of the pain message, or in other words, the nerve is blocked without medication (of course, depending on the temperature used, this block will vary from the block of pain fibers alone to the complete block of the nerve. In fact, there are two types of RF :
1. Thermal, in which the nerve is burned.
2. Pulse, in which only pain transmission is inhibited.

In what cases is RF used? It is very useful in controlling pain that is resistant to treatment and in those who are not candidates for surgery to control pain due to their physical conditions.
for example:
1. Failed back surgery syndrome(failed back surgery syndrome)
2.Controlling pain caused by hyperactivity of the sympathetic system, such as complex regional pain syndrome (CRPS) and migraine and cluster headaches, as well as excessive palm sweating (Hyperhydrosis).
3. Chronic shoulder pain such as frozen shoulder (Adhesive capsulitis) or severe wear and tear in the shoulder or knee joint (genicular nerve lesioning)

4.Severe wear in the facet joints(Facet joints) or discogenic pains(internal disc disruption)
5. Facial trigeminal nerve pain(Trigeminal neuralgia)
6....

How is this procedure done? According to the problem of the patient, the desired nerve is selected and under the guidance of fluoroscopy or ultrasound, the radiofrequency probe is placed next to the desired nerve, and after ensuring the proper distance between the probe and the nerve based on the stimulation of the motor and sensory parts of the nerve, the device is turned on. We adjust the basis of the desired treatment method in terms of temperature and duration of irradiation and turn it on. It may take 2 to 4 weeks to see the full effects of RF. Also, based on the different parameters used in RF, the effects of this method may vary between 6 months and 4 years. There is no need for anesthesia to perform RF and this work is done only with local anesthesia. Although in some cases there may be a need for sedation.

Author: Dr. Hossein Arjamand

epidural injection

As the name of this procedure suggests, it means injecting medicine in the epidural space or the space that is placed on the dura (around the spinal canal). This space is located from above to the foramen magnum and from below to near the end of the sacrum and surrounds the spinal canal. This space also includes nerve roots.
Epidural space is a space full of fat and blood vessels and has the ability to increase volume.
In various diseases in which the nerve roots are under pressure for any reason, such as: disc herniation, spinal canal stenosis, adhesions caused by previous operations, etc., steroid or other drugs can be injected around the nerve root involved in inflammation and Control and treat pain caused by pressure. Also, in controlling the pain in the nerve areas related to each of the nerve roots, it is possible to control the pain related to that area by injecting medicine or using radiofrequency waves, or in other words, block the nerve root. For example, control and treatment of discogenic pains (Internal disc disruption) or pain control during surgery or pains caused by malignancy, etc.

Types of epidural injections:
Inter laminar:The place where the needle enters is between the lamina of two neighboring vertebrae, and actually the back part of the epidural space is targeted. In this method, it is not possible to specifically target a nerve root, and at the same time, depending on the amount of drug and the volume used, several levels are blocked.

Transforaminal:In this method, the nerve roots can be targeted more specifically, and in this way, it will also be useful for diagnosis, to find the involved root and make subsequent decisions. Also, more than other methods, the drug is spread in the front part of the epidural space.

caudal: The place of needle entry will be from the sacral hiatus and again like interlaminar, specific block is not done and several nerve roots are targeted at the same time. This type of epidural injection is only used to treat lower back problems

How to perform epidural injection:Due to the importance of observing the sterility conditions and the sensitivity of the work due to the vulnerability of the nerve roots and proximity to the spinal cord, this treatment method is performed in hospitals or centers equipped with the necessary facilities and under the guidance of a fluoroscope.
A week before the treatment, the patient should stop taking medications that interfere with blood coagulation. (like aspirin)
This procedure does not require general anesthesia and is performed only with local anesthesia. Of course, in certain circumstances, it may be necessary to use intravenous drugs for sedation.
After doing the work, the patient is monitored for a few hours and then discharged.
It should be noted that due to the length of the effect of this treatment, it may need to be repeated. This treatment can be repeated at the same level up to three times a year.

Author: Dr. Hossein Arjamand

Osteoporosis

It is one of the prominent diseases of this century, which has a lot to do with incorrect lifestyle and improper nutrition. This disease is more common in women, especially after menopause and following hormonal changes. Of course, bone density decreases naturally with age, but if If this reduction is more than normal, the person should be treated. Lifestyle has a significant impact on the appearance of this disease. For example, lack of physical activity, especially the types that are accompanied by weight bearing exercise, smoking, lack of consumption of dairy products and calcium-rich sources, lack of vitamin D, long-term use of certain drugs such as coronet, etc.
Various other causes and factors are also effective in the occurrence of this disease, which we have no role in correcting. Such as genetics, early menopause and light skin.

Importance: Due to the reduction of bone density and the so-called thinning of the bone, the person is exposed to dangerous fractures in the spine, organs, and especially the pelvis, which may cause the person to fall to the ground and cause physical and mental consequences for the person and dependents.

Symptoms: Osteoporosis does not have a clear sign like what we see in other diseases. Of course, scattered and non-specific pains in the limbs or spine may be one of its symptoms.

Diagnosis:It is given based on a special test that is designed for this disease and is actually a kind of radiological imaging (Dual x-ray absorptiometry). This test is based on comparing the density obtained from the said test and comparing it with the average of young age groups. It is recommended that women perform this test at least once after menopause, and it is not recommended to perform this test after an interval of less than two years for those who are undergoing treatment for follow-up.

Based on the results of the bone density test, patients are classified into three groups:1. The normal range that is not considered sick by nature.
2. In this group, a decrease in bone density has occurred, but not so much that it enters the range of osteoporosis. (osteopnea)
3. Osteoporosis

Treatment: Different drugs may be used according to the patient's condition.
1. Bisphosphonates: may be prescribed at the doctor's discretion. The effects of these drugs appear in the long term, so they should be used in the long term (between 2 and 5 years). Reducing the progressive loss of bone tissue and reducing the risk of fracture are among the effects of these drugs. Among these drugs are alendronate and vatidronate.
2. Different groups of drugs may be prescribed according to the patient's condition, such as: raloxifene, parathyroid hormone, calcitonin.
3. Of course, taking calcium and vitamin D supplements should not be missed.

What foods should we not eat?Some drugs reduce the absorption of calcium, such as salty foods, and excessive consumption of caffeine can have a negative effect on calcium absorption, as well as excessive consumption of alcoholic beverages.

Author: Dr. Hossein Arjamand

Peripheral neuropathy

peripheral neuropathy: Definition: Damage to the messenger and messenger nerves to the spinal cord and brain that are outside the central nervous system (brain and spinal cord).
A wide range of diseases are included in this group, from the damage of one nerve such as carpal tunnel syndrome to the involvement of all peripheral nerves in diseases such as diabetes.
Peripheral neuropathy can be divided based on local involvement of one nerve (mononeuropathy) or involvement of a set of nerves (polyneuropathy).

Mononeuropathy : Reasons : Various things such as trauma or long-term pressure on a nerve after being in one position, for example sitting for a long time or doing repetitive movements that put intermittent pressure on the nerve, such as typing for a long time, can cause this type of neuropathy. One of mononeuropathy The most common causes are hand nerve canal stenosis (CTS).

Symptoms : Depending on whether the damaged nerve is sensory or motor, there may be symptoms such as weakness in the muscle related to the involved nerve or a feeling of numbness, heaviness, tingling and numbness, a feeling of swelling or coldness in the area of the involved nerve.
Sometimes nerves related to internal organs such as the heart or blood vessels may be involved, which is called autonomic neuropathy, and symptoms such as excessive sweating or low blood pressure can be seen in this type of neuropathy.

Polyneuropathy: Involvement of a large number of peripheral nerves at the same time is called polyneuropathy.

Causes and factors such as :Vitamin B deficiency, excessive alcohol consumption, cancer, chronic kidney diseases, diabetes, etc. can cause this type of neuropathy. Chronic diabetes is one of the most common causes.

symptoms: Burning sensation, pain, murmur, loss of sensation in the limbs and may be seen.
Due to the loss of feeling of heat and cold and pain, the involved tissues are exposed to the risk of injuries such as burns and repeated traumas, and these injuries may lead to chronic wounds, which are very difficult and time-consuming to treat. For this reason, this group of patients must take great care of their organs and avoid being in situations where there is a possibility of injury, such as wearing tight shoes, being close to heat sources such as heaters, etc.
If nerves related to internal organs are involved, symptoms such as: constipation, diarrhea, urinary or sexual problems may be seen.
One of the most dangerous types of polyneuropathy is Guillain-Barre. In this disease, the immune system is activated against the peripheral nerves, and in an acute case, the person suffers paralysis of the organs, and due to the possibility of involvement of the nerves of the internal organs and disturbances in the rhythm of the heart and breathing, as well as blood pressure, they must be hospitalized. Fortunately, this disease can be cured in most cases by receiving appropriate treatment.

Treatment:1. Fixing the underlying cause such as vitamin deficiency or blood sugar control and in cases of mononeuropathy, avoiding harmful factors such as doing hard and repetitive work with hands or considering ergonomic rules to avoid injury are the first steps of treatment. Of course, it should be noted that in many cases, if treatment measures are not started faster and the disease process leads to serious damage to the nerves, other treatment measures will not have much result, because the repair capacity of the nerves is very low.
2. We can use different drugs to control unpleasant symptoms of neuropathy. Among these drug groups, tricyclics or anticonvulsants can be mentioned.
3. Some physiotherapy modalities such as TENS can also be effective in controlling symptoms.
4. Intervention treatments in refractory cases may be considered according to the cause of neuropathy. For example, injecting steroids in the wrist and carpal tunnel in median nerve entrapment, or injecting neurolytic drugs such as alcohol in neuropathic pain caused by visceral malignancies, or using radiofrequency (RF) to block sympathetic nerves in cases such as peripheral neuropathic pain or CRPS (chronic regional pain syndrome)

Author: Dr. Hossein Arjamand

Pain caused by cancer

Many cancer pains are caused by the pressure of the cancerous mass on bones, nerves or other organs.
Sometimes these pains are related to cancer treatment, for example, chemotherapy drugs may cause burning or numbness in the organs. Of course, it should be noted that all pain in cancer patients is not necessarily due to cancer. Involvement of different organs may cause different types of pain.

Pain caused by nerve involvement: If the cancerous mass presses on the spinal cord or peripheral nerves, the patient may experience pains with special features, which are called neuropathic pain. Features such as burning sensation, tingling and burning sensation, deadly arrow, etc. Sometimes these pains occur after surgery to treat cancer. In fact, nerve damage may occur during surgery to remove a cancerous mass. Sometimes nerve damage may occur after treatments such as chemotherapy or radiotherapy.

Pain caused by bone involvement: In case of invasion of cancer cells into bone tissue and destruction of bone cells, the patient will feel a vague and unpleasant pain but with a relatively specific location. This type of pain is called somatic pain.

Analgesia from soft tissue involvement: Pains caused by involvement of internal organs such as kidneys or muscles. For example, kidney involvement may manifest as back pain. The location of this type of pain is usually bright and clear (pin point).

phantom pain:It means feeling pain in a limb that has been severed and no longer exists externally. For example, feeling pain in a leg that has been amputated due to sarcoma. The cause of this pain is not yet known correctly, but the remaining parts of the brain that were responsible for that part of the body in the past are considered to be the cause of this feeling. Of course, these pains usually decrease or disappear after time passes, but sometimes They remain for years and their intensity does not decrease. Surgical techniques are also effective in this type of pain.

referred pain: Sometimes the pain caused by an organ in the body is felt in another part of the body. For example, the involvement of the liver may show itself as shoulder pain, and this is due to pressure on the nerves that innervate parts of the shoulder.

Interventional pain management: They are an important and effective part of pain control in cancer patients. This part includes blocking or inhibiting the transmission of pain messages by the involved nerves, which, depending on the type of involvement, may be done with drugs such as steroids, alcohol, phenol, or the use of radiofrequency waves. For example, in upper abdominal malignancies such as pancreatic cancer, the patient's pain can be controlled to a great extent by blocking the celiac ganglion, or in controlling cancer pains in the pelvis, the patient can be helped by inhibiting the hypogastric plexus. .
Among the other therapeutic devices that are included in this section is the spinal cord stimulation, which is actually a thin fiber for working around the spinal cord. This fiber is connected to an electric stimulator that is implanted under the skin and by producing special waves around the spinal cord, it inhibits the transmission of pain messages to the brain.
Also, intrathecal pumps are among other treatment options. In fact, certain drugs, including narcotics, are placed in a small source under the skin, and this source is directed into the cerebrospinal fluid (CSF) by a catheter, and the pain is suppressed by releasing the drug into it.
Of course, it should be noted that any of the treatment options may be considered at the doctor's discretion and according to the type and location of malignancy.

