De Quervain's Tendonitis

The condition known as de Quervain's tendonitis, or tenosynovitis, results from the tendons at the base of the thumb becoming irritated or inflamed. When the tendon gets inflamed, the tunnel that surrounds it swells, and it becomes painful to move the thumb or wrist. Those who suffer from de Quervain's tendonitis feel pain when they hold things or try to form a fist.

Causes of De Quervain's Tendonitis

Formally known as first dorsal tendonitis, de Quervain's tendonitis is caused when the tendons at the thumb's base become irritated, usually as a result of a new repetitive activity. It is a frequent complaint from new mothers, who need to care for their babies with awkward hand positions they are not familiar with. Furthermore, changes in hormone levels from pregnancy and nursing add to the possibility of the condition showing up in new mothers.

A change to the way the wrist normally works and moves because of a fracture or severe strain can also trigger de Quervain's tendonitis because of the new and unusual stress the tendons may incur.

Signs & Symptoms

The main symptom of de Quervain's tendonitis is pain in the side of the wrist near the thumb. The pain might show up either suddenly or over time, but is felt in the wrist's first dorsal compartment. The pain can run up the forearm or down into the thumb. Moving the hand or thumb makes it worse, especially if they are twisted or used to hold onto something firmly.


The base of the thumb may become swollen and a cyst filled with fluid may even appear. The thumb, when moved, may sometimes catch or pop, and it may be hard to pinch. The nerve that lies on top of the tendon's sheath or tunnel may also become irritated and cause the index finger and back of the thumb to become numb.

Diagnosis of Tendonitis

Your hand surgeon will carefully examine your hand and wrist for signs of de Quervain's tendonitis and check if the tendons at the base of the thumb are tender. To test for it, you may be asked to make a fist with your thumb inside your fingers and your hand surgeon may then try to gently bend your fist toward your little finger. If you have de Quervain's tendonitis, this movement will cause pain.

Non-Surgical & Surgical Treatments

Your hand surgeon will treat the condition so that your pain is removed or lessened by reducing the irritation and swelling in the affected tendons. Your hand doctor may suggest that you wear a splint to rest your thumb and wrist and may recommend some anti-inflammatory medications. Sometimes the inflammation can be relieved by a shot of cortisone or other steroid, and any of these treatments can reduce the swelling and pain. Changing or eliminating the motions that cause the pain can also get rid of them.

If the symptoms are very severe or the treatments tried so far don't work, surgery can often help. During the surgery, your hand surgeon will open up the compartment to give the inflamed tendons more room to move. This procedure eliminates the inflamed tendons swelling even further, which in turn increases the inflammation, and so on. Following the surgery, a splint may be suggested, but once comfort and strength have returned, normal hand, wrist, and thumb function will come back.

Your Money in The Bank Does NOT Affect Your Entitlement To SSDI!

This is a very common mistake by the vast majority of the population. They believe that even though they are disabled, and have plenty of money in the bank, they will not qualify for Social Security Disability Benefits. THIS IS ABSOLUTELY WRONG!! Others believe they need to wait until this money is gone before I apply for Social Security disability benefits? ONCE AGAIN, THIS IS NOT TRUE!!

If you have worked in recent years and are now disabled, it does not matter how much money you have in the bank. There is no reason to wait to file the claim. Contact the attorneys at Minnesota Disability today to assist you with your application process. Attorney Tom Atkinson meets with clients thoughout Minnesota and Western Wisconsin seven days a week. Contact Minnesota Disability today, there is NEVER a fee until you are awarded benefits! Tom Atkinson 651-324-9514

Diagnostic Testing in Social Security Disability Claims

Musculoskeletal Diagnostic Test

  

X-ray 

This test uses radiation to take a picture of structures inside the body, especially bones. Back x-rays may show signs of arthritis, degenerative disk disease, osteoporosis, or a tumor.

MRI Scan
This test uses strong magnetic waves to take pictures of structures inside the body. An MRI can show disc herniations, disc degeneration, spinal cord or spinal nerve root compression, tumors, or infections in the spine.

