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Just Published: Nerve Conduction Studies in Surgical Cubital Tunnel Syndrome Patients

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.

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.

West Virginia State Medical Association Advocacy Day 2019

Advocating for Public Health and the Practice of Medicine at the WV State Capitol.

WV Senate President Mitch Carmichael and WVSMA members

At the AMA Interim Meeting 2018

Interview with WV Senator Stollings

At the ASSH Annual Meeting

Presenting my ” Nerve Conduction Studies in Surgical Cubital Tunnel Syndrome” at the American Society for Surgery of the Hand, Boston MA.

Avocado Hand

Avocado, the green-skinned, egg-shaped fruit, is getting more popular than ever. With it, there are increasing reports in media and medical news about avocado related  hand injuries .

 

Accidental knife injuries happen to fingers of the hand holding the avocado while peeling it. Such injuries has increased to the point that is they have been named ‘ Avocado hand’.

The hard shell covering a soft fruit allows the knife to slip through the flesh of the avocado and aim straight to ones fingers.  The best way to safely cut the avocado is not to hold it in your hand, but on a plate and aim the sharp edge of the knife away from your fingers. This can lead to serious injuries such as cut tendons, nerves, and blood vessels.

Ir Med J. The Avocado Hand. 2017 Dec 18;110(10):658.

Poster presentation at AAOS 2018

YPSgram Issue #1: On Costumer Service and the ‘Good Doctor”

WVSMA Young Physician Section

Earlier this month, I was proud to help publish the first issue of the YPSgram, the newsletter of the Young Physician Section of the West Virginia State Medical Association. Here is a link to the newsletter titled: On Customer Service and the ‘Good’ Doctor

 

Ribbon cutting at new WVU Medicine clinic in Fairmont

adapted from WVU Medicine CONNECTionsdsc_350420copy2

I am glad to share that WVU Medicine cut a ribbon at the new Fairmont facility on Sept. 22. A photo gallery from the ribbon-cutting ceremony is available on CONNECT.

The $13.9 million, 25,000-sq ft. outpatient center is located off Downtown Fairmont Exit 136 of I-79, near the Fairmont Gateway Connector.

I am pleased to be part of he Fairmont clinic team providing Hand, Elbow, shoulder orthopaedic care to the residents of Marion county and surrounding areas. new building and providers, a community open house is planned for Saturday, Oct. 21, from 10 a.m.-2 p.m. Watch for more details.

The image of the human hand encoded in DNA!

From the BBC

Researches chose the image of a human hand, representing the first form of human painting, to be the first DNA encoded image in a living form!
They inserted DNA sequences that represent the image into the genome of bacteria. Later, They decoded the sequences  into an image using a computer algorism with at least 90% accuracy.

The original DNA-coded image and the decoded image

WV Medical Journal Guest Editorial- July August 2017

http://digital.graphcompubs.com/publication/?m=30875&l=1#{“issue_id”:419834,”page”:20}

At the AAOS Clinical Practice Guideline Workgroup for Rotator Cuff 

I am happy to be part of the American Academy of Orthopaedic Surgeons’ CPG for the Rotator Cuff.

Giant Robotic Hand on Display in Pittsburgh

 

BioMechanical Hand at the Cwrnegie Science Center, Pittsburgh PA

BioMechanical Hand at the Carnegie Science Center, Pittsburgh PA

The Carnegie Science Center‘s Roboworld  exhibit in Pittsburgh PA features a giant mechanical hand. You can move its individual parts using a computerized controller. If you are into Robots and / or Mechanical displays, this is the place to go to.

 

 

The Robot with a Soft Touch

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.

 

Change is Here

Dear Visitors,

Today is my official first day as a full-time faculty at the West Virginia University Department of Orthopaedics, at the rank of Assistant Professor.

Broken Shoulder- 3 million years ago

Adapted from The Smithonian

Lucy, the famous 3 million years old hominin, has been a mistery for the last few years: how did she die? A group of orthopedic surgeons were asked to review recently obtained 3D CT scans of her skeletal remains and recognized something we are all too familiar with: fracture patterns of the shoulder and other bones that we see with high energy injuries in humans. Those were fractures that happened just before and led to her and not bone breakdown that happens to bone fossils.

Dream Land

​I just attended the feature presentation by author Sam Quinones at the WVSMA Healthcare Summit.

He describes how aggressive promotion of highly a addictive painkiller and the development of cheap underground heroin production, marketing, and delivery industry led to the current opioid epidemic.

The book won several awards including Amazon’s Best Nonfiction Book for 2015.

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.

Hand and Upper Extremity Clinical Practice Guidelines

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

Just received from the Evidence-Based Medicine Unit, American Academy of Orthopaedic Surgeons

“Congratulations on being nominated and selected for the Carpal Tunnel Syndrome Appropriate Use Criteria voting panel.”

and the Winner is…

Adapted from ABC news

Anaya Ellick, 7, a first grader from Virginia, had such good handwriting that she won the national handwriting contest last week.

There was just one thing special about Anaya: She was born without hands….

My Better Half: The First Ten Years

http://digital.graphcompubs.com/publication/?i=298770&ver=html5&p=13#{“page”:12,”issue_id”:298770}

Submission to Journal of Hand Surgery accepted

> Dear Dr. Sraj,
>
> I am pleased to inform you that your manuscript A Simple Phalangeal External Fixator Using Kirschner Wires and Locking Balls: No need for Cement or Rubber Bands has been accepted for publication in The Journal of Hand Surgery.

….

> We look forward to seeing this manuscript published and to receiving your next one.
>
> Best wishes,
> Section Editor
> The Journal of Hand Surgery
>

An Arrow in the Humerus Uncovers a Colossal Bronze Age Battle

Adapted from Science magazine

In 1996, an amateur archaeologist found a humerus bone north of Berlin. A flint arrowhead was embedded into the one end of the bone, ( funny it is nicknamed the surgical neck) prompting archaeologists to dig more. They found 130 people and five horses so far, and the bones were dated to about 1250 B.C.E., Europe’s Bronze Age. It is estimated that as much as  4000 warriors took part in the fighting- a large number for the bronze age which reflects significant advances in social organization to supports armies of this scale. “It could be the first evidence of a turning point in social organization and warfare in Europe,” one author said.

 

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