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Hi, I'm Dr. Robert Nucci of Nucci medical.

Have you ever wondered why you have neck pain after an accident, a fall or a car accident, or even a lifting injury?

Well, today I'm going to try to explain exactly the reasons that a person would have neck pain after such an injury.

The neck is a complicated structure, but generally I tell patients that there are essentially four things that I look at when someone comes in with neck pain. After an accident, one of those things is muscular pain, and certainly there's a muscular component, many types of neck pain. So, muscle is clearly one of them. Whiplash from a car accident, a twisting injury, giving you muscular neck pain. There are other causes.

However, another one that patients always worry about is discogenic pain in the neck, and actually throughout the entire spot, their bones blocks.

And in between the blocks, a little discs, which are the cushions. I tell patients like a little jelly donuts. Those can be injured. The soft inner disc material can protrude out. And that can be painful. Usually that's not the reason people have neck pain. It can be, but it's not one of the main causes, but it's one of the ones that we think about. The third reason patients have neck pain, surprisingly to most, is the shoulder. The shoulder is right next to the neck and shoulder pain can give you neck pain. Many times in auto accidents, people injured their shoulder with a seatbelt, not even aware of it. They come in with neck pain, it's ingest to be their shoulder. And you diagnose that on examination by an orthopedic surgeon, orthopedic spine surgeon.

The fourth reason is facet pain. And on previous videos we discussed, facet pain and you can link to that, but the facets are small joints in the back of the spine, like little finger joints allowing you to bend and move.

There is actually one on each side, it molds the levels of your neck and actually all the way down your back. Those are often injured in a fall or a lifting injury or a car accident. Facet pain is extremely common, and it can be all four of those things. It could be two of the four, three of the four, and that's where the, examination and diagnosis comes in. Depending upon what's really the biggest problem, or with the two biggest problems treatment is, is then determined.

Treatment usually is nonsurgical. Very, very rarely do these things need surgery, but the important thing is to make the diagnosis first. So if you hurt your neck, by lifting or twisting injury or car accident. Those are the four things that need to be looked at and, examined and diagnosed so you can get better as quickly as possible.

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Hi, I'm Dr. Robert Nucci of Nucci Medical. And today we're going to discuss how to diagnose Facet pain.

The first thing to know, or first thing to ask is what is the facets. And we're talking about particularly the, low back today.

The facets are small joints in the back of the spine, that allow you to bend and move like little finger joins, allowing you to move around.

And I have a model here, which is slightly enlarged, but it'll give you the idea. These are the bones, and this is the disc in between. In the back of the spine. The spine is processes. Have you run your finger down your back You feel those little bumps. That's what these things are right here are the joints of the, of the back. So as the spine moves, those joints, move. Those are your facet joints. There's one on each side and they run all the way up your spine to your neck.

And they are, often injured in accidents and then falls. How to make the diagnosis. First is physical examination. Usually there's neck pain, or in this case, we're talking about low back, low back pain. And the pain is often with extensions and you're bending your back. You're squeezing those small facet joints and that causes pain in the area of the low back, and the area of the facets. That's usually a very good way to make the diagnosis.

But we confirm that diagnosis with either something called a medial branch block or a facet injection. They're very similar injections. They're diagnostic injections. Basically, you numb up the nerve, Medial Branch Nerve, that actually goes to the facet joint. So, if the nerve is numb, and you're able to move. It doesn't hurt. You've made the diagnosis of facet pain, because it was there before you numbed up the nerve, the sensory nerve, that goes to the small joint, and it doesn't hurt anymore. You've now have your diagnosis of facet pain.

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One of our viewers asked if a cervical disc herniation is always surgical. Today, We are going to attempt to answer that question.

I'm Dr. Robert Nucci of Nucci Medical. Disc herniations in the neck, in the short answer usually are not surgical. Disc herniations, symptomatic ones even, usually heal with non-surgical, conservative care. But disc herniations are seen often on diagnostic studies and people, patients, are not sure what that means. The cervical and neck MRI can show the, does show the discs and the bones of the neck, and the reading of the MRI can say a disc herniation.

Discs are soft on the inside and hard on the outside. And the softer inner material can pop out and hit a nerve or a spinal of the spinal cord in the neck. Actually, I have my lumbar model here, which is a sort of fun. It's a little bit larger than reality, but the disc is the soft thing in the middle and the bones or the blocks are on the outside there.

And the nerves here on the side, you can see them coming out and the disc herniation is the popping out essentially of the, of the disc, hitting a nerve that is clearly exaggerated, but you get the idea. In the neck, the disc herniation can hit the nerve spinal cord and cause pain and injury. But usually it's not the case.

The disc herniations are diagnosed on the MRI studies, which I mentioned earlier, which show the soft tissues and bones. And it's an, what we call an incidental finding. We see it many times is not mean very much. It requires an examination, and evaluation by an orthopedic spine surgeon or a spine surgeon who determined if it is even symptomatic. If it even is causing any pain. And if it is often, it will improve with conservative non-surgical care almost all the time, but sometimes they are surgical.

That don't get better or get worse over time. those kinds of things can be treated with outpatient procedures often, which are very successful. And on our website at NucciMedical.com, you can see some of the procedures that we do for cervical disc herniations, to get patients better, quickly and return to function quickly.

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