There’s Nothing Funny about the Funny Bone
Most of us have been unlucky enough to experience that “electric” shock of pain when whacking our “funny bone” just so. The pain generated from a small bump to the ulnar nerve is enough to bring tears to your eyes. Now, imagine that type pain on an ongoing basis–in your back, neck, legs, or feet.
UCSF assistant professor and neuroradiologist Doctor Vinil Shah is at the vanguard of nerve treatment, employing modern imaging technology to diagnose, treat, and optimally resolve nerve pain.
What does a neuroradiologist do?
I’m trained to interpret images of the brain, spine, head, and neck gathered through a variety of imaging technologies – including MRI, CT scan, and ultrasound. I also perform minimally invasive procedures pertaining to those areas.
You have dual fellowships. Explain what they are and how they complement each other.
Both my fellowships are from Massachusetts General Hospital in Boston. One is in neuroradiology, a subspecialty of radiology that focuses on the diagnosis of abnormalities of the central and peripheral nervous system. The other is in musculoskeletal radiology–which includes the bones, spine and joints. The training you get as a spine specialist is very complementary to neuroradiology.
What are the causes of nerve pain?
There are numerous reasons for nerve pain. It could be the result of injury, or due to an anatomical or physiological reason. When nerves are impinged, or inhibited, the pain can range from annoying to debilitating.
One of the most symptomatic types of nerve pain occurs when a person has a bulging, or herniated, disk. If the disk bulges into the spinal canal where the spinal cord and nerve roots traverse, it can produce a sharp, radiating, electric-like pain. The location and distribution of the pain correspond to the nerve being contacted by the disk.
A nerve being contacted or compressed by a disk is not enough to cause pain. What plays a very critical role is inflammation. A herniated disk will “recruit” inflammatory chemicals to the site of the herniation. Our studies show that it takes more than just the compression of a disk to instigate pain–it’s the combination of compression, impingement, and inflammation that results in severe pain.
How is nerve pain treated?
Nerve pain can be very difficult to treat. When nerves are incited, they produce inflammatory chemicals in the region, which further exacerbates the pain. However, through the use of imaging technologies, we can precisely target where the treatment, usually a combination of anti-inflammatory steroids and an anesthetic, is applied. Corticosteroid treatment works well for nerve pain because of its powerful anti-inflammatory properties.
Sometimes, the effects of steroid treatment are sufficient to decrease the inflammation and provide relief to the affected nerve, and resolve the issue–if not permanently, then temporarily. Although, the effects might not be long term, treatment provides us with important diagnostic information that will help direct future therapies for a neurologist or peripheral nerve surgeon.
Are there downsides to corticosteroid treatments?
Epidural steroid treatments have been in use since the 1950s, but within the last 10 to 15 years the imaging component has become critical. Today, we can use really low, small doses of steroids, which studies have shown to be just as effective as previously administered large doses, specifically because we can inject them precisely where needed. With the assistance of imaging technology there are now far fewer complications associated with epidural injections.
That being said, epidural injection treatments should be done only under image guidance to avoid damage to the critical structures surrounding the nerves, or disks. When I’m administering an epidural injection, I can see my needle as I navigate toward the nerve, providing me with precise control of my instrument and much better outcomes.