News and Updates

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

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{“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

I know what distracts me. Do you?

April is Distracted Driving Awareness Month. The American Academy of Orthopaedic Surgeons released its “No Small Distractions” videos  that highlight the importance of safety behind the wheel.

Distractions behind the wheel may not be as small as they seem.

Fixing sharp edges on a cast with a glue gun

wp-1460471115474.jpgMy patient  showed me today a neat trick to cover up the sharp edges of a Fiberglass cast.

She simply used a glue gun. The glue holds very well. In this case, for over a week. The edges are soft and it holds well to fiberglass. No more catching on clothes. She has not tried it close to her skin, and if you do want to try it, be careful not to burn yourself.

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.



On Broken Elbows and the Difference between Dictating and Writing

From NPR

Following an injury to her elbow resulting in a broken bone, writer Julia Reed learned about the difference between her speaking voice and her writing voice. “You’d be amazed at what you need two arms and hands for, including, as it happens, my job, ” she said. She sought help from several dictation apps. It won’t be a problem. She the apps as ‘highly temperamental … and …. steadfastly refused to understand almost everything [she] had to say.’ The author also realized that one cannot ‘talk’ a story. When we talk, we do not edit ourselves, and writing (or typing) things down gives us at least a second chance to fix what needs fixed and remove what does not belong there.

Many a time, you do not realize the value of what you have until you can’t have it anymore ( or, in this case, cast it)…

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…

Doctors and Santa Claus may be Equally Reliable

Source: Doctors are as Reliable as Santa Claus (or Vice Versa)

A team of researchers decided wanted to find out what people thought of doctors how that compared to … Santa.

The researchers showed a film in which a narrator dressed as either Santa Claus or a doctor and told an identical story.

The results:

1- Santa Claus was perceived to be friendlier.

2- Both were equally reliable….


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!

%d bloggers like this: