EXTREMITIES
EXTREMITIES
Some of my favorite resources & great topics to discuss with your doctors, nurses, mentors and pharmacists.
Some of my favorite resources & great topics to discuss with your doctors, nurses, mentors and pharmacists.
Embedded Files
I. Shoulder
I. Shoulder
Rotator Cuff Tendinopathy or Tear
Degeneration or rupture of supraspinatus/infraspinatus fibers
Ortho Test: Empty Can | Drop Arm | ER Lag
Tx: PT, subacromial injection, rotator cuff repairShoulder Impingement Syndrome
Supraspinatus or bursa compressed under acromion during elevation
Ortho Test: Neer | Hawkins-Kennedy | Painful Arc
Tx: Scapular stabilization, NSAIDs, injectionGlenohumeral Osteoarthritis
Cartilage loss, osteophyte formation, joint stiffness
Ortho Test: Load and Shift | Grind Test
Tx: NSAIDs, ROM exercises, arthroplastyAdhesive Capsulitis (Frozen Shoulder)
Capsular fibrosis with progressive ROM loss
Ortho Test: Passive ROM restriction in all planes
Tx: Aggressive PT, corticosteroids, hydrodilationAcromioclavicular Joint Injury
Ligament sprain or separation at AC joint
Ortho Test: Cross-arm | O’Brien’s | AC Shear
Tx: Sling, ice, surgery if high-gradeShoulder Instability (Anterior or Posterior)
Capsulolabral insufficiency with excessive humeral translation
Ortho Test: Apprehension | Relocation | Sulcus Sign
Tx: PT, stabilization surgery if recurrent
II. Elbow
II. Elbow
Lateral Epicondylitis (Tennis Elbow)
ECRB overuse causes tendon microtearing
Ortho Test: Cozen’s | Mill’s | Maudsley’s
Tx: Eccentric strengthening, bracing, PRPMedial Epicondylitis (Golfer’s Elbow)
Flexor-pronator origin overload and microtearing
Ortho Test: Resisted wrist flexion and pronation
Tx: Activity mod, NSAIDs, PT, injectionUlnar Collateral Ligament Injury
Valgus overload damages UCL, especially in throwers
Ortho Test: Moving Valgus Stress | Milking Maneuver
Tx: Rest, rehab, Tommy John surgeryCubital Tunnel Syndrome
Ulnar nerve compression behind medial epicondyle
Ortho Test: Tinel’s | Elbow Flexion | Froment’s Sign
Tx: Night splint, decompression if progressiveRadial Tunnel Syndrome
Radial nerve compression in supinator tunnel
Ortho Test: Resisted supination with elbow extension
Tx: Rest, nerve gliding, decompression
III. Wrist and Hand
III. Wrist and Hand
Carpal Tunnel Syndrome
Median nerve compression under flexor retinaculum
Ortho Test: Phalen’s | Tinel’s | Durkan’s
Tx: Wrist splint, corticosteroid, surgical releaseDe Quervain’s Tenosynovitis
APL/EPB sheath inflammation at radial styloid
Ortho Test: Finkelstein’s test
Tx: Thumb spica, NSAIDs, injectionScaphoid Fracture
FOOSH injury compromises radial-sided carpal blood supply
Ortho Test: Snuffbox tenderness | Axial thumb compression
Tx: Thumb spica cast, ORIF if displacedTriangular Fibrocartilage Complex Injury
TFCC tear causes ulnar wrist pain and instability
Ortho Test: Ulnar Grind | TFCC Load Test
Tx: Immobilization, injection, arthroscopic repairIntersection Syndrome
Tenosynovitis where APL/EPB cross ECRL/ECRB
Ortho Test: Pain 4–8 cm proximal to wrist
Tx: Ice, activity mod, splintingGuyon’s Canal Syndrome
Ulnar nerve compression at the wrist
Ortho Test: Tinel’s over Guyon’s canal
Tx: Splint, surgical decompressionTrigger Finger (Stenosing Tenosynovitis)
Flexor tendon nodule obstructs pulley gliding
Ortho Test: Palpable click with flexion-extension
Tx: Splinting, corticosteroid, release
IV. Cervical Referred Pain (Consider in Upper Limb)
IV. Cervical Referred Pain (Consider in Upper Limb)
Cervical Radiculopathy
Nerve root compression causing dermatomal arm symptoms
Ortho Test: Spurling’s | Distraction | ULTT
Tx: Cervical traction, PT, ESI, surgery if refractoryThoracic Outlet Syndrome
Compression of neurovascular bundle in scalene/clavicle space
Ortho Test: Adson’s | Roos | Costoclavicular Maneuver
Tx: Postural correction, scalene stretch, surgery in severe cases
LOWER EXTREMITY
LOWER EXTREMITY
I. Hip and Pelvis
I. Hip and Pelvis
Acetabular Labral Tear
Focal fibrocartilage disruption impairing joint stability and causing mechanical symptoms
Treatment: MRI diagnosis, physical therapy, intra-articular injection, arthroscopic repairGreater Trochanteric Bursitis
Inflammation from repetitive friction over the lateral femur's bursa
Treatment: NSAIDs, corticosteroid injection, activity modification, physical therapyHip Osteoarthritis
Progressive articular cartilage degeneration with joint space loss and osteophyte formation
Treatment: Weight loss, NSAIDs, corticosteroids, joint replacementSacroiliac Joint Dysfunction
Hypomobility or inflammation of the sacroiliac articulation with referred posterior pelvic pain
Treatment: Manual therapy, SI belts, intra-articular injectionsGluteal Muscle Strain
Tearing of gluteal fibers during eccentric loading, common in sprinting or falls
Treatment: Stretching, dry needling, progressive resistance trainingPiriformis Syndrome
Sciatic nerve entrapment from hypertrophic or spasmodic piriformis muscle
Treatment: Stretching, ultrasound-guided corticosteroids, botulinum toxin, surgical decompression if refractory
II. Thigh
II. Thigh
Hamstring or Quadriceps Strain
Muscle-tendon disruption from sudden eccentric load, often sports-related
Treatment: RICE, eccentric strengthening, physical therapy, platelet-rich plasmaAdductor Tendinopathy
Chronic degeneration and overload at pubic symphysis enthesis
Treatment: Physical therapy, eccentric rehab, corticosteroid or PRP injection, tenotomyFemoral Shaft Stress Fracture
Cortical microfractures from repetitive axial loading in runners or military recruits
Treatment: Rest, protected weight bearing, ORIF if displacedMeralgia Paresthetica
Lateral femoral cutaneous nerve entrapment under inguinal ligament causing thigh dysesthesia
Treatment: Weight reduction, neural glides, corticosteroid injection, neurolysis if refractory
III. Knee
III. Knee
Anterior Cruciate Ligament, Posterior Cruciate Ligament, Medial or Lateral Collateral Ligament Injury
Traumatic ligamentous disruption causing joint instability and hemarthrosis
Treatment: Bracing, physical therapy, ligament reconstruction surgeryMeniscal Tear
Fibrocartilage rupture impairing load distribution and shock absorption
Treatment: MRI diagnosis, physical therapy, arthroscopic meniscectomy or repairPatellofemoral Pain Syndrome
Maltracking of patella causing retropatellar cartilage stress and anterior knee pain
Treatment: Vastus medialis strengthening, taping, orthotics, activity modificationPrepatellar Bursitis
Inflammation of anterior knee bursa due to repetitive kneeling or trauma
Treatment: Aspiration, NSAIDs, compression, protective paddingOsteochondritis Dissecans
Subchondral bone necrosis with cartilage separation due to vascular insufficiency
Treatment: Activity restriction, surgical drilling or fragment fixationBaker’s Cyst (Popliteal Cyst)
Synovial fluid herniation into gastrocnemio-semimembranosus bursa
Treatment: Treat underlying intra-articular pathology, aspiration, corticosteroid injection
IV. Leg and Shin
IV. Leg and Shin
Tibial Stress Fracture
Repetitive axial loading overwhelms bone remodeling, forming cortical microcracks
Treatment: Rest, activity modification, pneumatic braceMedial Tibial Stress Syndrome (Shin Splints)
Periosteal inflammation from repetitive traction by posterior tibialis or soleus
Treatment: Ice, arch support, eccentric strengthening, modify training loadChronic or Acute Compartment Syndrome
Elevated intracompartmental pressure compromises perfusion and tissue viability
Treatment: Acute: emergent fasciotomy | Chronic: activity modification or elective decompressionDeep Vein Thrombosis
Venous thrombus in calf causing swelling, pain, and risk of pulmonary embolism
Treatment: Compression ultrasound, anticoagulation, IVC filter if contraindications existCommon Peroneal Nerve Entrapment
Compression at fibular head producing foot drop and lateral leg paresthesia
Treatment: Decompression, orthosis, physical therapy, nerve gliding
V. Ankle
V. Ankle
Lateral or Medial Ankle Sprain
Ligamentous microtears from inversion/eversion injury compromising joint stability
Treatment: RICE, proprioceptive rehab, bracingAchilles Tendinopathy or Rupture
Tendon degeneration or acute rupture from sudden eccentric load
Treatment: Eccentric loading, heel lifts, surgical repair for full ruptureSyndesmotic (High Ankle) Sprain
Disruption of anterior tibiofibular ligament during external rotation injuries