Author: Dr. Hossein Arjamand

ورزشهای کمر درد و دیسک کمر

1.جمع کردن پا ها در شکم

در هر یک از حالتهای مقابل 10 ثانیه میمانیم و در مجموع 3 بار این مجموعه را تکرار میکنیم ( در یک وعده تمرین). در روز 3 وعده این تمرین را تکرار میکنیم

2.فشردن قوس کمر به زمین

قوس کمر را به زمین فشار میدهیم و این حالت را به مدت 10 ثانیه حفظ میکنیم.در هر وعده تمرین این حرکت را 3 بار تکرار میکنیم (بهتر است روزانه سه وعده تمرین های مربوط به کمر درد تکرار شوند)

3.بلند کردن لگن از زمین

لگن را از زمین بلند میکنیم و این حالت را 10 ثانیه حفظ میکنیم. این تمرین را در هر وعده 3 بار تکرار میکنیم

ارتوز و پروتز (orthosis & prosthesis)

تجویز انواع ارتوز و پروتز در
• ناتوانی های عضلانی و اسکلتی در جهت افزایش عملکرد بیمار و هر چه ناوابسته تر شدن به اطرافیان مانند انواع اندام مصنوعی و بریس های پوشیدنی ( long leg brace , AFO , KAFO, …)

• اصلاح ناهنجاریها ی بیومکانیکی مانند استفاده از انواع کفی (wedge, arch support, pads, …) یا زانوبند (knee cage, …) و کمربند (Milwaukee, chair back, …) و...

• برای کاهش حرکت در راستای کاهش التهاب و بهبود بافت اسیب دیده مانند انواع زانوبند و مچ بند و گردن بند و ...

تزریق های بافت نرم

انواع تزریق های بافت نرم مانند :
• تزریق نقاط ماشه ای (trigger point)

• تزریق بورس (bursa) درانواع بورسیت ها : pes anserine, subdeltoid, ischial, trochanteric و...

• تزریق اطراف تاندون در انواع تاندینیت ها (tendonitis) مانند: De Quervain, tennis elbow, golf elbow و ...

• تزریق اطراف لیگامانهای اسیب دیده در انواع ligament sprain مانند: ankle sprain و ...
• تزریق داخل عضلانی زیر گاید فلوروسکوپ در عضلاتی مانند : psoas, piriformis, quadratus lumbrum

اوزون تراپی ozontherapy

بکار گیری گاز اوزون در غلظت های درمانی جهت مداوای ساییدگی مفاصل ، اسیب های ورزشی، فتق دیسک(ozone nucleolysis).گاز اوزون با دارا بودن خواص ضد درد و رژنراتیو ( ترمیمی) و فعال کردن سیستم ایمنی اثرات درمانی خود را اعمال میکند و در مقایسه با سایر روش های در مانی عوارض ناچیزی دارد .

- فتق دیسک :

انواع خاصی از دیسک را میتوان با تزریق اوزون داخل دیسک درمان نمود .البته این روش در شرایط کاملااستریل ، در بیمارستان و با کمک دستگاه c-arm بصورت سرپایی ( بدون بیهوشی و تنها بابیحسی موضعی) انجام میشود .
پس از تزریق اوزون به داخل دیسک 2 تا 4 هفته طول میکشد تا بخش بیرون زده دیسک بتدریج پسرفت کند .
- ساییدگی مفاصل :
از دیگر موارد کاربرد اوزون تزریق داخل مفصلی ان میباشد ،البته برای رسیدن به بیشترین اثر درمانی در این موارد باید جلسات تزریق بین 3 تا 5 بار با فواصل زمانی مشخص تکرار شوند .

تزریق های داخل مفصلی

انجام تزریق های داخل مفصلی در بیماریهای مختلف مانند ساییدگی ، بیماریهای التهابی و تروما جهت درمان یا کنترل درد و التهاب مانند: مفاصل اینتر فالنژیال ((interphalangeal، مچ پا و دست، زانو و ارنج، شانه و هیپ (hip)، ساکروایلیاک (sacroiliac)، فاست (facet)، اکرومیوکلاویکولار (acromioclavicular)، استرنوکلاویکولار (sternoclavicular)، تمپورومندیبولار (temporomandibular)

دربعضی موارد برای اطمینان از تزریق در مفصل مورد نظر نیاز به انجام تزریق زیر گاید داریم ، مانند مفصل هیپ ، SI، facet ، TM joint . در این موارد ممکن است از گاید فلوروسکوپی یا سونوگرافی بهره ببریم.

بلاک گانگلیون ستاره ای (stellate ganglion block)

این گانگلیون در واقع امتداد زنجیره سمپاتیک است که در سراسر ستون فقرات در دو طرف مهره ها قرار گرفته اند .
محل قرار گیری ان در سمت خارجی جلوی مهره های C6 یا C7 میباشد ( دوطرفه).
ممکن است در درمان وضعیت های دردناک مرتبط با سمپاتیک در سر و گردن و اندام فوقانی و درماتوم های بالایی توراسیک ان را بلاک کنیم. مانند:
1.    (Post herpetic neuralgia) (PHN)
2.    (Complex regional pain syndrome) (CRPS)
3.    دردهای سرطانی اندام فوقانی و سر و گردن
4.    وضعیت های دردناک مربوط به سیستم عروقی مانند : نارسایی عروقی، وازواسپاسم، امبولی شریانی
5.    درد قفسه سینه ناشی از انژین صدری
6.    تعریق زیاد دست ها ( همراه با بلاک سمپاتیک توراسیک)

بلاک ممکن ممکن است زیر گاید فلوروسکوپ یا سونو گرافی و با بی حسی موضعی انجام شود .برای بلاک بلند مدت میتوان از RF سود جست.

گرد اوری : دکتر حسین ارجمند

بلاک گانگلیون اسفنوپالاتین (sphenopalatine ganglion block)

مجموعه ای از اعصاب سمپاتیک و پاراسمپاتیک و حرکتی و حسی در تشکیل این این گانگلیون نقش دارند.
این گانگلیون در پشت بینی قرار گرفته است .
اندیکاسیون های بلاک گانگلیون اسفنوپالاتین
1.    اسفنوپالاتین نورالژی
2.    سردرد های میگرنی و خوشه ای (cluster)
3.    دردهای نامشخص صورتی (Atypical facial pain)
4.    زونای درگیر کننده شاخه چشمی عصب سه قلو (Herprs zoster ophthalmicus)
5.    نورالژی تریژمینال (Trigeminal neuralgia)

بلاک این گانگلیون ممکن است در ابتدا از طریق بینی و با لوکال انستتیک صورت گیرد و در صورت مشاهده پاسخ مناسب در مرحله بعدی بوسیله RF برای مدت طولانیتری انجام شود.
برای انجام این پروسیجر نیاز به استفاده از فلوروسکوپ جهت اطمینان حاصل کردن از موقعیت درست نوک سوزن میباشد.
نیاز به بیهوشی ندارد و تنها با بیحسی موضعی انجام میشود.

نویسنده: دکتر حسین ارجمند

بلاک اعصاب سمپاتیک

ازجمله درمانهای مداخله ای در کنترل و در مان درد در بیماریهاییست که بیش فعالی این سیستم برای بیمار مشکلاتی را بوجود اورده است یا این سیستم در انتقال درد نقش بازی میکند.

1. Sphenopalatine ganglion یا گانگلیون اسفنوپالاتین که در پشت بینی قرار دارد

2. Stellate ganglion یا گانگلیون ستاره ای که در گردن قرار دارد.

3. Lumbar sympathetic chain که در کمر قرار دارد.

4. Impar ganglion که در لگن قرار دارد.

رادیوفرکوئنسی (Radiofrequency neurotomy)

در زمینه درد به عنوان روشی موثر و کارامد در کنترل درد در بیماران با دردهای مقاوم به دیگر درمانها کاربرد زیادی دارد.
در این روش پروب رادیوفرکوئنسی در کنار عصب مورد نظر قرار میگیرد و از دو طریق حرارت و ایجاد امواج الکترومغناطیس تغییراتی را در عصب بوجود میاورد که در نهایت باعث کنترل و مهار انتقال پیغام درد میشود یا به عبارتی بدون دارو ان عصب بلاک میشود (البته بسته به درجه حرارت مورد استفاده این بلاک از بلاک فیبرهای درد به تنهایی تا بلاک کامل عصب متغیر خواهد بود. در واقع RF دونوع است : 1. حرارتی (thermal) که به اصطلاح در ان عصب سوزانده میشود 2. پالس (pulse) که در ان تنها انتقال درد مهار میگردد.

در چه مواردی از RF استفاده میشود؟
در کنترل درد های مقاوم به درمان و کاربرد زیادی دارد .نیز در کسانی که بدلیل شرایط جسمی کاندید عمل جراحی برای کنترل درد نیستند . برای مثال:
1.    سندرم جراحی کمر ناموفق (failed back surgery syndrome)
2.    کنترل دردهای ناشی از بیش فعالی سیستم سمپاتیک مانند سندرم درد پیچیده ناحیه ای (CRPS) و سردردهای میگرنی و خوشه ای، نیز تعریق بیش از حد کف دست (Hyperhydrosis)
3.    دردهای مزمن شانه مانند شانه یخ زده (Adhesive capsulitis) یا ساییدگیهای شدید و مقاوم به درمان در مفصل شانه یا زانو (genicular nerve lesioning)

4.    ساییدگی شدید در مفاصل فاست (Facet joints) یا درد های دیسکوژن مانند (internal disc disruption)
5.    دردعصب سه قلوی صورت (Trigeminal neuralgia)
6.    و ....
این پروسیجر چگونه انجام میشود؟
با توجه به مشکل بیمار عصب مورد نظر انتخاب شده و زیر گاید فلوروسکوپ یا سونوگرافی ، پروب رادیوفرکوئنسی در کنار عصب مورد نظر قرار میگیرد و پس از اطمینان از فاصله مناسب میان پروب و عصب بر پایه تحریک بخش های موتور و سنسوری عصب ، دستگاه را بر اساس روش درمانی مورد نظر از نظر درجه حرارت و مدت زمان پرتودهی تنظیم کرده و ان را روشن میکنیم.
برای دیده شدن اثرات کامل RF ممکن است نیاز به 2 تا 4 هفته زمان باشد. نیز بر اساس پارامتر های مختلف بکار برده شده در RF ممکن است ماندگای اثر این روش بین 6 ماه تا 4 سال متغیر باشد .
برای انجام RF نیاز به بیهوشی نیست و این کار تنها با بیحسی موضعی انجام میشود. اگر چه در برخی موارد ممکن است نیاز به sedation وجود داشته باشد.

نویسنده: دکتر حسین ارجمند

تزریق اپیدورال (epidural injection)

همانگونه که از نام این پروسیجر بر میاید به معنا ی تزریق دارو در فضای اپیدورال یا فضایی که روی دورا (اطراف کانال نخاعی) قرار گرفته است میباشد . این فضا از بالا تا سوراخ ماگنوم و از پایین تا نزدیکی انتهای ساکروم قرار دارد و گرداگرد کانال نخاعی را در بر گرفته است. این فضا ریشه های عصبی را نیز در میگیرد.
فضای اپیدورال فضایی اکنده از چربی و عروق خونیست و قابلیت افزایش حجم را دارد .
در بیماریهای مختلفی که در انها به هر دلیلی ریشه های عصبی تحت فشار قرار گرفته اند مانند: فتق دیسک، تنگی کانال نخاعی، چسبندگی های ناشی از عمل های پیشین و ... میتوان باتزریق استرویید یا دیگر داروها در اطراف ریشه عصبی درگیر التهاب و درد ناشی از فشار را کنترل و درمان کرد. نیز در کنترل درد در محدوده های عصبی مربوط به هر یک از ریشه های عصبی میتوان با تزریق دارو یا بکارگیری امواج رادیوفرکوئنسی درد مربوط به ان ناحیه را کنترل کرد یا به عبارت دیگر ان ریشه عصبی را بلاک کرد(root block). برای مثال کنترل و درمان دردهای دیسکوژنیک (Internal disc disruption) یا کنترل درد در حین عمل جراحی یا درد های ناشی از بدخیمی و ...
انواع تزریق های اپیدورال :
Inter laminar:
محل ورود سوزن از بین لامینای دو مهره همسایه است و در واقع بخش پشتی فضای اپیدورال هدف قرار میگیرد. در این روش نمیتوان بصورت اختصاصی یک ریشه عصبی را هدف گرفت و همزمان با توجه به میزان دارو و حجم مورد استفاده چند سطح بلاک میشوند.

Transforaminal::در این روش میتوان ریشه های عصبی را اختصاصی تر هدف گرفت و به این ترتیب کاربرد تشخیصی نیز خواهد داشت، برای یافتن ریشه درگیر و تصمیم گیریهای بعدی.نیز بیش از دیگر روش ها دارو در بخش جلویی فضای اپیدورال پخش میشود.

caudal: محل ورود سوزن از ساکرال هیاتوس خواهد بود (sacral hiatus) و باز هم مانند اینترلامینار، بلاک اختصاصی صورت نمیپذیرد و همزمان چند ریشه عصبی هدف قرار میگیرند. این نوع تزریق اپیدورال تنها در درمان مشکلات سطوح پایینی کمر کاربرد دارد و

چگونگی انجام تزریق اپیدورال :
بدلیل اهمیت رعایت شرایط استریلیتی و حساسیت کار باتوجه به اسیب پذیر بودن ریشه های عصبی و نزدیکی به نخاع ، این روش درمانی در بیمارستان یا مراکز مجهز به امکانات لازم و زیر گاید فلوروسکوپ انجام میشود.
یک هفته پیش از درمان بیمار باید داروهایی را که در انعقاد خون تداخل ایجاد میکنند قطع کند. (مانند اسپرین)
این روش نیاز به بیهوشی عمومی ندارد و تنها با بیحسی موضعی انجام میشود. البته در شرایط خاص ممکن است لازم به استفاده از داروی درون وریدی برای sedation باشد.
پس از انجام کار بیمار چند ساعت تحت نظر گرفته شده و سپس مرخص میشود.
باید توجه داشت که با توجه به طول اثر این روش درمانی ممکن است نیاز به تکرار داشته باشد. میتوان این درمان را در یک سطح تا سه بار در سال تکرار کرد.

