Ask the Doctors November 2018 Issue

Ask The Doctors: November 2018

Q:I have lumbar stenosis. My doctor says an operation will help the neuropathic effects in my legs but may not help my lower back pain. Why won't surgery help my low back pain?

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Arthritis Advisor Editor-in-Chief Steven Maschke, MD, Department of Orthopaedic Surgery, Cleveland Clinic Orthopaedic & Rheumatologic Institute.

A:The hallmark sign of lumbar stenosis is low back pain accompanied by pain and other symptoms (such as numbness or tingling) that radiate down the legs. They are worse with standing and walking and relieved with sitting or leaning over. The symptoms that radiate down the legs are "neuropathic effects" because they are caused by pressure on nerves.

The pain in your back may or may not be related to the stenosis. Low back pain can be caused by problems with the disks, nerves, joints or soft tissues, or a combination. The exact source can be difficult to pinpoint.

The spine is a complex structure, the core of which is a stack of small bones (vertebrae). Cushioning disks separate each vertebral body, and the bones are connected to each other at small joints (facet joints) between bony protrusions at the back of each vertebra. The spinal cord runs through the center of the spine. Nerves exit this spinal canal through openings at most levels of the spine. Layers of muscles, ligaments and tendons surround the spine.

Stenosis is the narrowing of the spinal canal or of the spaces where nerves branch out from the spine. This is caused by degenerative changes in the structures of the spine over time. Nerves that originate in the low back extend down the legs. Surgery opens up the narrowed space, thus taking pressure off nerves and relieving pain in the legs.

If low back pain is related to the stenosis, it may improve with surgery. Because the pain can have other causes, surgery more predictably relieves pain in the legs than in the back.

Q:I have osteoarthritis in my hands and I've developed hard bumps near the tips of some of my fingers. They make my hands look deformed, and sometimes they're painful. Can I do anything about these?

A:The bumps near your fingertips are called Heberden's nodes. When they occur at the joint in the middle of the finger they're called Bouchard's nodes. In both cases, they are a sign of osteoarthritis. Of the several joints in the hand, the ones near the tips of the fingers (excluding the thumbs) are common sites of osteoarthritis. The middle joint of the fingers can also be affected. With the thumb, it's the joint at the base (where it meets the wrist) that's most susceptible.

Osteoarthritis occurs when cartilage (the tough tissue that covers the ends of bones in joints) deteriorates. When it's functioning normally, cartilage creates a smooth gliding surface for movement and cushions joints. As cartilage wears down, the altered surfaces no longer move smoothly against each other. Bone can rub against bone, causing friction and irritation. The area may become inflamed, painful and stiff. Damage from wear and tear and friction can cause bony overgrowths, known as osteophytes, to form along the margins of the joint. In the finger joints, these bone growths may form visible bumps, which are the Heberden's or Bouchard's nodes.

Initially, they can be painful, red and swollen. They may interfere with your ability to bend and straighten your fingers. The pain eventually diminishes, but the bony protrusion is permanent. The pain can be treated with rest, splints, heat or ice, physical therapy and pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs).

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