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WVU Medicine develops in-office surgery options

Dr. Shafic Sraj leads ‘Wide awake local anesthesia no-tourniquet’ surgery effort, which provides lower costs and more convenience to patients

Featured on wvnews.com

As featured on WVU News: “WALANT – Wide Awake Surgery at WVU Medicine”

From WVnews.com

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

https://youtu.be/PVHgYWxS25g

AAOS’s Innovation Theater a Huge Success

I am very pleased to share that our first-time Innovation Theater has been a huge success. I am proud to be a member of the AAOS Exhibits Committee and the chairperson for the Innovation Theater Sub-committee.

Pins and Needles

Adapted from BBC

Does it feel like pins and needles? (Credit: Science Photo Library)

Does it feel like pins and needles? (Credit: Science Photo Library)

Everyone has experienced that tingling sensation in the hands. It is commonly called “pins and needles” because it feels like tiny pointy needles. Some describe it as numb, or “falls asleep,” and is uncomfortable to place pressure on it.

The sensation itself is called “paresthesia,” or alternate sensation.

Sensation is transmitted from your body to your brain via nerves, your biological Internet cables. If you place too much pressure on one of them, the signal gets distorted. We call it Neuropathy, ie sick nerves. Once the pressure is relieved, it goes back online soon. If the pressure is not removed within reasonable time, it causes permanent change to the inner structure of the nerve and permanent change to the signal. More severe and long standing pressure can cause permanent loss of signal even. There are several nerves in the arm, and each may be subject to pressure at several spots. For more info, check the Numbness and Tingling page.

Athletic Hand Injury

Adapted in part from the Hospital for Special Surgery PlayBook

Sports related injuries can be the result of a single trauma or due to repetitive overuse. Certain sports such as boxing, basketball, and volleyball have greater risk of injury to the  bones, ligaments and muscles of the hand and wrist.

One common injury is a boxer’s fracture, which is a fracture of one of the metacarpal bones: it happens when your punch lands wrong.

Basketball and volleyball players frequently get ‘jammed’ fingers. This happens with a forceful encounter with the ball. There may be visible misalignment of the finger. A jammed finger can be anything from an innocent sprain to a bad fracture-dislocation requiring urgent surgery. 

Looks can be deceiving and these injuries should never be underestimated.It is easy but costly to dismiss a serious injury. If pain and swelling do not go away in reasonable time, you should seek medical attention including proper x-rays.

Appropriately sized, and well applied hand wraps and/or gloves protect the hands from such injuries, and proper training is essential to prevent such injuries. Some of these injuries come with an easy fix while others require surgery and dedicated hand therapy.

While still recovering, you may still work on staying in shape and game ready by running, working on lower body and strengthening your core.Your treating physician, together with your therapist, will set the schedule and time frame towards full use and will let you know when it is safe to start exercising your injured hand.If you do too much too soon and push through pain, you may be delaying your recovery or reversing the outcome of your treatment.

Titanium Rings

Adapted from NPR

Emergency room staff frequently have to remove rings and wedding bands of the fingers of patients when fingers swell up for any of several reasons. Finger swelling traps rings, which in return restrict blood flow, and cause even more swelling and pain. It not taken off in time, more severe blood flow restriction may lead to the loss of the finger- not fun.

Ordinarily, this wouldn’t be much of a problem. But… this was before Titanium rings became fashionable. Titanium rings are growing in popularity because they’re very strong, light, hypoallergenic and less expensive gold or platinum rings. But that strength makes them more difficult to remove, even with ring cutters. Sometimes bolt cutters have to be used as seen in this picture.

 

 

 

Your Chef is: a Pair of Robot Hands!

Adapted from NPR

Tim Anderson, a freelance chef who won the BBC’s MasterChef competition in 2011, donned a special pair of gloves and started cooking. Those were motion sensor gloves, and his moves were being recorded and coded- and the data was fed into the all new Robot Chef!

Anderson taught the robot how to prepare stir fry, sushi, steak, pasta as well as crab bisque. The plan is to teach the robot about 2000 dishes before releasing it to the public.

But don’t give away all your cookbooks just yet. The robot chef costs about $15,000.

Will A Transplanted Hand Feel Like One’s Own?

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!

Better Late than Never…

I forgot to post this at the time…Thank you from Cutting Edge Meeting 2014

Banning the Handshake From the Health Care Setting?

