Sunday, October 30, 2011

Diagnosis - Thoracic Outlet Syndrome

Thoracic Outlet Syndrome

Thoracic outlet syndrome is a type of Brachial Plexus lesion involving compression of the neural (nerves) and/or vascular (blood vessels) structures between the rib cage, collar bone and neck:

Compression can occur at 3 sites:

1.) At an abnormal cervical rib.
2.) At the clavicle (collar bone).
3.) At the anterior muscles of the neck called the Scalenes.

Pain, numbness/tingling in the pinky and ring fingers (4th and 5th digits) and the inner forearm. Pain and tingling in the neck and shoulders areas which can be worsened by carrying something heavy. Poor circulation in the hand or forearm (a bluish color, cold hands, or a swollen arm.) Weakness of the muscles in the hand and arm.


Sporting injuries, trauma such as Whiplash resulting from car or motorcycle accidents, poor posture, carrying heavy backpacks, birth trauma and other rare conditions such as tumors can cause Thoracic Outlet Syndrome.


Diagnosis of TOS is made by seeing a Doctor familiar with this condition which includes a thorough history, physical exam and Orthopedic and Neurologic tests and may include diagnostic tests such as: X-ray, MRI, CT angiogram and Electrodiagnostic evaluation (nerve tests).


In non-severe cases, most cases of Thoracic Outlet Syndrome can resolve without the need for surgical intervention. Chiropractic treatment includes: cervical spine and clavicle manipulation, soft tissue procedures such as transfriction massage or myofascial release, therapeutic exercises to stretch the scalene muscles and postural exercises.

At Peninsula Spine & Sports Rehabilitation in San Mateo, we offer a Chiropractic solution which is unique in that it addresses the osseous (bony) and soft tissue causes of Thoracic Outlet Syndrome. This condition is becoming increasingly prevalent due to poor posture associated with long term computer use. Call us at (650) 347-2225 for your initial consultation with Dr. Hindocha.

Recovery of Brachial Plexus Lesions Resulting from Heavy Backpack use.

From: BMC Musculoskeletal Disorders. 2011;12(1) © 2011 BioMed Central, Ltd.

Brachial plexus lesions as a consequence of carrying a heavy backpack have been reported, but the typical clinical course and long-term consequences are not clear. Here we evaluated the clinical course and pattern of recovery of backpack palsy (BPP) in a large series of patients.

Eighty percent of the patients recovered totally within 9 months after the onset of weakness. Prolonged symptoms occurred in 15% of the patients, but daily activities were not affected. The weight of the carried load at the symptom onset significantly affected the severity of the muscle strength loss in the physiotherapeutic testing at the follow-up. The initial electromyography did not predict recovery. Genetic testing did not reveal de novo hereditary neuropathy with pressure palsies.
Conclusions: The prognosis of BPP is favorable in the vast majority of cases. Electromyography is useful for diagnosis. To prevent brachial plexus lesions, backpack loads greater than 40 kg should be avoided.

What is a Brachial Plexus injury ?

A brachial plexus injury is an injury to the the network of nerves that sends signals from your spine to your shoulder, arm and hand. A brachial plexus injury occurs when these nerves are stretched or, in the most serious cases, torn. This happens as result of your shoulder being pressed down forcefully while your head is pushed up and away from that shoulder.  

Brachial Plexus injuries arise from: contact sports, poor posture, heavy backpack use (above), Whiplash injuries arising from auto or motorcycle accidents, infants can acquire this condition during birth and other rare occurrences such as tumors.

Most Brachial Plexus lesions are treated conservatively (with therapy and/or rest) but severe lesions require surgical intervention.


Neck pain, burning, numbness/tingling and/or weakness into one or both arms.

One of the most common forms of Brachial Plexus lesions is a condition called Thoracic Outlet Syndrome which will be discussed in a separate post. 

At Peninsula Spine & Sports Rehabilitation is San Mateo, Dr. Hindocha offers Chiropractic treatment of non-surgical Brachial Plexus lesions. Please call us at (650) 347-2225 for an initial consultation.

Saturday, October 29, 2011

Prevalence and Tracking of Back Pain From Childhood to Adolescence

It is generally acknowledged that back pain (BP) is a common condition already in childhood. However, the development until early adulthood is not well understood and, in particular, not the individual tracking pattern.

Prevalence of neck pain, mid-back pain and low back pain was tracked in children ages 9, 13 and 15.

The results were:

The prevalence estimates for children at the ages of 9, 13, and 15, respectively, were for Back Pain 33%, 28%, and 48%.