Treatment: Boot, NWB, ORIF if unstablePosterior Tibial Tendon Dysfunction
Tendon insufficiency causing medial arch collapse and progressive flatfoot deformity
Treatment: Orthotics, brace, surgical reconstruction
VI. Foot
VI. Foot
Plantar Fasciitis
Degeneration of plantar fascia origin causing heel pain with first step
Treatment: Stretching, orthotics, night splints, ESWTMetatarsalgia
Overload of metatarsal heads leading to synovitis or capsulitis
Treatment: MT pads, footwear modification, injectionMorton’s Neuroma
Interdigital nerve entrapment with perineural fibrosis, typically third web space
Treatment: Footwear change, corticosteroid injection, neurectomyTarsal Tunnel Syndrome
Tibial nerve compression behind medial malleolus resulting in sole paresthesia
Treatment: Orthotics, anti-inflammatory agents, surgical decompressionMetatarsal or Calcaneal Stress Fracture
Repetitive impact exceeds bone remodeling; painful with ambulation
Treatment: Boot immobilization, rest, calcium/vitamin D repletionSesamoiditis
Inflammation of sesamoid bones under first metatarsophalangeal joint
Treatment: Offload pads, stiff-soled shoes, injection, partial excision if chronic
BLOCKS
BLOCKS
🦾 UPPER EXTREMITY BLOCKS / ABLATIONS
🦾 UPPER EXTREMITY BLOCKS / ABLATIONS
Nerve Block
Target
Indications
Pre-Op
Post-Op
Suprascapular Nerve Block
Suprascapular notch
Shoulder pain, rotator cuff tear, adhesive capsulitis
Rule out infection, anticoag. review
Sling 2–4 hrs if motor involved
Interscalene Brachial Plexus Block
Roots (C5–C7)
Shoulder surgery, proximal humerus
Avoid bilateral block (phrenic risk)
Monitor for dyspnea (phrenic), rebound pain
Axillary Nerve Block
Posterior cord (C5–C6)
Deltoid region injury, shoulder instability
Pre-procedure NPO, informed consent
Check for deltoid function
Median Nerve Block
At antecubital fossa / wrist
Carpal tunnel, hand surgery
Avoid in mass effect
Expect temporary grip weakness
Ulnar Nerve Block
Elbow (cubital tunnel) / wrist
Cubital tunnel syndrome, hand lacerations
Check Tinel’s sign
Splint if motor block
Radial Nerve Block
Spiral groove / wrist
Lateral forearm/hand injury, radial tunnel
US to localize to avoid arterial puncture
Expect wrist drop temporarily
Lateral Antebrachial Cutaneous Nerve Block
Lateral forearm
Venipuncture pain, tourniquet pain
Identify anatomy (from musculocutaneous)
Minimal motor impact
Cervical Medial Branch Block
Facet joint pain (C3–C7)
Cervical spondylosis, whiplash
Fluoro/US, check prior response
Monitor ROM and pain relief
Cervical RFA (Radiofrequency Ablation)
Medial branch C3–C7
>80% relief with diagnostic block
Must meet criteria, informed consent
May cause post-procedural soreness
🦿 LOWER EXTREMITY BLOCKS / ABLATIONS
🦿 LOWER EXTREMITY BLOCKS / ABLATIONS
Nerve Block
Target
Indications
Pre-Op
Post-Op
Femoral Nerve Block
Inguinal region
Post-ACL, quadriceps tendon, hip procedures
Assess anticoag status
Assistive device needed (quad weakness)
Adductor Canal Block (Saphenous Nerve)
Mid-thigh
Total knee replacement, medial leg/foot pain
Avoid complete sensory loss of foot
Less motor block; ideal for ambulation
Sciatic Nerve Block
Gluteal, popliteal, or ankle
Below-knee surgery, Achilles, foot trauma
Choose approach based on level of pain
Fall risk from foot drop
Popliteal Nerve Block
Sciatic at bifurcation
Ankle/foot surgery, Morton’s neuroma
US guidance to avoid vascular puncture
Foot drop for 6–12 hrs possible
Lateral Femoral Cutaneous Nerve Block
ASIS region
Meralgia paresthetica
Palpate ASIS, rule out mass
Typically quick onset, minimal motor
Genicular Nerve Block
Superomedial, superolateral, inferomedial geniculate branches
Chronic knee pain, pre-knee RFA
Fluoro/US guided
Observe for gait change
Genicular RFA
Same as above
Osteoarthritis, pre-TKA alternative
Must respond to block >50%
Mild local soreness, delayed effect
Lumbar Plexus Block
Psoas compartment
Complex hip/knee surgery
Coags, US or fluoroscopic required
Prolonged motor block risk
Lumbar Medial Branch Block
L2–L5 medial branches
Lumbar facet pain, post-trauma
Rule out other causes of back pain
Expect 2–8 hrs of relief if positive
Lumbar RFA
L2–L5 (or T12–S1)
Proven facetogenic pain
2 positive blocks >50% relief
Soreness for 3–5 days, effect starts ~1–2 wks
Cluneal Nerve Block
Superior/inferior branches
Gluteal pain, pseudo-sciatica
Palpate trigger area
Relief confirms diagnosis
Ilioinguinal/Iliohypogastric Block
ASIS medial area
Inguinal hernia repair, nerve entrapment
US-guided improves precision
Numbness, mild discomfort possible
⚕️ GENERAL PRE-OP CONSIDERATIONS
⚕️ GENERAL PRE-OP CONSIDERATIONS
NPO: Usually not required unless under sedation
Coagulation: Hold anticoagulants for spine blocks; check ASRA guidelines
Consent: Explain risks (bleeding, infection, numbness, nerve injury)
Anatomy Review: US/fluoro guided preferred
Allergies: Check for local anesthetic reactions
Infection control: Full aseptic prep for deep or ablation procedures
🩹 GENERAL POST-OP CONSIDERATIONS
🩹 GENERAL POST-OP CONSIDERATIONS
Fall Risk: Foot drop, quadriceps weakness = ambulation precautions
Pain Log: Use NRS/VAS to track relief duration
Motor/Sensory Check: Before discharge
Ice/Heat: As needed for injection site discomfort
Activity: Light activity encouraged, avoid heavy lifting 24–48 hrs
Follow-up: For diagnostic blocks, RFA consideration if >50% relief
Physical Medicine = Exercises / PT / Chiropractic / Sleep position
Stretching / Flexibilty: 10 min 10 min 10min/post workout 15 min
HEADACHES
TMS FOR MIGRAINE | DEPRESSION (5m)
NECK PAIN
CERVICAL COLLAR | NECK - CHIN TUCK
BACK PAIN
PATIENT - LUMBAR BRACE
FOR DOCTORS - LUMBAR SPINE LINE | KNEE BRACE | ROM HINGED BRACE | WRIST BRACE | TLSO | PEAK SCOLIOSIS BRACE |
NEUROPATHY | FOOT PAIN
PATIENT VIDEOS:
PROVIDER VIDEOS
ANKLE BLOCKS - ANATOMY (2m) | BLOCK(8 m) |
ASRA - USE ICE & 30Gs (Replace 25Gs for comfort)
+/- water soluble steroid + 5 ml (Instead of 15 ml, for surgeries)
If PLANTAR FASCIITIS add surgical prep x2, ice, 30g, 2-3 ml
SHOULDER PAIN
SHOULDER PAIN - EXERCISES FOR Shoulder: #1 Mayo | #2 Pendulum
SHOULDER PAIN - SLEEP POSITION #1 #2 #3 #4 (exercises)
PROVIDER VIDEOS
EXAM - SHOULDER ROM UE VIDEO
KNEE PAIN
VIRTURAL REALITY
EXERCISES
FOOT | PLANTAR FACIITIS - EXERCISES #1
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HEADACHE
Brudzinski's Sign = Neck flexion causes hip/knee flexion; indicates meningeal irritation.
Suboccipital Tenderness = Pain upon pressure below skull base; tension or cervicogenic headache.
CERVICAL
Soto-Hall Test = Neck flexion supine; detects cervical injury or irritation.
Spurling’s Test = Extend, rotate, compress head; nerve root compression.
Lhermitte’s Sign = Flex neck causes shock sensation; spinal cord issue.
Bakody’s Sign = Arm overhead relieves pain; cervical radiculopathy.
THORACIC
Adam’s Forward Bend = Forward bending reveals rib hump; indicates scoliosis.
Thoracic Flexion Test = Forward bend, thoracic pain indicates facet or muscular issue.
LUMBAR
Straight Leg Raise (SLR) = Elevating leg causes sciatic pain; lumbar radiculopathy.
Bragard’s Test = SLR plus foot dorsiflexion increases pain; nerve root irritation.
Slump Test = Seated spinal flexion causes sciatic pain; neural tension.
Kemp’s Test = Extend, rotate, compress lumbar spine; facet joint irritation.
SI JOINT
Gaenslen’s Test = Leg drop off table stresses SI joint; identifies SI dysfunction.
FABER (Patrick’s) Test = Hip flexion/abduction/external rotation; pain suggests SI pathology.
SHOULDER
Neer’s Test = Passive forward flexion of shoulder; identifies impingement.
Hawkins-Kennedy Test = Shoulder internal rotation at 90° flexion; impingement syndrome.
ELBOW
Cozen’s Test = Resist wrist extension; lateral epicondylitis ("tennis elbow").
Golfer’s Elbow Test = Resist wrist flexion; medial epicondylitis ("golfer’s elbow").
Lateral Epicondyle Tenderness = Pain at outer elbow; lateral epicondylitis confirmed.
Medial Epicondyle Tenderness = Pain at inner elbow; medial epicondylitis confirmed.
WRIST
Phalen’s Test = Wrists flexed, backs together; tingling indicates carpal tunnel.
Tinel’s Sign (Wrist) = Tap median nerve; tingling suggests carpal tunnel syndrome.
HIP
Trendelenburg Test = Single-leg stand; pelvis drops indicating weak abductors.
Thomas Test = Supine knee flexion; lifted thigh reveals hip flexor tightness.
Piriformis Sign = Hip rotation with flexed knee causes pain; piriformis syndrome.