Patients who have had previous back surgery will need a contrast, Gadolinium, injected. This substance helps differentiate scar tissue resulting from previous surgery. Gadolinium enhances the images of structures and alters local magnetic field in tissues being examined. Normal and abnormal tissue responds differently to the alteration from the contrast allowing the radiologist to visualize tissue abnormalities and disease processes. There is slight risk of an allergic reaction to contrast material, however, most reactions are mild and can be controlled with medications.

For some patients, MRI is not an option. An MRI cannot be done for patients who have:

• Pacemakers - an MRI can cause malfunction
• Shrapnel
• Bone plates or pins
• Aneurysm clips - an MRI may cause the clip to tear the artery it is trying to protect
• Metal fragments in eye - can cause eye damage or blindness
• Implanted spinal cord stimulators
• Inner ear implants
• Dental implants - some are magnetic
• Metal heart valves
• Tattooed eyeliner - iron pigments can cause irritation
• Women who have intrauterine devices (IUD)
• Pregnant women

Nerve Conduction Study
In this test, an electrical current is passed through a nerve to determine the health or disease of that nerve. This test is used in combination with an EMG.

Electromyography (EMG)
This test measures the electrical activity of muscle by placing needle electrodes into the muscle.

Myelography
In this test, a special dye is injected into the spinal canal. X-rays are then taken to see how the dye lines the space in the spinal canal and see if there are disc herniations or pinched nerves in the spine. A CT scan is usually performed after a myelogram in order to help visualize structures in the spine.

Before the CT/Myelogram
You will be instructed about not eating or drinking before the test. You will need to remove all jewelry, hairpins, hearing aids, and dental work.

You will lie on a moving table that slides into a scanner. The scanner moves around to change angles of x-rays.

Advise the Radiology Department if:

• You are pregnant
• Allergic to iodine dye
• Have kidney problems - the contrast can damage the kidneys
• Have diabetes
• Have had a barium enema within 4 days of the CT Myelogram

After CT/Myelogram
You will be instructed to keep your head elevated and not to bend over or lie flat. This helps keep the contrast material out of your head.

CT Scan
This type of x-ray uses a computer to generate images of structures inside the body. CT scans of the spine may show disc herniations, tumors, arthritis, vertebral fractures, or the stability of spinal fusions.

Bone Scan
A bone scan evaluates bones for infection, disease, fractures, tumors or other bone abnormalities. Bone scans examine the entire skeletal system. The scan can help diagnose the cause of unexplained bone pain, such as low back pain, detect damage to bones caused by infection or other disease, evaluate damage to bones, detect cancer that has metastasized to bones, and monitor conditions that can affect bones such as trauma or infection.

A small amount of radioactive tracer is injected into the bloodstream and the bones will absorb it. It may take up to three hours for the tracer to be absorbed and the scan to begin. During the waiting period, patients may be asked to drink 5-8 cups of water to help eliminate any radioactive tracer that is not absorbed into the bones. You can eat and drink as normal before the scan.

A Bone scan can take up to an hour. You will lie on your back while a scan camera moves slowly above and around your body. The camera will scan for the radioactive tracer and produce pictures of bones. The camera does not produce radiation.

A normal bone scan will show the tracer evenly distributed throughout the bones.

An abnormal bone scan shows the tracer accumulated in an area of the bone, indicating a "hot spot". Hot spots may be caused by a fracture that is healing, bone cancer, bone infection, arthritis, or a disease of a bone.

Some bones lack the tracer indicating a "cold spot". Cold spots may be caused by a certain type of cancer or lack of blood supply to a bone.

The body rids itself of the injected radioactive tracer thru urine or stool and is usually eliminated over a period of 24 hours.           

Back & Neck Pain

Causes of back pain

Muscles/Ligaments

There are many causes of back pain, the most common of which is a sprain or strain of muscles or ligaments. Muscle spasm can occur after twisting or bending awkwardly, or from a simple sneeze or cough. The majority of muscle spasms tend to get better over time. Severe cases of muscle spasms are treated with medication, physical therapy, or injections.

Discs

Disc Degeneration
Disc problems are common causes of back pain. Discs are usually moist, like a sponge with water in it. After a disc injury, or as we age, discs lose water and deteriorate in a process called disc degeneration.

The earliest form of injury to a disc is in the form of tears or fissures in the annulus fibrosis (outer portion) of the disc. The annulus fibrosis is like a large round ligament that prevents the nucleus pulposus (inner portion) of the disc from pushing outward. Tears in the annulus heal by scar formation resulting in tissue that is not as strong as normal tissue. The repeated cycle of many annular tears healing by scar formation lead to a disc that begins to degenerate.

As a disc degenerates it becomes stiff, narrows, and losses it's ability to act as a shock absorber. Bone from the vertebrae above and below the disc may grow forming bone spurs. If bone spurs get large enough, they may cause pressure on nerves in the spinal canal, causing pain, numbness, and weakness in the arms or legs. The combination of disc degeneration and bone spur formation in the spine is called spondylosis. Any narrowing within the spinal canal, from bone spur formation or from any other cause is called spinal stenosis. Spondylosis or spinal stenosis can occur at any level in the spine-cervical, thoracic, or lumbar.

Bulging Disc, Protruding Disc, Herniated Disc, Extruded disc
Over time, because of injury or degeneration, discs start to change shape. Many terms describe this change in shape including bulging, protruding, herniated, prolapsed, slipped. They generally describe a disc that is displaced beyond the limits of the intervertebral disc space.

The earliest change in shape many times is in the form of a disc bulge-a wide based extension of the disc. Often, disc bulges do not cause pain. As the degenerative process progresses, the central, nucleus pulposus portion of the disc can extend through a tear in the outer annular wall of the disc, resulting in a focal protrusion or herniation of the disc. Disc protrusions can cause symptoms of pain, numbness, or weakness from nerve root pinching. In some individuals however, disc protrusions will not cause any symptoms. A disc extrusion is a severe version of a disc protrusion in which a large portion of the nucleus pulposus is displaced through the wall of the disc. A disc extrusion is almost always symptomatic.

Facet Joints

Lumbar facet joint are small pairs of joints on the back side of the spine where the vertebrae meet. These joints provide stability to the spine by interlocking two adjacent vertebrae. Facet joints also allow the spine to bend forward (flexion), bend backward (extension), and twist.

Inflammation of facet joints can occur from injuries or from arthritis. Many times, particularly in the case of injuries, one may not see abnormalities on an x-ray or MRI.

Spinal Stenosis
The term lumbar stenosis refers to any narrowing of the spinal canal. There are many causes of spinal stenosis; the most common is degeneration of the spine, which occurs almost inevitably as a part of the aging process.

Several factors contribute to the narrowing of the spinal canal with degenerative changes. First, wear and tear causes the facet joint to enlarge into the spinal canal. Second, the major ligament of the spinal canal, the ligamentum flavum, undergoes hypertrophy (enlargement) and buckling. Third, the intervertebral discs may bulge backwards or herniate into the canal. Fourth, the vertebrae may slip forward in a condition called spondylolisthesis. Finally, these changes may be superimposed on a congenitally narrow canal.

The hallmark of lumbar stenosis is pain in the back and legs which is aggravated by standing and walking and relieved by sitting or forward bending. The syndrome of pain induced by walking is known as neurogenic claudication (from the Latin claudico, to limp). Neurogenic claudication must be distinguished from is vascular claudication, or leg pain on walking caused by insufficient blood flow to the legs. The features which help to distinguish neurogenic from vascular claudication are the following:

1. Pain occurs after varying amounts of exercise, with standing, or with coughing. Vascular claudication is reliably produced with a fixed amount of exercise, such as walking a certain number of blocks, and is rare at rest.
2. Pain relief with rest is variable and slow, usually requiring sitting or stooping. Resting in a standing position is usually not enough to relieve the pain and may even aggravate the pain. In contrast, the pain of vascular insufficiency is usually quickly relieved by resting in a standing position. This is the main distinguishing feature.
3. Pain from spinal stenosis is usually in a distribution of a spinal nerve rather than the muscles exercised.
4. Sensory loss is also in a nerve root distribution, while with vascular insufficiency it is in a stocking-glove distribution.
5. Signs of vascular insufficiency should be absent: diminished pulses, foot pallor on elevation, and decreased temperature of the feet.

