A new treatment that aims electrical pulses at irritated nerves around the spinal cord appears effective at relieving chronic lower back pain and sciatica, a preliminary study suggests.
The minimally invasive procedure, called image-guided pulsed radiofrequency, eased lingering pain in 80 percent of 10 patients after a single 10-minute treatment. Ninety percent were able to avoid surgery.
“Given the very low risk profile of this technique, patients suffering herniated disc and nerve root compression symptoms may undergo a safe and fast recovery, going back to normal activities within days,” said study author Dr. Alessandro Napoli. He’s an interventional radiologist at Sapienza University, in Rome, Italy.
“In fact,” he added, “one of the dramatic advantages of this technology is that we can perform it in a day-surgery setting, without anesthesia, and [patients] go home the same day.”
Napoli’s study is scheduled for presentation Wednesday at the Radiological Society of North America’s annual meeting, in Chicago. Studies presented at scientific conferences typically haven’t been peer-reviewed or published, and results are considered preliminary.
About 8 in 10 people suffer from lower back pain at some point in their lives, according to study documents. This pain can be due to a herniated disc in the lower spine. Sciatica is radiating leg pain caused by a pinched nerve in the lower spine, which also may be due to a herniated disc.
Also called a slipped or ruptured disc, a herniated disc occurs when the spongy material inside a spinal disc squeezes through its tough outer shell because of aging or injury. This material can press on surrounding nerves, causing pain and numbness or tingling in the legs, according to the American Academy of Orthopaedic Surgeons (AAOS).
Conservative, nonsurgical approaches typically ease symptoms of a herniated disc over time, according to the AAOS. These treatments include rest, gentle exercise, pain relievers, anti-inflammatory drugs, cold or hot compresses and physical therapy.
However, about 20 percent of those with acute low back pain don’t find relief through these measures. That leads some to decide on surgery to remove disc material pressing on their spinal nerves. For these people, Napoli said, image-guided pulsed radiofrequency treatment may become a viable option if larger studies reinforce his findings.
Napoli’s research included 80 people who had experienced at least three months of low back pain from a herniated disc that hadn’t responded to conservative treatments.
Image-guided pulsed radiofrequency treatment uses computed tomography — a CT scan — to help physicians insert a needle to the location of the herniated disc and surrounding nerves. A probe that’s inserted through the needle tip delivers pulsed radiofrequency energy to the area over a 10-minute period, resolving the herniation without touching the disc, Napoli explained.
More than 80 percent of the 80 study participants were pain-free a year after a single treatment. Six people required a second treatment session.
Pulsed radiofrequency has been widely used in pain medicine for other types of chronic pain, Napoli noted.
He said the treatment works by “eliminating the inflammation process” in nerves surrounding the herniated disc, hindering painful muscle contractions. “The aim was to interrupt this cycle and give the body the chance to restore a natural healing,” he added.
Dr. Scott Roberts, a physiatrist with Christiana Care Health System in Wilmington, Del., said the new findings showed “an impressive drop in pain and improvement in function.” However, he noted that the research didn’t include a control group for comparison with people not given the treatment.
“With no control group, we don’t know how much of the improvement we’re seeing would have happened anyway,” Roberts said. “I was very encouraged by [the study] because its results are significant, but it’s far from conclusive without a control group.”
What is a boxer’s fracture?
A boxer’s fracture is a break in the neck of the fifth metacarpal bone in the hand. It gets its name because the injury is common in inexperienced boxers.
The metacarpal bones are the intermediate bones of the hand found inside the flat of the hand. They connect the bones of the fingers (the phalanges) to the bones of the wrist (the carpals). The fifth metacarpal is the metacarpal of the fifth (pinky) finger. The neck of the metacarpal bone is where the main shaft of the bone starts to widen outwards towards the knuckle.
Boxers are not the only people who can get a boxer’s fracture, but usually the injury results from direct injury to a clenched fist. The force fractures the neck of the metacarpal bone below the pinky.
Your doctor will need to distinguish boxer’s fractures from other metacarpal fractures, which break the shaft of the metacarpal, or fractures of the base of the small finger. These injuries may need different treatments.
Metacarpal bones, in general, are some of the most commonly fractured bones in the hands. A large percentage of these qualify as “boxer’s fractures.”