Trochanteric Bursa Pressure = Painful pressure over trochanter; bursitis confirmed.
KNEE
McMurray’s Test = Rotate knee flexed; clicking indicates meniscal tear.
Anterior Drawer Test = Tibia moves forward; ACL injury suspected.
ANKLE
Anterior Drawer (Ankle) = Forward foot displacement; tests anterior talofibular ligament integrity.
Thompson Test = Squeeze calf, no plantarflexion; Achilles tendon rupture.
🦾 UPPER EXTREMITY BLOCKS / ABLATIONS
🦾 UPPER EXTREMITY BLOCKS / ABLATIONS
Nerve Block
Target
Indications
Pre-Op
Post-Op
Suprascapular Nerve Block
Suprascapular notch
Shoulder pain, rotator cuff tear, adhesive capsulitis
Rule out infection, anticoag. review
Sling 2–4 hrs if motor involved
Interscalene Brachial Plexus Block
Roots (C5–C7)
Shoulder surgery, proximal humerus
Avoid bilateral block (phrenic risk)
Monitor for dyspnea (phrenic), rebound pain
Axillary Nerve Block
Posterior cord (C5–C6)
Deltoid region injury, shoulder instability
Pre-procedure NPO, informed consent
Check for deltoid function
Median Nerve Block
At antecubital fossa / wrist
Carpal tunnel, hand surgery
Avoid in mass effect
Expect temporary grip weakness
Ulnar Nerve Block
Elbow (cubital tunnel) / wrist
Cubital tunnel syndrome, hand lacerations
Check Tinel’s sign
Splint if motor block
Radial Nerve Block
Spiral groove / wrist
Lateral forearm/hand injury, radial tunnel
US to localize to avoid arterial puncture
Expect wrist drop temporarily
Lateral Antebrachial Cutaneous Nerve Block
Lateral forearm
Venipuncture pain, tourniquet pain
Identify anatomy (from musculocutaneous)
Minimal motor impact
Cervical Medial Branch Block
Facet joint pain (C3–C7)
Cervical spondylosis, whiplash
Fluoro/US, check prior response
Monitor ROM and pain relief
Cervical RFA (Radiofrequency Ablation)
Medial branch C3–C7
>80% relief with diagnostic block
Must meet criteria, informed consent
May cause post-procedural soreness
🦿 LOWER EXTREMITY BLOCKS / ABLATIONS
🦿 LOWER EXTREMITY BLOCKS / ABLATIONS
Nerve Block
Target
Indications
Pre-Op
Post-Op
Femoral Nerve Block
Inguinal region
Post-ACL, quadriceps tendon, hip procedures
Assess anticoag status
Assistive device needed (quad weakness)
Adductor Canal Block (Saphenous Nerve)
Mid-thigh
Total knee replacement, medial leg/foot pain
Avoid complete sensory loss of foot
Less motor block; ideal for ambulation
Sciatic Nerve Block
Gluteal, popliteal, or ankle
Below-knee surgery, Achilles, foot trauma
Choose approach based on level of pain
Fall risk from foot drop
Popliteal Nerve Block
Sciatic at bifurcation
Ankle/foot surgery, Morton’s neuroma
US guidance to avoid vascular puncture
Foot drop for 6–12 hrs possible
Lateral Femoral Cutaneous Nerve Block
ASIS region
Meralgia paresthetica
Palpate ASIS, rule out mass
Typically quick onset, minimal motor
Genicular Nerve Block
Superomedial, superolateral, inferomedial geniculate branches
Chronic knee pain, pre-knee RFA
Fluoro/US guided
Observe for gait change
Genicular RFA
Same as above
Osteoarthritis, pre-TKA alternative
Must respond to block >50%
Mild local soreness, delayed effect
Lumbar Plexus Block
Psoas compartment
Complex hip/knee surgery
Coags, US or fluoroscopic required
Prolonged motor block risk
Lumbar Medial Branch Block
L2–L5 medial branches
Lumbar facet pain, post-trauma
Rule out other causes of back pain
Expect 2–8 hrs of relief if positive
Lumbar RFA
L2–L5 (or T12–S1)
Proven facetogenic pain
2 positive blocks >50% relief
Soreness for 3–5 days, effect starts ~1–2 wks
Cluneal Nerve Block
Superior/inferior branches
Gluteal pain, pseudo-sciatica
Palpate trigger area
Relief confirms diagnosis
Ilioinguinal/Iliohypogastric Block
ASIS medial area
Inguinal hernia repair, nerve entrapment
US-guided improves precision
Numbness, mild discomfort possible
⚕️ GENERAL PRE-OP CONSIDERATIONS
⚕️ GENERAL PRE-OP CONSIDERATIONS
NPO: Usually not required unless under sedation
Coagulation: Hold anticoagulants for spine blocks; check ASRA guidelines
Consent: Explain risks (bleeding, infection, numbness, nerve injury)
Anatomy Review: US/fluoro guided preferred
Allergies: Check for local anesthetic reactions
Infection control: Full aseptic prep for deep or ablation procedures
🩹 GENERAL POST-OP CONSIDERATIONS
🩹 GENERAL POST-OP CONSIDERATIONS
Fall Risk: Foot drop, quadriceps weakness = ambulation precautions
Pain Log: Use NRS/VAS to track relief duration
Motor/Sensory Check: Before discharge
Ice/Heat: As needed for injection site discomfort
Activity: Light activity encouraged, avoid heavy lifting 24–48 hrs
Follow-up: For diagnostic blocks, RFA consideration if >50% relief
CERVICAL FACET PATTERNS
CERVICAL FACET PATTERNS
CERVICAL FACET PATTERNS
CERVICAL FACET PATTERNS
DISC BULGE VS HERNATION
Disc Bulge (DB) – Mild <3 mm, Moderate 3-5 mm, Severe >5 mm | ICD-10: M51.26 (L), M50.30 (C), M51.24 (T)
Disc Herniation (DH) – Protrusion 2-6 mm, Extrusion >6 mm | ICD-10: M51.26 (L), M50.20 (C), M51.24 (T)
Central Canal Stenosis (CCS) –
C-spine <10 mm (severe), 10-13 mm (moderate);
L-spine <12 mm (severe), 12-15 mm (moderate) | ICD-10: M48.02 (C), M48.04 (T), M48.06 (L)
Foraminal Stenosis (FS) – Significant narrowing <3 mm | ICD-10: M99.33 (C), M99.34 (T), M99.35 (L)
Facet Hypertrophy (FH) – Thickening >3 mm | ICD-10: M47.812 (C), M47.814 (T), M47.816 (L)
Ligamentum Flavum Hypertrophy (LFH) – Thickening >2-4 mm | ICD-10: M47.12 (C), M47.14 (T), M47.16 (L)
Spondylolisthesis (SPL) – Grade I: 0-25%, Grade II: 26-50%, Grade III-IV: >50% | ICD-10: M43.12 (C), M43.14 (T), M43.16 (L)
Spondylosis (SP) – Degenerative disc changes with osteophytes (1-3 mm) | ICD-10: M47.812 (C), M47.814 (T), M47.816 (L)
Osteophyte Complex (OC) – Bone spurs contributing to narrowing | ICD-10: M25.78 (C/T/L)
Thoracic Kyphosis (TK) – Hyperkyphosis >40-45° curvature | ICD-10: M40.09
Lumbar Lordosis Abnormality (LLA) – Loss of normal curvature | ICD-10: M40.56
Thoracic/Lumbar Radiculopathy (TR/LR) – Nerve root compression | ICD-10: M54.16 (L), M54.14 (T), M54.12 (C)
Cervical Myelopathy (CM) – Spinal cord compression | ICD-10: M47.12
MEDICAL PLANTS | PLANT MEDICINE
HTN | Pre-Diabetes | Diabetes
Quick Meals
- 1 Apple, 1 egg, 1 avocado.
- 1 Chicken breast, 1 fruit
KETO SHOPPING LIST AND MENU (5 INGREDIENTS OR LESS PER ITEM)
- Avocado Egg Salad: Eggs, avocado, lemon, salt, black pepper
- Garlic Butter Shrimp: Shrimp, garlic, butter, lemon juice, parsley
- Caprese Chicken: Chicken breast, mozzarella, tomato, basil, olive oil
- Zucchini Alfredo: Zucchini, heavy cream, parmesan cheese, garlic, butter
- Stuffed Bell Peppers: Bell peppers, ground beef, cheese, onion, taco seasoning
- Baked Salmon: Salmon, olive oil, dill, lemon, garlic powder |
- Cauliflower Mash: Cauliflower, butter, cream cheese, garlic, salt
- Spinach Omelette: Eggs, spinach, cheddar cheese, salt, black pepper
- Greek or Non-dairy Yogurt Bowl: yogurt, blueberries, almonds, chia seeds, cinnamon
- Steak and Asparagus: Steak, asparagus, butter, garlic, salt
- Egg (300F for 12-15 min air fry),
QUICK MEALS:
ADDITIONAL SALMON (or sub Chicken or other lean meat) RECIPES
Lemon Garlic Chicken/Salmon: add lemon slices, garlic, olive oil, parsley
Parmesan Crusted: add parmesan cheese, almond flour, butter, garlic powder
Salmon Lettuce Wraps: add lettuce, avocado, lime juice, cilantro
Salmon with Pesto: add basil pesto, cherry tomatoes, olive oil, salt
Cajun Salmon: add Cajun seasoning, olive oil, garlic, lemon
Coconut Curry Chicken/Salmon: add coconut milk, curry powder, garlic, spinach
- BENEFITS OF THE KETO DIET
- Supports rapid weight loss by promoting fat burning.
- May improve mental clarity and focus.
- Helps stabilize blood sugar levels and manage diabetes.
- Reduces appetite and cravings due to high-fat, satiating meals.
- Can enhance energy levels and physical endurance.
HIGH BLOOD PRESSURE: SEE Dietary Approaches to Stop Hypertension (DASH)
- VIDEO ON HTN | STRESS and HTN
- MANAGING HTN |EAT LESS SODIUM |
- Limit high blood pressure (HTN) with daily hibiscus tea (2-3 cups), about 250ml of beet juice, and by following the DASH diet rich in fruits, vegetables, and low sodium.
- FOR HYPERTENSION - Hibiscus Tea, Beets, Garlic
DIABETES EDUCATION
- PRE-DIABETES --> Prediabetes: Strategies for a Healthy Life
- PRE-DIABETES ACTION PLAN
- Managing Type 2 Diabetes
- Are You at Risk for Type 2 Diabetes? Why You Should Avoid Junk Food
- Diabetes and Choosing the Right Foods Diabetes and Exercise
- Diabetes Screening A1c TEST MONITORING GLUCOSE
- DIABETES FACTS
- After Your Diabetes Diagnosis
- TYPE 2 DIABETES
- INSULIN MED
- Diabetes and Foot Care
- Diabetes Eye Exam
- DIABETES IN KIDS Diabetes (Type 1)
- Managing Type 1 Diabetes in Children and Teens
ANTI-INFLAMMATORY DIET (video) DIABETES EDU( CLICK HERE FOR RESOURCES II - ANTI-AGING | ANTI-CANCER | ET AL )
NEW! - Antioxidant Smoothie Ingredients: 1/2 cup blueberries (fresh), 1/2 cup pomegranate seeds (or juice) 🍷, 1/2 cup kale leaves 🥬, 1/4 cup broccoli sprouts (or sub with 1 tsp broccoli sprout powder) 🥦, 1/2 tsp turmeric powder (with a pinch of black pepper for absorption) 🌿, 1/2 tsp Ceylon cinnamon 🌰, 1/2 inch fresh ginger (ginger paste) , 1 cup brewed and cooled green tea or matcha powder (matcha preferred) 🍵, 1/2 banana (optional, for natural sweetness) 🍌, 1/2 cup ice 🧊.
Prostate-Protective Power Smoothie - Blueberries (1/2 cup), pomegranate juice or seeds (1/2 cup), kale leaves (1/2 cup), broccoli sprouts or sprout powder (1/4 cup or 1 tsp), lycopene supplement (10–15 mg, opened or taken before smoothie), turmeric powder (1/2 tsp), black pepper (pinch), Ceylon cinnamon (1/2 tsp), fresh ginger (1/2 inch or 1 tsp paste), brewed and cooled green tea or matcha powder (1 cup or 1/2 tsp), banana (1/2, optional), ice (1/2 cup).
DOWNLOADS
Vitamin A – Found in carrots, sweet potatoes, spinach, kale, red bell peppers; deficiency causes night blindness, dry skin, weak immunity.
Vitamin B1 – Found in green peas, asparagus, Brussels sprouts, spinach, sunflower seeds; deficiency causes fatigue, nerve damage, beriberi.
Vitamin B2 – Found in crimini, shiitake, portobello, spinach, almonds; deficiency causes cracked lips, sore throat, light sensitivity.
Vitamin B3 – Found in maitake, shiitake, tomatoes, green peas, sweet potatoes; deficiency leads to pellagra with rash, diarrhea, confusion.
Vitamin B6 – Found in bananas, spinach, potatoes, avocados, prunes; deficiency causes irritability, neuropathy, seizures.
Vitamin B9 – Found in spinach, lettuce, asparagus, citrus fruits, avocados; deficiency leads to anemia, fatigue, birth defects.
Vitamin B12 – Found in nori, fortified cereals, fortified plant milks; deficiency causes anemia, numbness, memory loss.
Vitamin C – Found in oranges, strawberries, kiwi, bell peppers, broccoli; deficiency causes scurvy, bleeding gums, poor healing.
Vitamin D – Found in UV-exposed maitake, portobello, chanterelle mushrooms, fortified juice; deficiency causes bone pain, fatigue, rickets.
Vitamin E – Found in avocados, spinach, broccoli, mango, kiwi; deficiency causes weak muscles, vision loss, nerve damage.
Vitamin K – Found in kale, spinach, broccoli, cabbage, parsley; deficiency causes bleeding, bruising, poor clotting.
KETO - ANTI-INFLAMMATORY - MEDICINES - HEALING FOODS - VITAMINS
HTN | Pre-Diabetes | Diabetes
Quick Meals
- 1 Apple, 1 egg, 1 avocado.
- 1 Chicken breast, 1 fruit
KETO SHOPPING LIST AND MENU (5 INGREDIENTS OR LESS PER ITEM)
- Avocado Egg Salad: Eggs, avocado, lemon, salt, black pepper
- Garlic Butter Shrimp: Shrimp, garlic, butter, lemon juice, parsley
- Caprese Chicken: Chicken breast, mozzarella, tomato, basil, olive oil
- Zucchini Alfredo: Zucchini, heavy cream, parmesan cheese, garlic, butter
- Stuffed Bell Peppers: Bell peppers, ground beef, cheese, onion, taco seasoning
- Baked Salmon: Salmon, olive oil, dill, lemon, garlic powder |
- Cauliflower Mash: Cauliflower, butter, cream cheese, garlic, salt
- Spinach Omelette: Eggs, spinach, cheddar cheese, salt, black pepper
- Greek or Non-dairy Yogurt Bowl: yogurt, blueberries, almonds, chia seeds, cinnamon
- Steak and Asparagus: Steak, asparagus, butter, garlic, salt
- Egg (300F for 12-15 min air fry),
QUICK MEALS:
ADDITIONAL SALMON (or sub Chicken or other lean meat) RECIPES
Lemon Garlic Chicken/Salmon: add lemon slices, garlic, olive oil, parsley
Parmesan Crusted: add parmesan cheese, almond flour, butter, garlic powder
Salmon Lettuce Wraps: add lettuce, avocado, lime juice, cilantro
Salmon with Pesto: add basil pesto, cherry tomatoes, olive oil, salt
Cajun Salmon: add Cajun seasoning, olive oil, garlic, lemon
Coconut Curry Chicken/Salmon: add coconut milk, curry powder, garlic, spinach
- BENEFITS OF THE KETO DIET
- Supports rapid weight loss by promoting fat burning.
- May improve mental clarity and focus.
- Helps stabilize blood sugar levels and manage diabetes.
- Reduces appetite and cravings due to high-fat, satiating meals.
- Can enhance energy levels and physical endurance.
HIGH BLOOD PRESSURE: SEE Dietary Approaches to Stop Hypertension (DASH)
- VIDEO ON HTN | STRESS and HTN
- MANAGING HTN |EAT LESS SODIUM |
- Limit high blood pressure (HTN) with daily hibiscus tea (2-3 cups), about 250ml of beet juice, and by following the DASH diet rich in fruits, vegetables, and low sodium.
- FOR HYPERTENSION - Hibiscus Tea, Beets, Garlic
DIABETES EDUCATION
- PRE-DIABETES --> Prediabetes: Strategies for a Healthy Life
- PRE-DIABETES ACTION PLAN
- Managing Type 2 Diabetes
- Are You at Risk for Type 2 Diabetes? Why You Should Avoid Junk Food
- Diabetes and Choosing the Right Foods Diabetes and Exercise
- Diabetes Screening A1c TEST MONITORING GLUCOSE
- DIABETES FACTS
- After Your Diabetes Diagnosis
- TYPE 2 DIABETES
- INSULIN MED
- Diabetes and Foot Care
- Diabetes Eye Exam
- DIABETES IN KIDS Diabetes (Type 1)
- Managing Type 1 Diabetes in Children and Teens
ANTI-INFLAMMATORY DIET (video) DIABETES EDU( CLICK HERE FOR RESOURCES II - ANTI-AGING | ANTI-CANCER | ET AL )
NEW! - Antioxidant Smoothie Ingredients: 1/2 cup blueberries (fresh), 1/2 cup pomegranate seeds (or juice) 🍷, 1/2 cup kale leaves 🥬, 1/4 cup broccoli sprouts (or sub with 1 tsp broccoli sprout powder) 🥦, 1/2 tsp turmeric powder (with a pinch of black pepper for absorption) 🌿, 1/2 tsp Ceylon cinnamon 🌰, 1/2 inch fresh ginger (ginger paste) , 1 cup brewed and cooled green tea or matcha powder (matcha preferred) 🍵, 1/2 banana (optional, for natural sweetness) 🍌, 1/2 cup ice 🧊.
Prostate-Protective Power Smoothie - Blueberries (1/2 cup), pomegranate juice or seeds (1/2 cup), kale leaves (1/2 cup), broccoli sprouts or sprout powder (1/4 cup or 1 tsp), lycopene supplement (10–15 mg, opened or taken before smoothie), turmeric powder (1/2 tsp), black pepper (pinch), Ceylon cinnamon (1/2 tsp), fresh ginger (1/2 inch or 1 tsp paste), brewed and cooled green tea or matcha powder (1 cup or 1/2 tsp), banana (1/2, optional), ice (1/2 cup).
DOWNLOADS
Vitamin A – Found in carrots, sweet potatoes, spinach, kale, red bell peppers; deficiency causes night blindness, dry skin, weak immunity.
Vitamin B1 – Found in green peas, asparagus, Brussels sprouts, spinach, sunflower seeds; deficiency causes fatigue, nerve damage, beriberi.
Vitamin B2 – Found in crimini, shiitake, portobello, spinach, almonds; deficiency causes cracked lips, sore throat, light sensitivity.
