Treat your pain and live a better life…

best-pain-doctor-nycWelcome to my blog about pain. Unfortunately, many people suffer from chronic pain. As a board certified physician in physical medicine and rehabilitation, my specialty is treating these people with both acute and chronic pain.

A majority of my practice is working with patients that are experiencing back and neck pain.

My goal with this blog is to help patients who are experiencing any type of back or neck pain to understand what is causing their pain and discuss options that are available to end their pain. I hope to be able to provide readers with a portal that they can can use to educate themselves and facilitate treatment.

My specialty is my Interventional Spine Skills including cervical and lumbar epidural steroid injections, facet injections, medial branch blocks, Radiofrequency ablation, sympathetic ganglion blocks, spinal cord stimulator trials, sacroiliac joint injection, piriformis muscle block and musculoskeletal joint injection. I also perform many other procedures to alleviate acute and chronic pain.

I hope you enjoy reading my blog as much as I enjoy writing it and observing people from all over the world reading it.

– Matthew Grimm, M.D.

Category Archives: Uncategorized

Thoracic Epidural Steroid Injections Doctor NYC

Thoracic Epidural Steroid Injections

nyc-top-doctor-for-thoracic-epidural-steroid-injections-01Roughly 20% of all people will experience acute thoracic pain in their life. Clearly, this is a common problem. Many treatments exist to relieve the pain associated with thoracic inflammation. These treatments include use of medications, exercise, massage, and surgery. These vary in degree of invasiveness and amount of potential risk involved. In order to provide the best treatment possible, the least invasive option should be attempted first. This includes thoracic epidural spinal injections. Thoracic epidural spinal injections are a minimally-invasive low-risk treatment that provide effective results.

How Thoracic Epidural Steroid Injections Work

lower-thoracic-epidural-steroid-injection-information-specialist-02Thoracic epidural steroid injections are provided by an approved physician on an outpatient basis. This means that the treatment will be completed within the day and the patient will return home afterwards. To begin, localized anesthetic is provided around the injection site so that the steroid injection itself will not cause any pain. Once the target area is numb, the doctor will use x-rays along with colored dye, as well as patient report to target the exact tissues in need of steroid treatment. The steroids act to reduce inflammation which causes swelling and pain. Once the correct area has been located, steroids will be injected and the needle will be removed. What’s the treatment is complete, the patient is free to go. It should be noted that whenever anesthetics or sedatives are used, driving should be limited until the effects have completely worn off.

What Causes Thoracic Pain?

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The causes of thoracic pain are numerous and varied. Potential reasons include poor posture, injury, health issues, and more. Common sources for posture related thoracic pain include poor ergonomic and body mechanic technique implementation in the workplace and the car. One important and underrated risk of injury related to the thoracic spine is that involved in twisting. The anatomy of the spine allows for limited rotational movement, such as twisting. However, once this limit has been reached, further twisting or bending will cause injury. The body’s natural response to this injury will include inflammation, providing vital nutrients to the affected area. However, this inflammation also is commonly associated with swelling and pain. Therefore, movements of the entire body should be used as opposed to quick, jerking twisting motions.

Another common source of thoracic pain is associated with internal health problems. For example, developmental issues at any stage can create properly formed bones or tissues in the spinal region. In addition, autoimmune disorders can cause overactive inflammation in the spinal region which results in pain. For any of the above-mentioned concerns, thoracic spinal epidural injections are an excellent potential treatment

How to Maintain Thoracic Pain Relief

The solution to spinal pain concerns lies and the source of the problem. For those who have experienced thoracic pain in conjunction with injury or overuse, home and lifestyle modifications can be done so that further injuries do not occur. This may include something as simple as adjusting the seat in your car. When seated and driving, one should keep their feet around a 45° angle, their knees bent around a 45° angle, and their hips at a 90 degree angle with their back pointed straight. The positioning of the legs has a direct impact on the positioning and strain on the thoracic spine. In addition, massage and exercises can be provided to reduce inflammation and relieve pain.

Are you ready to end your thoracic spinal pain? Call Dr. Grimm to schedule an appointment to discuss thoracic epidural steroid injections to provide you with pain relief.

 

Doctor for Shoulder Pain and Common Shoulder Problems

Shoulder Pain

Often we take for granted the ability to have great mobility in our shoulders. We use our shoulders for the simplest of tasks, such as getting dressed to go out to more complex tasks needed to work and sustain a livelihood. With proper use and care, most shoulders problems are temporary and easily treatable. It is repetitive and frequent motion or injury that can affect the ability to properly use your shoulder area and cause pain.

shoulder painThe shoulder is an intricate combination of several joints combined with tendons. This allows you to perform the daily simple tasks such as lifting groceries to more specialized and demanding moves such as pitching a fastball.

