Dr. Uday Doctor has once again been named a Texas Super Doctor. Marking his fourth year on this prestigious list, this honor first begins with a simple question to the physician community: “If you needed medical care in one of the following specialties, which doctor would you choose?” SpineCare Consultants is proud to have Dr. Doctor recognized by his peers as a Texas Super Doctor!
1) How do you diagnose whether the pain I have is coming from the shoulder or the neck?
We use a continuous x-ray machine and place an anesthetic inside the shoulder joint. We then assess the patient to see if the pain is gone. If the pain is not significantly better, we know there is another reason for the shoulder pain. We will then place an anesthetic and steroid on the nerve that goes from the neck to the shoulder. If the pain is gone within ten to fifteen minutes after this procedure, we have a diagnosis of a cervical nerve that is creating “referred” pain to the shoulder.
2) Who is a good candidate for these procedures?
Persons who have experienced any of the following are good candidates for our procedures:
a) If you have had constant shoulder pain that has not responded to conservative care, including rest, medications, physical therapy, and/or chiropractic care over a four week period
b) If you have had surgery on your shoulder and still have shoulder pain
c) If your shoulder pain limits your normal functions and keeps you from enjoying a full active lifestyle
3) Why do the procedures give long-term relief if the steroid is gone in a week?
Long-term relief from the injection can be achieved just because we are able to eliminate the inflammation. Remember, a lot of people have degenerated shoulder joints and cervical discs, but they only have pain when a structure in their shoulder or neck becomes inflamed. Most of our patients report relief that lasts from months to years. One of the most important ways to get long-term relief after the pain is to work on body mechanics and posture, which will keep the structure that was creating your pain from becoming inflamed again.
4) What can I do to keep the pain from reoccurring?
Using proper body mechanics and posture are the most important things to remember. The cervical discs are located in the front of the spine right behind your voice box. That means every time you bend your head down to look at your phone, look at your computer, or read a book, you put a lot of pressure on the discs, which in turn can lead to degeneration of the discs in the neck over a period of time. Look at the section on “tips for a healthy neck” in this newsletter for specific things you can do to avoid putting stress on your spine.
5) You do not perform pain management techniques, such as series of epidural steroid injections, Botox injections, and trigger point injections in the neck. Is there a reason why you avoid doing these types of procedures?
These procedures are based on chronic pain management techniques where the main goal is to have ongoing long term care of the patient. There is absolutely no diagnostic information gained by these procedures, and they really just mask the problem. Our main goal is to either eradicate the pain long-term or locate the exact issue creating the pain and have it fixed.
There are many possible causes of pain in the shoulder, but the two main problems that create pain in this area is inflammation in the shoulder itself, or a nerve in the neck that refers pain to the shoulder. Diagnosing pain in the shoulder area may be difficult at times due to the fact that as we age there will be wear and tear in the shoulder joint without creating pain.
The same type of changes will occur in the neck with all of us gradually having herniated discs and arthritis, causing only minimal discomfort unless a specific structure in the spine is actually inflamed. 50% of all people aged 50 and above have been found to have significant changes by MRI with no pain. This is the reason why just getting an MRI of the shoulder or neck will not give you an answer.
Our goal at SpineCare Consultants is to locate the exact structure that is inflamed and eliminate your shoulder pain. This information can then be used to make the right decisions when it comes to therapy, exercises, and, if needed, surgery. The most important thing to realize is that you usually hurt only because there is a structure either in your shoulder or neck that is inflamed, and if we can eradicate the inflammation, you have the possibility of long-term relief.
It’s not uncommon today to walk into a room and see the majority of people looking down at their phone. Surely that can’t be doing any good for the neck and spine! As mentioned in a Forbes article, a new study by Dr. Kenneth Hashraj, The Chief of Spine Surgery at the New York Spine Surgery and Rehabilitation Medicine, discusses the effects of prolonged phone use.