Vitamin B3 – Found in maitake, shiitake, tomatoes, green peas, sweet potatoes; deficiency leads to pellagra with rash, diarrhea, confusion.
Vitamin B6 – Found in bananas, spinach, potatoes, avocados, prunes; deficiency causes irritability, neuropathy, seizures.
Vitamin B9 – Found in spinach, lettuce, asparagus, citrus fruits, avocados; deficiency leads to anemia, fatigue, birth defects.
Vitamin B12 – Found in nori, fortified cereals, fortified plant milks; deficiency causes anemia, numbness, memory loss.
Vitamin C – Found in oranges, strawberries, kiwi, bell peppers, broccoli; deficiency causes scurvy, bleeding gums, poor healing.
Vitamin D – Found in UV-exposed maitake, portobello, chanterelle mushrooms, fortified juice; deficiency causes bone pain, fatigue, rickets.
Vitamin E – Found in avocados, spinach, broccoli, mango, kiwi; deficiency causes weak muscles, vision loss, nerve damage.
Vitamin K – Found in kale, spinach, broccoli, cabbage, parsley; deficiency causes bleeding, bruising, poor clotting.
PSYCHOSOCIAL , MEDITATION & MENTAL WELLNESS
MEDITATION VIDEOS
MORE ADVANCED | 2 HR VIDEO
Natural Anxiety Options
CBD (25–100 mg/day) – Available in drops/tinctures; helps calm the brain and reduce anxiety.
L-Theanine (200–400 mg/day) – From green tea; promotes calm focus without making you drowsy.
Magnesium (200–400 mg/day) – A calming mineral that helps your body and brain relax.
Ashwagandha (300–600 mg/day) – A natural root that lowers stress hormones like cortisol.
Rhodiola (200–400 mg/day) – Helps your body stay strong under stress and boosts mental energy.
Lemon Balm (300–600 mg/day) – A gentle herb that soothes anxiety and helps with sleep.
Mental Health Test - https://mhanational.org/
Suicide Hotline - https://988lifeline.org/
988 Suicide and Crisis Lifeline
988 Suicide and Crisis Lifeline
STATISTICS ON MENTAL HEALTH
Anxiety Disorders: Approximately 19.1% of U.S. adults experience anxiety disorders annually.
Specific Phobias: Affect about 9.1% of U.S. adults annually.
Major Depressive Disorder: About 8.3% of U.S. adults have had at least one major depressive episode in the past year.
Social Anxiety Disorder: Approximately 7.1% of U.S. adults experience social anxiety disorder each year.
Attention-Deficit/Hyperactivity Disorder (ADHD): While often associated with children, ADHD affects about 4.4% of U.S. adults.
Post-Traumatic Stress Disorder (PTSD): Experienced by about 3.6% of U.S. adults annually.
Bipolar Disorder: Affects approximately 2.8% of U.S. adults each year.
Generalized Anxiety Disorder (GAD): Affects about 2.7% of U.S. adults annually.
Panic Disorder: Approximately 2-3% of U.S. adults experience panic disorder in a given year.
Obsessive-Compulsive Disorder (OCD): Approximately 1.2% of U.S. adults are affected each year.
EDUCATIONAL VIDEOS
Generalized Anxiety Disorder (GAD) Living With Social Anxiety Disorder Anxiety in Children
Phobia (Specific) Social Anxiety Disorder (Social Phobia)
Depression Living With Depression Depression in Children Psychotherapy (Talk Therapy)
Cognitive Behavioral Therapy (CBT)
Attention Deficit Hyperactivity Disorder (ADHD) in Adults (ADHD in Children)
Post Traumatic Stress Disorder (PTSD)
Bipolar Disorder (Overview) Living With Bipolar Disorder Panic Disorder
Panic Attack | Obsessive-Compulsive Disorder (OCD)
Clinical Trials for Mental Health Research Traumatic Events and Mental Health
Substance Use Disorders and Mental Health Taking Care of Your Mental Health in College
Mental Illness Mental Illness Warning Signs Cognitive Behavioral Therapy (CBT)
Getting the Most From Talk Therapy | Medical Marijuana (Medical Cannabis)
AWARENESS MONTHS
January
Mental Wellness Month: Recognized by organizations such as Mental Health America (MHA) and the National Alliance on Mental Illness (NAMI).
February
National Eating Disorders Awareness Week: Promoted by the National Eating Disorders Association (NEDA).
Rheumatoid Arthritis Awareness Day (February 2): Recognized by the Rheumatoid Patient Foundation.
March
Self-Harm Awareness Month: Supported by various mental health organizations to raise awareness about self-injury.
Dissociative Identity Disorder Awareness Day (March 5): Acknowledged by mental health advocacy groups.
Brain Injury Awareness Month: Led by the Brain Injury Association of America (BIAA).
April
Stress Awareness Month: Recognized by health organizations to highlight the impact of stress.
World Semicolon Day (April 16): Supported by mental health advocates to symbolize hope and love for those struggling with mental health issues.
May
Mental Health Awareness Month: Initiated by Mental Health America (MHA) in 1949.
National Anxiety Month: Recognized by organizations focusing on anxiety disorders.
Children’s Mental Health Awareness Week: Promoted by the National Federation of Families for Children’s Mental Health.
Arthritis Awareness Month: Led by the Arthritis Foundation.
International Fibromyalgia Awareness Day (May 12): Supported by the National Fibromyalgia Association.
International May 12th Awareness Day: Recognized by organizations focusing on ME/CFS and related conditions.
June
National Migraine and Headache Awareness Month: Promoted by the National Headache Foundation.
Pride Month: Celebrated by LGBTQ+ organizations and allies.
National PTSD Awareness Month: Recognized by the U.S. Department of Veterans Affairs.
July
Bebe Moore Campbell National Minority Mental Health Awareness Month: Established by NAMI to highlight mental health disparities.
International Self-Care Day (July 24): Promoted by the International Self-Care Foundation.
September
Suicide Prevention Awareness Month: Recognized by organizations like the American Foundation for Suicide Prevention (AFSP).
Pain Awareness Month: Led by the American Chronic Pain Association.
Rheumatic Disease Awareness Month: Promoted by the American College of Rheumatology.
National Spinal Cord Injury Awareness Month: Recognized by the United Spinal Association.
October
Mental Illness Awareness Week (First full week of October): Established by NAMI.
World Mental Health Day (October 10): Observed by the World Health Organization (WHO).
National Depression Screening Day: Promoted by Screening for Mental Health, Inc.
November
National Family Caregivers Month: Recognized by the Caregiver Action Network.
Transgender Awareness Week (November 13–19): Supported by GLAAD and other LGBTQ+ organizations.
International Survivors of Suicide Loss Day: Organized by the American Foundation for Suicide Prevention (AFSP).
Note: World Semicolon Day is observed annually on April 16 to raise awareness about mental health, suicide prevention, and self-injury. It also recognizes people who have survived suicide and those who are struggling with mental illness.
What is the significance of the semicolon?
The semicolon represents a choice to continue living, rather than ending one's life.
The semicolon separates two clauses, rather than ending one, which symbolizes hope and perseverance.
RESOURCES
Self-Help Groups
Self-Help Groups
Additional Resources
Additional Resources
Treatment Quitline: (800) 227-2345
Center for Substance Abuse Prevention (CSAP)
Center for Substance Abuse Treatment (CSAT)
Controlled Substance Schedule
Johnson Intervention Support
National Association of Alcoholism and Drug Abuse Counselors
NIDA Notes Newsletter
Principles of Drug Addiction Treatment: A Research Guide
Safe and Drug-Free Schools Program
Drug Abuse Warning Network
Smoking, Vaping, and Tobacco-Related Resources
Smoking, Vaping, and Tobacco-Related Resources
Toll-Free Quitlines:
Florida Department of Health: 1-877-U-CAN-NOW (1-877-822-6669)
The American Cancer Society: 1-800-227-2345
Local and state quitlines: 1-800-QUIT-NOW
Web Resources:
Smokefree.gov – Step-by-step quit smoking guides, SmokefreeTXT mobile service
SCS Trial
Preprocedure Instructions & Avoiding Complications
NPO (Nothing Per Os = Nothing by mouth) GUIDELINES
PREOPERATIVE ABX [ Start the DAY of the procedure ]
* Called in (preferably) 1 week before the trial, if possible.
Call the patient the day before AND the day of the procedure to confirm they will take the 1st dose 1 hour BEFORE the procedure.
Cefalexin (aka Keflex) Take 1000 mg (2 tabs) PO 1 hour before the procedure, then 500 mg Q12 hours during the trial. 500mg x15 tabs. [If PCN allergic, consider Clindamycin et al]
Cut and paste these instructions: Take 2 tabs(1000 mg) PO 1 hour before the procedure, then 500 mg Q12 hours during the trial. Dispense 16 tabs.
HERBAL SUPPLEMENTS TO AVOID (The 3 “Gs”) for 7, 3, and 1 days.
Garlic - Inhibition of platelet aggregation (may be irreversible). 7 DAYS
Ginkgo - Inhibition of platelet-activating factor. 3 DAYS
Ginseng - Incr. prothrombin and activated partial PTs, potential to increase risk of bleeding. 1 DAY
MEDICATIONS
For most part, continue on the patient’s current regimen.
Any limitations, changes, discontinuation, etc to be determined individually for each pt.
No Pts on blood thinners. STOP NSAIDS 7 days. STOP STEROIDS varies/usu. 7 days.
Primary Time Points (for each assessment), where applicable. [ Ambulatory Surgery Center ]
MATERIALS NEEDED
REP Brings = SCS TRIAL KIT - Ordered by Dr. N, varies by trial type & # of leads to be placed.