Your shoulder is made up of three bones:
Upper arm bone (humerus)
Shoulder blade (scapula)
Collarbone (clavicle)

Some patients only feel pain shoulder when they move their shoulder, while others feel it all of the time. Either way, pain shoulder should always be evaluated and treated by a doctor to help avoid a worsening condition. Most shoulder problems result from tendon inflammation or tendon tear, instability, arthritis and broken bones. Other causes for shoulder pain can include:
Bursitis: Bursae are small, fluid-filled sacs located in joints that act as cushions between bones and soft tissues. Inflammation and swelling of the bursa can be caused by excessive use of the shoulder.

Tendinitis: Acute or chronic tendinitis is usually a result of a wearing down of the tendon that occurs slowly over time. Can lead to tendon tears.

Impingement: Shoulder impingement happens when the top of the shoulder blade puts pressure on the soft tissues as the arm is moved away from the body. It causes pain and limits motion. This can lead to bursitis, tendinitis and a rotator cuff tear.

Instability: Shoulder instability occurs from shoulder dislocations that can be partial or a complete. Dislocations can occur repeatedly when ligaments, tendons and muscles around the shoulder become loose or torn.

Arthritis: The most common type of arthritis in the shoulder is osteoarthritis. This is a common complaint for middle age individuals. Osteoarthritis develops slowly and becomes increasingly painful.

Fracture: Fractures are broken bones and often cause severe pain, swelling and bruising in the shoulder.
More serious (and less common) causes of shoulder pain can include tumors, infection and nerve-related problems.

Shoulder Pain Relief

For individuals suffering from an acute injury causing intense pain, medical care should be sought as soon as possible. If the pain is tolerable, a few days or rest may be all that is needed to see if time will resolve the problem. If symptoms continue, see a doctor for shoulder pain. The doctor will follow steps to conduct a thorough evaluation in order to determine the cause of your shoulder pain and provide you with treatment options:

Medical Historypain doctor Doctor for shoulder pain
Physical Examination
Tests

Treatment for shoulder pain includes activity changes and physical therapy to help patients improve shoulder strength and flexibility. Medications may also be prescribed to reduce inflammation and pain. Shoulder pain doctors may also apply injections of numbing medications or steroids to relieve shoulder pain.

Surgery for Shoulder Pain

Most patients will respond to simple treatment methods such as changing activities, rest, exercise and medication. In some cases, surgery may be required to resolve some shoulder problems.

Some shoulder problems, such as recurring dislocations, cannot be treated with exercise. In these cases, surgery may be recommended fairly early. Depending on your symptoms and diagnosis your doctor may need to repair torn tissues or perform traditional, open procedures for shoulder reconstructions or replacement.

The first step in resolving your shoulder pain is to see a doctor for shoulder pain. Contact us today at 646-862-5555
to schedule an appointment with the best pain doctor in NYC.

Dr. Grimm answers the question: What is an EMG test?

What Is an EMG?

Best-EMG-Testing-Doctor-NYC-1Electromyography or EMG is a study of the electrical activity of muscles. If you have numbness or weakness your doctor may request an EMG to determine the cause. In cases of neck or low back pain associated with numbness or weakness of an arm or leg, an EMG can help to identify which nerve root is compressed or irritated. This can help guide treatment decisions.

An EMG test is routinely accompanied by a nerve conduction study in order to definitively identify the level of nerve involvement. In other words, your doctor wants to make sure that your leg numbness or weakness is not caused by a problem of your peripheral nerves.

Procedure: How is an EMG done?

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Under sterile conditions, a very fine electrode is inserted into select muscle groups to measure their electrical activity at rest and during contraction. The electrical activity is visualized on a computer monitor and analyzed by the performing physician.

During the nerve conduction portion of the exam, select peripheral nerves are stimulated electrically and responses of the appropriate muscle groups are recorded. This test determines the integrity and function of your peripheral nerves.

Indications for an EMG

Best-EMG-Testing-Doctor-NYC-3An EMG and nerve conduction study is frequently performed in cases of neck or low back pain specifically for the purpose of identifying cervical or lumbar nerve root irritation. Assuming that nerve root irritation has been present for at least three weeks, the test can aid in localizing the level and severity of nerve root involvement. An EMG is a valuable adjunctive test in the evaluation of neck or low back pain when nerve root irritation is suspected.

If you suffer from neck or back pain, contact the best pain doctor in NYC, Dr. Matthew Grimm to schedule an examination.