نویسنده: دکتر حسین ارجمند

بوتاکس

بوتاکس(توکسین کلستریدیوم بوتولینوم):
بوتاکس با اثر بر محل اتصال عصب به عضله (سیناپس) و جلوگیری از عبور پیغام عصبی به عضله باعث از کارافتادن بخشی از عضله مورد درمان میشود .این ویژگی کاربرد وسیع این دارو در زمینه های مختلف را بدنبال داشته. از جمله در درمان چین و چوروک های صورت و کاربرد زیبایی بوسیله از کار انداختن عضلات بوجود اورنده چین وچوروک.
اما انچه در این مرکز انجام میشود بکارگیری این دارو در درمان بیماریهای مختلف میباشد، از جمله:
سردرد های میگرنی (migrain headache):

بخش عمده درد ناشی از میگرن بدنبال اسپاسم عضلات مختلف اطراف کاسه سر رخ میدهد که با تزریق بوتاکس در عضلات مسیول این اسپاسم های شدید کنترل شده و درمان سردرد را بدنبال خواهد داشت.البته باید توجه داشت که طول اثر بوتاکس محدود میباشد و ممکن است پس از سه تا شش ماه نیاز به تکرار تزریق داشته باشیم.

اسپاستیسیتی های ناشی از سکته (CVA)یا اسیب های مغزی(TBI):

درمان انقباض مداوم عضلات (spasticity)در اندامها بدنبال بیماریهای مذکور که موجب بروز وضعیت های ناهنجار در ظاهرو عملکرد اندامها میشود

فلج مغزی (cerebral palsy):

بدنبال اسیب مغزی(با شدت و ضعف مختلف) در دوره جنینی یا بدو تولد ممکن است در مراحل بعدی زندگی در بخشهای مختلف بدن شاهد بروز اسپاستیسیتی باشیم (بسته به ناحیه اسیب دیده و وسعت ان در مغز ) که میتوانیم با استفاده از بوتاکس ان را کنترل نماییم.

دیستونی گردنی (cervical dystonia):

وضعیت های ناهنجار گردنی که بدنبال بروز اسپاستیسیتی در عضلات مختلف گردن رخ میدهد.
علت این پدیده همچنان ناشناخته است.
با استفاده از تزریق بوتاکس در عضلات مسیول میتوانیم به درمان این بیماری کمک کنیم.

اسپاسم نیمه صورت (hemifacial spasm):

اسپاسم تونیک وکلونیک نامنظم در عضلات صورت ( عصبدهی شده توسط عصب هفتم).علت معمولا وجود عامل فشارنده در ریشه عصب هفت هنگام خروج از جمجمه میباشد.معمولا اسپاسم از عضلات اطراف چشم شروع میشود و به تدریج ممکن است باقی عضلات نیمه صورت نیز در گیر شوند.این بیماری معمولا درسنسن بالا و خانم ها رخ میدهد.

ozone nucleolysis

استفاده از اوزون در علم پزشکی درمانی نسبتا نوین است که روز به روز کاربرد ان در زمینه های مختلف افزوده میشود. از جمله مواردی که اخیرا اثرات درمانی اوزون مورد توجه قرار گرفته در درمان دیسک (disc prolapse) کمر است.

البته این روش ممکن است برای تمام انواع بیرون زدگیهای دیسک مناسب نباشد.

بیمار باید بدرستی بر اساس معایته فیزیکی و ویژگیهای MRI انتخاب شود.

اوزون نوکلئولیز روشی کم تهاجمی (minimally invasive) است. با توجه به اهمیت رعایت شرایط استریلیتی و نیاز به استفاده از فلوروسکوپ ، در اتاق عمل انجام میشود. البته در طول عمل بیمار کاملا هوشیار است و این عمل با بی حسی موضعی انجام میشود .
قبل از عمل بیمار یک دوز انتی بیوتیک پروفیلاکسی جهت پیشگیری از بروز عفونت در دیسک (diskitis) دریافت میکند.
عمل معمولا بین نیم ساعت تا یک ساعت ممکن است طول بکشد. پس از ان بمدت دو ساعت بیماردر بیمارستان تحت نظر گرفته میشود و بعد از اطمینان از شرایط بیمار ، مرخص میشود. بیمار میتواند با پای خود به منزل باز گردد، اگر چه بهتر است بیمار همراه داشته باشد.

پس از اماده شدن بیمار و خوابیدن بر روی شکم ، زیر گاید فلوروسکوپ، سوزن های ویژه ای به درون دیسک مورد نظر فرستاده میشود و پس از اطمینان از محل مناسب سوزن با استفاده از تزریق کنتراست، مخلوطی از اکسیژن و اوزون که در همان لحظه توسط دستگاه مخصوص تولید اوزون(ozone generator) تهیه شده است به داخل دیسک (nucleous) تزریق میشود. نیز بخشی از اوزون در اطراف ریشه عصبی اسیب دیده تزریق میشود.
مکانیسم اثر: اوزون با دناتوره کردن هسته دیسک باعث کاهش حجم دیسک شده و بدنبال ان فشار ناشی از بیرون زدگی دیسک بر روی ریشه عصبی برداشته شده و نتیجه مورد نظر حاصل میشود. البته برای تاثیر اوزون و ظهور نتایج ان بین دو تا چهار هفته زمان لازم است.
پس از انجام عمل بیمار میتواند فعالیت های روزمره خود را تا حدی که منجر به فشار بر ستون مهره ها نشود انجام دهد و نیاز به استراحت مطلق نمیباشد.

نویسنده: دکتر حسین ارجمند

Spinal stenosis

It is a disease of middle age and old age, and its occurrence occurs gradually and after long-term pressure on the spine, over the years. In fact, following continuous pressures, the body automatically builds more bone and soft tissues around the vertebral column in order to cope with these pressures, and the intervertebral discs lose their water and become wrinkled. After that, the beads get closer to each other.

Diagnosis: Along with the signs and symptoms of the disease and the findings of the physical examination, imaging of the vertebral column such as MRI may also be considered to better examine the involved levels and the severity of the involvement.
Also, performing a nerve and muscle strip test to check the involved nerve roots can be helpful.

Treatment: Depending on the severity and weakness of the symptoms, different treatments may be considered, such as:
- Modifying the way of life in order to reduce the pressure on the spine
- Use of anti-inflammatory and anticonvulsant drugs such as gabapentin and...
- Physiotherapy and doing special sports
- Spine interventional treatments such as: epidural injections or facet joint injections.
- In severe cases, surgery may be one of the treatment options.

Author: Dr. Hossein Arjamand

back ache

When does back pain need further follow-up? 1. Not responding to common treatments and chronic pain (more than three months)
2. Occurrence of symptoms such as muscle weakness, numbness of the limbs, shooting pains in the limbs, deviation in the spine, weight loss, night pains, excessive and abnormal dryness in the spine, etc.

What follow-ups may be needed? Simple radiology of the vertebral column can be the most accessible paraclinical examination that can provide us with valuable information about the general vertebral column, especially the bone tissue.
Various tests such as rheumatological tests or investigation of inflammatory markers as well as elements from bone metabolism can be another part of the follow-up.
MRI is also very valuable in cases where we want to examine the soft tissue of the vertebral column, such as the disc and contents of the spinal canal, or to examine malignancies and metastases.
Osteoporosis examination may also be considered according to the patient's age.
Performing a nerve and muscle tape (EMG and NCS) may also be requested in cases where back pain is accompanied by shooting pains in the limbs or numbness and tingling.

Treatment: Some of the back pains, which are often classified under the mechanical category, are often treated by taking drugs such as NSAIDs and muscle relaxants, rest or a short period of physical therapy and appropriate exercises, and follow-ups such as They don't have MRI or radiography.In case of non-response to common treatments, appropriate treatment options are considered according to physical examinations and paraclinical results such as tests and imaging results. Spine intervention treatments at this stage and in patients who are not candidates for surgery and whose laboratory findings are reported to be normal, can help to treat and control the patient's pain. Treatments such as facet intervertebral joint injection or sacroiliac joint (SI) or disc intervention or epidural nerve blocks with drug injection or radiofrequency waves and...

Author: Dr. Hossein Arjamand

Disc

Spinal disc herniation is one of the relatively common diseases. The disc actually has a flexible structure and is located between the vertebrae, which provides flexibility to the spine and our ability to bend and straighten.
The disc has a two-part structure including a jelly core (nucleus) and a firm capsule (annulus), and if too much pressure is applied to it, the annulus may protrude or tear, and due to the closeness of the disc to the nerve roots that are coming out. The spinal canal of this protrusion may cause pain and nerve symptoms such as tingling and murmur or burning and cold feeling in the area of the involved nerve by putting pressure on the neighboring nerves (radiculopathy).

The treatments used may be different according to the symptoms and the time since the symptoms appeared.
The use of anti-inflammatory drugs and steroids, rest and avoiding activities that put pressure on the spine, physical therapy, special exercises to increase the muscle strength of the abdominal muscles or neck muscles and reduce the pressure on the disc, including therapeutic measures. They are primary. Of course, in certain types of discs that only include less than 5 percent of the discs, surgery is needed.
Another part of the treatment that may be considered if the symptoms do not improve after conservative treatments (rest, medicine, physiotherapy) are minimally invasive or interventional treatments (spine intervention)..
In this part of the treatment, according to the findings of imaging and nerve and muscle tape, and of course, most importantly, the patient's examination, the involved nerve roots are identified and are proportional to various factors such as the degree of hydration of the disc, the level of involvement, the duration When the symptoms have passed or the symptoms are chronic, different treatment methods such as epidural injections, use of radio frequency waves (RF nerve ablation) or ozone discectomy are used..
Interventional procedures are performed in the hospital and of course only with local anesthesia and without anesthesia in completely sterile conditions.
Due to the need for high precision, these procedures are performed under the guidance of a fluoroscope. Also, after performing these operations, there is no need to be admitted to the hospital, and only a few hours are observed to ensure the patient's condition and then he is discharged.

Author: Dr. Hossein Arjamand

Migraine

sacroiliac joint dysfunction

Dr. Hossein Arjamand, sacroiliac joint, back pain, rheumatism, ankylosing spondylitis, physical medicine and rehabilitation specialist, pain specialist, sacroiliac joint dysfunction, back pain.

sacroiliac dysfunction or sacroiliac syndrome: The most common cause of wear and tear in this joint is caused by factors such as: overweight, lack of symmetrical distribution of forces between the two legs in those who do not walk normally, for example in those who suffer from wear and tear in the hip or knee joints or have short limbs. They are lower (leg length discrepancy). Also, due to hormonal changes and laxity in the ligaments around the joint, pregnancy exposes it to high pressures and abrasions..

There are many other diseases that can cause inflammation in this joint, such as: Gout, rheumatism (RA), psoriasis, ankylosing spondylitis and...

Symptoms: The most common symptom of involvement is pain that may be felt in the lower back, over the joint itself, hip, groin or thigh. The way to diagnose the source of pain is through special physical examination tests. The pain caused by this disease is usually aggravated by standing and walking or sitting for a long time and gets better by lying down.

Diagnosis: After the physical examination and the history of the disease, simple radiology is the first step of the examination. In the next steps, it is possible to benefit from CT-scan or MRI and sometimes even bone scan.

Treatment:1. Investigating the possible underlying cause such as osteoarthritis of the knee or hip joint or inflammatory diseases and focusing on eliminating the possible underlying cause
2. Anti-inflammatory drugs (NSAIDs) and sometimes steroids
3. Using different modalities of physiotherapy
4. The use of manipulation methods can be helpful in certain cases.
5. Carrying out special exercises of the sacroiliac joint

6. Intra-articular injection of steroid can also be considered as a part of diagnosis and treatment, of course, to perform this injection we need a device as a guide such as ultrasound or fluoroscopy.

7. Finally, in some cases, it may be necessary to perform surgery.

Author: Dr. Hossein Arjamand

Soft patella (chondromalacia)

chondromalacia or patellofemoral syndrome: Pain in the front of the knee (place of the patella) is usually known by this name. This disease often occurs in teenagers, hard workers and athletes. The place of injury is usually in the cartilage under the patella.

Reasons : Pressure on the knee while the patella does not move properly in its special groove located on the thigh bone or femur (patellar tracking disorder) will eventually cause damage to the cartilage under the patella and pain appears in front of the knee. This happens especially in teenagers who have softer cartilage.