Fluoroscopy, Fluoroscopy table (Prone position with PPP, lumbar flexion), 2nd assistant / Tech
C-ARM DRAPE,1-2 HALF DRAPES, STERILE TOWELS FOR OVER THE PATIENT
FULL STERILE GOWN (EXTRA LARGE)
FACE MASK, CAP/HAT, Gloves – sterile 7.5 LATEX FREE, ChloraPrep (at least 10-ml) X3
[] 4 X 10 Tegaderm
Needles
27-gauge, 1.25″ – for skin numbing
27-gauge, 3.5″ – for numbing a tract down to the LAMINA.
Already in the kit = SCS TRIAL TOUHY [ KIT ]
Syringes
10-ml plastic syringe x 2 for local anesthesia
[] LOR syringe (glass preferred but plastic is okay)
Injectables
1-2% lidocaine (10 ML) +/- sodium bicarbonate
Oral Medications
Prophylactic Abx - Called in before the trial. Started by the patient before the trial.
In-office: Oral sedation. Varies based on physician orders. After the day of procedure exam, consent, confirmation of the responsible adult driver, and all the patient’s questions are answered. Alprazolam 0.5mg, 1mg, 2mg or equivalent 15-20 minutes before initial incision/injection.
SURGERY VIDEOS
Athletes post fusion surgery
Athletes post fusion surgery
🧠 Peer-Reviewed Medical Studies
🧠 Peer-Reviewed Medical Studies
Return to Play After Cervical Spine Surgery in Pro Athletes (Peyton Manning)
Journal of Neurosurgery: Spine (2015)
Corrected Link: https://pubmed.ncbi.nlm.nih.gov/23615099/
(Note: This PubMed link is for "Outcomes after anterior cervical discectomy and fusion in professional athletes" which is likely the one you're referencing, as it's the most common and relevant study from that journal and time period relating to professional athletes and cervical spine surgery.)
Return to Play After Lumbar Spine Surgery in NFL Players (Gronkowski)
Spine (2016)
Corrected Link: https://pubmed.ncbi.nlm.nih.gov/27543402/
(This link is for "Return to Play After Lumbar Spine Surgery" published in Clin Sports Med, 2016 Oct, which is a review article summarizing outcomes in athletes, including lumbar spine surgery.)
Outcomes After Cervical Spine Injury in NFL Players
The American Journal of Sports Medicine (2019)
Corrected Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC8373533/
(This link is for "Cervical Spine CT Can Miss Fractures in American Football Players When Protective Equipment is in Place: A A cadaver Study" which is a study from 2019 in AJSM. There is another from 2019 (2023 pub date but data from 2016-2021) "Characterizing neck injuries in the national football league: a descriptive epidemiology study" in PMCID: PMC10474715. If the latter is what you're looking for, let me know!)
📰 Reputable Media & Health Institutions
📰 Reputable Media & Health Institutions
Harvard Health Blog on Rob Gronkowski’s Back Surgery
(I could not locate a Harvard Health blog post with the exact title you provided. The closest reputable source found discussing "Gronkowski's back surgery" around that time frame was this AdventHealth blog post from 2020 which discusses similar topics and mentions Gronkowski's injury.)
Spine-Health: Spinal Fusion Surgery and Sports
Corrected Link: https://www.spine-health.com/treatment/spinal-fusion/spinal-fusion-surgery-recovery-3-months-and-after
(This Spine-Health article discusses recovery and return to activity/sports after spinal fusion, aligning with your description.)
CFI LFI CBB | MBB -> CRFA LRFA CESI
LESI TFESI SIJ / HIP / KNEE ONB TPI
ASA PHYSICAL STATUS I-VI [ASA READ]
NITRONOX PLUS - Training (5 min) Training 20 min ,
https://pubmed.ncbi.nlm.nih.gov/
Anxiolysis|Sedation|Anesthesia Overview - go to conscious sedation(New!)
SPINE:
CERVICAL- FACET MBB RFA | ESI (CESI w/o ctr) |ONB | TPI |TH-ESI
LUMBAR - FACET MBB RFA | ESI (LESI w/o ctr) |TFESI |SACROILIAC JOINT|CAUDAL
NEVRO - Nevro channel SCS TRIAL [ download print 4 pages] - Detailed/40min
NERVE BLOCKS | TRIGGER POINT:
MIGRAINE NERVE BLOCKS: ONB |SPG block | Botox
UE NERVE BLOCKS | JOINT INJECTIONS
| SHOULDER | ELBOW | WRIST
LE NERVE BLOCKS | INJECTIONS
LATERAL FEMORAL CUT. NERVE
https://thepainsource.com/procedure-lateral-femoral-cutaneous-nerve-block/
KNEE PAIN:
Surgeries - Mobi-c Minimally Invasive TLIF TLIF
Sample info on Artificial Discs
MORE ON NITRONOX ...
AVOID IN 1ST AND 2ND TRIMESTER, OFTEN GIVEN FOR LABOR PAIN.
DISCUSS WITH YOUR DOCTOR 1ST ( Blood thinners | English )
**** Important Reminder - FOR REFERENCE ONLY
SEEK INSTRUCTIONS FROM YOUR DOCTORS ****
***For Spine AND HIP INJECTIONS - here are instructions to stop bloodthinners.
For SI joint injections - no need to stop your blood thinner.
Do not stop taking your anticoagulant until you have been cleared to do so by the medical provider prescribing that medication.
Anticoagulants
Coumadin (warfarin): Stop 5 days before procedure; INR must be obtained on the day of the procedure.
Pradaxa (dabigatran): Stop 4 days before procedure.
Eliquis (apixaban): Stop 3 days before procedure.
Xarelto (rivaroxaban): Stop 3 days before procedure.
Bevyxxa (betrixaban): Stop 6 days before procedure.
Antiplatelets / Platelet Inhibitors
Aspirin / Excedrin (any dose “baby” or otherwise): Stop 7 days before procedure.
Plavix (clopidogrel): Stop 7 days before procedure.
Effient (prasugrel): Stop 10 days before procedure.
Ticlid (ticlopidine): Stop 5 days before procedure.
Pletal (cilostazol): Stop 2 days before procedure.
NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
Advil (ibuprofen): Stop 1 day before procedure.
Arthrotec (diclofenac): Stop 1 day before procedure.
Indomethacin: Stop 2 days before procedure.
Lodine (etodolac): Stop 2 days before procedure.
Mobic (meloxicam): Stop 4 days before procedure.
Aleve (naproxen): Stop 4 days before procedure.
Relafen (nabumetone): Stop 6 days before procedure.
Feldene (piroxicam): Stop 10 days before procedure.
Supplements
Fish oil: Stop 6 days before procedure.
Garlic: Stop 7 days before procedure.
Vitamin E: Stop 7 days before procedure.
Turmeric: Stop 7 days before procedure.
Again, confirm these timelines with the provider who prescribed your medication.
**** Recordatorio importante - SOLO PARA REFERENCIA
BUSQUE INSTRUCCIONES DE SU MÉDICO ****
Para inyecciones en la columna vertebral Y la cadera – aquí están las instrucciones para suspender anticoagulantes.
Para inyecciones en la articulación sacroilíaca (SI) – no es necesario suspender su anticoagulante.
No deje de tomar su anticoagulante hasta que haya sido autorizado por el proveedor médico que le recetó ese medicamento.
Anticoagulantes
Coumadin (warfarina): Suspenda 5 días antes del procedimiento; el INR debe obtenerse el día del procedimiento.
Pradaxa (dabigatrán): Suspenda 4 días antes del procedimiento.
Eliquis (apixabán): Suspenda 3 días antes del procedimiento.
Xarelto (rivaroxabán): Suspenda 3 días antes del procedimiento.
Bevyxxa (betrixabán): Suspenda 6 días antes del procedimiento.
Antiplaquetarios / Inhibidores de Plaquetas
Aspirina / Excedrin (cualquier dosis “baja” o normal): Suspenda 7 días antes del procedimiento.
Plavix (clopidogrel): Suspenda 7 días antes del procedimiento.
Effient (prasugrel): Suspenda 10 días antes del procedimiento.
Ticlid (ticlopidina): Suspenda 5 días antes del procedimiento.
Pletal (cilostazol): Suspenda 2 días antes del procedimiento.
AINEs (Antiinflamatorios No Esteroides)
Advil (ibuprofeno): Suspenda 1 día antes del procedimiento.
Arthrotec (diclofenaco): Suspenda 1 día antes del procedimiento.
Indometacina: Suspenda 2 días antes del procedimiento.
Lodine (etodolaco): Suspenda 2 días antes del procedimiento.
Mobic (meloxicam): Suspenda 4 días antes del procedimiento.
Aleve (naproxeno): Suspenda 4 días antes del procedimiento.
Relafen (nabumetona): Suspenda 6 días antes del procedimiento.
Feldene (piroxicam): Suspenda 10 días antes del procedimiento.
Suplementos
Aceite de pescado: Suspenda 6 días antes del procedimiento.
Ajo: Suspenda 7 días antes del procedimiento.
Vitamina E: Suspenda 7 días antes del procedimiento.
Cúrcuma: Suspenda 7 días antes del procedimiento.
ASA PHYSICAL STATUS
SCS Trial Instructions (General | Talk to your doctor)
DISCHARGE INSTRUCTIONS:
For SPINAL CORD STIMULATOR TRIALS:
Keep your wound site clean and dry. Do not remove the bandage. Do not shower or bathe during the trail. You can sponge bathe.
No lifting, twisting, or turning. Avoid stretching, being, pulling and sudden movement. Do not bend or twist at the waist. The stimulator can be on at night. Beware that stimulation may become uncomfortable, if you twist or turn during sleep.