For Low Back Pain: 4% (9 y/o), 22% (13 y/o), and 36% (15 y/o).

For Mid Back Pain: 20% (9 y/o), 13% (13 y/o), and 35% (15 y/o)

Neck Pain 10% (9 y/o), 7% (13 y/o), and 15% (15 y/o).

Seeking care for Back Pain increased from 6% and 8% at the two youngest ages to 34% at the oldest.

What are the causes of back pain which were dismissed as "growing pains" years ago ? Numerous studies have reported: Back Pack use, texting, use of computers and lap tops and sporting injuries.

One of the main reasons that Chiropratic has become an ever increasing utilized service is it's drugless approach which is embraced by more and more parents and Pediatricians. Adolescents and teens typically have a very quick response and it is our hope that early spine care can stave off more serious spine problems in adulthood.

At Peninsula Spine & Sports Rehabilitation in San Mateo, Dr. Hindocha treats adolescents and teenagers with neck, mid-back and low back problems with gentle Chiropractic therapy including: therapeutic exercises and gentle soft tissue procedures. Dr. Hindocha's experience has been adolescents and teens respond very quickly to Chiropractic therapy. We are located in San Mateo, CA, and offer gentle Chiropractic therapy. Talk to your Pediatrician today !

Does eating chocolate lower stroke risk ?

Chocolate lovers may have another reason to indulge. A new study shows that consuming chocolate on a regular basis may decrease stroke risk by 20%.

According to a recent study published in the October 18 issue of the Journal of the American College of Cardiology.

Chocolate is thought to have cardiovascular benefits resulting from the flavonoids in cocoa that have antioxidant properties. Antioxidants protect the body from damage caused by free radicals and can suppress oxidation of low-density lipoprotein. Dark chocolate consumption has also been shown to reduce blood pressure, which is a strong risk factor for stroke, as well as improve endothelial and platelet function and heighten insulin resistance.

Interestingly, women with hypertension had a reduction of stroke risk with chocolate consumption that was not statistically significant, whereas those without hypertension had a statistically significant risk reduction for stroke

Alcohol & Sleep ?

Alcohol is often used by patients as a sleeping aid. Many patients say they have a drink to relax and help them sleep; yet those same patients often complain of sleep problems. Alcohol's effect on sleep has been extensively studied for more than 50 years. Certainly, it can help you get to sleep more quickly, but then its effect wears off and it can disrupt sleep.

They studied nearly 100 healthy adults; two thirds were women and one third were men. Participants were given either a placebo or an alcohol drink. Breath alcohol concentration was measured and those getting alcohol had to drink until intoxicated. They also filled out a questionnaire about sleep, both at bedtime and the following morning. Polysomnography was performed to monitor sleep patterns. The results showed that sleep quality ratings were worse for those drinking alcohol compared with those getting sham alcohol. There was also a sex difference. Women who had taken alcohol slept worse than the men who imbibed. The female drinkers had fewer hours of sleep and it was more disrupted. They woke more often and for longer periods. Researchers say the reasons could be explained by sex differences in alcohol metabolism.

Friday, October 28, 2011

Yoga, Stretching Ease Chronic Low Back Pain

An online study published on October 24 in Annals of Internal Medicine found that stretching, regardless of whether it is achieved via yoga classes or conventional stretching exercises, has moderate benefits in adults with moderately impairing chronic low back pain.

In a comparative effectiveness study, researchers found that yoga classes were more effective than a self-help book, but not more effective than stretching classes, in improving function and reducing symptoms resulting from chronic low back pain, with benefits lasting at least several months.

These results are encouraging and at Peninsula Spine & Sports Rehabilitation, I have encouraged my patients to take a more active role in managing their chronic low back pain.

If you suffer from Chronic Low Back Pain, we have had success in eliminating or greatly reducing symptoms and increasing our patients quality of life. We are located in San Mateo & San Francisco and we offer Chiropractic treatment with physiotherapy including core and cervical stabilization exercise programs and Spinal Decompression Therapy in San Mateo utilizing the VAX-D. Call us today for a consultation at (650) 347-2225.

Thursday, October 27, 2011

Epidural Steroid Injections for Chronic Low Back Pain

An interesting study published in the British Medical Journal on the effects of Epidural Steroid Injections for Chronic Low Back Pain. Here are the highlights:

Epidural injections involve injection a steroid mixture into the Epidural space near the irritated nerve root. Participants received two injections with a two week interval.

