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“If you need hand surgery such as carpal tunnel surgery or cyst removal, you don’t necessarily have to go to the hospital to have it done. There’s a newer way to do hand surgery — in the doctor’s office with local anesthesia. Mary Ravasio Minard explains WALANT — wide awake surgery.”
Follow the link to watch it on Youtube
Background: Electrodiagnostic studies (EDX) serve a prominent role in the diagnostic workup of cubital tunnel syndrome (CBTS), but their reported sensitivity varies widely. The goals of our study were to determine the sensitivity of EDX in a cohort of patients who responded well to surgical cubital tunnel release (CBTR), and whether the implementation of the Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) criteria improves the sensitivity.
Methods: We identified 118 elbows with clinical CBTS who had preoperative EDX and underwent CBTR. The EDX diagnoses were CBTS, ulnar neuropathy (UN), and normal ulnar nerves. We divided the 118 elbows into those that received above-elbow stimulation (XE group) and those that did not (non-XE group). We calculated the sensitivities for all groups and reinterpreted the results according to the AANEM guidelines.
Results: Cubital tunnel release provided significant relief in 93.6% of the elbows. Based on the EDX reports, 11% patients had clear CBTS, 23% had UN, and 66% showed no UN. The sensitivities were 11.7% for CBTS and 34.2% for any UN. In the XE group, the sensitivity of the EDX reports for CBTS and UN climbed to 33.3% and 58.3%, respectively. When we calculated the across-elbow motor nerve conduction velocity, the sensitivity for CBTS and UN was 87.5% and 100%, respectively. The XE and non-XE groups showed no difference except for sex, bilaterality, concomitant carpal tunnel release, and obesity (P < .05).
Conclusion: Implementing AANEM guidelines results in significant improvement in correlation of clinical and electrodiagnostic findings of CBTS.
Presenting my ” Nerve Conduction Studies in Surgical Cubital Tunnel Syndrome” at the American Society for Surgery of the Hand, Boston MA.
Presenting my findings on “Hand and Upper Extremity Clinical Practice Guidelines” at the Cleveland Clinic 16th Annual New Technology in Upper Extremity: The Cutting Edge, with Advancing Translational Research
“Congratulations on being nominated and selected for the Carpal Tunnel Syndrome Appropriate Use Criteria voting panel.”
Adapted from Medscape
For several years, there has been a push to ban using powder in medical gloves. The US Food and Drug Administration (FDA) recently unveiled a proposal to ban powdered surgeons’ gloves and the absorbable powder lubricating them, as well as powdered gloves for patient examinations. Both synthetic gloves and those manufactured from natural rubber latex are covered.
Professional groups such as the American College of Surgeons, the American Academy of Allergy, Asthma and Immunology, and the American Nurses Association had already taken stands against powdered gloves. Government agencies such as the Centers for Disease Control and Prevention joined the chorus, as did the healthcare systems of Germany and the United Kingdom, as well as several healthcare organizations, such as Cleveland Clinic and Johns Hopkins, have either restricted or forbidden the use of these gloves.
Surgical gloves were first used in 1889, and soon, all sorts of lubricants were used to make them easier to don. Several studies has indicated respiratory complications.
Recent research at UC Davis Health System looked into two questions about knuckle cracking: What causes the “crack” sound, and does it damage the hand? Ultrasound evaluations showed that the knuckle–cracking sound occurs when gas bubbles form in joints very quickly — faster than the blink of an eye. The study also suggests that the “crack” is caused by bubble forming, rather than bubble bursting.
Examinations by hand specialists found no problems in the joints of knuckle crackers, a finding that contradicts a previous study that suggested that knuckle cracking may cause joint swelling and weaken grip.
Author’s note: I personally used to crack my knuckles. My 8-years-old don does that now. I keep telling him not to do it, but- I guess- I do not have a good reason anymore…
A team of researchers decided wanted to find out what people thought of doctors how that compared to … Santa.
The researchers showed a film in which a narrator dressed as either Santa Claus or a doctor and told an identical story.
1- Santa Claus was perceived to be friendlier.
2- Both were equally reliable….
Give it a Strong Handshake: Resistance Training Helps Hand Osteoarthritis
Adapted from the American College of Rheumatology
Resistance strength training reduces pain and increases function in patients with hand osteoarthritis, according to new research findings presented this week at the American College of Rheumatology Annual Meeting in San Francisco.
Several studies have shown the effectiveness of exercise therapy on osteoarthritis of the hips and knees. Researchers in Brazil shared the results of their study on the effectiveness of progressive resistance strength training on pain, function and strength in people with hand OA.
The researchers followed 60 participants — who had doctor-diagnosed hand OA for at least one year and who were experiencing pain in the joints of their fingers — for 12 weeks. One group followed a resistance exercise program for targeted at the small muscles in the hand and fingers the remainder of the study, and the second group did not.
The evaluators found that patients in the exercise group show better function, and less pain compared to group that did not follow the exercise program.
Dr Sraj’s Commentary: This article brings good news for patients of osteoarhritis of the hand. It does not, however, clarify which fingers or joints were involved and whether the two groups were comparable in this regards. Thumb arthritis and pinky arthritis have very different impact on hand function and pain, and this information is critical to determine the validity of the results.
During the WVOS board meeting today, past of the WV State Medical Association annual meeting, my proposal for “WVOS stance on Informed Consent” was approved by the Board.
From NBC news
Scientists have recently discovered the oldest known fossil of a hand bone to resemble that of a modern human. They suggest it belonged to an unknown human relative, much taller and larger.
A key feature that distinguishes humans from all other species alive today is the ability to make and use complex tools. This capability depends not only on the brain,but also on the dexterity of human hands. Human hands allow a variety of grips and manipulation. This manipulation capability together with brain power allowed to tools, which in return helped develop intelligence.
For more details check out Nature Communications.
At the15th Annual New Technology in Upper Extremity Surgery, the Cutting Edge, Cleveland OH.
The Struder Conference I attended end of last month covered medical leadership, hospital administration, and costumer service. It was one conference that was all about healthcare but none about medical care! It emphasized that there is a lot more about care than medicine; more to treating people well than prescriptions and injections. I left the conference the same medical doctor but a much better healthCARE provider.
Title: written Informed Consent- Requirement or Interpretation?
Adapted from National Public Radio
Hand transplants have been controversial for decades because, to prevent rejection, patients have to take powerful drugs that suppress the immune system and prevent it from attacking the transplant hand.
Until now, everyone who’s had a hand transplant got it because of an accident, or an illness. Would you request a transplant hand because of a birth defect?
The situation may be different, and Ethics specialist are looking into it.
Patients with birth defect had had lived their whole childhood with their defect and had adjusted well to it for the most part. Besides, a hand transplant could end be a huge disappointment. The patient has to accept somebody else’s body part as their own, especially that the transplanted hand is visible, compared for heart and lung transplants. The first person to have hand transplant surgery couldn’t get used to having someone else’s hand; he ended up asking his doctors to remove it.
Besides no one knows whether the patient’s brain is even wired to use a new hand- there was never one on that side since before birth!