Spondylolysis and Spondylolisthesis
The most common cause of low back pain in adolescent athletes is a stress fracture in one of the vertebrae that make up the spinal column. Technically, this condition is called spondylolysis (spon-dee-low-lye-sis). It usually affects either the fourth or the fifth lumbar vertebra in the lower back. The fracture site is called a pars defect.

If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the top vertebrae can shift forward on top of the bottom vertebrae. This condition is called spondylolisthesis (spon-dee-low-lis-thee-sis).

In adults, a spondylolisthesis is usually caused from degenerative changes in the spine. If too much slippage occurs, the bones may begin to press on nerves and surgery may become necessary to correct the condition.

Causes

• Genetics: There may be an inherited aspect to spondylolysis. An individual may be born with a thin vertebral bone and therefore may be predisposed to this condition. Rapid growth spurts in a teen may also encourage slippage.
• Overuse: Several types of athletics, such as gymnastics, weight lifting and football, put a great deal of stress on the bones in the lower back. They also require that the individual constantly over-stretch (hyperextend) the spine. In either case, the excessive stress can lead to fractures of the vertebrae.
• Spondylolisthesis may also develop because of degenerative changes in the vertebral joints and certain medical conditions such as cerebral palsy.

Sacroiliac Joints
The sacroiliac joint connects the sacrum (the triangular bone at the bottom of the spine) with the pelvis (iliac crest). The joint:

1. Transmits all the forces of the upper body to the pelvis (hips) and legs
2. Acts as a shock-absorbing structure
3. Does not have much motion

The sacroiliac joint can become inflamed from an acute injury or from chronic postural abnormalities such as undue stress on the joint following low back fusion surgery. Pain from sacroiliac joint abnormalities can occur in the low back, buttock/hip, abdomen, groin, or legs.

Ankylosing Spondylitis
Ankylosing spondylitis primarily affects the spine or back. In a person with ankylosing spondylitis, the joints and ligaments that normally permit the spine to move become inflamed and stiff. The bones of the spine may grow together, causing the spine to become rigid and inflexible. Other joints such as the hips, shoulders, knees, or ankles also may become involved.

Other rare causes of back pain include:

• Benign or malignant tumors
• Infections
• Problems of the digestive tract or genitourinary tract
• Vascular problems such as an aneurysm or hardening of the arteries 

Social Security Disability Benefits - Waiting: Survival Skills

Anyone who practices social security disability law understands the truth behind this articles subject.  For many, waiting for Social Security Disability (SSD) benefits, depending upon your support system, is a time that can be a horrifying and scary experience. 

You all have survival skills and many of you are not aware that you have them. Sometimes we do not become aware of them until we are faced with a very serious situation. 

Many of you believe that life will "swallow you up" if certain events happened. I think you would be surprised and many of you already realize this as you yourself have survived horrible situations. 

I want to give you an example of some survival skills I found in myself that I had no clue were there during a time in my life when I was very ill and my life was falling down all around me.

My point in sharing this is to point out that most of us would feel that we would crumble inside in certain situations but our survival skills kick in and we get through these times.

Patty Fleener shares her experiences for this article.

Let me paint the picture as quickly as I can. I was 39 years old (I'm 47 now). This happened directly before I met my husband. I had applied for SSD 3 times and two times went back to work, not finishing the application process. I had a difficult time "giving up." As a result I accrued many bills. 

The third and final time I applied, I was denied temporary funds while waiting for SSD. Strange because I was accepted the first two times but this new psychologist said I could go back to work within one year. Later I learned she said that about everyone and she even wrote in my report that because I was a social worker I would know how to fake an evaluation. She had to amend her evaluation later because the man that referred me advised her that I presented well and advised her of what she missed about me.

Anyway, I had zero money to live on while waiting to see if SSD would accept me and in most cases SSD does not accept people the first time you apply. 