Do not raise your arms above your head. This could cause your electrode wires (leads) to move from their current position. It is ok to brush or scratch your head.
Do not lift more than 10 pounds. Remember a gallon of milk weighs about 8.5 pounds. Avoid lifting anything heavier than this. Ask for help.
Take all medication exactly as directed. Do not attempt to take yourself off any of your pain medications even though your pain may improve. It is important to take antibiotics exactly as directed until they are gone.
Movement may cause changes in stimulation intensity. For example, you may notice a change in stimulation when you stand, sit or lie down. This is normal during the first several weeks following the procedure.
HYPERTENSION - SEE YOUR DOCTOR | DASH FOR HTN | DASH DIET/MAYO CLINIC
HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 1 130 – 139 or 80 – 89
HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 2 140 OR HIGHER or 90 OR HIGHER
HYPERTENSIVE CRISIS (consult your doctor immediately) HIGHER THAN 180 and/or HIGHER THAN 120
BLOOD PRESSURE CATEGORY = SYSTOLIC mm Hg (upper #) and/or DIASTOLIC mm Hg (lower #)
NORMAL LESS THAN 120 and LESS THAN 80
ELEVATED 120 – 129 and LESS THAN 80
HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 1 130 – 139 or 80 – 89
HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 2 140 OR HIGHER or 90 OR HIGHER
HYPERTENSIVE CRISIS (consult your doctor immediately) HIGHER THAN 180 and/or HIGHER THAN 120
FROM: https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure
Natural Supplements TO DISCUSS WITH YOUR PRIMARY DOCTOR
1. 🌺 Hibiscus Tea (Hibiscus sabdariffa) Effect = Lowers systolic and diastolic BP Mechanism = Natural ACE inhibitor, diuretic, antioxidant
Study: McKay et al. (2009) found that drinking 3 cups/day reduced SBP by ~7 mmHg in prehypertensive adults. PMID: 19923373
1. 🌺 Hibiscus Tea (Hibiscus sabdariffa) Effect = Lowers systolic and diastolic BP Mechanism = Natural ACE inhibitor, diuretic, antioxidant
Study: McKay et al. (2009) found that drinking 3 cups/day reduced SBP by ~7 mmHg in prehypertensive adults. PMID: 19923373
2. ❤️ Beetroot Juice Effect = Rapid reduction in BP, especially systolic Mechanism = High in dietary nitrates → nitric oxide → vasodilation
Study: Kapil et al. (2015) showed 250 mL/day led to a ~7.7/2.4 mmHg drop in BP.
2. ❤️ Beetroot Juice Effect = Rapid reduction in BP, especially systolic Mechanism = High in dietary nitrates → nitric oxide → vasodilation
Study: Kapil et al. (2015) showed 250 mL/day led to a ~7.7/2.4 mmHg drop in BP.
3. 🧘🏽 Mindfulness Meditation / Breathing Effect = Reduces stress-driven BP spikes Mechanism = Lowers cortisol, activates parasympathetic response
Study: Park & Han (2017) demonstrated a significant BP drop in adults practicing mindful breathing 20 mins/day.
3. 🧘🏽 Mindfulness Meditation / Breathing Effect = Reduces stress-driven BP spikes Mechanism = Lowers cortisol, activates parasympathetic response
Study: Park & Han (2017) demonstrated a significant BP drop in adults practicing mindful breathing 20 mins/day.
4. 🧄 Garlic Supplements (Aged Extract) Effect = Lowers BP in hypertensive patients Mechanism = Enhances nitric oxide, mildly inhibits ACE
Study: Ried et al. (2013) found ~8.6 mmHg reduction in SBP with aged garlic extract
4. 🧄 Garlic Supplements (Aged Extract) Effect = Lowers BP in hypertensive patients Mechanism = Enhances nitric oxide, mildly inhibits ACE
Study: Ried et al. (2013) found ~8.6 mmHg reduction in SBP with aged garlic extract
5. 🥦 DASH Diet + Magnesium-Rich Veggies Effect = Clinically proven to lower BP Mechanism = Potassium, magnesium, fiber, low sodium
Study: DASH-Sodium trial: Reduced SBP by up to 11.5 mmHg in hypertensive adults
5. 🥦 DASH Diet + Magnesium-Rich Veggies Effect = Clinically proven to lower BP Mechanism = Potassium, magnesium, fiber, low sodium
Study: DASH-Sodium trial: Reduced SBP by up to 11.5 mmHg in hypertensive adults
EXAMPLE OF Outpatient Surgery Criteria for Blood Pressure (BP) | MAY VARY BASED ON OTHER MEDICAL HISTORY / CONDITIONS.
DISCUSS THIS WITH YOUR FACILITY AND DOCTORS AS EACH SITUATION IS DIFFERENT.
Most facilities follow these general criteria, but always confirm with local protocols and anesthesia guidelines:
✅ Acceptable Ranges for Outpatient Surgery:
Systolic BP: 90–160 mmHg / Diastolic BP: 50–100 mmHg / MAP (Mean Arterial Pressure): 65–110 mmHg (if used)
🚫 May Delay or Cancel Surgery if: Systolic BP ≥180–200 mmHg or Diastolic BP ≥110–120 mmHg, especially if persistent
Hypertensive urgency/emergency suspected (e.g. with chest pain, headache, vision changes, neuro deficits)
Hypotension: Systolic <90 mmHg or symptomatic low BP (e.g., dizziness, syncope)
🕐 Preoperative Optimization Needed If:
Poorly controlled chronic hypertension
Recent med noncompliance
Acute changes in baseline BP
Presence of end-organ damage (renal, cardiac, cerebrovascular)
📋 Notes:
BP is ideally controlled over time, not just on day of surgery
Some anesthesiologists may proceed cautiously if SBP <180 and no symptoms
Antihypertensive meds are typically continued the morning of surgery unless otherwise advised
Let me know if you want this converted into a surgical clearance checklist or chart format.
TOP 10 MEDICAL DISEASES IN ADULTS
1. 🩸 Hypertension = High BP | 🛑 Salt, 🏃♂️ exercise | 💊 Meds, 🥗 DASH diet
2. 🧈 High Cholesterol = LDL ↑ heart risk | 🥦 Fiber, 🍤 diet | 💊 Statins, 🏋️♀️ fitness
3. ⚖️ Obesity = BMI ≥30 | 🥗 Whole foods, 🚶♂️ activity | 💊 Meds, 🏥 surgery
4. 🍬 Type 2 Diabetes / Pre Diabetes = Insulin resistance | 🥕 Low sugar | 💊 Metformin, 🏃♂️ wt loss
5. 🦴 Arthritis = Joint pain | 🛡 Avoid injury, ⚖️ weight control | 💊 NSAIDs, 🧘 PT
6. 😔 Depression = Mood ↓ 2+ weeks | 🤝 Social support | 💬 Therapy, 💊 SSRIs
7. 😰 Anxiety = Excess worry | 🧘♀️ Manage stress | 💊 Meds, 🧠 CBT
8. 🌬 Asthma/COPD = Airway issues | 🚭 No smoking | 💨 Inhalers, 💊 steroids
9. ❤️ Heart Disease = Clogged arteries | 🚭 Quit, 🚴♀️ move | 💊 Statins, 🥗 diet, 🏥 stents
10. 🧪 Chronic Kidney Dz = Kidney function ↓ | 🩺 BP, sugar control | 💊 ACEi, 🥬 diet, 🩻 dialysis
OBESITY | WEIGHT LOSS
Foods known to "starve" fat cells by reducing insulin spikes, inflammation, or promoting lipolysis include:
Green tea (EGCG boosts metabolism) w/ STEVIA INSTEAD OF SUGAR
Avocado (healthy fats decrease inflammation)
Cinnamon (improves insulin sensitivity)
Turmeric (curcumin reduces fat inflammation)
Blueberries (anthocyanins limit fat storage)
Fatty fish (omega-3 reduces adipocyte inflammation)
Chili peppers (capsaicin increases metabolism)
Broccoli (fiber and sulforaphane fight fat storage)
Apple cider vinegar (reduces insulin spikes)
Leafy greens (low-calorie, high nutrient density)
PRE-DIABETES | DIABETES - SEE YOUR DOCTOR AND DISCUSS YOUR TREATMENT OPTIONS
🩸 BLOOD SUGAR CATEGORY = A1C (%) and/or FASTING BLOOD GLUCOSE (mg/dL)
🩸 BLOOD SUGAR CATEGORY = A1C (%) and/or FASTING BLOOD GLUCOSE (mg/dL)
NORMAL = A1C less than 5.7% and = Fasting glucose less than 100 mg/dL
PREDIABETES = A1C 5.7% – 6.4% or = Fasting glucose 100 – 125 mg/dL
TYPE 2 DIABETES = A1C 6.5% or higher or = Fasting glucose 126 mg/dL or higher (on 2+ tests)
SEVERE OR UNCONTROLLED DIABETES = A1C over 9.0% and/or = Fasting glucose above 180–200 mg/dL (often with symptoms)
📚 Source: CDC Prediabetes and Diabetes Info
📚 Additional: ADA Diagnosis Criteria
Types of Pain
TYPES OF PAIN -> TESTS -> TREATMENTS
Most Common Types of Pain =
LBP - HAs - Joint - Neuropathic - FBM - Whiplash (acute)
Neck - Abd/Pelvic - Post-Op - CA - Dental/Face | PAIN RESEARCH
XRAY MRI EMG NCV | Cracking Joints | Sciatic N. |
1️⃣ Lower Back Pain (Most Common) | ~30-40% of adults at some point in life | Leading cause of disability worldwide | Causes: Muscle strain, herniated discs, arthritis (Spine | Knee), spinal stenosis.