The handshake represents a deeply established social custom. In recent years, however, there has been increasing recognition of the importance of hands as vectors for infection, leading to formal recommendations and policies regarding hand hygiene in hospitals and other health care facilities.1 Such programs have been limited by variable compliance and efficacy. In an attempt to avoid contracting or spreading infection, many individuals have made their own efforts to avoid shaking hands in various settings but, in doing so, may face social, political, and even financial risks.

Particularly in the current era of health care reform, innovative, practical, and fiscally prudent approaches toward the prevention of disease will assume increasingly important roles. Regulations to restrict the handshake from the health care setting, in conjunction with more robust hand hygiene programs, may help limit the spread of disease and thus could potentially decrease the clinical and economic burden associated with hospital-acquired infections and antimicrobial resistance. Effective development and implementation of such a handshake ban will likely require further study to confirm and describe the link between handshakes and the transmission of pathogens and disease; the promotion of an alternative, health-conscious gesture to substitute for the handshake; and widespread media and educational programs.

via JAMA Network | JAMA | Banning the Handshake From the Health Care Setting.

Decide to Drive

Did you know:

  • 421000 motor vehicle crash injuries were related to distracted driving in 2011?
  • Eating is related to three-fold increase in risk of crashing a vehicle?
  • Risk of crashing increases 700% when a teen driver reaches a phone?
  • Texting increased risk of crashing a motor vehicle by 2300%?

Just Uploaded: 1-minute demonstration of needle Fasciotomy for Dupuytren Contracture

Getting Kids Started in Sports

Adapted From In Motion: Active Living for All Ages.

Sports is a fun way to introduce your child into a healthy lifestyle. Benefits of Sports are countless, and include promotion of growth and development, socialization and teamwork, development of self-esteem and goal setting, as well as providing a healthy alternative for less desirable engagements.

You can encourage your child to get involved by:

Staying fit yourself — Be a good role model. Your kids are watching you more than you think. If you have a healthy lifestyle, they are more inclined to emulate these positive exercise experiences.

Play sports with your child — Simple running, kicking a ball, or playing outdoor games, biking and swimming are fun experiences from which the child builds.

Free play — Under the age of five, free play is best and comes first. As the child grows, team sports participation can be introduced, usually around the age of 5 or 6. Before then, the attention span may not lend itself to team efforts, and stressing the child to be involved beyond his attention span can create an unwanted experience.

Expose your child to various sports — Taking the child to organized athletic events introduces the child to various team sports. You don’t have to take the child to a professional event. Merely taking the child to a little league soccer or baseball game may show them that other kids are doing physical activities and having fun.

Safety and proper couching —  It is important to be sure the child is in a safe environment with proper coaching and equipment needed for the sport. Parents should be supportive and let the child enjoy themselves. Positive reinforcement promotes self-esteem and confidence. Don’t put excessive pressure on the child. Keep it fun and safe.

Anabolic Steroid: A High Price Tag

From In Motion: Active Living for All Ages

 

Anabolic Steroids

Anabolic Steroids: Performance Enhancing But at What Cost?

The temptations of winning and of becoming bigger and stronger can be quite powerful. Performance enhancing drugs, especially anabolic steroids, have become widespread, including usage by non-athletes who want to improve their physical appearance. Younger athletes see their role models using these substances, only adding to their appeal. Unfortunately, anabolic steroids have potentially dangerous and permanent side effects…. Complete Article.

Supplements for Joint Pain?

Adapted from New York Times

People have wildly conflicting opinions about the benefits of nutritional suppliments marketed for joint health. These include glucosamine, chondroitin, and MSM, short for methylsulfonylmethane. Vendors promise they lessen creaking and soreness of knees, backs, hips and other joints.

The results of scientific studies of the supplements are equivocal. In the largest study to date, published in 2006, more than 1,500 adults with knee osteoarthritis were randomly assigned to receive glucosamine, a painkiller or a placebo. After 24 weeks, only those participants taking the painkiller reported less knee pain. Glucosamine was no more effective than a placebo.

Two years later, 600 of the participants had continued to take glucosamine, painkillers or a placebo. There still was no obvious benefit from the glucosamine.

Oral suppliments are very different from viscosupplimentation, which is the scientific name for joint injections of similar nature to joint fluid. Those, although sometimes disputed, have a well documented record, and may help when other treatments, including steroids injections, have failed.

When asked about joint suppliments, I tell people that if they have already tried them and found some relief, it is OK to continue. I do not actively recommend nor suggest them to patients. The only serious side effects that I know of is spending money!