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Sacroiliac Joint Injections

 

Best Pain Doctor NYC1Sacroiliac Joint Injections are safe and effective treatments indicated for chronic low back pain that is unresponsive to conservative medical management. The sacroiliac joint lies next to the spine and connects the sacrum to the hip on both sides. It has been shown to be a source of pain in up to 30% of cases of chronic low back pain. Patients with medical conditions such as rheumatoid arthritis, gout, psoriasis, ankylosing spondylitis, fracture, congenital deformity, cancer, or infection can also develop pain in the sacroiliac joint. Pregnant women, people with a leg length discrepancy and patients who have undergone spinal surgery are also at risk for this type of lower back pain.

How Sacroiliac Joint Injections WorkBest Pain Doctor NYC3

Sacroiliac joint injections involve depositing of medicine, consisting of a mixture of a local anesthetic and a steroid, directly into the joint. These injections can help diagnose the source of pain, because by placing the medicine into the joint, the amount of pain relief experienced will help confirm whether the joint is the source of pain. Complete pain relief in the sacroiliac joint confirms that this area is likely to be the source of pain.

Along with the local anesthetic, time-release steroid is also injected into the sacroiliac joint to reduce inflammation, which often provides long-term pain relief. Since the treatment uses locally administered medications, it does not have a widespread effect on the body; rather, only painful areas are targeted, and no systemic side effects are expected.

Patients benefit from this procedure because after the injection, inflammation and pain are reduced for several months, allowing the patient to resume normal activities and undergo rehabilitation or physical therapy while healing takes place.

General Procedure

Best Pain Doctor NYC2A sacroiliac joint injection is an outpatient procedure performed by a qualified Chronic Pain Specialist who is an expert with the treatment. The patient is initially briefed about the procedure and prepared beforehand so that he is relaxed.

The patient is asked to lie face down on his stomach on the radiography table. A pillow may be placed under the hips for patient comfort. The skin overlying the sacroiliac joint is sterilized. After the exact area to be injected is located using live x-ray guidance (fluoroscopy), the skin overlying the joint is numbed with a local anesthetic.

A needle is advanced into the sacroiliac joint. A small amount of water-soluble dye may be injected to confirm proper needle position. Once this is confirmed, a mixture of anesthetic and anti-inflammatory medication (steroid) is injected into the joint space. The needle is then slowly withdrawn.

After the procedure, the patient is monitored in the recovery area and discharged on the same day. Upon discharge, they will be asked to evaluate their improvement in the succeeding week and report for follow-up. Repeat injections may be performed up to three times, if needed, every two weeks.

Contact UsBest Pain Doctor NYC4

A Sacroiliac Joint Injection is a minimally invasive, safe, and effective means of treating low back pain that is unresponsive to other forms of treatment. If you want more information about treating chronic low back pain, contact our Pain Management Specialist who will examine you and conduct tests to determine the cause of your back pain.  Make an appointment with the NYC’s top board-certified interventional pain management physician to know if sacroiliac injections are a treatment option for you.

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Trigger Point Injections

 

Best Pain Management Doctor NYC3Trigger point injections are used to treat chronic pain in discrete, focal muscle groups in the neck, arms, legs, and lower back. These multiple muscle groups have trigger points, which are hyperirritable knots of muscle that are taut and which fail to relax. These cause local pain, which may also radiate or spread to other parts of the body. Although trigger points may be treated using nonsteroidal anti-inflammatory drugs, antidepressants, physical therapy and acupuncture, their effects are often short lasting compared to trigger point injections.

Trigger point injections may also be used to treat a variety of conditions, including fibromyalgia, tension headaches, temporomandibular joint pain, and myofascial pain syndrome.

How Trigger Point Injections WorkBest Pain Management Doctor NYC2

Trigger-point injection is a minimally invasive, safe, and effective way to inactivate trigger points and provide prompt, symptomatic pain relief. The procedure involves inserting a small needle into the patient’s trigger points, which are located in muscle groups in the neck, arms, legs and lower back. The injection contains a local anesthetic and may include a corticosteroid to reduce inflammation. Usually, a brief course of treatment that is given in a doctor’s office will result in sustained relief. Since the treatment uses locally administered medications, it does not have a widespread effect on the body; rather, only painful areas are targeted, and no systemic side effects are expected.

Patients benefit from this procedure because after the injection, trigger points are inactivated and inflammation and pain are reduced for several months, allowing the patient to resume normal activities and undergo rehabilitation or physical therapy while healing takes place.