What causes a boxer’s fracture?
Usually, a boxer’s fracture happens when you punch a wall or another solid object at a high speed. You also might get a boxer’s fracture if you fall hard on your closed fist. The neck of the metacarpal bone is its weakest point, so it tends to fracture here.
What are the symptoms of a boxer’s fracture?
Symptoms of a boxer’s fracture can include:
- Painful bruising and swelling of the back and front of the hand
- Tenderness of the back of the hand in the region of the fractured fifth metacarpal
- Bent, “claw-like” pinky finger that appears out of alignment
- Limited range of motion of the hand and of the fourth and fifth fingers
Your knuckle may also not have its normal bumpy shape. Your symptoms may vary in severity depending on the complexity of your fracture. You might have only mild pain, or the pain might be more severe.
How is a boxer’s fracture diagnosed?
Your doctor will ask you about your symptoms, how you injured the hand, and your past medical problems. Your doctor will also examine your hand carefully, checking for tenderness, strength, misalignment, range of motion, breaks in the skin, and other features.
An X-ray of the hand can clearly confirm a boxer’s fracture.
How is a boxer’s fracture treated?
Your treatment depends on how severe the fracture is. Initial treatment might include:
- Washing any cuts that are present in the skin
- Getting a tetanus shot if you have a cut and haven’t had a shot for several years
- Resting your hand for a few days
- Keeping your hand above the level of your heart for a few days
- Icing your injury several times a day
- Taking pain medicine (prescription or over-the-counter)
- Wearing a splint for several weeks
Before your doctor puts your hand into a splint, he or she may need to put your bones back into alignment. Usually, you’ll receive a local anesthetic to keep you from feeling any pain, and your doctor will physically manipulate the bones back into place. In some cases, your doctor might have to open up your hand surgically to get the bones back into alignment.
You also may need to work with a physical therapist for a while as your fracture heals. You’ll learn exercises to strengthen the muscles of your hand and keep them from getting stiff.
If you have an unusually severe boxer’s fracture, you may need immediate and more complicated surgery. For example, if your bone has broken through the skin, or if it has broken in several places, you will probably need surgery. You might also need surgery if you have a job or significant hobby that requires a lot of fine-motor movement of the hand, like playing the piano.
Even if you don’t need surgery right away, you might need it at some point. If your hand doesn’t heal as well as expected, surgery might be an option.
What are the complications of a boxer’s fracture?
An untreated boxer’s fracture can lead to a decrease in your ability to grip, limited range of motion of the finger, and an abnormal looking finger. With proper treatment, these complications are usually minor, if present at all.
What can I do to prevent a boxer’s fracture?
Avoid fistfights and punching solid objects to prevent many cases of boxer’s fracture. If you box, make sure you use the correct technique and the proper equipment.
How to manage a boxer’s fracture
Your doctor may give you some instructions about how to manage your boxer’s fracture, such as:
- Keep your bones strong by eating a healthy diet with enough vitamin D, calcium, and protein
- Stopping smoking, to help your fracture heal more quickly
- Keeping your splint from getting wet
Your hand will be very easy to reinjure for 4 to 6 weeks after your splint is gone. You may need to use a hand brace if you return to contact sports during this time. Talk with your doctor about what makes sense for you.
When should I call my healthcare provider?
Call your doctor if:
- You have numbness or tingling in your fingers
- You fingers look blue
- You have severe pain or worsening swelling
- Your splint gets damaged and you need a new one
A boxer’s fracture is a break in the neck of the fifth metacarpal bone in the hand. It usually happens when you punch an object at a high speed.
- Symptoms of a boxer’s fracture include pain and swelling of the hand, limited range of motion of the pinky finger, and misalignment of the finger.
- Your doctor can diagnose your boxer’s fracture with a medical history, physical exam, and X-ray.
- You might need treatment with simple rest, ice, pain medicine, and splinting.
- You might need surgery for your injury if it is severe.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
Seniors with a fractured hip need surgery as soon as possible or they could suffer life-threatening complications, a new Canadian study concludes.
Having surgery within 24 hours decreases the risk of hip fracture-related death. It also lowers odds of problems such as pneumonia, heart attack and blocked arteries, the researchers found.
“We found that there appears to be a safe window, within the first 24 hours,” said lead researcher Daniel Pincus, a doctoral student with the University of Toronto.
