Lower back pain can stem from a wide range of issues including disc herniations, however, not all herniations are the same. Schmorl’s nodes, named after the pathologist Christian Schmorl, were first described in 1927 and are a form of herniation. While they can occur in any part of the spine, they are most common in the middle and lower regions.
To better understand what a disc herniation is let’s first look at the structure of the spine. The spine is made of a series of vertebrae, bony structures with a hollow channel running down the back side that encases our spinal cord. Vertebrae by themselves we be extremely rigid and cause our backs to be stiff and unable to bend. To be flexible, the bones are connected to each other by a series of discs. The discs are made of a fibrous outer layer that allows for some movement between bony levels and an inner gelatinous layer that allows for shock absorption.
Disc herniations, sometimes referred to as “slipped discs”, are when the disc sandwiched between the two bony vertebrae is ruptured in such a way that the inner gelatinous fluid is released. The most common form is when the posterior aspect of the disc is ruptured, and the fluid pushes out towards the spinal cord. This can trigger nerve irritation that leads to symptoms such as pain, numbness, or weakness wherever the affected nerve travels (often down the leg).
Schmorl’s nodes differ in that they are a vertical type of herniation. Rather than the inner fluid of a disc being pushed out the front or back it is pushed up or down into the bony vertebrae. Despite their first description nearly a hundred years ago there is still no consensus on the cause of Schmorl’s nodes. Some researchers view Schmorl’s nodes as a secondary finding of an underlying disease such as Scheuermann’s disease or lumbar disc degeneration. In fact, most Schmorl’s nodes are asymptomatic, and they are often incidental findings on imaging reports such as Xray or MRI. However, in some patients they can cause significant chronic pain and lead to reduced quality of life.
Treatment for Schmorl’s nodes often begins with conservative care, such as chiropractic, as they are often seen in conjunction with other spinal conditions. If unresponsive more invasive treatments such as nerve blocking or surgery can be considered.
If you suspect that you might have a Schmorl’s node mention this article to your chiropractor or physician. Expect your doctor to do a thorough examination and to rule out other possible causes of your symptoms first and be ready for possible imaging such as X-ray or MRI.
References: 1) Kyere KA, Than KD, Wang AC, Rahman SU, Valdivia-Valdivia JM, La Marca F, Park P. Schmorl's nodes. Eur Spine J. 2012 Nov;21(11):2115-21. doi: 10.1007/s00586-012-2325-9. Epub 2012 Apr 28. PMID: 22544358; PMCID: PMC3481099. 2) https://radiopaedia.org/articles/schmorl-nodes-3?lang=us
Wrist pain is a common occurrence whether from computer use or a sporting injury. In some cases this can be caused by a ganglion cyst which may or may not appear as a visible bump or mass over the affected joint. While it is possible to form a ganglion cyst over most joints, approximately 90% are found on the wrist and are three times more common in women than men. Due to the nature of being fluid filled the cyst is often soft rather than hard and firm. You may also have noticed this mass but have no wrist pain, that is okay, it is not uncommon for ganglion cysts to be asymptomatic as well.
In a typical healthy joint you would expect there to be a capsule surrounding the joint that is then filled with a lubricating liquid that helps the joint move smoothly. Currently, it is thought that ganglion cysts are caused by repetitive and chronic trauma to the capsule around a joint that leads to deterioration and tears. Eventually a tear produces a pouch that is filled with joint fluid resulting in a cyst. Depending on the size of the pouch this may or may not be visible over the wrist. For this reason athletes with high wrist use, such as gymnasts, are prone to this condition.
Examination by your chiropractor can help evaluate and rule out other possible causes of wrist pain. It may be necessary to get imaging, such as xray, to rule out other severe causes of wrist pain.
Treatment of ganglion cysts will vary depending on symptoms. Even in cases where it is asymptomatic you should still have an evaluation to rule out other possible causes. The ganglion cyst may regress by itself, however, in the cases of wrist pain a conservative care approach can be offered. This may include modifying activities, adjusting ergonomics, splinting and more. It is not recommended to try and pop or drain the cyst yourself.
In cases with pain, nerve symptoms or for cosmetic appearance you may be a candidate for an aspiration of the cyst. This is a minimally invasive technique where a needle is inserted and the excess fluid is drained. It should be noted that there is a chance of recurrence. In these cases surgery may be performed to remove the pouch which has a much lower chance of recurrence.
*This blog is not intended to officially establish a physician-patient relationship, to replace the services of a trained physician, naturopathic doctor, physical therapist or chiropractor or otherwise to be a substitute for professional medical advice, diagnosis, or treatment.
Carpal tunnel syndrome (CTS) is a well-known condition that can cause wrist and hand pain. It is notorious for causing pain and/or numbness along with the hand among office workers, gardeners, and anyone performing repetitive tasks. It is caused by the squeezing of the median nerve as it passes through a narrow tunnel at the wrist. However, despite how prevalent CTS is it is not the only location the median nerve can become compressed.
Pronator Teres Syndrome (PTS) is a lesser-known form of median nerve compression and may mimic, and even be misdiagnosed, as CTS. The condition is named after the muscle that causes it, the pronator teres. This is a relatively small forearm muscle located at the inner elbow and is responsible for turning our forearm palm side up (known as pronation). What makes this muscle interesting is that in most people there are two heads to the muscle and the median nerve passes directly between the two. As a result, muscle tension or injury can lead to compression of the median nerve. Compression at the elbow will result in downstream effects such as pain, pins and needles sensation, numbness or muscle weakness in the hand, again mimicking the effects of CTS. Interestingly, around 1 in 7 people are missing the second head of the pronator teres muscle which is thought to reduce the risk of developing this condition.
Patients suffering from PTS may have increased forearm irritation when activating the pronator muscle and may also experience upper forearm pain. However, differentiating the conditions can be nuanced so checking with your doctor and having a detailed physical exam can help differentiate the two. While a physical exam is often sufficient in severe cases your doctor may recommend that additional nerve tests be ordered.
Management of PTS often includes the following:
Muscle release techniques: These techniques aim to help ease pain and release muscle tension to free up the median nerve.
Exercises and Stretches: A variety of programs can be performed at home that aim to improve flexibility and decrease muscle tension.
Activity Modification: Depending on your occupation and home needs your doctor may modify your daily routines and activities to reduce the use and stress on the pronator teres muscle.
Rest: Inflammation and swelling around an injured muscle can add pressure to the nerve. Allowing the muscle to rest and the body to clear the inflammation will aid in recovery.
Ice/heat: In cases of trauma or acute injury, the use of ice and/or heat can help reduce pain and bring blood to the area.
Ultimately both CTS and PTS are caused by the compression of the median nerve just at different locations. A thorough examination is vital in differentiating the two conditions and for appropriate treatment to be applied.