Best Pain Management Doctor NYC4General Procedure

A trigger point injection is an outpatient procedure performed by a qualified Chronic Pain Specialist who is an expert with the treatment. The patient is initially briefed about the procedure and prepared beforehand so that he is relaxed.

The patient is placed in a comfortable recumbent position (either prone or supine) to allow muscle relaxation. Trigger points are located by palpating the muscles and finding knots under the skin. Once a trigger point is located the overlying skin is cleansed. The doctor isolates the point with a pinch between the thumb and index finger to stabilize it and inserts a needle directed to the point. The doctor warns the patient of the possibility of a sharp pain, muscle twitching, or unpleasant sensation when the needle touches the tight muscular band.

A small amount of local anesthetic is injected into the trigger point. The doctor then withdraws the needle a little and redirects it in different directions under the skin, injecting small amounts of anesthetic in each direction. This is done until the local twitch response is no longer elicited or muscle tautness is no longer felt. Pressure is applied on the skin after the needle is completely withdrawn to stop any bleeding. A simple bandage is applied to cover the area.

Post-injection soreness may be experienced, but this is expected to resolve in a few days. Patients are encouraged to remain active, using a full range of motion in the muscles, but are advised to avoid strenuous activity a few days after injection.

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Trigger Point Injection is a minimally invasive, safe, and effective means of treating muscle pain that is unresponsive to other forms of treatment. If you want more information about treating painful trigger points, contact our Pain Management Specialist who will examine you and conduct tests to determine the cause of your pain.  Make an appointment with the NYC’s top board-certified interventional pain management physician to know if trigger point injections are a treatment option for you.

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Cervical Stellate Ganglion Block

 

BestPainDoctorNYC1A Cervical Stellate Ganglion Block is a procedure that may be performed to determine the cause and/or to relieve chronic pain in the face and head, arms and chest. This type of pain is caused by increased sensitivity of the nerves found at the level of the sixth and seventh cervical (neck) vertebrae. This collection of sympathetic nerves is called the stellate ganglion, and to reduce pain, a Chronic Pain Specialist must block its activity using local anesthetic injections.

How Cervical Stellate Ganglion Block WorksBestPainDoctorNYC2

The stellate ganglion is a sympathetic nerve which becomes hyperactive due to chronic pain. Conditions like herpes zoster, Raynaud’s Disease, phantom limb, cancer, frostbite, and Complex Regional Pain Syndrome lead to symptoms often unrelieved by medications or conservative therapy. These symptoms include intense burning pain, an increase or decrease in temperature in the affected area, and increased sweating in the area. The goal of a cervical stellate ganglion block is to break the cycle of pain and sympathetic nerve activity and to improve blood flow to the area. This helps to desensitize the nerves and encourage healing of tissues.

A cervical stellate ganglion block consists of injection of local anesthetic into the front of the neck. It is a short, minimally invasive procedure that can effectively treat a wide array of conditions unresponsive to medical management. It provides relief for sympathetic-related pain in face, chest, and upper extremities, improves circulation in the upper extremities and face, decreases perspiration in upper extremities and face, and reduces hot flashes and associated sleep disturbances.

BestPainDoctorNYC3General Procedure

A Chronic Pain Specialist first determines if a patient is a candidate for the block, and prepares him for the procedure, which will be done on an outpatient basis. The injection is usually quick, taking only several minutes for each side of the neck. A small amount of sedation may be given to decrease anxiety. Monitors are used to watch the patient’s blood pressure, heart rate, and blood oxygen.

After sterile preparation of the neck region, the injection site is determined using X-ray guidance. A local anesthetic is applied to the injection site, which helps decrease the pain at the injection site. The needle is advanced toward the location of the stellate ganglion, which is confirmed using liquid contrast. The local anesthetic medication is then injected, and the needle is taken out at the end of the procedure.

The patient is monitored for about an hour in the recovery area and discharged within the day. A little soreness may be felt in the injection site, but the pain in the face, chest, and arms will be significantly relieved. Patients may also experience a droopy eyelid, redness of the eye, warmth in the face and hoarseness of the voice, but these effects are temporary and may last only a few hours.

Injections may be repeated after a few weeks if needed.

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A Cervical Stellate Ganglion Block is a minimally invasive, safe, and effective means of treating pain in the head, face, chest, and arms that is unresponsive to other forms of treatment. If you want more information about treating chronic pain, contact our Pain Management Specialist who will examine you and conduct tests to determine the cause of your pain.  Make an appointment with the NYC’s top board-certified interventional pain management physician to know if Cervical Stellate Ganglion Blocks are a treatment option for you.

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