TUESDAY, June 16, 2020 (HealthDay News) — Patients with lower back problems often worry about how much time they’ll need to recover if they have surgery. A new study finds similar results for two common minimally invasive spine procedures.
Surgery may be recommended for degenerative conditions of the lower spine, such as a herniated disc or spinal stenosis.
Researchers at Hospital for Special Surgery in New York City compared 117 patients who had minimally invasive lumbar decompression surgery and 51 who had minimally invasive lumbar spine fusion surgery. All the procedures were performed by the same orthopedic surgeon.
“Our study is the first of its kind to look at return to activities and discontinuation of narcotic pain medication after single-level lumbar decompression or single-level lumbar spine fusion performed with a minimally invasive technique,” said senior investigator Dr. Sheeraz Qureshi, a spine surgeon at the hospital.
It took the 117 decompression patients a median of three days before they no longer required narcotic pain medication, and seven days for the 51 spinal fusion patients.
Among patients who drove before their surgery, decompression patients took a median of 14 days to resume driving, and 18 days for the fusion patients.
There was no statistically significant difference between the two groups in how long they took to return to work, according to the study.
The findings are important because standard open spinal fusion surgery generally requires a much longer recovery and slower return to activities than standard lumbar decompression, Qureshi noted.
“In our study, all the patients in both groups were able to resume driving and return to work within three weeks of surgery,” he said in a hospital news release.
“When you compare this time frame to that of standard open spinal fusion surgery, it’s really striking. Patients having a standard spinal fusion could take six months or longer for a full recovery,” Qureshi said.
Degenerative conditions of the lower spine are common causes of pain and disability, and surgery may be considered when initial treatments such as medication and physical therapy don’t provide relief.
Lumbar decompression surgery involves removal of a small section of bone or part of a herniated (bulging) disc that is pressing on a nerve. Spinal fusion is a more extensive surgery in which surgeons join two or more vertebrae together, sometimes using screws and connecting rods.
The findings were presented online earlier this year at a virtual meeting of the American Academy of Orthopaedic Surgeons. Data and conclusions released at meetings are usually considered preliminary until peer-reviewed for publication in a medical journal.
The American Academy of Family Physicians has more on low back pain.
SOURCE: Hospital for Special Surgery, news release, June 15, 2020
Carpal tunnel syndrome and cubital tunnel syndrome share similar symptoms, but they are distinct conditions affecting different nerves in the elbow and wrist.
If you’re experiencing pain and numbness in your fingers, you may assume you have carpal tunnel syndrome. But did you know another condition — called cubital tunnel syndrome — could also be the source of these symptoms?
Both carpal tunnel syndrome and cubital tunnel syndrome result from nerve compression; however, the damaged nerve for each is located in a different part of the body. In cubital tunnel syndrome, the ulnar nerve within the elbow becomes compressed due to injury or repeated bending of the elbow. The ulnar nerve sits inside the cubital tunnel, a passageway consisting of bone, muscle, and ligaments.
On the other hand, the compressed nerve causing carpal tunnel syndrome is the median nerve in the wrist. Repetitive motions of the hand and wrist (such as typing), fractures, and sprains are typically to blame. In addition, chronic conditions such as diabetes and arthritis are considered risk factors for carpal tunnel syndrome.
Despite some similarities — compressed nerves, hand pain, weakness when gripping objects — cubital tunnel syndrome and carpal tunnel syndrome are characterized by several differences. Knowing the symptoms for each can help you identify which condition you may have and determine the right treatment.
Carpal Tunnel vs. Cubital Tunnel
Both syndromes affect the hand and fingers, but the pain, tingling, and numbness of carpal tunnel syndrome is felt most acutely in the thumb, index finger, middle finger, and half of the ring finger. It’s also characterized by pain and burning in the hand and wrist that sometimes radiates up the forearm to the elbow.
Meanwhile, cubital tunnel syndrome is marked by numbness, pain, and tingling in the little and ring fingers as well as the inside of the hand. If you have cubital tunnel syndrome, you may notice these symptoms flare up at night when you bend your elbow for long periods as you sleep.
Diagnosing cubital tunnel syndrome or carpal tunnel syndrome begins with a physical examination. An orthopedist may also perform a nerve conduction study to assess nerve impulses in the wrist or elbow. Weak nerve activity in a certain area could indicate, for example, carpal tunnel syndrome.
Treating the Symptoms
Treatment options differ for each syndrome, although conservative therapies are recommended at first to reduce symptoms and restore function to the hand. Because cubital tunnel symptoms are more pronounced at night, you might be advised to wear a brace that straightens the elbow while you rest. Wrapping your arm in a towel to keep it straight can work as well.
If conservative treatments fail to relieve the nerve compression or muscle wasting is severe, surgery is another option. Two types of cubital tunnel surgery are currently performed: a medical epicondylectomy and an ulnar nerve transposition. In a medial epicondylectomy, the bony bump inside the elbow (the medial epicondyle) is removed. This allows the ulnar nerve to flex and straighten without pain. For an ulnar nerve transposition, the surgeon creates a new cubital tunnel and moves the ulnar nerve to the recreated tunnel.
Treating carpal tunnel syndrome non-surgically usually entails resting the hand, avoiding activities that aggravate symptoms, wearing a splint for several weeks, and applying ice to reduce swelling. Anti-inflammatories and steroids may also be prescribed. Once the pain subsides, you can practice exercises to stretch and strengthen the wrist and hand.
If these conservative treatments don’t alleviate carpal tunnel symptoms, surgery to relieve pressure on the median nerve by cutting the transverse carpal ligament may be necessary. This procedure is followed by physical therapy to strengthen the wrist.
What’s Causing Your Hand Pain?
If you’re experiencing hand and finger pain, you may be suffering from either cubital tunnel syndrome or carpal tunnel syndrome. The doctors at Comprehensive Orthopaedics can diagnose your condition and prescribe the proper treatment regimen. Whether through conservative therapy or surgery, our goal is to help our patients live pain-free. Contact us today for an appointment.
TUESDAY, May 12, 2020 (HealthDay News) — People at high risk for knee arthritis don’t need to avoid jogging and other types of vigorous exercise, a new study suggests.
Some folks hold back on physical activity because they fear it will increase their chances of developing knee arthritis, so researchers from Northwestern University’s Feinberg School of Medicine in Chicago took a closer look.
“Our study findings convey a reassuring message that adults at high risk for knee [arthritis] may safely engage in long-term strenuous physical activity at a moderate level to improve their general health and well-being,” said study author Alison Chang, associate professor of physical therapy and human movement sciences.
The study included nearly 1,200 people from several U.S. cities, ages 45-79, who were at high risk for knee arthritis but had no evidence of the condition.
Obesity, previous joint injury, surgery, aging and chronic knee symptoms increase the risk of developing arthritis of the knee.
Participants were followed for up to 10 years. Chang and her colleagues found that long-term participation in strenuous physical activities such as jogging, swimming, cycling, singles tennis, aerobic dance and skiing was not associated with risk of developing knee arthritis.
In fact, those who did vigorous exercise had a 30% lower risk of knee arthritis, but that’s not considered statistically significant, according to the authors.
Lots of sitting wasn’t associated with either an increased or reduced risk of arthritis.
“People suffering from knee injuries or who had arthroscopic surgical repair of ACL or meniscus are often warned that they are well on the path to develop knee [arthritis],” Chang said in a university news release.
“They may be concerned that participating in vigorous activities or exercises could cause pain and further tissue damage. To mitigate this perceived risk, some have cut down on or discontinued strenuous physical activities, although these activities are beneficial to physical and mental health,” she said.
The bottom line? “Health care providers may consider incorporating physical activity counseling as part of the standard care for high-risk individuals at an early stage when physical activity engagement is more attainable,” Chang said.
The study findings were published May 4 in the journal JAMA Network Open.
The American Academy of Family Physicians has more on arthritis.
SOURCE: Northwestern University, news release, May 4, 2020
How do you know if your joint symptoms mean you have arthritis? Only a health care professional can tell you for sure, but certain signs usually point to arthritis. There are four important warning signs that should prompt you to talk to a health care provider.
Pain from arthritis can be constant or it may come and go. It may occur when at rest or while moving. Pain may be in one part of the body or in many different parts.
Some types of arthritis cause the skin over the affected joint to become red and swollen, feeling warm to the touch. Swelling that lasts for three days or longer or occurs more than three times a month should prompt a visit to the doctor.
This is a classic arthritis symptom, especially when waking up in the morning or after sitting at a desk or riding in a car for a long time. Morning stiffness that lasts longer than an hour is good reason to suspect arthritis.
4. Difficulty moving a joint.
It shouldn’t be that hard or painful to get up from your favorite chair.
