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Carpal Tunnel. Always Surgery?

For patients I see with long standing carpal tunnel symptoms surgery offers the best chance of relief.

If symptoms are short to medium term, other measures might help.

  • If symptoms occur with a particular activity or form of exercise, you can modify it.
  • Symptoms at night are often controlled wearing a night splint.
  • Take a non steroidal medication such as Advil or similar.
  • I can inject the carpal canal with a water based steroid to shrink tissue in the carpal canal.

Injections Can Boost Knee Surgery Outcome

For people with arthritis, injections of sodium hyaluronate can improve recovery from arthroscopic surgery. I have had the best results using a 5 injection series of Supartz. This is the typical situation that I might use it in.

I am doing arthroscopic surgery on a patient over 40 who I know has a torn cartilage.

The patient also, on plain standing x-rays and MRI, appears to have some mild arthritis changes.

At surgery the joint is found to be much more arthritic than I had suspected. That is when I probably would discuss using Supartz as a follow up to the arthroscopic surgery.

Viscosupplementation In the Shoulder?

Viscosupplementation currently is only FDA approved for osteoarthritis of the knee. Most insurances consider it investigational when used in other joints.

Several studies have found that it is as effective in the shoulder and hip as it is in the knee. This has been my experience also.

It has been used in the shoulder and hip in Europe for many years and is known to be safe and effective. There is an important difference, however. Injections into the shoulder and hip joints are technically complex and difficult.

I always use fluoroscopic x-ray imaging to guide my needle placement to be sure I am injecting into the joint.

X-rays Often Don’t Find Hip and Pelvic Fractures

A recent study in a prestigious Radiology Journal pointed out that x-rays taken in the Emergency Department are often inconclusive for detecting hip and pelvic fractures.

On a personal note, I have effectively used the even more basic items of history and careful examination before x-ray studies are done to diagnose hip and pelvic fractures. Then I also do x-rays after I take a history and examine the patient.

Even if x-rays appear to be negative and I think a fracture exists, I will admit the patient to the hospital and do further imaging studies.

Bilateral Total Knee Replacement

I often see patients who have arthritis in both knees which is equally bad and both knees need total knee replacement. Nine times out of ten the patient chooses which knee to have operated first and does not insist on having both done at the same time.

While it is surgically possible to do that, the decision is based on the health status of the patient.

The ideal patient for bilateral total knee replacement is younger, in good physical health, with no cardiac, pulmonary or vascular disease.

Pro: You have only one surgical event with a single anesthesia.

Con: Early rehabilitation is very difficult and there is a slightly higher risk of “cardiac events”.

Tie: Overall risk of infection, blood clots or death is about the same.

Tai Chi Reduces pain of Knee Arthritis

Adults over 65 with knee arthritis who use Tai Chi regularly to improve their physical function experience less knee pain from osteoarthritis. After 13 weeks, patients using Tai Chi experienced a 75% reduction in pain and 22% improvement in their ability to perform everyday tasks such as up and down stairs. Tai Chi is consistent in improving range of motion, flexibility and muscle conditioning. Tai Chi promotes psychological well being countering the negative affects of chronic pain.

Beer Prevents Weak Bones

Now here is some factoid information you can really use!! I picked up on this immediately.

A new study suggests that the very high silicon amount in beer is a key for increasing bone mineral density, thus preventing osteoporosis.

Beer made from malted barley and hops had lots more silicon than those made from wheat or corn.

As in all things moderate beer (alcohol) intake is advised. Although silicon contributes to bone health it is way behind the essential calcium and vitamin D.

Joint Replacement Surgery is Safe

Any major surgery carries a certain risk as everyone knows. Joint replacements are among the biggest surgical procedures I do. A very large study published this year in the Journal of Bone and Joint Surgery (my professional bible!) found the mortality rate to be 0.1%. The finding of a very low post operative mortality should be reassuring for patients considering such surgery.

Don’t Overdo After Hip Replacement

I have done hip replacements for a long time. Lately it is “fashionable” to tell patients after surgery to “put all your weight on it” and basically do whatever you want.

My approach as the key to a speedy recovery is to not over do it.

Why? It is very big surgery. You want this to last the rest of your life. The protection of a walker or crutches makes sense to allow time for tissue healing and for bone to grow into the prosthesis. This takes at least 6 weeks for the majority of patients.

Take it easy and your hip will thank you for it. Doesn’t that make sense?

The Amazing, Vulnerable Foot

The structure of the foot and ankle is hugely complex. How it works at all is a wonder.

  • 28 bones in the foot
  • One fourth the number of bones in the body
  • More than 30 joints
  • Ligaments, tendons, even muscles galore
Feet of course bear our entire weight. If in good shape, they are a platform that enables standing comfortably even indefinitely. We can walk, run, jump.

And how do we treat them? What thanks do feet get? People wear flip-flops for shoes!

Yoga Reduces Inflammation

Yoga done regularly lowers compounds in the blood that promote inflammation. IL-6 is an important marker of inflammation in the body. It is high in heart disease, stroke and arthritis.

IL-6 is low in persons who do yoga on a regular basis. Yoga is a way to lower risk for developing heart disease, stroke and arthritis.

In addition, Yoga increases flexibility which is an antidote for the stiffness that comes with aging. The stretching and exercise that yoga provides increases flexibility which in turn allows relaxation that can lower stress.

Older Patients Improve Balance with Total Knee Replacement

For older patients a total knee replacement may do more than reduce pain. A new knee joint may also improve balance.

In a large number of patients studied, all showed major improvement in balance measures after several months.

I always close articles with the statement, “Our goal is simple – to help our patients live more pain free, functional lives.”

Major improvement in balance is a BIG functional improvement I would say.

So when I do a total knee replacement and the person has less pain that is not the only benefit.

Everybody knows that poor balance and increased risk of falls are common in older persons. It’s nice to know pain can be in most cases eliminated and balance greatly improved by total knee replacement.