Fragility Fractures

Fragility Fractures

A Fragility Fracture is any fracture that follows a low impact injury, typically, a fall from a standing height or less.

In healthy people, such falls should not cause any bone fractures. If this happens, irrespective caused the fall, one should wonder what made the bones fragile. The first fracture is a warning sign, and a very important one! One broken bone  is plenty, and all effort should me made to prevent a future, and potentially more serious, fracture.

The most common cause of fragility fractures is osteoporosis.  An earlier stage is called osteopenia. About 52 million Americans have osteoporosis or osteopenia. Of those, two million break a bone each year. This number is expected to double by 2040.

  • Osteoporosis has no signs or symptoms until a fracture occurs.
  • One half of all women and up to one quarter of all men will suffer a fragility fracture in their lifetime.
  • If you have had a previous fragility fracture, you are twice as likely to suffer a fracture in the future.
  • Over 2 million fragility fractures occur each year – more than heart attacks, stokes, and breast cancer combined. This number is on the rise and expected to double by 2040.
  • While a wrist fracture may not have the most severe impact on life, a spine fracture, or a hip fracture, may end the patient up in a nursing home for life. There is also 25% increased risk for mortality following a hip fracture.

For more information about fragility fractures, prevention, and treatment, please check the main fragility fracture webpage.

Value of ice water soak for sore muscles still unclear

From Reuters Health – A short soak in ice water is supposed to cure the discomfort of sore muscles, but it may not be worthwhile.

In a recent study from Northern Ireland, amateur athletes 2-point difference on a 10-point muscle pain scale after repeated soaks in 6°C (43°F) water.

While a 20 percent reduction  might have an impact on elite athletes, its value may not be as high for amateur athletes.

http://mobile.reuters.com/article/idUSBREA1D1EI20140214?feedType=RSS&irpc=932

More sleep may help prevent athletic injuries in adolescents

From Orthopedics Today-

The best way to aid young athletes in the prevention of sports-related injuries may be to help them get more rest at night.
“Sleep deprivation and increasing grade in school appear to be associated with injuries in an adolescent athletic population,” Matthew D. Milewski, MD, and colleagues write in the study.

http://www.healio.com/orthopedics/pediatrics/news/online/%7B84d0db29-ea4c-4ee7-9503-83d8ceb943e9%7D/more-sleep-may-help-prevent-athletic-injuries-in-adolescents

Weather may Truly Affect Arthritis Pain

Faces Pain Scale

Adapted from Reuters Health

People talk about it all the time. Arthritis pain gets worse with weather changes. A recent study published in Pain Journal last month tracked hip arthritis pain and stiffness as weather changed.

More than 60 percent of patients with osteoarthritis say that weather conditions, such as rain, barometric pressure and temperature have an impact on their pain and stiffness, according to the study.

The researchers gathered weather reports for the days the patients filled out the questionnaires. The information gathered from the Royal Netherlands Meteorological Institute included average temperature, wind speed, hours of sunlight, rainfall, humidity and barometric pressure.

The average starting (WOMAC) pain score was 23.1 (scale 0 to 100; no pain=0; worst possible pain=100). The study found that pain scores worsened by 1 point for each 10 percent increase in humidity.

The least clinically relevant change in WOMAC score is considered to be 10 points. Weather changes could only account for  6 points at the most. This means that although some people notice the change, they may not necessarily need something done for it.

After all, some patients, it turned out, may be truly sensitive to the weather.

Study: 20 young people a day hospitalized for gun injuries

From USA Today-

A recent study published in the journal Pediatrics showed that almost one child or teen is injured due to firearms and requires hospitalization every hour due to firearms related injuries. Firearm injuries are the second leading cause of death, behind motor vehicle crashes, for teens ages 15 to 19, according to the Centers for Disease Control and Prevention. For those lucky to escape death, recovery often requires extensive treatment, which may include one or more trips to surgery, rehabilitation, home health care, and mental health or social services.

 The most common types of firearm injuries included open wounds (52%), fractures (50%) and internal injuries of the thorax, abdomen or pelvis (34%). In children under age 10, 75% of hospitalizations were due to unintentional injuries.

The American Academy of Pediatrics stresses that “the safest home for children and teens is one without guns.” Guns should be “stored unloaded and locked, with the ammunition locked away in a separate place.”

