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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.
Adapted from NPR
Cornell University just made a robot hand with a soft touch. it is not just soft, but it can also sense the shape and texture of what it comes into contact with.
Welcome to the growing field of soft robotics.
For more information about soft robotics and their development with human interaction, follow this link.
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.”
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.
At the15th Annual New Technology in Upper Extremity Surgery, the Cutting Edge, Cleveland OH.
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!
Wonderful course. I learned a lot.
I am excited to be joined the medical students from the West Virginia School of Osteopathic Medicine starting January 2015. My colleagues and myself met with the State wide Campus Director and the Regional Assistant Dean earlier this week and agreed to offer the 3rd and 4th year medical students an elective in Orthopedic Surgery. We already received the first request!
From: Am J Orthop <em>
Date: Thu, Oct 2, 2014 at 9:21 PM
I am pleased to inform you that your manuscript entitled “CASE REPORT: Osteoid Osteoma of the Talar Neck with Sub-Acute Presentation” has been approved for publication in The American Journal of Orthopedics.
I am an international medical graduate (IMG) and I completed my residency program outside the USA. The new fellowship eligibility requirement would have prevented me from pursuing fellowship training in the United States, and I would not have been practicing orthopedic surgery in the United States. For more details, check the original paper- The International Orthopedic Surgery Fellow: The Beginning of the End, published August 2014
Presenting “Providing Upper Extremity Care to the Incarcerated- Obstacles and Challenges”.
published March 2014.
If you want to discourage a worker, subject them to policies and procedures that don’t make sense.
Unfortunately, this is being widely applied today in medicine. Changes in healthcare payment systems, the use of information technology, and the doctor-patient relationship have left many doctors deeply discouraged.
Consider these examples.
A physician taking a patient’s history points and clicks a computer form to record information, but many parts of the patient’s story are lost because they don’t fit the template.
A physician trying to learn more about a patient’s prior hospital admission can’t find the information she needs because the record is an example of “note bloat”.
My personal (Shafic Sraj) take on electronic records-
While I am a strong advocate of encorporating technology in medical documentation, I find myself forcing my note into the electronic format available, and not able to find a format that would fit into my way of recording a medical note There is a lot more to put in a note than filling and editing templates. Building and customizing your own is restricted, difficult, and time-consuming. I hope this is just growing pain, and that a day will come when I won’t have to spend as much effort entering information into the medical record. Hopefully before it is time to retire, that is…
Some people 3D- print weapons. Others 3D-print arms.