“After 24 hours, risk began to clearly increase,” Pincus said.
U.S. and Canadian guidelines recommend hip fracture surgery within 48 hours of injury, but it’s likely that many people don’t receive care that quickly, he noted.
In the United Kingdom, guidelines call for surgery within 36 hours, but hospitals often fail to get patients promptly into the operating room, Pincus added. Rates range from 15 percent to 95 percent among U.K. hospitals, according to the report.
Oftentimes, there’s no operating room or surgeon available, or other patients are awaiting surgery, Pincus explained.
“There’s a triage system and these patients historically were not prioritized,” he said. “Sometimes there’s medical reason for the delay, but that’s very rare. We’re starting to realize there’s almost no reason why a patient should be delayed.”
Delay also likely occurs because doctors approach these elderly patients with a good deal of caution, said Dr. Harry Sax. He is executive vice chair of surgery for Cedars-Sinai Medical Center in Los Angeles.
“The perception is that if you’re old and you’ve broken your hip, that you’re going to have a lot of other [health problems],” said Sax, co-author of an editorial accompanying the new study. “Therefore, I need to spend several days running tests on you to try to make sure I can get you through the hip fracture surgery. ”
To see how this delay affects the health of patients, Pincus and his colleagues evaluated data on over 42,000 people treated for hip fracture at 72 hospitals in Ontario between April 2009 and March 2014. The patients’ average age was 80.
The investigators compared patients based on whether they had surgery before or after 24 hours.
Overall, about 12 percent of hip fracture patients died within the month following their surgery.
However, patients who got surgery within 24 hours were 21 percent less likely to die during the following month, compared with those who had a delay in surgery, the findings showed.
Those patients also had lower complication rates. They were 82 percent less likely to develop a blood clot in the leg veins (deep vein thrombosis); 61 percent less likely to have a heart attack; and 49 percent less likely to suffer a blood clot in the lung (pulmonary embolism). They were also 5 percent less likely to develop pneumonia during the month following surgery.
“The problem is the longer you sit in bed, the more likely you are to get pneumonia and blood clots. The unfixed bone is continuing to flick off little bits of fat, which can go to the lungs,” Sax said. “The delay doesn’t necessarily make things better. It could make things worse.”
People with an elderly relative facing hip fracture surgery should ask the health care team to get their loved one into surgery as soon as possible, with as little additional testing as possible, Pincus and Sax said.
“A prompt evaluation to make sure there’s nothing quickly correctable should be done, but otherwise the patient should move to the operating room as quickly as possible,” Sax said.
Families should ask doctors about every test, scan or screen that delays the surgery, Sax said.
“The question needs to be, what is the information that you’re going to gain and how would that change your management of this patient,” Sax said. “There are very few things you find with all this expensive testing that you can do anything about.”
The patient would be best off in a hospital that has a specific program to manage elderly people with hip fractures, Sax added. These programs have a team of surgeons, geriatricians, anesthesiologists and other professionals well-versed in the procedure.
“If you can find a hospital that does that, the chances are your outcomes are going to be better,” Sax said.
The study was published Nov. 28 in the Journal of the American Medical Association.
For more on hip fractures, visit the American Academy of Orthopaedic Surgeons.
SOURCES: Daniel Pincus, doctoral student, University of Toronto, Ontario, Canada; Harry Sax, M.D., executive vice chair, surgery, Cedars-Sinai Medical Center, Los Angeles; Nov. 28, 2017, Journal of the American Medical Association
Seniors with type 2 diabetes may be at increased risk for fractures. And researchers think they know why.
“Fracture in older adults with type 2 diabetes is a highly important public health problem and will only increase with the aging of the population and growing epidemic of diabetes,” said study author Dr. Elizabeth Samelson.
Samelson and her colleagues used special medical scans to assess more than 1,000 people over a three-year study period. The investigators found that older adults with type 2 diabetes had bone weakness that cannot be measured by standard bone density testing.
“Our findings identify skeletal deficits that may contribute to excess fracture risk in older adults with diabetes and may ultimately lead to new approaches to improve prevention and treatment,” said Samelson, of Hebrew SeniorLife’s Institute for Aging Research in Boston.