Symptoms: The main symptom is knee pain. This pain is especially pronounced when the knee is bent or doing movements such as squats, especially when going down the stairs. There may be a feeling of wear or noise in the joint when walking or moving the knee.

Diagnosis: Physical examination and medical history are usually sufficient for diagnosis. Although sometimes for further investigation, the doctor may request plain radiography or MRI.

Treatment: • The first step is to avoid doing movements that cause the pain to worsen. Weight loss is very important.
• Performing appropriate exercises to strengthen the thigh muscles, especially the quadriceps muscle, can play an important role in treatment. Of course, it should be noted that the intensity of these activities should not be excessive so that they do not cause the problem to worsen. Also increasing the flexibility of different parts around the knee by doing stretching exercises.
• Anti-inflammatory drugs such as ibuprofen or... can play a role in controlling symptoms.
• The use of different modalities of physiotherapy can also be part of the treatment.
• Taping is used to regulate patella movements.
• Using special knee braces to increase stability in patellar movements.
• Sometimes surgery may be the only way.

Author: Dr. Hossein Arjamand

heel spur

The most common cause of heel pain.

Cause: There is a ligament in the sole of the foot that connects the heel bone to the toes (plantar fascia) and thus plays an important role in maintaining the arch of the foot. If for any reason this ligament is stretched and damaged (strain), it will lead to inflammation, swelling and weakness in this ligament, and then it will be painful, especially when standing, when the pressure on the ligament increases.

According to the explanations given below, in the cases where the pressure on this ligament increases, it is more likely to occur • Flat feet or excessive arching of the feet
• Walking, standing or running for long periods of time
• Overweight
• Inflexibility of calf muscle or Achilles tendon

Symptoms: The feeling of pain in the heel, especially in the morning when waking up, is more intense than ever, and the patient has to walk on his toes for a while. Of course, with the passage of time and the start of activity, the intensity of the pain gradually decreases. Also, after a period of immobility such as sitting, the pain becomes severe again when starting to move.

Diagnosis: It is given based on physical examination and disease history. It should be noted that what is sometimes shown to patients as a heel spur in the radiology image (bony prominence at the bottom of the heel bone) has nothing to do with it and may also be seen in the radiology image of a healthy person. In fact, it is the cause of inflammation in the plantar ligament, which cannot be seen in the radiology picture. Of course, radiology may be requested to rule out other possible causes of heel pain.

Treatment: • Avoiding activities that aggravate pain, such as standing for long periods of time or walking for long periods, especially on hard surfaces.
• Use of appropriate medical shoes and insoles.
• Using different modalities of physiotherapy such as ultrasound or shock wave
•Performing appropriate exercises to increase the flexibility of the calf muscles and the Achilles tendon.
• Weight Loss
• Anti-inflammatory drugs such as NSAIDs
• Steroid injection around the injured ligament.
It should be noted that after the treatment, if the causative factors are not avoided, the symptoms may return.

Author: Dr. Hossein Arjamand

Arthrosis

Arthrosis is actually equivalent to the word abrasion and means the occurrence of degenerative or destructive changes in different joints of the body.
Arthrosis is a part of the natural aging process in every human being and it starts from the beginning of youth. But sometimes due to various reasons such as excessive pressure on the desired joint over time, direct damage to the joint tissue due to trauma, weakness of the muscles around the joint, abnormalities Congenital skeletal problems such as club feet, unequal length of limbs, etc., this natural process takes on a pathological appearance and is accompanied by pain and disturbance in the daily functioning of the person. The most common joints exposed to arthrosis include: knee-shoulder-spine.

Treatment :

1. The first step in treatment is to modify the lifestyle and avoid activities that put pressure on the injured joint. For example, in knee arthritis, avoid long walks, going up and down stairs, sitting on the floor, and losing weight, etc.
2. Strengthening the muscles around the injured joint is the next step. Of course, the sports used should be controlled by the minister based on scientific principles so that double damage is not done to the injured tissue.
3. Physiotherapy can also be a part of the treatment process.
4. Part of the treatment may be the use of special orthoses, for example, in the knee, the use of special knee braces or the making of insoles suitable for each person's foot to adjust the distribution of pressure on the knee joint and reduce the pressure on the injured part.
5. The use of different drugs such as anti-inflammatory drugs can also be part of the process of pain treatment and control.
One of the new methods of abrasion control and treatment is the use of ozone gas (ozone therapy). In this way, this gas with a special combination with oxygen is injected in and around the injured joint during several sessions, and its regenerative and pain-relieving effects gradually appear during the treatment sessions.

6. Finally, in very advanced cases of arthrosis that do not respond to any of the aforementioned treatments, surgery and joint replacement can be one of the treatments.

In those who are candidates for surgery due to the severity of wear and tear, but their physical conditions do not allow such a heavy operation, RF nerve ablation or radio frequency waves can be used to modulate the transmission of pain messages from the injured joint. Of course, this part of the treatment requires special facilities and is performed in special centers under the guidance of a fluoroscope.
Currently, the facilities and conditions for this procedure are available

Author: Dr. Hossein Arjamand

Abrasion of the shoulder joint

Of course, the prevalence of wear and tear in the shoulder joint is much less compared to other joints such as the knee or spine. Wear and tear is a disease that occurs over time and gradually, and as a result of constant pressure on the joint, the cartilage tissue of the joint is gradually damaged and the joint space becomes thinner and thinner, and finally the tissue under the cartilage, which contains many pain receptors. It is exposed to damage and pressure and joint pains appear.

Diagnosis: In the first step, physical examinations and then the use of imaging methods such as simple radiography of the shoulder joint can help us in diagnosing the disease.

treatment:- Anti-inflammatory drugs or massage drugs can help control and reduce pain, or drugs that affect the pain cycle, such as SSRI drugs and anticonvulsants, etc.
- Performing special exercises that put less pressure on the joint (isometric exercise) in order to strengthen the muscles of the shoulder girdle, stretching exercises can also play a significant role in controlling the disease.
- Changing lifestyle and avoiding activities that put pressure on the shoulder joint.
- Physiotherapy modalities can also be part of the treatment.
- Interventional pain management may be considered in cases where the previous steps are not effective in controlling pain. Methods such as intra-articular injections (steroid or ozone), suprascapular nerve block by steroid injection or radiofrequency waves.
- In very severe cases, surgery and joint replacement may be treatment options.

Author: Dr. Hossein Arjamand

coccyx pain

Coccygodynia:The coccyx is the last bone of the vertebral column, which is connected to the bone before it, the sacrum, and is composed of 4 smaller bones. Trauma or injury to this bone, such as falling with the buttocks or difficult childbirth, and small but continuous traumas over time, such as riding a bicycle or sitting for long periods in obese people, can cause damage to the sacrococcygeal ligament (the ligament connecting the two coccyx and sacrum bones). Or arthrosis in the mentioned joint and cause pain.
The pain appears mostly when sitting, and the patient may not feel pain when walking.

Diagnosis: Physical examination and disease history are given. Usually, a reliable finding is not seen in the radiology image.

treatment: - Anti-inflammatory drugs
- Using special pillows to reduce pressure on the injured joint
- Physiotherapy modalities
- Manipulation (manipulation) or insertion through the anus may be helpful in some cases.
Interventional treatments (interventional pain management) including steroid injection in the injured joint and finally impar ganglion block under the fluoroscope guide by steroid injection or using radio frequency (RF) waves.
- In very severe cases that do not respond to any of the above treatments, removal of the coccyx may be considered with the help of surgery.

Subdeltoid bursitis

subdeitoid bursitis Or rotator cuff tendinitis: Bursae in the body are cushion-like structures that are placed between muscles and tendons and facilitate the movement of the two on each other.

If for any reason the stock gets injured, the movements related to it will also be painful.

One of the bursas that is commonly injured and inflamed is the bursa located between the deltoid muscle and the rotator cuff tendon, which results from excessive pressure on these muscles, such as lifting heavy objects or repetitive movements that require lifting. have a hand, will be injured.

Symptoms: Painful movement of the shoulder, especially when trying to raise or move the hand behind the head. Pain caused by inflammation of this bursa may spread to the outer surface of the arm.

Diagnosis: It is often based on physical examination and disease history, and of course, in suspicious cases, ultrasound and MRI can help us.

Treatment: - Anti-inflammatory drugs and reducing pressure on the bursa by immobilizing the shoulder are the first steps of treatment.
- In the next stage, physiotherapy and strengthening and stretching movements specific to the disease
- Taping can be part of the treatment.
- Injection of anti-inflammatory drugs inside the bursa and around the tendon of the shoulder muscles, if conservative treatments do not work. It is better to perform this injection under ultrasound guidance to increase accuracy.
- In cases where anatomical problems have led to the occurrence of this disease, surgery may be considered.

Shoulder joint adhesions

(adhesive capsulitis) or (frozen shoulder):

It is a disease with an unknown cause in which the capsule of the shoulder joint decreases in flexibility and as a result decreases the range of motion. Usually, this decrease is accompanied by severe shoulder pain. The disease has three stages: 1. Onset of shoulder pain with progressive decrease in range of motion lasting between 1 and 3 months.
2. In this stage, which lasts between 3 and 9 months, the reduction of movements and freezing of the joint reaches its peak, but the pain will not change much.
3. It will take between 9 and 15 months and gradually the pain and frostbite will decrease.

This disease is more common in women between the ages of 40 and 60. It also occurs more among diabetic patients, heart, stroke and especially after immobilization of the shoulder following fractures.

Diagnosis : It is given based on physical examinations. It is not seen in imaging findings such as shoulder graph or any special point.

Treatment: 1. Anti-inflammatory drugs as well as drugs from other groups such as tricyclics (nortriptyline) or anticonvulsants (gabapentin)
2. Using physiotherapy modalities
3. Doing special exercises. It should be noted that immobilizing the shoulder in this disease worsens the situation.
4. Interventional treatments (interventional pain management): First of all, intra-articular steroid injection is effective in reducing pain and shortening the course of the disease. If the pain is not controlled, it is possible to control the pain with suprascapular nerve block with steroid injection or by using radiofrequency nerve ablation and prepare the patient to participate in physical therapy sessions.
5. Surgical treatments may also be part of the treatment in resistant patients.

carpal tunnel syndrome

One of the nerves that feed sensation and movement in the hand is the median nerve. At the point where this nerve enters the hand, it passes through the carpal tunnel. They appear.

Reasons : This disease usually occurs in those who work too much with their hands. Of course, this disease may also be seen in some diseases such as hypothyroidism or some inflammatory diseases.

Symptoms: Tingling, murmur, pain and heaviness in the patient's hand are prominent symptoms of this disease, which increase with activity and decrease with rest. Symptoms are often aggravated at night and during sleep and may wake the person up.

Diagnosis: After physical examination and paying attention to the history of the disease, the best way to diagnose is to perform a nerve strip.

Treatment: Depending on the severity and weakness of the disease, different methods may be considered.
1. Changing the way of life in order to reduce the activities that lead to an increase in the symptoms of the disease
2. Using special wristbands that must be worn day and night for at least 2 to 3 months.
3. Anti-inflammatory drugs and...
4. Physiotherapy
5. In more severe cases, injecting steroids in the nerve canal can help treat the disease.
6. In very severe cases and resistant to other treatments, surgery may be considered.

tennis elbow or lateral epicondylitis

Tennis elbow:

It is a common disease accompanied by pain in the outer part of the elbow, which is usually Due to excessive pressure on the tendons of the wrist extensors and the occurrence of inflammation and small tears at the junction of those muscles with the elbow. The pain may extend to the muscles of the forearm or arm.

In the affected person, even small pressures on the mentioned muscles, such as turning a key or lifting a kettle, can be painful. Putting pressure on the tendons of said muscles may occur. Such as: painting a wall, turning a screwdriver or...

Diagnosis:It is given by performing a physical examination and examining the history of the disease. Usually, there is no need to do a radiological examination. Although sometimes X-Ray or MRI may be requested for further investigation.

treatment:1. Resting the injured tissue by avoiding doing movements that are harmful and aggravate the pain, for example, lifting objects while the palm is facing up.
2. Physiotherapy modalities can also be part of the treatment.
3. Anti-inflammatory drugs such as NSAID types: Ibuprofen and...
4. Braces or special elbow braces to reduce pressure on the injured tendon.

5. Performing special stretching and strengthening movements for injured muscles.
6. Steroid injection around the damaged tendon. Ozone gas can also be used.
7. Manipulation can be helpful in some cases.

Author: Dr. Hossein Arjamand

Trigger Finger

The feeling of fingers being stuck after folding them together with the pain in the place where the fingers join the palm. Opening the folded finger is painful and feels like pulling a trigger, and sometimes it is necessary to take help from the opposite finger.

The Reason:After performing hard and repetitive work, the tendon of the fingers may become inflamed and swollen, and their soft movement may be disrupted when opening and closing the fingers inside the tendon sheath.
Other causes include diabetes, gout and rheumatism.

Diagnosis:It is given based on the physical examination and the history of the disease, and there is often no need to do a radiological examination.

Treatment:1. Avoiding doing hard work with the injured hand and resting it with the help of a finger splint or special splints
2. Using physiotherapy modalities such as paraffin bath and ultrasound.
3. Anti-inflammatory drugs such as ibuprofen or diclofenac
4. Steroid injection in the damaged tendon sheath
5. In cases resistant to treatment, surgery may be considered.

