News and Updates

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}

Gloves Through History

Adapted from: Fashion Times

Gloves played a substantial role in the conduct of human affairs and social interactions beyond keeping one’s hands warm and protected since ancient societies. Early Egyptian Pyramids contained hand covers without fingers. The tomb of Tutankhamen had the remains of decorated gloves.

Falconry, from De Arte Venandi cum Avibus, (On The Art of Hunting with Birds) , 1240 AC

Leather gloves were popular in the 1100s. Sturdy leather gloves were worn by laborers, falconers, and knights, whereas fashion gloves were crafted of fine leathers such as doeskin and lamb. Scented gloves were developed in the 1500s. Chicken skin gloves were worn at night to keep hands soft and white. Fabric gloves crafted from silk, satin, velvet, cotton, and linen were stylish in the 1500s.

 

Gloves had a variety of symbolic uses. The delivery of a glove to a monarch at an inauguration ceremony symbolized recognition of the new authority. Nobles received a glove when knighted.  Bishop status was granted by the delivery of a glove as well.  On the same token, Knights conveyed defiance or launched a challenge by casting down their war-gloves (gauntlet).

Gloves were used as messages of good will between sovereigns and dignitaries. They were sent to wish a person well, to congratulate them, or to console them. Gloves were also used for binding a bargain or as a bribe.

Gloves were a token of love.  They served a knight as an everlasting reminder of his love, inducing him to courage, loyalty and constancy while away. It also served as a charm against evil during conflict.

Today, gloves are practical articles that warm and protect our hands. People continue the tradition of wearing gloves at funerals, weddings, state functions, formal events, and the opera,  as gloves maintain their symbolic value and fashion statements.

Washing Your Hands

Adapted from BBC

Washing your hands- straightforward, or is it?

There’s plenty of evidence that washing one’s hands can reduce the spread of disease, only 5% of people wash their hands ‘properly’ ‘all the time’.

10% of 3000 people were witnessed leaving public toilets without washing their hands, and of those who did,33% didn’t use soap. While it is well established that we need to wash our hands properly, there are plenty of myths about what is proper.

Does the water need to be hot to get your hands clean?

In a survey of 500 adults, 69% believed that the temperature of the water has an impact on the effectiveness of hand-washing. Researchers found that water temperature made no statistically significant difference when other factors are controlled. Temperature still affects washing, though, because excessively cold or hot water lets people spend less time washing their hands than comfortable water temperature.

Is anti-bacterial hand wash better than soap?

A 2007 and a 2015 review both concluded that anti-bacterial hand washes  did not reduce the number of bacteria remaining on people’s hands after washing any more than soap did, nor was it any better than soap. Triclosan, a main ingredient on most antibacterial hand soaps, May increase anti-bacterial resistance and that and has been banned in the US and in the European Union.

Do you need to dry your hands afterwards?

Letting new hands air-dry is fine as long as he did not contaminated hands before they try out. Durkan’s transfer to your hands more easily if they’re wet.

Hand dryer or hand towel?

There’s a lot of debate surrounding this one. Most of us don’t want for as long as 45 minutes needed for the hands to dry using hand dry. New were hand dryers take 10 seconds hand and our equivalent to paper towels.

Making toilets nicer also makes a difference. One study observe 3,000 people in the US, found that if the toilets were clean and well-kept, people were more likely to stop and wash their hands properly. When the sinks were dirty, they just wanted to get out of there.

Whichever way you choose to wash and dry your hands, do it for longer than you think.

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.

 

 

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.

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.

Haunted Arm Cast

My young patient had a happy surprise when she realized her cast was a glow-in-the-dark ‘ghost’ cast.

Harry Potter’s Brackium Emendo- healing broken bones in Witchcraft

Adapted from HarryPotterWikia

Harry Potter fans know very well that witchcraft can be dangerous.

Harry broke his ‘arm’ ( in reality, it was both-bone forearm fracture) during a Quidditch game and was ‘doctored’ by Professor Lockhart. The spell he used, Brackium Emendo, did not work as intended: instead of healing the bones, it made them disappear. Harry was then taken to the Hospital wing and treated with Skele-Gro, an awful tasting potion that grows missing bones.

 

I offer these few points to consider from an Orthopedic point of view:

This is a Sports injury! Should Quidditch players not wear protective ‘armor’?