A total of 116 participants were included in the study and they were split into 3 groups:

1.) Subcutaneous "sham" injections of 2 mL of 0.9% Saline solution (salt-water).
2.) Epidural injection of 30 mL of 0.9% Saline solution (salt-water).
3.) Epidural injection of 40 mg triamcinolone acetonide in 29 mL 0.9% saline.


All groups improved after the interventions, but we found no statistical or clinical differences between the groups over time.

At Peninsula Spine & Sports Rehabilitation, we offer a non-surgical treatment of chronic low back pain in San Mateo, CA. We offer VAX-D spinal decompression to treat chronic low back pain from: Sciatica, Herniated Discs, Degenerative Disc Disease, Spinal Arthritis. Please visit our Spinal Decompression website or schedule an appointment for your chronic low back pain treatment in San Mateo at (650) 347-2225.

Consumer Reports rates Chiropractic for high patient satisfaction.

Buying a new car ? TV ? Digital camera ? Where do we turn to ? The choice is clear, most people will research their next big purchase on the internet. There are many great review sites available such as Yelp, CNET and of course Consumer Reports.

Consumer reports conducted an online survey of more than 45,000 of their subscribers on Alternative Health Care usage. Here are some of the highlights:

Back Pain: 36% of survey respondents utilized chiropractic for back pain; 65% said it "helped a lot." Compare that with 38% of respondents who utilized prescription medications; 53% said it "helped a lot". 58% of respondents utilized over-the-counter medication with 28% stating "substantial relief".

Neck Pain: 41% of survey respondents utilized chiropractic for neck pain; 64% said it "helped a lot." Over-the-counter and prescription medications were the second and fourth most utilized treatment methods (56% and 33%), but only 39% (over-the-counter) and 25% (prescription), respectively, said the medication "helped a lot."

With statistics like these, should Chiropractic still be considered "alternative" treatments or is it time this becomes the first line of spine care  ?

Wednesday, October 26, 2011

Diagnosis - Arthritis


Arthritis is a general term referring to a joint disorder affecting one or more joints. There are over 100 different types of Arthritis including: Degenerative Joint Disease, Rheumatoid Arthritis, Gout, Psoriatic Arthritis, Stills disease, Ankylosing Spondylitis, etc.


Arthritis can be classified as: inflammatory (Rheumatoid), degenerative (Osteoarthritis) or metabolic (Gout).


The most common form of Arthritis is Degenerative Joint Disease (also known as Osteoarthritis, Spondylosis, Osteoarthrosis, Degenerative Osteoarthritis, Degenerative Osteoarthrosis).

Degenerative Joint Disease is the more accurate term, replacing Osteoarthritis, as Osteoarthritis indicates that it is an inflammatory arthritis which is incorrect.

Arthritis can be primary or secondary. Primary Osteoarthritis is idiopathic (no known cause). It is widely thought that this is caused by abnormal stresses on the joints which erodes the cartilage in a non-uniform fashion or normal stresses acting on "weakened" joints. Although aging does not cause arthritis, there is an association. Secondary Osteoarthritis results from chronic or sudden injuries to the joints such as: trauma, sporting injuries, repetitive stress injuries, poor posture, certain metabolic disorders (Gout) and many other factors.


Degenerative joint disease can affect weight bearing joints such as: knees, hips, spine as well as other joints such as: hands, fingers, shoulders and fingers.

Symptoms include: morning stiffness - due to the joints being relatively immobile at night, pain - due to cartilage erosion, less fluid in the joint space, "bone-on-bone" contact, less flexibility - due to cartilage erosion and "popping and crackling" of the joints - due to uneven cartilage erosion.


A thorough history and physical exam can help distinguish between primary and secondary arthritis. However, X-ray, MRI or CT scan will provide a definitive diagnosis.


Medical treatment involves the use of medication called NSAID's (non-steroidal anti-inflammatories). There has been some concern in the recent years due to long term use of these medications which have been linked to: ulcers, liver and kidney failure and cardiovascular events (heart attacks). Since Arthritis is a chronic disease, unfortunately, lifetime medication usage is the primary mode of treatment.

Chiropractic treatment focuses on spinal manipulation of the involved joints. Careful manipulation of the involved joints can decrease pain and restore motion.

Generally, many patients benefit from light exercises and the self-application of heat.

At Peninsula Spine & Sports Rehabilitation, we offer a non-surgical, non-pharmacological, treatment and rehabilitation of degenerative joint disease and degenerative disc disease. Please call us today at (650) 347-2225 for an initial consultation.