Author: Dr. Hossein Arjamand

Golfers elbow or medial epicondylitis

pain in the the inside of the elbow at the junction of the muscles of the fingers and wrist (flexor) . Because this disease is common among golfers, it is called by this name. The pain may also radiate to the fingers and arm.

the reason:Excessive and prolonged pressure on the muscles of the wrist and fingers can cause damage to the joint of these muscles with the end of the humerus and small tears in the tendon (inner part of the elbow). Movements such as: throwing heavy objects, carrying heavy objects, High pressure on the mentioned muscles in sports such as rock climbing and...

treatment:1. Resting the injured tissue by avoiding doing harmful and pain-intensifying movements, for example, lifting objects while the palm is up.
2. Cold water compress several times a day
3. Anti-inflammatory drugs such as NSAID types: Ibuprofen and...
4. Braces or special elbow braces to reduce pressure on the injured tendon.
5. Using taping tapes periodically.
6. Performing special stretching and strengthening exercises for injured muscles.

7. Steroid injection around the injured tendon. Ozone gas can also be used.
8. Surgery may be considered in resistant cases.

Author: Dr. Hossein Arjamand

Spinal Cord

Turn Around

Upper limb

lower limb

Therapeutic Exercies

Physiotherapy

Laser

Ozonetherapy

Nerve block

arthrosis

Osteoporosis

Joint and soft tissue injections

Non-surgical disc treatments (interventional)

Botox

Spasticity

Neuropathy

Orthosis and prosthesis

Pain caused by cancer

Varicose veins laser

Treatment of spider varicose veins with advanced laser technique, without pain and bleeding, in the shortest possible time

RACZ training workshop, Antalya, Dr. Hossein Arjamand

The Rocks training workshop was held at Akdeniz University in Antalya with the presence of prominent professors from Iran, England and Turkey. In this two-day workshop, the new Rocks Neuroplasty (RACZ) methods were taught in the back and neck areas, and at the same time, students practiced how to perform the procedures correctly on cadavers in the dissection hall for better training.

Lecture on new views on the treatment of joint diseases

In this seminar, Dr. Hossein Arjamand presented his lecture on the treatment and control of pain in severe wear and tear of the knee joint with the help of knee nerve block. In this seminar, there were participants from different fields such as physical medicine and rehabilitation, orthopedics, rheumatology. The financial supporter of the seminar, Life Cell Company, presented its latest achievements in the field of treating muscle and skeletal diseases with the help of stem cells.

Musculoskeletal injections in physical medicine and rehabilitation

Participation in the seminar of muscular and skeletal injections in the specialized field of physical medicine and rehabilitation as a speaker. Organizer: Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences. In this seminar, Dr. Hossein Arjamand reviewed and taught injections in the pelvic area.

Speech in clinical oncology seminar on pharmacotherapy in cancer pain

Participation in the seminar of the Oncology and Radiotherapy Department as a speaker on the topic: drug therapy in cancer pain. The seminar was held in Zandiyeh Hotel, Shiraz, and various professors from the departments of surgery, psychiatry, oncology, physical medicine and rehabilitation, and radiology were present.

Equipping the clinic with an ultrasound machine

Equipping the pain clinic with an advanced ultrasound machine in order to accurately perform muscular and skeletal injections and types of nerve blocks and minimize possible errors and complications.

Holding a training workshop on spinal interventional treatments

On May 20 and 21, 1997, a training workshop and conference on interventional spine treatments was held at Pars Hotel and Faraproto Radiology Center. This workshop was organized by the Physical Medicine and Rehabilitation Association of Fars and with the support of Dard Tavana Clinic and Faraperto Center. Dr. Rahimi from Tabriz, Dr. Farpour from Shiraz and Dr. Arjamand from Shiraz were in charge of organizing the workshop and conference. Participants from different cities of the country attended this training workshop. In this workshop, various treatments and new non-surgical disc treatment methods were reviewed and taught.

Equipping the pain clinic with a high-power laser

Dard Tavana Clinic is equipped with a high-power giga diode laser , one of the selected lasers in the medical field, with a power of 30 watts and a wavelength of 980 + 1470 nm. One of the features of this laser is receiving the FDA certificate from the United States, which is a confirmation of the device's effectiveness and safety.

In addition to being used in a physiotherapy clinic, this device can also be converted into a surgical laser and can be used in disc laser operations. Also, having a special probe, it can be used to treat and eliminate spider veins caused by varicose veins.

The opening of a multi-specialty pain clinic soon

Soon Dard Tavana clinic will start working in the new location of the office, on Abiordi street.

Colleagues from the fields of psychiatry, neurosurgery, orthopedics, physical medicine, general medicine and physiotherapy will cooperate with the pain clinic.

Physiotherapy and acupuncture departments will be new departments.

Lumbar disc treatment by ozone (ozone nucleolysis) for the first time in Shiraz

Lumbar disc treatment without surgery in Shiraz, intradisc ozone injection, Shiraz Central Hospital, epidural injection, spinal canal stenosis treatment in Shiraz, MRA, foot scan in Shiraz, ozone therapy in Shiraz, braced knee, lumbar arch, nerve tape And muscle, tingling and throbbing of organs

The first ozone therapy center in Shiraz

The first ozone therapy center in Shiraz, Lumbar disc treatment without surgery, cancer pain treatment, lumbar disc treatment with ozone, physical medicine and rehabilitation in Shiraz, Dr. Hossein Arjamand, joint wear treatment in Shiraz, shoulder wear treatment, shoulder joint adhesion treatment, stroke, knee pain treatment

Inauguration of Dr. Hossein Arjamand's personal website

Dr. Hosein Arjmand, Shiraz, physical medicine and rehabilitation, pain fellowship, discopathy, low back pain, ozone therapy, osteoarthritis, knee pain, hand pain, Iran, ozone nucleolysis

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Varicose veins laser

What is varicose veins? Veins in the body are responsible for returning blood from the organs to the heart. The veins in this path have one-way valves that prevent the return of blood from the center to the periphery (pigeon nest valves). These valves may gradually become damaged. This phenomenon leads to the blood remaining in the environment and the dilation of the veins, which we know as varicose veins and the appearance of these vessels on the surface of the skin.

What type of varicose veins can be treated with laser?

Varicose veins with a diameter of less than 4 mm are suitable for laser treatment. Thicker varicose veins may require other methods, including surgery.

How many laser sessions are required for treatment? Depending on different people and the extent of the involvement, between one and three laser sessions may be necessary. Varicose veins fade after the first session and disappear by the end of a month.

Does varicose laser have any side effects? according to The fact that the way the laser works is based on light and heat energy does not cause any special complications. Only some patients may feel a slight and temporary burning sensation in that area, or a slight color change may occur in that area.

Advantages of laser in the treatment of varicose veins: - No pain or bleeding
- Surrounding tissues are not damaged

- The speed of doing the work is high compared to surgery
- The recovery period is very short
- The scar does not stay in place

Recovery after laser varicose veins: In this method, there is actually no recovery period and the person can immediately go about his daily activities. The only point to consider is that it is better not to expose the treated area to the sun for a week. It does not mean limiting activities or wearing varicose stockings.

Softening related to knee wear

Soft number One: While sitting on a chair, straighten one leg as shown in the figure and stay in the same position for five or ten seconds. Do this three times for each leg.

Soft number Two: Lying in a supine position while the knees are close to ninety degrees. Place a pillow between your legs and press both sides of the pillow, press the pillow for ten seconds, then release. Do this three times.

Soft number Three:As shown in the figure while lying on your side, open and close your legs five times, then lie on the opposite side and repeat this movement. Repeat this for each side two or three times, depending on your ability.

Soft number four:Place a band around your foot, at the point where the toes join the sole of the foot, and hold both sides of it with both hands, so that you feel tension and stretch in the back of the thigh, under the knee, and in the sole of the foot. Hold the leg for ten seconds and then release. Repeat this for the opposite side.

Do all the exercises according to the instructions three times a day.
If any of the exercises aggravate your pain, remove it.

Author: Dr. Hossein Arjamand

video and picture

Movies:

In this section, you can see videos related to various actions and procedures.

Pictures:

In this section, you can see different pictures related to the clinic or events related to the clinic.

Partners

In this clinic, we will benefit from consultation with colleagues from other disciplines. Distinguished colleagues in the following fields will be present at the clinic weekly.

.: Dr. Mehdi Abdoli, psychiatry specialist

.: Dr. Ali Razmkan, neurosurgeon specialist

.: Dr. Arash Khazaei, orthopedic specialist

Back pain and lumbar disc exercises

1. Gathering the legs in the stomach We stay in each of the opposite positions for 10 seconds and repeat this set 3 times in total (in one training session). We repeat this exercise on the 3rd day

2. Pressing the arch of the back to the ground We press the arch of the back to the ground and maintain this position for 10 seconds. We repeat this movement 3 times in each training session (it is better to repeat three sessions of exercises related to back pain daily)

3. Lifting the pelvis from the ground We lift the pelvis from the ground and maintain this position for 10 seconds. We repeat this exercise 3 times in each meal

Author: Dr. Hossein Arjamand

orthosis and prosthesis

Prescribing all kinds of orthoses and prostheses• Muscular and skeletal disabilities in order to increase the patient's performance and whatever becoming more independent to the people around, such as various artificial limbs and wearable braces (long leg brace, AFO, KAFO, …)

• Correcting biomechanical abnormalities such as using different types of insoles (wedge, arch support, pads, …) or knee braces (knee cage, …) and belts (Milwaukee, chair back, …) and...

• To reduce movement In order to reduce inflammation and improve damaged tissue, such as knee braces, wrist braces, neck braces, etc.

Soft tissue injections

Types of soft tissue injections such as:
• trigger point
• Stock market injection(bursa) In all types of bursitis: pes anserine, subdeltoid, ischial, trochanteric و...

•Injection around the tendon in all types of tendinitis(tendonitis) As: De Quervain, tennis elbow, golf elbow و ...

• Injections around injured ligaments in all types ligament sprain as: ankle sprain و ...
•Intramuscular injection under fluoroscopic guidance in muscles such as: psoas, piriformis, quadratus lumbrum

ozontherapy

- Abrasion of joints:Another use of ozone is its intra-articular injection, of course, in order to achieve the greatest therapeutic effect in these cases, the injection sessions must be repeated between 3 and 5 times with specific time intervals.

Intra-articular injections

Golfers elbow or medial epicondylitis

Pain in the inner part of the elbow at the junction of the flexor muscles. Because this disease is common among golfers, it is called by this name. The pain may also radiate to the fingers and arm.

Cause:Excessive and prolonged pressure on the adductor muscles of the wrist and fingers can cause damage to the joint of these muscles with the end of the humerus and small tears in the tendon (inner part of the elbow). Movements such as: throwing heavy objects, carrying heavy objects, High pressure on the mentioned muscles in sports such as rock climbing and...

treatment: 1. Resting the injured tissue by avoiding injurious and pain-intensifying movements, for example, lifting objects with the palm facing up.
2. Cold water compress several times a day
3. Anti-inflammatory drugs such as NSAID types: Ibuprofen and...
4. Braces or special elbow straps to reduce the pressure on the injured tendon.
5. Using taping tapes periodically.
6. Performing special stretching and strengthening exercises for injured muscles.

7. Steroid injection around the injured tendon. You can also use ozone gas.
8. Surgery may be considered in resistant cases.

Author: Dr. Hossein Arjamand

sacroiliac joint dysfunction

The sacroiliac joint consists of the connection of the two bones of the sacrum and the pelvis (ilium). In fact, this joint is the place where the pelvis is connected to the vertebral column and plays the main role in transferring the weight of the upper body to the legs. The bones of this joint are held together by strong ligaments, and unlike many other joints, only small movements of a few millimeters occur here. This inflexibility causes a lot of pressure on this joint and causes arthrosis in it

sacroiliac dysfunction or sacroiliac syndrome:The most common cause of wear and tear in this joint is caused by factors such as: overweight, lack of symmetrical distribution of forces between the two legs in those who do not walk normally, for example in those who suffer from wear and tear in the hip or knee joints or have short limbs. They are lower (leg length discrepancy). Also, due to hormonal changes and laxity in the ligaments around the joint, pregnancy exposes it to high pressures and wear and tear.
There are many other diseases that can cause inflammation in this joint, such as:
Gout, rheumatism (RA), psoriasis, ankylosing spondylitis and...

Symptoms:The most common symptom of involvement is pain that may be felt in the lower back, over the joint itself, hip, groin or thigh. The way to diagnose the source of pain is through special physical examination tests. The pain caused by this disease is usually aggravated by standing and walking or sitting for a long time and gets better by lying down.

Diagnosis:After the physical examination and the history of the disease, simple radiology is the first step of the examination. In the next steps, it is possible to benefit from CT-scan or MRI and sometimes even bone scan.