Can this spell truly heal broken bones instantly?  No cast! No Surgery! No down time! I should go spend sometime at Hogwarts.

Oops. The spell did not work after all. On top, it had the unintended consequence of missing bones: a Complication.

The ‘Doctor’ did not explain the treatment ( the spell itself), its risks ( missing bones), other alternatives ( let it heal with a cast), and did not get consent for treatment. In fact, Potter did not want him to cast the spell! In our world, it is an easy law suit!

The ‘credentials’ of the ‘doctor’ were suspicious to start with. Was he Witchcraft-Certified? even better for the law suit.

Skele-Gro was used to reverse the complication. Where can I get one? Would it work on stubborn fractures ( nonunions) and missing bone fragments? Yet another reason to visit Hogwarts.

 

 

Paper Cuts Hurt so Much

Adapted from BBC

Paper, seemingly completely harmless, can be a weapon in disguise: paper cuts hurt way beyond expectations.

It’s all to do with nerve endings. There are a lot more pain receptors in your fingertips than almost anywhere else in your body, which explains the intense fiery quality of finger paper cuts that are worse that than deeper cuts on the arm or the thigh. They don’t slice that deep into your body, which is perhaps why it’s puzzling that they should hurt so much. But it’s exactly for this reason that paper cuts hurt bad. A deeper wound would result in bleeding. The blood would clot and a scab would develop protecting it from the environment. The shallow wound of a paper cut doesn’t get the same cover, leaving the injured nerve endings exposed and more irritated.

Having said that, nobody has ever proven that this is the case, but it is a reasonable hypothesis. Don’t you agree?

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.”

Wrist x-rays can predict a Child’s age

Adapted from Radiopaedia.org

Can you guess the bone age of this wrist x-ray?

Did you know that your kid’s wrist x-ray roughly matches his/her age?

The small bones of the wrist are called the carpal bones. They start out with no calcium at birth, and do not show on x-ray. They start building up calcium during the first three months of age in a process called Ossification. This occurs in a predictable manner and the bones ‘start appearing’ on x-ray in this order:

  • One bone:                 1-3 months
  • Two bones:               2-4 months
  • Three bones:            2-3 years
  • Four bones:              2-4 years
  • Five-seven bones:   4-6 years
  • Eight bones:             8-12 years

Next time you get an x-ray of your child’s wrist, count the ‘little round’ bones to find out the ‘bone age’.

Time to ossification, similar to height and weight of a growing child, can be highly variable and bone age X-rays are not obtained for  healthy children. A discrepancy between bone age and actual age is not a reason to worry unless there are concerns about the child’s growth.

 

What it’s like to be a Hand Model

From the Big Great Story

Ever wondered who and how some people end up as  hand models?

This short video takes you behind the scenes and shares the experiences of three professional hand models.

 

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}

On Fingerprints and What They Stand for

adapted from Wikipedia

Fingerprints are the detailed, unique, difficult to alter, impressions left by the friction ridges of fingers. Fingerprints are deposited on smooth surfaces by the natural secretions of sweat of the finger tips. Fingerprints are useful to confirm identity. They may be employed by police or other authorities to identify individuals who are incapacitated, deceased, or unable to identify themselves, such as young children or lost their memories. The ability to recover fingerprints and compare them, led to Fingerprint analysis, which has been in use since the early 20th century and has led to many crimes being solved. Today, many criminals wear gloves to avoid being caught. In 2015, fingerprint analysis was reported to be able to determine find the person’s gender.

Fingerprints have been found on ancient Babylonian artifacts, on the walls of Egyptian tombs, Greek, and Chinese pottery, as well as on bricks and tiles from ancient Babylon and Rome. Fingerprints were used as signatures in ancient Babylon,2000 BCE, and are still used in countries where some people do not know how to write and sign their names. who  in the second millennium BCE.

Fingerprints can also be a subject, or tools, of art. More than 320 students and staff at King Street Intermediate School in Danbury, Connecticut, fingerprinted themselves for fingerprint art installation for The Aldrich Contemporary Art Museum in Ridgefield, Connecticut. Artist Sandy Garnett has a whole fingerprint-themed art project.

One last point: patients with a  very rare medical condition, adermatoglyphia, have no fingerprints. The have completely smooth fingertips, palms, toes and soles, but no other related medical problems.

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
>

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