Fractures among seniors with osteoporosis — the age-related bone-thinning disease — are a major concern. Such fractures can lead to decreased quality of life, disability and even death, as well as significant health care costs, she said in an institute news release.
Even those with normal or higher bone density than their peers appeared to have a higher fracture risk if they had type 2 diabetes, the researchers said.
Specifically, these people had a 40 percent to 50 percent increased risk of hip fracture, the findings showed. This is considered the most serious type of osteoporosis-related fracture.
The study authors said that better understanding of the various factors that influence bone strength and fractures will aid prevention efforts.
The report was published Sept. 20 in the Journal of Bone and Mineral Research.
The U.S. National Institutes of Health has more on bone health.
SOURCE: Hebrew SeniorLife’s Institute for Aging Research, news release, Sept. 20, 2017
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Icy winter weather may lead to fewer hip fractures than many believe.
Most fall-related hip fractures among elderly people in a New England study occurred in warm months and indoors — with throw rugs a common culprit.
“Given the results of this study, it appears that efforts to decrease fall risk among the elderly living in cold climates should not be preferentially aimed at preventing outdoor fractures in winter,” said study author Dr. Jason Guercio.
Instead, preventive efforts should focus on conditions present year-round, and especially on indoor risk, said Guercio. He’s with North American Partners in Anesthesiology at the Hospital of Central Connecticut in New Britain, Conn.
The researchers analyzed details about hip fractures suffered by 544 patients treated at the Hospital of Central Connecticut between 2013 and 2016.
More than 55 percent of the hip fractures occurred during warm months, with the highest rates in May, September and October (around 10 percent each). In addition, the investigators found that more than three-quarters of the hip fractures occurred indoors.
Moreover, 60 percent of outdoor fractures occurred from May through October, not in the depths of winter.
The most common cause of both indoor and outdoor hip fracture? Tripping over an obstacle. Indoors, throw rugs were the most common obstacle cited.
Falling out of bed was the second leading cause of indoor hip fractures.
Outdoors, the other leading causes of hip fractures were being struck by a vehicle or falling from a vehicle, followed by accidents on stairs.
The study was scheduled for presentation Monday at the annual meeting of the American Society of Anesthesiologists, in Boston.
“Falls are one of the most common health concerns facing the elderly today. And this population is the fastest growing segment of the U.S.,” Guercio said in a meeting news release.
“Falls leading to fracture can result in disability and even death. Understanding the risk factors for fractures can help to focus efforts on decreasing them, and guide resources and appropriate interventions to prevent them,” Guercio said.
“It is counterintuitive that the risk for hip fracture would be higher in warm months, as ice and snow would appear to be significant fall risks,” he added.
Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.
The U.S. Centers for Disease Control and Prevention has more on hip fractures among older adults.
SOURCE: Anesthesiology annual meeting, news release, Oct. 23, 2017
Rheumatoid arthritis, a painful disease in which a person’s immune system attacks the joints, appears to be more common among people in certain types of jobs, researchers suggest.
The findings “indicate that work-related factors, such as airborne harmful exposures, may contribute to disease development,” study author Anna Ilar said. She is a doctoral student in epidemiology at the Karolinska Institute in Stockholm.
The study looked at more than 3,500 people in Sweden with rheumatoid arthritis, and nearly 5,600 people without the disease.
Among men, those in manufacturing jobs had a higher risk of rheumatoid arthritis than those in the professional, administrative and technical sectors, the findings showed. The risk was twice as high for electrical and electronics workers, and three times higher for bricklayers and concrete workers.
Among women, assistant nurses and attendants had a slightly higher risk, but women in manufacturing jobs did not. The researchers suspect that’s because fewer women than men work in manufacturing.
More study is needed to zero in on the exposures that may be involved, Ilar noted. Potential culprits include silica, asbestos, organic solvents and engine exhaust.
The report was published online Aug. 10 in the journal Arthritis Care & Research.
“It is important that findings on preventable risk factors are spread to employees, employers, and decision-makers in order to prevent disease by reducing or eliminating known risk factors,” Ilar said in a journal news release.
The researchers said they accounted for lifestyle factors associated with rheumatoid arthritis, such as body fat, smoking, alcohol use and education level. However, while the study found an association between certain occupations and rheumatoid arthritis risk, it didn’t prove a cause-and-effect relationship.