Treatment: 1. Investigating the possible underlying cause such as osteoarthritis of the knee or hip joint or inflammatory diseases and focusing on eliminating the possible underlying cause
2. Anti-inflammatory drugs (NSAIDs) and sometimes steroids
3. Using different modalities of physiotherapy
4. The use of manipulation methods can be helpful in certain cases.
5. Carrying out special exercises of the sacroiliac joint

7. Finally, in some cases, it may be necessary to perform surgery.

Author: Dr. Hossein Arjamand

trigger finger

The feeling of fingers being stuck after folding them together with pain in the place where the fingers join the palm.

Opening the folded finger is painful and feels like pulling a trigger, and sometimes it is necessary to take help from the opposite finger.

Cause:After performing hard and repetitive work, the tendon of the fingers may become inflamed and swollen, and their soft movement may be disrupted when opening and closing the fingers inside the tendon sheath.

Other causes include diabetes, gout and rheumatism.

Diagnosis:It is given based on the physical examination and the history of the disease, and there is often no need to do a radiological examination.

Treatment: 1. Avoiding doing hard work with the injured hand and resting it with the help of a finger splint or special splints.
2. Use of physiotherapy modalities such as paraffin bath and ultrasound.
3. Anti-inflammatory drugs such as ibuprofen or diclofenac
4. Steroid injection in the damaged tendon sheath
5. Surgery may be considered in refractory cases.

Author: Dr. Hossein Arjamand

tennis elbow or lateral epicondylitis

Tennis elbow:It is a common disease accompanied by pain in the outer part of the elbow, which usually occurs due to excessive pressure on the wrist extensor tendons and the occurrence of inflammation and small tears at the junction of those muscles with the elbow. The pain may extend to the muscles of the forearm or arm.

In the affected person, even small pressures on the mentioned muscles, such as turning a key or lifting a kettle, can be painful.

This injury occurs mostly in tennis players, although it may occur in those who for any reason repeatedly and long-term put pressure on the tendons of the said muscles. Such as: painting a wall, turning a screwdriver or...

treatment:1. Resting the injured tissue by avoiding injurious and pain-intensifying movements, for example, lifting objects with the palm facing up.
2. Physiotherapy modalities can also be part of the treatment.
3. Anti-inflammatory drugs such as NSAID types: Ibuprofen and...
4. Braces or special elbow straps to reduce the pressure on the injured tendon.

5. Performing special stretching and strengthening exercises for injured muscles.
6. Steroid injection around the injured tendon. You can also use ozone gas.
7. Manipulation can be helpful in some cases.

Author: Dr. Hossein Arjamand

stellate ganglion block

This ganglion is actually an extension of the sympathetic chain that is located throughout the spine on both sides of the vertebrae.

Its location is on the outer side in front of the C6 or C7 vertebrae (bilaterally).

We may block it in the treatment of sympathetically related painful conditions in the head and neck and upper limbs and upper thoracic dermatomes. As:

1. (Post herpetic neuralgia) (PHN)

2. (Complex regional pain syndrome) (CRPS)

3. Cancer pains of upper limbs and head and neck

4. Painful conditions related to the vascular system such as: vascular insufficiency, vasospasm, arterial embolism

5. Chest pain caused by angina pectoris

6. Excessive sweating of the hands (along with thoracic sympathetic block)

The block may be performed under the guidance of fluoroscope or sonography and with local anesthesia. For long-term block, RF can be used.

Roundup: Dr. Hossein Arjamand

sphenopalatine ganglion block

A set of sympathetic and parasympathetic, motor and sensory nerves are involved in the formation of this ganglion.

This ganglion is located behind the nose.

Sphenopalatine ganglion block indications

1. Sphenopalatine neuralgia

2. Migraine and cluster headaches

3. Atypical facial pain

4. Shingles involving the ophthalmic branch of the trigeminal nerve (Herprs zoster ophthalmicus)

5. Trigeminal neuralgia

The block of this ganglion may be done initially through the nose and with local anesthetic, and if a suitable response is observed, it can be done in the next stage by RF for a longer period.

To perform this procedure, it is necessary to use a fluoroscope to ensure the correct position of the needle tip.

It does not require anesthesia and is performed only with local anesthesia.

Author: Dr. Hossein Arjamand

Sympathetic nerve block

1.Sphenopalatine ganglionor the sphenopalatine ganglion located behind the nose

2.Stellate ganglion Or the stellate ganglion located in the neck.

3.Lumbar sympathetic chain which is located in the waist.

4.Impar ganglion which is located in the pelvis.

Radiofrequency neurotomy

In the field of pain, it is widely used as an effective and efficient method to control pain in patients with pain resistant to other treatments.

In this method, the radiofrequency probe is placed next to the desired nerve, and it causes changes in the nerve through heat and electromagnetic waves, which ultimately controls and inhibits the transmission of the pain message, or in other words, the nerve is blocked without medication (of course, it is closed). The temperature used in this block will vary from the block of pain fibers alone to the complete block of the nerve. In fact, there are two types of RF: 1. Thermal, which burns the nerve, 2. Pulse, in which Only pain transmission is inhibited.

In what cases is RF used? It is very useful in controlling pain that is resistant to treatment and in those who are not candidates for surgery to control pain due to their physical conditions. for example:
1. Failed back surgery syndrome
2. Controlling pain caused by hyperactivity of the sympathetic system, such as complex regional pain syndrome (CRPS) and migraine and cluster headaches, as well as excessive palm sweating (Hyperhydrosis).
3. Chronic shoulder pains such as frozen shoulder (adhesive capsulitis) or severe wear and tear in the shoulder or knee joint (genicular nerve lesioning)

4. Severe wear in the facet joints or discogenic pains (internal disc disruption)
5. Trigeminal neuralgia
6. And ....

How is this procedure done? According to the problem of the patient, the desired nerve is selected and under the guidance of fluoroscopy or ultrasound, the radiofrequency probe is placed next to the desired nerve, and after ensuring the proper distance between the probe and the nerve based on the stimulation of the motor and sensory parts of the nerve, the device is turned on. We adjust the basis of the desired treatment method in terms of temperature and duration of irradiation and turn it on.
It may take 2 to 4 weeks for the full effects of RF to be seen. Also, based on the different parameters used in RF, the effects of this method may vary between 6 months and 4 years.
There is no need for anesthesia to perform RF and this work is done only with local anesthesia. Although in some cases there may be a need for sedation.

Author: Dr. Hossein Arjamand

epidural injection

Epidural space is a space full of fat and blood vessels and has the ability to increase volume.
In various diseases in which the nerve roots are under pressure for any reason, such as: disc herniation, spinal canal stenosis, adhesions caused by previous operations, etc., steroid or other drugs can be injected around the nerve root involved in inflammation and Control and treat pain caused by pressure. Also, in controlling the pain in the nerve areas related to each of the nerve roots, it is possible to control the pain related to that area by injecting medicine or using radiofrequency waves, or in other words, block the nerve root. For example, control and treatment of discogenic pains (Internal disc disruption) or pain control during surgery or pains caused by malignancy, etc.

Types of epidural injections:Inter laminar:The place where the needle enters is between the lamina of two neighboring vertebrae, and actually the back part of the epidural space is targeted. In this method, it is not possible to specifically target a nerve root, and at the same time, depending on the amount of drug and the volume used, several levels are blocked.

Transforaminal :In this method, the nerve roots can be targeted more specifically, and in this way, it will also be useful for diagnosis, to find the involved root and make subsequent decisions. Also, more than other methods, the drug is spread in the front part of the epidural space.

caudal:

The place of needle entry will be from the sacral hiatus and again like interlaminar, specific block is not done and several nerve roots are targeted at the same time. This type of epidural injection is only used to treat lower back problems

A week before the treatment, the patient should stop taking medications that interfere with blood coagulation. (like aspirin)

This procedure does not require general anesthesia and is performed only with local anesthesia. Of course, in certain circumstances, it may be necessary to use intravenous drugs for sedation.

After doing the work, the patient is monitored for a few hours and then discharged.

It should be noted that due to the length of the effect of this treatment, it may need to be repeated. This treatment can be repeated at the same level up to three times a year.

Author: Dr. Hossein Arjamand

Soft patella (chondromalacia)

chondromalacia or patellofemoral syndrome Pain in the front of the knee (place of the patella) is usually known by this name. This disease often occurs in teenagers, hard workers and athletes. The place of injury is usually in the cartilage under the patella.

reasons: Pressure on the knee while the patella does not move properly in its special groove located on the thigh bone or femur (patellar tracking disorder) will eventually cause damage to the cartilage under the patella and pain appears in front of the knee. This happens especially in teenagers who have softer cartilage.

symptoms: The main symptom is knee pain. This pain is especially when the knee is bent or performing movements such as squats, especially when Going down the stairs is more obvious. There may be a feeling of wear or noise in the joint when walking or moving the knee.

diagnosis: Physical examination and medical history are usually sufficient for diagnosis. Although sometimes for further investigation, the doctor may request plain radiography or MRI.

treatment: The first step is to avoid doing movements that cause the pain to worsen. Losing weight is very important.
• Performing appropriate exercises to strengthen the thigh muscles, especially

Quadriceps can play an important role in treatment. Of course, it should be noted that the intensity of these activities should not be excessive so that they do not cause the problem to worsen. also increasing the flexibility of different parts around the knee by performing stretching exercises.
• Anti-inflammatory drugs such as ibuprofen or... can play a role in controlling the symptoms.
• Using different modalities of physiotherapy can also be part of the treatment.
• Taping is used to adjust patella movements.
• Using special knee braces to increase stability in patella movements.
• Sometimes surgery may be the only way.

Author: Dr. Hossein Arjamand

Botox

Botox (clostridium botulinum toxin):By affecting the place where the nerve connects to the muscle (synapse) and preventing the passage of the nerve message to the muscle, Botox causes a part of the treated muscle to become disabled. This feature This drug has been widely used in various fields. including in the treatment of wrinkles and wrinkles on the face and beauty application by disabling the muscles that cause wrinkles and wrinkles.
But what is done in this center is the use of this medicine in the treatment of various diseases, including:

Migrain headache:Most of the pain caused by migraine occurs due to the spasm of various muscles around the skull, which can be controlled by injecting Botox in the muscles responsible for these severe spasms and treatment of the headache. From three to six months, we need to repeat the injection.

spasticity caused by stroke (CVA) or traumatic brain injury (TBI): Treatment of continuous muscle contraction (spasticity) in the organs due to the mentioned diseases, which causes abnormal conditions in the appearance and function of the organs.

cerebral palsy): Following a brain injury (with different severity and weakness) during the embryonic period or at birth, we may witness spasticity in different parts of the body in the later stages of life (depending on the damaged area and its extent in the brain), which we can use Botox to treat. to control

cervical dystonia: Abnormal neck conditions that occur due to the occurrence of spasticity in various neck muscles.
The cause of this phenomenon is still unknown.

hemifacial spasm: Irregular tonic and clonic spasm in the facial muscles (innervated by the seventh nerve). The cause is usually the presence of a compressive factor in the root of the seventh nerve when it exits the skull. The spasm usually starts from the muscles around the eyes, and gradually the rest of the muscles of the half of the face may also be affected. This disease usually occurs in old age and women.

Author: Dr. Hossein Arjamand

ozone nucleolysis

The use of ozone in medical science is relatively new and its use in various fields is increasing day by day. Among the cases where the therapeutic effects of ozone have recently been noticed is the treatment of lumbar disc prolapse.

Of course, this method may not be suitable for all types of disc protrusions.

The patient should be properly selected based on physical examination and MRI features.

Ozone nucleolysis is a minimally invasive method. Due to the importance of observing sterility conditions and the need to use a fluoroscope, it is performed in the operating room. Of course, the patient is fully awake during the operation and this operation is performed with local anesthesia.
Before the operation, the patient receives a dose of antibiotic prophylaxis to prevent infection in the disk (diskitis). The operation usually takes between half an hour and an hour. After that, the patient is observed in the hospital for two hours and after confirming the patient's condition, he is discharged. The patient can return home on his own, although it is better to be accompanied by the patient.

After preparing the patient and lying on his stomach, under the guidance of the fluoroscope, special needles are sent into the desired disc and after ensuring the correct location of the needle, using contrast injection, a mixture of oxygen and ozone, which is at the same moment by ozone generator It is prepared and injected into the disc (nucleus). Also, a part of ozone is injected around the damaged nerve root

Mechanism of action: By denaturing the core of the disc, ozone reduces the volume of the disc and then the pressure caused by the protrusion of the disc on the nerve root is removed and the desired result is achieved. Of course, it takes between two to four weeks for the effect of ozone and the appearance of its results.
After the operation, the patient can carry out his daily activities to the extent that it does not lead to pressure on the spine and requires absolute rest. Is not.