DX: Spinal Stensosis - Cervical Lumbar
LUMBAR - FACET MBB RFA | ESI (LESI w/o ctr) |TFESI |SACROILIAC JOINT|CAUDAL
CERVICAL- FACET MBB RFA | ESI (CESI w/o ctr) |ONB | TPI |TH-ESI
2️⃣ Headaches & Migraines | ~15-20% of the population regularly [Tension 40% / Migraine 10% ] | Includes tension headaches, migraines, cluster headaches | Causes: Stress, dehydration, neurological disorders, hormonal changes. WHIPLASH (HEADACHE) |
3️⃣ Joint Pain (Arthritis & Osteoarthritis) | ~25% of adults | Common in knees, hips, hands, shoulders | Causes: Aging, wear-and-tear, autoimmune conditions (rheumatoid arthritis).
NON-STEROID TREATMENTS
Topical Treatments
CBD/THC Topicals – Apply 2–3 times daily as needed (20–30 mg per dose).
Diclofenac Gel (Voltaren 1%) – Apply 2–4 g up to four times daily.
Capsaicin Cream (0.025–0.1%) – Apply 3–4 times daily (initial burning sensation expected).
Therapies & Physical Treatments
Acupuncture – 1–2 sessions per week (based on response).
TENS Therapy – Use 15–30 min per session, up to 2–3 times daily.
Paraffin Wax Therapy – Heat wax to 125–130°F, dip hands 5–10 times, wrap, and leave for 15–20 min, repeat daily or as needed.
Hand Exercises – 5–10 min, twice daily (stretching, grip strength, and mobility drills).
Supplements & Natural Remedies
CBD - OTC is supplement - buy only at a reviewed, reputable company - usually 25-50 mg per dose 2-3x per day
Omega-3 (Fish Oil, EPA/DHA) – 1,000–3,000 mg daily.
Curcumin (Turmeric w/ Black Pepper Extract) – 500–1,500 mg daily, divided into 2–3 doses.
Collagen Peptides – 5–10 g daily (powder or capsules).
Magnesium Lotion (or Oral Supplement) – Apply 1–2 times daily OR take 200–400 mg magnesium glycinate orally.
LUPUS | LIVING WITH LUPUS | ANTI-INFLAMMATORY DIET | RESEARCH = CANNABIS AND AUTOIMMUNE DZ CANNABIS AND LUPUS
LUPUS AND DIET | LUPUS + NUTRITION |
4️⃣ Neuropathic Pain (Nerve Pain, Sciatica, Neuropathy) | ~10-15% of the population | Includes sciatica, diabetic neuropathy, post-herpetic neuralgia, carpal tunnel syndrome | Causes: Diabetes, nerve compression, injury, chemotherapy.
5️⃣ Musculoskeletal Pain (Fibromyalgia, Myofascial Pain, Chronic Pain Syndrome) | ~10-12% of adults | Widespread pain, often linked to stress or nervous system dysfunction | Causes: Muscle overuse, central nervous system disorders, psychological stress.
6️⃣ Neck Pain | ~10-12% of adults | Often work-related or posture-related | Causes: Poor posture, whiplash, arthritis, disc herniation.
7️⃣ Abdominal & Pelvic Pain (IBS, Endometriosis, Menstrual Pain) | ~10-15% of the population | Common in women and people with digestive disorders | Causes: Inflammatory conditions, hormonal imbalances, digestive disorders.
8️⃣ Post-Surgical & Post-Traumatic Pain | ~10-15% of surgery patients | Can develop into chronic pain | Causes: Nerve damage, scar tissue formation, inflammation.
9️⃣ Cancer Pain | ~30-50% of cancer patients (70-90% in late-stage cases) | Often severe and persistent | Causes: Tumor growth, nerve compression, chemotherapy side effects.
🔟 Facial & Dental Pain (TMJ, Toothache, Trigeminal Neuralgia) | ~5-10% of the population | Often related to nerve disorders or jaw misalignment | Causes: Tooth decay, jaw misalignment, nerve dysfunction (trigeminal neuralgia).
TOPICALS FOR RELIEF | KNEE PAIN | NEUROPATHY
OTC TOPICALS (CHECK WITH YOUR PRIMARY CARE DOCTOR PRIOR TO STARTING)
Menthol: Apply thin layer, 3–4x/day
Methyl Salicylate: No heat pads, 3x/day,
Lidocaine Patch: 12 hrs on, 12 hrs off,
Lidocaine Cream: Thin layer, max 4x/day
Diclofenac Upper: 2g, 4x/day, max 8g, Diclofenac Lower: 4g, 4x/day, max 16g, Diclofenac: Use card, not with NSAIDs
Capsaicin: Use 3–4x/day, not eyes, Capsaicin: Burning normal, consistent use needed
Camphor: Avoid broken skin, apply 3x/day
KNEE PAIN:
Diclofenac (Topical or Oral)
Diclofenac is a potent NSAID, inhibiting COX-1 and COX-2 enzymes, reducing prostaglandin synthesis, and alleviating pain and inflammation in knee structures.
Ice (Cryotherapy)
Cryotherapy reduces cellular metabolism, vasoconstricts blood vessels, and decreases inflammatory mediator release, effectively reducing acute swelling, pain, and tissue damage post-injury.
Compression (Knee Sleeves or Wraps)
Compression supports joint stability, minimizes swelling through fluid restriction, improves proprioception, and enhances venous return, promoting quicker recovery post-injury.
Elevation
Elevation enhances lymphatic drainage and venous return by leveraging gravity, reducing extravascular fluid accumulation, and mitigating localized inflammation and edema in the knee.
Platelet-Rich Plasma (PRP) Injections
PRP utilizes autologous concentrated platelets to release growth factors like PDGF and TGF-β, accelerating tissue regeneration, reducing inflammation, and promoting cellular repair in knee injuries.
Corticosteroid Injections
Corticosteroids inhibit pro-inflammatory cytokines, reducing synovial inflammation, suppressing immune response, and providing analgesic effects, particularly for acute inflammatory flare-ups in knee injuries.
TERPENES
✅ Top Medical Cannabis Terpenes (Nature = Effects | <15 words)
Myrcene = Mangoes, hops = Sedative, anti-inflammatory, enhances cannabinoid blood-brain absorption.
Limonene = Citrus peels = Mood-elevating, antidepressant, modulates serotonin/dopamine.
Linalool = Lavender = Calming, anti-anxiety, interacts with GABA/serotonin systems.
Pinene = Pine, rosemary = Bronchodilator, memory enhancer, inhibits acetylcholinesterase.
Beta-Caryophyllene = Black pepper, cloves = Analgesic, anti-inflammatory, activates CB2 receptors.
Terpinolene = Tea tree, apples = Sedative, antioxidant, modulates CNS activity.
Humulene = Hops, basil = Anti-inflammatory, reduces appetite, blocks prostaglandin pathways.
Ocimene = Mint, parsley = Antiviral, decongestant, boosts immune response via inflammation reduction.
1. Keep Warm
= Stay indoors in cold weather
= Wear layers: hat, scarf, gloves, warm socks
= Use thermal underwear for insulation
= Preheat car before driving
= Use gloves or hand warmers
= Take warm showers or baths
2. Manage Triggers
= Practice stress-reduction like meditation
= Reduce or eliminate caffeine
= Stop smoking to improve circulation
= Review medications with your doctor
3. Other Strategies
= Exercise regularly to boost circulation
= Eat a balanced, anti-inflammatory diet
= Try omega-3 or circulation-boosting supplements
= Use biofeedback to regulate temperature
4. Seek Medical Advice
= Schedule regular doctor visits
= Ask about prescription treatment options
= Discuss alternative therapies like acupuncture
1. Reduce Wrist Strain
= Keep wrists straight during typing
= Use ergonomic keyboards and mousepads
= Avoid prolonged repetitive hand movements
= Take frequent breaks to stretch hands
2. Support & Comfort
= Wear wrist splints, especially at night
= Apply cold packs to reduce swelling
= Elevate hands to reduce pressure
3. Improve Hand Health
= Stretch fingers and wrists daily
= Perform hand-strengthening exercises carefully
= Avoid gripping tools too tightly
4. Lifestyle Modifications
= Maintain healthy weight to reduce pressure
= Treat underlying conditions like diabetes or arthritis
= Reduce inflammation with anti-inflammatory foods or medications
5. Medical Options
= Get a nerve conduction test if needed
= Consider corticosteroid injections for severe pain
= Explore surgery if conservative treatments fail
VISIT CPT CODES
VISIT CPT CODES
🆕 New Patient Visit Codes (CPT):
99202 – New patient, straightforward MDM | 15–29 minutes
99203 – New patient, low complexity MDM | 30–44 minutes
99204 – New patient, moderate complexity MDM | 45–59 minutes
99205 – New patient, high complexity MDM | 60–74 minutes
+99417 – Add-on for prolonged services (used with 99205) | Each additional 15 minutes beyond 74
🔁 Established (Follow-Up) Patient Visit Codes (CPT):
99211 – Minimal service (e.g., nurse-only visit) | No time required
99212 – Straightforward MDM | 10–19 minutes
99213 – Low complexity MDM | 20–29 minutes
99214 – Moderate complexity MDM | 30–39 minutes
99215 – High complexity MDM | 40–54 minutes
+99417 – Add-on for prolonged services (used with 99215) | Each additional 15 minutes beyond 54
QUICK RESOURCES
https://thepainsource.com/icd-10-codes-for-physical-medicine-and-pain-management/
https://thepainsource.com/homepage/cpt-codes-pmr-pain-management-billing-and-coding/
SI JOINT INJECTION = 27096 + 77002 [ see aapc above, medicare , pain source ]
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