I had food stamps and it took awhile to be accepted into the county housing program. I had to find a place to live where the rent was $400. or below and it could not be in the town of Salem where I lived as it was a county program. 

I gave plasma at the plasma back and received $5 or $10 up to $20. each time and I could only donate twice per week. I thought I would never do this but I turned my mind around and told myself I was helping others and I was. This was my gas money.

I searched and searched for a place to live for that amount or less. Nothing existed! I had a deadline to meet as I was of course being evicted from my apartment. 

Inside I knew there was a real reality that I could be homeless. It was hard to believe, as I was 39 years old, educated, etc., however I was disabled period.

Each morning I woke up and I realized the full extent of the trouble my life was in. I knew very well that I would be homeless if I became weak or fragile, which I truly was. I knew I had to search deep within for any ounce of strength and use it. 

When I woke up, inside my head I said to myself "Stand!" I said it to myself very sternly. I saw myself in my mind as someone who was made only of strength and I was powerful and I could get through anything. Any other feeling or thought besides this was totally dismissed because my strength that I imagined within was so strong and powerful it would simply stomp any "lesser feelings."

It is also very important to know that I am a Christian and during this whole time I prayed quite a bit. The thing that assisted me a great deal is the tremendous amount of faith I have in God to come through for me and He did. 

Months later I was accepted to SSD and a few months after that my relatives began to come to me. I had to work hard to get my father back as I had really raged at him. It wasn't until he began to hang up on me did I realize that I could not have him in my life unless I treated him with respect. (By the way, I am not recommending this to you parents out there. All of us with the BPD are different and your child may be suicidal when they call. So, it is different with each one of us).

It wasn't until I was safe that I unconsciously began to give up the "warrior" role I worked hard to develop. It took me at least a year after this experience before I really felt safe. I can't tell you how many dreams I have had about this.

The message in this story is that I believe we are designed to meet with hard challenges if we look deep within and BELIEVE that we are warriors.

Though this article may seem extreme to most, for those who have experienced the months waiting for the case to pass from the initial application, reconsideration and finally the long wait for hearing, many of Ms. Fleener's experiences may be all too real.

At MN Disability, attorney Tom Atkinson isn't focused on getting you benefits at the hearing, he does his best to prepare you case from the very beginning in the hopes of an award at the time of initial application.  Though this is an admittedly difficult task, his personal attention to your matter from the onset gives you every advantage possible by having a LOCAL Minnesota attorney represent you in your application for Social Security Disability benefits.  Contact him today for more information.  651-324-9514 or tom@mndisability.com  You can also find out more about his social security disability practice at www.mndisability.com

Medical Evidence of Disability

Medical evidence is the cornerstone for Social Security’s determination of your disability. A qualified Social Security Disability lawyer can explain how the benefits process works and save you time and effort.

Each person who files a disability claim is responsible for providing medical evidence showing that he or she has an impairment and how severe that impairment is. It is always best for your doctor to provide detailed records of your condition, along with an explanation of how it limits your ability to work or perform everyday tasks.

The medical evidence can also come from other “acceptable medical sources” depending on what condition has caused your impairment.

Acceptable Medical Sources

The Social Security Administration (SSA) defines “acceptable medical sources” as medical professionals including:

* licensed physicians (doctors)
* licensed or certified psychologists. Included are school psychologists or other licensed or certified individuals with other titles who perform the same function as a school psychologist in a school setting, for purposes of establishing mental retardation, learning disabilities and borderline intellectual functioning only.
* licensed optometrists, for purposes of establishing visual disorders only (except, in the U.S. Virgin Islands, licensed optometrists, for the measurement of visual acuity and visual fields only)
* licensed podiatrists, for purposes of establishing impairments of the foot, or foot and ankle, depending on whether the state in which the podiatrist practices permits the practice of podiatry on the foot only, or the foot and ankle
* qualified speech-language pathologists, for purposes of establishing speech or language impairments only. For this source, “qualified” means that the speech-language pathologist must be licensed by the state professional licensing agency, or be fully certified by the state education agency in the state in which he or she practices, or hold a Certificate of Clinical Competence from the American Speech-Language-Hearing Association.