Author: Dr. Hossein Arjamand

heel spur

The most common cause of heel pain.

the reasonThere is a ligament in the sole of the foot that connects the heel bone to the toes (plantar fascia) and thus plays an important role in maintaining the arch of the foot. If for any reason this ligament is stretched and damaged (strain), it will lead to inflammation, swelling and weakness in this ligament, and then it will be painful, especially when standing, when the pressure on the ligament increases.
Paying attention to the given explanations, in the following cases, when the pressure on this ligament increases, it is more likely to occur
• flat feet or excessive arch of the feet
• walking, standing or running for a long time
• Overweight
• Inflexibility of calf muscle or Achilles tendon

symptoms: The feeling of pain in the heel, especially in the morning when waking up, is more intense than ever, and the patient has to walk on his toes for a while. Of course, with the passage of time and the start of activity, the intensity of the pain gradually decreases. Also, after a period of immobility such as sitting, the pain becomes severe again when starting to move.

diagnosis: It is given based on physical examination and disease history. It should be noted that what is sometimes shown to patients as a heel spur in the radiology picture (bony prominence at the bottom of the heel bone) has nothing to do with it and may also be seen in the radiology image of a healthy person. In fact, it is the cause of the inflammation caused in the plantar ligament, which cannot be seen in the radiology picture. Of course, radiology may be requested to rule out other possible causes of heel pain.

treatment: • Avoiding activities that aggravate pain, such as standing for a long time or walking for a long time, especially on hard surfaces.
• Using appropriate medical shoes and insoles.
• Using different modalities of physiotherapy such as ultrasound or shock wave
• Performing appropriate exercises to increase the flexibility of the calf muscles and the Achilles tendon.
• weight loss
• Anti-inflammatory drugs such as NSAIDs
• Steroid injection around the injured ligament.
It should be noted that after the treatment, if you do not avoid the factors that cause the disease, the symptoms may return.

Author: Dr. Hossein Arjamand

Pain caused by cancer

Many cancer pains follow Cancer mass pressure on bones, nerves or other organs.
Sometimes these pains are related to cancer treatment, for example, chemotherapy drugs may cause burning or numbness in the organs. Of course, it should be noted that all pain in cancer patients is not necessarily due to cancer. Involvement of different organs may cause different types of pain.

Pain caused by nerve involvement:If the cancerous mass presses on the spinal cord or peripheral nerves, the patient may experience pains with special features, which are called neuropathic pain. Features such as burning sensation, tingling and burning sensation, deadly arrow, etc. Sometimes these pains occur after surgery to treat cancer. In fact, nerve damage may occur during surgery to remove a cancerous mass. Sometimes nerve damage may occur after treatments such as chemotherapy or radiotherapy.

Pain caused by bone involvement: If cancer cells invade the bone tissue And the destruction of bone cells, the patient will feel a vague and unpleasant pain but with a relatively specific location. This type of pain is called somatic pain.

Analgesia from soft tissue involvement: Pains caused by involvement of internal organs such as kidneys or muscles. For example, kidney involvement may manifest as back pain. The location of this type of pain is usually bright and clear (pin point).

phantom pain: It means feeling pain in a limb that has been severed and no longer exists externally. For example, feeling pain in a leg that has been amputated due to sarcoma. The cause of this pain is not yet known correctly, but the remaining and alive parts of the brain that were responsible for that part of the body in the past are considered to be the cause of this feeling. Of course, these pains usually decrease or disappear after the passage of time, but sometimes They remain for years and their intensity does not decrease. Surgical techniques are also effective in this type of pain.

Referred pain: Sometimes the pain caused by a conflict in an organ in the body is felt in another part of the body. For example, the involvement of the liver may show itself as shoulder pain, and this is due to pressure on the nerves that innervate parts of the shoulder.

Treatments: In addition to common treatments to reduce the volume of malignancy, such as radiotherapy, surgery and chemotherapy (which are sometimes the cause of pain), in cases of milder pain, you can benefit from anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, etc.

In cases such as neuropathic pains, it can be from different groups such as: He used anticonvulsants and antidepressants. Medicines such as corticosteroids are among the medicines used to reduce swelling and compressive effects of the tumor, which will naturally reduce pain. Non-pharmacological treatments such as physiotherapy, biofeedback, relaxation exercises can also help along with other treatments.

Interventional pain management:They are an important and effective part of pain control in cancer patients. This part includes blocking or inhibiting the transmission of pain messages by the involved nerves, which, depending on the type of involvement, may be done with drugs such as steroids, alcohol, phenol, or the use of radiofrequency waves. For example, in upper abdominal malignancies such as pancreatic cancer, it can be By blocking the celiac ganglion, the patient's pain can be controlled to a great extent, or in controlling cancer pain in the pelvis, the patient can be helped by inhibiting the hypogastric plexus. It is spinal cord stimulation, which is actually a thin fiber for working around the spinal cord. This fiber is connected to an electric stimulator that is implanted under the skin and by producing special waves around the spinal cord, it inhibits the transmission of pain messages to the brain.

Also, intrathecal pumps are among other treatment options. In fact, certain drugs, including narcotics, are placed in a small source under the skin, and this source is directed into the cerebrospinal fluid (CSF) by a catheter, and the pain is controlled by releasing the drug into it. It was noted that any of the treatment options may be considered at the doctor's discretion and according to the type and location of malignancy.

Author: Dr. Hossein Arjamand

Peripheral neuropathy

(peripheral neuropathy):
Definition: Damage to the messenger nerves and messages to the spinal cord and brain that are outside the central nervous system (brain and spinal cord)
A wide range of diseases from damage to one nerve such as carpal tunnel syndrome to the involvement of all nerves. Peripheral neuropathy is included in this group in diseases such as diabetes.
Peripheral neuropathy can be divided based on the local involvement of a nerve (mononeuropathy) or the involvement of a set of nerves (polyneuropathy).

Mononeuropathy : Reasons: Different things such as trauma or long-term pressure on a nerve after being in one position, for example, sitting for a long time or doing repetitive movements that put intermittent pressure on the nerve, such as typing for a long time, can cause this type of neuropathy. One of mononeuropathy The most common causes are hand nerve canal stenosis (CTS).

Symptoms: Depending on whether the damaged nerve is sensory or motor, there may be symptoms such as weakness in the muscle related to the involved nerve or a feeling of numbness, heaviness, tingling and numbness, a feeling of swelling or coldness in the area of the involved nerve.
Sometimes nerves related to internal organs such as the heart or blood vessels may be involved, which is called autonomic neuropathy, and symptoms such as excessive sweating or low blood pressure can be seen in this type of neuropathy.

Polyneuropathy: Involvement of a large number of peripheral nerves At the same time, it is called polyneuropathy.

Reasons:Factors such as vitamin B deficiency, excessive alcohol consumption, cancer, chronic kidney disease, diabetes, etc. can cause this type of neuropathy. Chronic diabetes is one of the most common causes.

Symptoms: Burning sensation, pain, murmur, loss of sensation in the organs and may be seen.
Due to the loss of the sensation of heat and cold and pain, the involved organs are exposed to the risk of injuries such as burns and repeated traumas, and this In some cases, injuries may lead to chronic wounds, which are very difficult and time-consuming to treat. For this reason, this group of patients must take great care of their organs and avoid being in situations where there is a possibility of injury, such as wearing tight shoes, being close to heat sources such as heaters, etc.
Involvement of nerves related to internal organs may cause symptoms such as: constipation, diarrhea, urinary or sexual problems.
One of the most dangerous types of polyneuropathy is Guillain-Barre. In this disease, the immune system is activated against the peripheral nerves, and in an acute case, the person suffers paralysis of the organs, and due to the possibility of involvement of the nerves of the internal organs and disturbances in the rhythm of the heart and breathing, as well as blood pressure, they must be hospitalized. Fortunately, this disease can be cured in most cases by receiving appropriate treatment.

Diagnosis:After examining the history of the disease and physical examinations, in order to complete the diagnosis process, biochemical tests or nerve and muscle tapes and in some cases biopsy of the involved nerves or even extraction of cerebrospinal fluid may be considered for laboratory tests.
Treatment:1. Fixing the underlying cause such as vitamin deficiency or blood sugar control and in cases of mononeuropathy, avoiding harmful factors such as doing hard and repetitive work with hands or considering ergonomic rules to avoid injury are the first steps of treatment. Of course, it should be noted that in many cases, if treatment measures are not started faster and the disease process leads to serious damage to the nerves, other treatment measures will not have much result, because the repair capacity of the nerves is very low.
2. We can use different drugs to control unpleasant symptoms of neuropathy. Among these drug groups, we can mention tricyclics or anticonvulsants, etc.
3. Some physiotherapy modalities such as TENS can also be effective in controlling symptoms.
4. intervention treatments (intervention) in resistant cases may be considered according to the cause of neuropathy. For example, injecting steroids in the wrist and carpal tunnel in median nerve entrapment or injecting neurolytic drugs such as alcohol in neuropathic pain caused by visceral malignancies or using radiofrequency (RF) to block sympathetic nerves in cases such as peripheral neuropathic pain or CRPS (chronic regional pain syndrome)

Author: Dr. Hossein Arjamand

Osteoporosis

It is one of the prominent diseases of the present century, which has a lot to do with incorrect lifestyle and improper nutrition.
This disease is more common in women, especially after menopause and following hormonal changes.
Of course, naturally with age. A decrease in bone density occurs, but if this decrease is too normal, the person should be treated.
Lifestyle has a significant effect on the appearance of this disease. For example, lack of physical activity, especially the types that are accompanied by weight bearing exercise, smoking, lack of consumption of dairy products and sources rich in calcium, lack of vitamin D, long-term use of certain drugs such as Corton and...< Various other causes and factors are also effective in the occurrence of this disease, which we have no role in correcting. Such as genetics, early menopause and light skin.

Importance: Due to the decrease in bone density and the so-called thinning of the bone, the person is exposed to dangerous fractures in the spine, organs, and especially the pelvis, which may cause the person to fall to the ground and cause physical and mental consequences for the person and dependents.

Symptoms:Osteoporosis does not have a clear sign like what we see in other diseases. Of course, scattered and non-specific pains in the limbs or spine may be one of its symptoms.

Diagnosis:The diagnosis is based on a special test designed for this disease, which is actually a type of radiological imaging (Dual x-ray absorptiometry). This test is based on comparing the density obtained from the said test and comparing it with the average of age groups. Younger is the criterion.
It is recommended that women do this test at least once after menopause, and it is not recommended to do this test with an interval of less than two years for those who are undergoing treatment for follow-up.

Based on the results of the bone density test, patients are classified into three groups: 1. The normal range that is not considered sick by nature.
2. In this group, a decrease in bone density has occurred, but not so much that it enters the range of osteoporosis. (osteopnea)
3. osteoporosis

Treatment:Different drugs may be used according to the patient's condition.
1. Bisphosphonates: may be prescribed at the doctor's discretion. The effects of these drugs appear in the long term, so they should be used in the long term (between 2 and 5 years). Reducing the progressive loss of bone tissue and reducing the risk of fracture are among the effects of these drugs. Among these drugs are alendronate and vatidronate.
2. Different groups of drugs may be prescribed according to the patient's condition, such as: raloxifene, parathyroid hormone, calcitonin.
3. Of course, taking calcium and vitamin D supplements should not be missed.

What foods should we not eat?Some drugs reduce the absorption of calcium, such as salty foods, and excessive consumption of caffeine can have a negative effect on calcium absorption, as well as excessive consumption of alcoholic beverages.

Author: Dr. Hossein Arjamand

Median nerve entrapment in the wrist (carpal tunnel syndrome)

One of the nerves that feed sensation and movement in the hand is the median nerve. At the point where this nerve enters the hand, it passes through the carpal tunnel. They appear.

Reasons:This disease usually occurs in those who work too much with their hands. Of course, this disease may also be seen in some diseases such as hypothyroidism or some inflammatory diseases.

Symptoms:Tingling, murmur, pain and heaviness in the patient's hand are prominent symptoms of this disease, which increase with activity and decrease with rest. Symptoms are often aggravated at night and during sleep and may wake the person up.

Diagnosis:After physical examination and paying attention to the history of the disease, the best way to diagnose is to perform a nerve strip.

Treatment:According to the severity and weakness of the disease, different methods may be considered.
1. Changing the way of life in order to reduce the activities that increase the symptoms of the disease
2. Using special wristbands that must be worn day and night for at least 2 to 3 months.
3. Anti-inflammatory drugs and...
4. Physiotherapy
5. In more severe cases, injection of steroid in the nerve canal can help to treat the disease.
6. In very severe cases and resistant to other treatments, surgery may be considered.

Author: Dr. Hossein Arjamand

Shoulder joint adhesions

(adhesive capsulitis) or (frozen shoulder):It is a disease with an unknown cause in which the capsule of the shoulder joint decreases in flexibility and as a result decreases the range of motion. Usually, this decrease is accompanied by severe shoulder pain.

The disease has three stages: 1. The onset of shoulder pain with a progressive decrease in range of motion that lasts between 1 and 3 months.
2. In this stage, which lasts between 3 and 9 months, the reduction of movements and freezing of the joint reaches its peak, but the pain will not change much.
3. It will last between 9 and 15 months, and the pain and freezing gradually decrease.
This disease is more common in women between the ages of 40 and 60. It also occurs more among diabetic patients, heart, stroke and especially after immobilization of the shoulder following fractures.

Diagnosis :It is given based on physical examinations. There is no special point in imaging findings such as shoulder x-ray or MRI.

