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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


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.


No More Powdered Gloves

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.



Hospital Day at the Legislature 2016

The 2016 Hospital day at the Legislature was an opportunity to raise awareness to engage with the delegates, senators, and governor with regard to healthcare related matters. Several bills are under review with direct impact on hospitals and physicians. I had the chance to discuss and present input as a hospital advocate and a physician member of the WV State Medical Association.


WV Governor, Earl Ray Tomblin


Congress members Facemire, Romano, and Smith

Hand, X-Rays and, wait… Smuggling!

Adapted from NRP

I have heard many odd stories about medicine, but this one is different…

The Soviet Union state censorship was real strict in the 1950s, and foreign music records were difficult if not impossible to obtain in Russia. Some russians figured out a way to smuggle those records, by cutting grooves into used vinyl X-rays. This was recently discovered, and now there is a book written about it titled X Ray Audio.



What Happens when Knuckles Crack?

Adapted from: MDLinx and UC Davis

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…

It’s More Than A Strong Handshake: Resistance Training Helps Ease Hand Osteoarthritis Symptoms

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.


Paper accepted for publication: “Providing Orthopedic Care for the Incarcerated: Obstacles and Challenges” has been accepted for publication in JAAOS

From: Journal of the American Academy of Orthopaedic Surgeons
Ref.: Ms. No. JAAOS-D-15-00215R3

Dear Dr. Sraj,

We are pleased to inform you that your manuscript "Providing Orthopedic Care for the Incarcerated: Obstacles and Challenges" has been accepted for publication in the Journal of the American Academy of Orthopaedic Surgeons.

Thank you again for considering JAAOS for your work.


Peter S. Rose, MD
Deputy Editor

2015 WV State Medical Association Healthcare Summit

The West Virginia State Medical Association Health Summit at the  Greenbrier Resort was memorable! I learned that there is a lot more to caring for patients than treating them.

I look forward to participate next year.
Source: 2015HealthcareSummitPhotos

Proposal for “WV Orthopedic Society Stance on Informed Consent” passed

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.

The Oldest Humanlike Hand Bone

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.



3D-printed prosthetic hand throws first pitch

From Sports Illustrated

Five-year-old girl, born with a hand birth defect, threw the first pitch for Baltimore Orioles using her 3D-printed prosthetic hand. The hand was designed and printed at the University of Nevada, Las Vegas.
Follow the link to watch the pitch!

Music and Surgery

Adapted from NRP

Music has always been suggested as a powerful tool to comfort patients recovery from surgery. The idea goes back to the days of Florence Nightingale. Music was used to ease surgical pain as early as 1914. Several studies have attempted to prove it, but those studies were small, and really didn’t find all that much.

Researchers in London started combing the medical literature for such studies and found hundreds of small studies suggesting some benefit. But once we put all the data together, they were able to find better evidence, that, yes indeed, surgery patients who listened to music, either before, during or after surgery, were reported less pain, less anxiety and more patient satisfaction.

On average, music helped the patients drop two points on the 10-point pain scale. That’s equal to pain relief reported with some pain medicines! And, unlike drugs,  music doesn’t seem to have side effects.

Presenting ” A Simple K-wire Fixator for Phalangeal Fractures”

At the15th Annual New Technology in Upper Extremity Surgery, the Cutting Edge, Cleveland OH.

Struder Conference

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.

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.

Just nominated and elected Member-at-Large, WV Orthopedic Society

Presenting at the WV Orthopedic Society Meeting

Title: written Informed Consent- Requirement or Interpretation?

Why Knuckles Crack

Adapted from National Public Radio.

Scientists think they may have solved an old question about the cracking of knuckles: Why does it do that?

The crack apparently comes from a bubble forming in the fluid within the joint when the bones separate. It’s like a tiny air bag inflating. This theory about knuckle-cracking was first proposed in 1947 but challenged in the 1970s.

One guy, who is really good at cracking his knuckles volunteered to put his hand inside a special MRI scanner, and made a movie of the inside of his knuckles as they pulled on the end of each finger to make it crack. What they saw was clear: The cracking sound comes when a bubble forms between the bones of the knuckle joint — not when it collapses.

The discovery challenges the common misconception that knuckle-cracking causes arthritis.

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!

An apple a day does not keep the doctor away

Adapted from Becker’s Hospital Review.

The proverb “An apple a day keeps the doctor away,” dates back to the 1860s. (The Washington Post).

A recent study published in the April Fool’s issue of JAMA  found no significant difference regarding doctor’s visit between daily apple eaters compared to others.

Apple eaters were slightly more successful in avoiding prescription medications, suggesting the proverb should say, “An apple a day keeps the pharmacist away.”

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