What To Do:
Your experience with these symptoms will help your doctor pin down the type and extent of arthritis. Before visiting the doctor, keep track of your symptoms for a few weeks, noting what is swollen and stiff, when, for how long and what helps ease the symptoms. Be sure to note other types of symptoms, even if they seem unrelated, such as fatigue or rash. If you have a fever along with these symptoms you may need to seek immediate medical care.
If the doctor suspects arthritis, they will perform physical tests to check the range of motion in your joints, asking you to move the joint back and forth. The doctor may also check passive range of motion by moving the joint for you. Any pain during a range of motion test is a possible symptom of arthritis. Your doctor will ask you about your medical history and may order lab tests as needed.
Most people start with their primary care physician, but it’s possible to be referred to doctors who specialize in treating arthritis and related conditions. Getting an accurate diagnosis is an important step to getting timely medical care for your condition.
TUESDAY, Jan. 28, 2020 (HealthDay News) — Fiberglass and plaster casts are widely used to treat broken bones in kids, but they have drawbacks compared with other methods such as braces and splints, experts say.
Doctors and patients should review the available options, considering not only treatment of the fracture, but also patient comfort and compliance as well as the burden on the family, according to a review article in the January issue of the Journal of the American Academy of Orthopaedic Surgeons.
Children “may be eager to get a cast, choosing a color that fits their personality,” said lead author Dr. Eric Shirley, a pediatric orthopedic surgeon at Naval Medical Center Portsmouth in Virginia.
“However, the thrill soon wears off when they learn that they will be unable to play, swim or engage in high-impact activities while wearing a cast. What’s more, complications like itching, blisters or dermatitis associated with cast management can lead to added frustration,” he said in a journal news release.
A cast can also be a challenge for children attending school, and families have to schedule follow-up visits for cast removal. For every 100 pediatric fracture clinic appointments, 54 school days and 25 workdays are missed.
And complications with casts can require emergency department visits that put time and cost burdens on both the family and the health care system.
“Pediatric patients are often seen in the emergency department with issues related to wet or damaged casts,” Shirley said. “These complications can nearly always be addressed during normal clinic hours; however, we find that families do not want to wait or feel anxious when caring for a cast.”
Using alternatives such as braces, soft casts or splints could help reduce patient anxiety, eliminate cast complications, and reduce follow-up visits, care costs and time missed from school and work, according to the review.
These alternatives are acceptable and effective for certain fractures to the forearm, shin, foot or ankle, but are not used not as often as they could be in children, the authors said.
Parents should talk with their orthopedic surgeon about the benefits and drawbacks of the different treatment options for children with broken bones, Shirley advised.
SATURDAY, Feb. 1, 2020 (HealthDay News) — Almost everyone gets stuck shoveling snow at some point during the winter. To prevent back pain and strain, one spinal expert has some advice.
Orthopedic surgeon Dr. Srinivasu Kusuma, from the University of Chicago Medicine Medical Group, noted it’s all in the precautions you take before you tackle your snow-covered driveway.
Decide if it’s safe to shovel. If you already have back issues and don’t exercise often, or if you are prone to lightheadedness or shortness of breath, maybe you shouldn’t be shoveling. Instead, consider using a snowblower. For those with heart problems or chest pains during exercise, Kusuma urges they check with their doctor about shoveling.
Warm up your muscles. “Make sure to warm up before you shovel, just as you would before a workout,” Kusuma said in a university news release. Stretching and strolling can warm up your muscles. If you’re going to shovel bright and early, make sure your muscles are loose before shoveling. Don’t have time to stretch out in the a.m.? You might want to shovel in the evening then.
Appropriate winter gear is important. A coat, pants, hat and gloves will keep you warm in frigid weather. Wearing waterproof boots can also give you traction and prevent slips and falls, Kusuma said. Use a lightweight shovel with an adjustable handle.
Use proper technique. Push the snow to the side instead of picking it up. If you need to lift the snow, don’t fill the shovel more than halfway. “Bend with your knees and not your back, using your powerful leg muscles instead of core muscles,” Kusuma said. Always keep your shoulders and hips square with the shovel and avoid twisting at the waist.
Take your time. “People are usually in a rush to get to work or to get out the door,” Kusuma said. “I see injuries like strains, sprains and herniated disks when people try to do too much too fast.” Stretch your arms and legs every 10 to 15 minutes to stay limber. “You’re less likely to [get] hurt if you plan ahead and take breaks so your muscles stay flexible,” he noted.
The American Academy of Orthopaedic Surgeons has more on safe shoveling.
SOURCE: University of Chicago Medical Center, news release, January 2020