For more details, please follow:
Study: 20 young people a day hospitalized for gun injuries http://www.usatoday.com/story/news/nation/2014/01/27/guns-children-hospitalizations/4796999/

New Doubts Regarding Value of Vitamin D Supplementation

From Medscape.com

A new meta-analysis of trials of vitamin D supplements failed to show beneficial effects for the prevention of hip fractures, myocardial infarction (MI), stroke, or cancer in otherwise healthy adults. These finding may also cast doubt about the use of vitamin D suppliments to fight osteoporosis.

“The take-away message is that there is little justification currently for prescribing vitamin D to prevent heart attack, stroke, cancer, or fractures in otherwise-healthy people living in the community,” lead author Mark Bolland, PhD, from the University of Auckland, New Zealand, told Medscape Medical News in an email.

“In our paper, the only benefit from vitamin D was in reducing hip-fracture risk in elderly women living in residential care”, the author added.

One exception is people who have documented low levels of vitamin D. People at risk of low vitamin D levels include elderly people living in nursing homes, people who actively avoid the sun, and people with deeply dark skin.

There has been a recent surge of criticism regarding the role of nutrional suppliments in health. Suppliments have Abigail economic impact. The sales of vitamin D suppliments in the United States increased 10-fold during the period from 2002 to 2011, from $42 million to $605 million.

I doubt many physicians will advise patients against taking Vitamin D, but now there is less reason to put it on high priority, for example in patients who are already on a lot of prescription medications.

For more detail, follow thhe link:
http://www.medscape.com/viewarticle/819670.

Doctors’ dress code aims to halt nasty germs – NBC News.com

A new guidance has just been issued on dress code for health care workers aiming at keeping dangerous germs from spreading among patients.

Short sleeves, bare hands and forearms and white coats that are laundered at least once a week may help prevent germs from hitching a ride on a doctor’s wrist.

Neckties are questionable. Watches and rings have to go. It’s not clear what to do about name tags, lanyards, necklaces and cell phones, but when in doubt, it’s best to clean the offending items — or get rid of them.

From NBC News. http://m.nbcnews.com/health/doctors-dress-code-aims-halt-nasty-germs-2D11959078

FDA limits acetaminophen dose in prescription combination products

Acetaminophen is a main  component of a lot of commonly used pain-killers. Tylenol#3, Percocet, Vicodin, Norco, Lortab, …. You name it. These are called combination pain-killers because they are made of two or more components. Pain-killers that share a common component are not supposed to be taken together. Well, they frequently are.

Suppose you just had surgery. You were given a prescription for Percocet. You go home, and then, in the middle of the night, you are in pain. You are only supposed to take it at certain times, so you open your medicine cabinet, reach for your Tylenol, and pop two pills. And then you do that several times for the next few days or weeks.

Unknowingly, you probably have exceeded what is considered a safe daily dose of acetaminophen.

For this reason, which happens too often, the Food and Drug Administration recently issued a regulation to decrease the maximum amount of acetaminophen present in combination painkillers to no more than 325 mg. Too much acetaminophen can cause irreversible liver damage. At the same time, taking more than the maximum allowed daily dose does not help reduce the pain any further.

“Acetaminophen overdose is one of the most common poisonings worldwide,” according to the National Institutes of Health.

The maximum recommended for adults at 4,000 milligrams per day. One pill of Tylenol contains 500 mg. A lot of people take two at a time. Do the math and you realize that you can take it no more than four times a day. Take in together with a combination acetaminophen-based medicine puts you well above the maximum allowed.

Press Announcements > FDA limits acetaminophen in prescription combination products; requires liver toxicity warnings.

Street-Light Color Code for Food may Help Promote Healthy Choices

Diet has a huge impact on health. Musculoskeletal health is no exception as both obesity and malnutrition have detrimental effects on bones and joints. Would a green-yellow-red label system help you make better food choices?

CHECK THIS OUT- Labeling Food With ‘Stop’ or ‘Go’ Colors Might Spur Healthier Diet – WebMD http://www.webmd.com/diet/news/20140107/labeling-food-with-stop-or-go-colors-might-spur-healthier-diet

Medical journal: ‘Case closed’ against vitamin pills

“The latest studies on vitamins have some medical experts saying “case closed” — it’s time for most consumers to stop wasting money on multivitamins and other supplements, because they have no proven benefits and some possible harms.”- USAToday.

http://www.usatoday.com/story/news/nation/2013/12/16/vitamin-supplements-research/4042037/

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