Treatment :1. Anti-inflammatory drugs as well as drugs from other groups such as tricyclics (nortriptyline) or anticonvulsants (gabapentin)
2. Using physiotherapy modalities
3. Perform special exercises. It should be noted that immobilizing the shoulder in this disease worsens the situation.
4. Interventional treatments (interventional pain management): First of all, intra-articular injection of steroid is effective in reducing pain and shortening the course of the disease. If the pain is not controlled, it is possible to control the pain with suprascapular nerve block with steroid injection or by using radiofrequency nerve ablation and prepare the patient to participate in physical therapy sessions.
5. Surgical treatments They may also be part of the treatment in resistant patients.

Author: Dr. Hossein Arjamand

Subdeltoid bursitis

(subdeitoid bursitis) or (rotator cuff tendinitis):Bursae are cushion-like structures in the body that are placed between muscles and tendons and facilitate the movement of the two on each other.
One of the bursae that is commonly injured and inflamed is the bursa located between the deltoid muscle and the rotator cuff tendon, which is due to excessive pressure on these muscles, such as lifting heavy objects or repetitive movements. who need to raise their hands, will be injured.

Symptoms: Painful movement of the shoulder, especially when trying to raise or move the hand behind the head. Pain caused by inflammation of this bursa may spread to the outer surface of the arm.

Diagnosis: It is often based on physical examinations and disease history, and of course, in suspicious cases, ultrasound and MRI They can help us.

Treatment: - Anti-inflammatory drugs and reducing pressure on the bursa by immobilizing the shoulder are the first step of treatment.
- In the next step, physical therapy and performing disease-specific strengthening and stretching exercises
- Taping can be part of the treatment.
- Injection of anti-inflammatory drugs inside the bursa and around the shoulder levator muscle tendon if conservative treatments do not work. It is better to perform this injection under ultrasound guidance to increase accuracy.
- In cases where anatomical problems have led to the occurrence of this disease, surgery may be considered.

Author: Dr. Hossein Arjamand

coccyx pain

(Coccygodynia): The coccyx is the last bone of the vertebral column, which is connected to the bone before it, the sacrum, and is composed of 4 smaller bones. Trauma or injury to this bone, such as falling with the buttocks or difficult childbirth, and small but continuous traumas over time, such as riding a bicycle or sitting for long periods in obese people, can cause damage to the sacrococcygeal ligament (the ligament connecting the two coccyx and sacrum bones). or arthrosis in the mentioned joint and cause pain.
The pain appears mostly when sitting and the patient may not feel pain when walking.

diagnosis : Physical examination and disease history are given. Usually, a reliable finding is not seen in the radiology picture.

treatment :- Anti-inflammatory drugs
- Use of special pillows to reduce pressure on the injured joint
- Physiotherapy modalities
- Manipulation or insertion through the anus may be helpful in some cases. Interventional treatments (interventional pain management) including steroid injection in the injured joint and finally impar ganglion block under the fluoroscope guide by steroid injection or using radio frequency waves (RF)- In very severe cases that do not respond to any of the above treatments, surgical removal of the coccyx may be considered.

Author: Dr. Hossein Arjamand

Abrasion of the shoulder joint

Symptoms:It includes reducing the range of motion of the joint, so that the person will no longer be able to easily raise his hand or behind his back, and these movements will be accompanied by pain and the sound of rubbing the joint surfaces (crepitation) on each other.

diagnosis: In the first step, physical examinations and then the use of imaging methods such as simple radiography of the shoulder joint can help us in diagnosing the disease.

treatment:- Anti-inflammatory drugs or massage drugs can help control and reduce pain, or drugs that affect the pain cycle, such as SSRI drugs and anticonvulsants and... (isometric exercise) in order to strengthen the muscles of the shoulder girdle, stretching exercises can play a significant role in disease control. Physiotherapy modalities can also be part of the treatment.
- Interventional pain management may be considered in cases where the previous steps are not effective in controlling pain. Methods such as intra-articular injections (steroid or ozone), suprascapular nerve block by steroid injection or radiofrequency waves
- In very severe cases, surgery and joint replacement may be among the treatment options.

Author: Dr. Hossein Arjamand

Spinal stenosis

The set of mentioned events leads to the narrowing of the space of the spinal canal and the holes on both sides where the nerve roots pass. The narrowing of the space causes pressure on the nerves and disrupts their function, and finally the symptoms of canal narrowing such as numbness, tingling and murmur in the limbs, weakness and weakness in the muscles and in severe cases muscle wasting and urinary symptoms occur. These symptoms usually occur. They decrease when resting and become severe when walking, so that the person is forced to sit down to regain strength and reduce the symptoms. Bending forward due to the increase in the diameter of the spinal canal reduces the symptoms, for this reason, these patients often have a bent position. they take In these patients, back pain may or may not be a symptom.

diagnosis:Along with the signs and symptoms of the disease and the findings of the physical examination, imaging of the vertebral column such as MRI may also be considered to better examine the involved levels and the severity of the involvement.
Also, performing a nerve and muscle strip test to check the involved nerve roots can be helpful.

treatment:Depending on the severity and weakness of the symptoms, different treatments may be considered, such as:
- modification of lifestyle in order to reduce the pressure on the spine
- use of anti-inflammatory and anticonvulsant drugs such as gabapentin and... .
- Physiotherapy and doing special exercises
- Spine interventional treatments such as: epidural injections or injection of the joints between the facet seals.
- Surgery may be one of the treatment options in severe cases.

Author: Dr. Hossein Arjamand

back ache

It is a very common disease that everyone experiences at least once in their lifetime. Various causes and conditions such as: disc problems, intervertebral ligaments, muscle spasms, wear and tear of intervertebral joints (facet), malignancies, vertebral fractures, osteoporosis and rheumatic diseases, etc.

When does back pain need further follow-up?1. Not responding to common treatments and chronic pain (more than three months)
2. Occurrence of symptoms such as muscle weakness, numbness of the limbs, shooting pains in the limbs, deviation in the spine, weight loss, night pains, excessive and abnormal dryness in the spine, etc.

What follow-ups may be needed?Simple radiology of the vertebral column can be the most accessible paraclinical examination that can provide us with valuable information about the general vertebral column, especially the bone tissue. The result of bone metabolism can be another part of the follow-up. MRI is also very useful in cases where we are looking for the examination of the soft tissue of the vertebral column, such as the disc and the contents of the spinal canal, or the examination of malignancies and metastases. It is valuable.
Osteoporosis examination may also be considered according to the patient's age. Numbness and numbness may be requested.

treatment:Part of the back pains which are often classified under the mechanical category are often treated by taking drugs such as NSAIDs and muscle relaxants, rest or a short period of physical therapy and appropriate exercises, and follow-ups such as They don't have MRI or radiography.
If they don't respond to common treatments, according to physical examinations and paraclinical results such as tests and imaging results, appropriate treatment options are considered.Interventional treatmentsSpine intervention at this stage and in patients who are not candidates for surgery and whose laboratory findings are reported to be normal, can help to treat and control the patient's pain. Treatments such as facet intervertebral joint injection or sacroiliac joint (SI) or disc intervention or epidural nerve blocks with drug injection or radiofrequency waves and...

Author: Dr. Hossein Arjamand

Disc

Spinal disc herniation is one of the relatively common diseases. The disc actually has a flexible structure and is located between the vertebrae, which provides flexibility to the spine and our ability to bend and straighten.
The disc has a two-part structure including a jelly core (nucleus) and a firm capsule (annulus), and if too much pressure is applied to it, the annulus may protrude or tear, and due to the closeness of the disc to the nerve roots While exiting the spinal canal, this protrusion may cause pain and nerve symptoms such as tingling and numbness or burning and coldness in the area of the involved nerve (radiculopathy) by putting pressure on the neighboring nerves.

Depending on the severity of the pressure on the nerve root and the place where the disc protrudes, various symptoms may appear, from low-intensity shooting pains to very severe pains, or numbness and heaviness in the area of the involved nerve, or muscle weakness, and even urinary disorders. and feces.
The treatments used may be different according to the symptoms and the time elapsed since the symptoms appeared.
Using anti-inflammatory drugs and steroids and... rest and avoiding activities that put pressure on the spine, physical therapy, special exercises to increase the muscle strength of the abdominal or cervical muscles and reduce the pressure on the disc. They are among the primary treatment measures. Of course, in certain types of discs that include only less than 5 percent of the discs, surgery is needed.
Another part of the treatment that may be considered if the symptoms do not improve after conservative treatments (rest, medicine, physical therapy)Minimally invasive or interventional treatments(spine intervention).
In this part of the treatment, according to the findings of imaging and nerve and muscle tape, and of course, most importantly, the patient's examinations, the involved nerve roots are specified and are appropriate to different factors such as the level of hydration. The presence of the disc, the level of involvement, the length of time that has passed since the onset of symptoms or the chronicity of the symptoms, various treatment methods such as epidural injections, the use of radiofrequency waves (RF nerve ablation) or ozone discectomy (ozone discectomy) are used. Placed .
Interventional procedures are performed in the hospital and of course only with local anesthesia and without anesthesia in completely sterile conditions. There is no need to be admitted to the hospital and only a few hours are observed to ensure the patient's condition and then he is discharged.

Author: Dr. Hossein Arjamand

Arthrosis

Arthrosis is actually equivalent to the word wear and tear and means the occurrence of degenerative or destructive changes in different joints of the body. Arthrosis is a part of the natural aging process in every human being and it starts from the beginning of youth. But sometimes due to various reasons such as excessive pressure from the limit to the desired joint over time, direct damage to the joint tissue due to trauma, weakness of the muscles around the joint, congenital skeletal abnormalities such as club feet, unequal length of the limbs or... this natural process has taken on a pathological appearance and With the occurrence of pain and disturbance in the daily functioning of the person. The most common joints exposed to arthrosis include: knee-shoulder-spine.

According to the above explanations, the treatment of arthritis is multi-dimensional and this disease cannot be controlled by using medicine alone.

treatment: 1. The first step in treatment is to modify the lifestyle and avoid activities that put pressure on the injured joint. For example, in knee arthritis, avoiding long walks, going up and down stairs, sitting on the floor and losing weight, etc.
2. Strengthening the muscles around the injured joint is the next step. Of course, the sports used should be controlled by the minister based on scientific principles so that double damage is not done to the injured tissue.
3. Physiotherapy can also be a part of the treatment process. Adjusting the distribution of pressure on the knee joint and reducing the pressure on the injured part.
5. The use of different drugs such as anti-inflammatory drugs can also be part of the treatment and pain control process.
One of the new methods. control and treatment of abrasion The use of ozone gas is ozone therapy. In this way, this gas with a special combination with oxygen is injected in and around the injured joint during several sessions, and its regenerative and pain-relieving effects gradually appear during the treatment sessions.
6. Finally, in very advanced cases of arthrosis that do not respond to any of the aforementioned treatments, the option of surgery And joint replacement can be one of the treatments.

In those who are candidates for surgery in terms of the severity of wear and tear, but their physical conditions do not allow such a heavy operation, RF nerve ablation or radio frequency waves can be used to modulate the transmission of pain messages from the joint. used injured Of course, this part of the treatment requires special facilities and is performed in special centers under the guidance of a fluoroscope. Currently, the facilities and conditions for performing this procedure are available.

Author: Dr. Hossein Arjamand

Migraine

Most of the pain caused by migraine occurs due to the spasm of various muscles around the skull, which can be controlled by injecting Botox in the muscles responsible for these severe spasms and treatment of the headache. From three to six months, we need to repeat the injection

RACZ training workshop, Antalya, Dr. Hossein Arjamand

Musculoskeletal injections seminar

Speech in the seminar of musculoskeletal injections

Speech in clinical oncology seminar

Pharmacotherapy in cancer pain

Physiotherapy clinic

Laser Power (HPLL)

Physiotherapy and mechanotherapy clinic

Physiotherapy clinic

Tavana Pain Clinic

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5 Conferences and Lectures

Pictures of the pain clinic

Photo Gallery

Teaching exercises for the neck disc

In this video, Dr. Hossein Arjamand teaches neck disc therapy and mechanical neck pain exercises.

Teaching exercises for back pain and lumbar disc

In this video clip, the best therapeutic exercises for back pain and lumbar disc are taught.

Teaching special exercises for knee wear

In this video clip, the best treatment exercises for knee wear are taught in the best way

Chronic back pain and ozone therapy

A patient who suffered from severe back pain for 2 years and did not respond to any treatment, explains her experience about ozone therapy.

Treatment of spinal stenosis and arthritis of lumbar joints

One patient's explanation about her experience of treating spinal canal stenosis and back arthritis one year after non-surgical treatments

Treatment of severe shingles pain

The remaining pains after shingles sometimes become very severe and chronic and do not respond to any medicine. The best treatment in these cases is epidural injection in the affected area.

Ozone injection in knee abrasion

Description of a patient with knee abrasion 9 months after ozone therapy

Adhesion treatment after surgery with the help of Rocks RACZ catheter

In 100% of patients after spine operations in the treatment of disc or spinal canal stenosis, a number of patients with chronic disc or spinal canal stenosis experience adhesions between the layers around the nerve roots and experience very painful conditions that require conventional treatments. They don't answer, some of these patients can be treated with this method.
In this method, a special catheter is directed to the adhesion site and the problem is solved mechanically and medicinally. This procedure does not require anesthesia