Evidence from Treating Sources

SSA regulations place special emphasis on evidence from treating sources because they are likely to be the medical professionals most able to provide a detailed assessment of the claimant’s impairment and may bring a unique perspective to the medical evidence. Timely and accurate reports from treating sources are essential for accelerating the claims process.

Medical Evidence From Health Facilities

Social Security will also request copies of medical evidence from hospitals, clinics or other health facilities where you have been treated. All medical reports received are considered during the disability determination process.

Other Evidence

Information from other sources may also help show the extent to which a person’s impairment affects his or her ability to function in a work setting; or in the case of a child, the ability to function compared to that of children the same age who do not have impairments. Other sources can include: public and private agencies; non‑medical sources such as schools, parents and caregivers, social workers and employers; and other practitioners such as naturopaths, chiropractors and audiologists.

Choosing a Social Security Disability Attorney

Did you know that many firms and national companies don't even have an attorney representing you in your application for social security disability benefits? Often a long term disability (LTD) carrier will hire a large national chain with a representative you will NEVER meet and isn't an attorney.

Most Social Security applicants (and some of these large national companies) don't understand what is required in successfully presenting their case in front of an administrative law judge. First, it is important to understand that it is normally not enough to prove that you can't work at your last job. Instead you must prove that you have a "medically determinable disability" which prevents you from engaging in any "substantial gainful employment". The word "substantial" is important because you can earn a small amount of wages and still be eligible for disability benefits. The amount is set by the Social Security Administration and can change from time to time. If you are already engaging in substantial employment, then you are not eligible to obtain disability benefits.

Secondly, there are regulations that Social Security attorneys refer to as "the Grid". The Social Security Administration recognizes different standards for claimants of different ages, levels of education and work backgrounds. Once the appropriate standards are determined, an attorney can determine whether the medical records are adequate to support the claim for disability. If not, an attorney may pose specific questions to a claimant's treating doctor(s).

Thirdly, it is important for an attorney to help his client quantify his complaints in a specific manner. A claimant may be asked, "How much can you lift". A bad answer would be "not very much". An answer like this doesn't help to describe the claimant's limitations. It should be noted that Social Security judges refer to something called "The Dictionary of Occupational Titles" for job information. This source describes the exertional requirements of all classified jobs that exist in the national economy. It is up to the claimant's attorney to prove that his client can't perform any substantial work for which he is qualified. In addition, "Social Security Judges" will often bring "vocational rehabilitation counselors" into a hearing in order to get clarifications as to the claimant's "work background", "work restrictions" and the requirements of various jobs. An attorney must be prepared to effectively challenge the vocational counselor's testimony through effective cross-examination.

Finally, Social Security Hearings are informal and usually take about an hour, although they can vary in length, depending on the judge's format and the complexity of the case. Be sure to dress appropriately, as it is important to create a favorable impression. In short, preparation is the key to winning your case, so talk to your attorney ask him what you can do to help your cause. The lawyers at MN Disability & Atkinson Law Office are ready to assist you in ALL aspects of your application from the “Initial Application” up to an including any necessary appeals. Feel free to contact attorney Tom Atkinson directly at 651-324-9514 or tom@mndisability with any questions. Also visit our web site at www.mndisability.com

Welcome to Minnesota Social Security Disability Secrets

Social security disability can be an imposing hurdle to the average person. FACT - A large percentage for individuals who initially file for social security disability are DENIED the first time. FACT - Many of these people give up and never try again. Fortunately MN Disability and Atkinson Law Offices can show you that the initial application is often only the first step to obtain social security disability benefits. At MN Disability we will have LOCAL MINNESOTA attorneys assist you from the the initial application through the appeal process. You won't be working with a telephone representative from across the country who likely isn't even an attorney. Your first meeting and every other meeting after that will be with a Minnesota attorney with nearly two decades of experience as an attorney working with injured and disable Minnesotans! Contact Attorney Tom Atkinson today to have him review and assist with your application OR appeal for social security disability benefits. 651-324-9514