The human head generally weighs between 10-12 pounds. When looking down at your phone, the spine and neck is under stress, causing extra strain, damaging your posture as well as spine. The force of the cervical spine (neck) increases as you move your neck forward at different angles. “The force increases by about 27 pounds at a 15-degree angle, 40 pounds at a 30-degree angle, 49 pounds at a 45-degree angle and 60 pounds at a 60-degree angle.” This poor posture associated with looking down at your phone is known as “text neck.”
“It is an epidemic or, at least it’s very common” mentions Dr. Hashraj in an interview with The Washington Post.
You may enjoy texting, tweeting, or talking while on your phone, but “text neck” may cause degeneration of the spine. You may be doing more harm than good, leading to spinal care much earlier on in life. “Text neck” will cause damage to the spinal tissue, causing it to stretch and making the tissue sore and inflamed.
Dr. Hashraj goes on to mention, “The ‘text neck’ effect is comparable to bending a finger all the way back and keeping it there for around an hour.” This image alone is disturbing as a picture of what is happening to the spine.
Even though it may be impossible to stop tilting your head forward while using a mobile device, there are a few options to help ease “text neck”:
1) How do you diagnose whether the pain that I have in my hip is coming from my hip or my back?
Using a continuous x-ray machine, I place an anesthetic inside of the hip joint. I then let you walk around over the next ten to fifteen minutes while the inside of the hip is numb. If you notice that your hip pain is gone, we now know that the pain was coming from the hip. If you still have pain, I know that the pain is likely coming from the lumbar spine. If the pain in the hip area is not gone, I will go ahead and put the local anesthetic and anti-inflammatory medication on the nerve in the lumbar spine that goes to the hip. If the hip pain goes away immediately after doing that, I know that the hip pain is actually coming from the lumbar spine.
2) Is it possible to have problems with both my hip and back at the same time?
Yes, it can happen, but usually when patients have this type of pain, what we find is that the majority of the pain is coming from one area. It is very important to know exactly where your pain is coming from because this will determine the therapy, exercises, and possible surgical options.
3) Will your procedures make my pain go away and for how long?
The pain will go away once we locate the exact cause of your pain. The duration of the pain relief is dependent on how severe the level of degeneration is, whether it is in the spine or the hip, and if you follow the instructions given to keep from re-aggravating your spine or hip. What you need to remember is that ALL of us are going to have degeneration in our spine as we age and luckily we will not have any pain until we get that structure inflamed. If I can eliminate the inflammation and teach you proper body mechanics and exercises to strengthen your spine, you will have a better chance of an extended period of relief.
4) Can I have the treatments repeated if necessary? Why do you not do series of injections a week apart?
These procedures can be repeated several times a year, if necessary, but we usually do not have to do this that frequently. If we can treat the exact structure and change the way the patient moves and exercises, we can usually limit the number of procedures. If we have to keep repeating the procedure, we try to see if there is a surgical fix. The good news is that since we know the exact cause of the pain, it makes the surgeon’s job so much easier.
Doing a series of injections was something we did many years ago when we did not have a continuous x-ray machine. The steroids take at least two weeks to work and, therefore, there is absolutely no reason to do a second injection before two weeks is up. If you are much better from the first injection, I would not do a second injection.
5) I see advertisements for Laser and other procedures on the television and radio. What is the difference?
You live in one of the largest and best medical centers in the country. There are a lot of very good spine and neurosurgeons in the medical center. These physicians do not do any of these laser or other “procedures” that you see advertised on the internet, television, or radio. Be careful when physicians offer multiple procedures in a short timeframe. Why not wait to see how the first procedure works, which is going to take at least a couple of weeks, before having something else done?
Hip arthritis almost always creates pain in the groin. If you do not have groin pain, but have pain in the buttock or the side of the hip, the cause of your pain is almost always due to a herniated disc irritating a nerve or the hole where the nerve leaves the spine is narrowed and, therefore, pinching the nerve.
Pain in the groin can still come from your back. Almost all of the lumbar nerves that come from your back can create groin pain.
Pain in the buttock or side of the hip is almost always due to one of the lower lumbar nerves. You should also know that the word “sciatica” just means pain down the leg and it could be coming from the L4, L5, or S1 nerves.
