Patient Education

Carpal Tunnel Surgery Appears More Effective Than Splinting

Carpal tunnel syndrome is a common condition that causes pain, tingling, weakness, and numbness in the hand.  It results when the median nerve in the wrist is compressed.  Carpal tunnel syndrome is treated with non-surgical treatments, such as splinting or corticosteroid injections, or surgery, to release the pressure from the nerve. In a recent review, researchers found that surgical treatment for carpal tunnel syndrome was more effective than splinting for symptom relief.

The majority of people choose to have non-surgical treatment for carpal tunnel syndrome.  The Cochrane Collaboration found  that people who had steroid injections or splinting  frequently turned to surgery in the future.  In contrast, people that had surgery rarely needed additional surgeries.  It is not clear if surgery is a more effective treatment than steroid injections. More research is needed, as some practitioners argue for a "watch and wait" approach to carpal tunnel syndrome.

Don’t Shrug Off Shoulder Replacement Surgery!

Are you one of the 16 million Americans with shoulder pain and function loss because of arthritis? Are you thinking about total shoulder replacement surgery, but fear it’s too costly or risky?  A new study from Johns Hopkins University shows that not only is total shoulder replacement surgery (arthroplasty) less expensive, but it is also associated with fewer complications than other types of total joint replacement surgery.

Shoulder arthroplasty involves replacing the affected joint with a metal and plastic artificial joint.  The procedure is associated with far fewer post-surgical complications than total knee or total hip replacement surgery.  It is also about $4,000 to $5,000 lower in cost. So, don’t put off shoulder arthroplasty.  In fact, 99% of people that received shoulder arthroplasty stated that they wished they had done it sooner!

Mobilization Appears Beneficial Following Ankle Fracture Surgery

Ankle fractures are one of the most common orthopedic injuries, especially among young males and older females. About 50% of ankle fractures require surgery to reposition the bones for healing. Traditionally, casts are used to prevent the ankle from moving and protect it while it heals. The lack of movement can lead to ankle pain, stiffness, swelling, and weakness. In contrast, researchers have recently found that using removable casts or splints and exercising the joint following surgery appears beneficial.

A team of Cochrane Researchers state that exercise performed soon after surgery can help reduce pain, swelling, and stiffness while increasing movement. For fractures that are stable, walking appears helpful too. Because there appears to be a slight risk of surgical wound problems with early exercise, the researchers caution that movements should be performed with care.

Pain Medication without GI or Cardiovascular Side Effects

You are an active tennis player but cannot return to the court since you sprained your ankle. Or perhaps you have battled the osteoarthritis in your knees for the past few decades. Maybe rheumatoid arthritis causes crippling joint pain in your mother’s hands. What can we do about the pain?

Only 5 years ago doctors, patients, and the pharmaceutical industry thought they had discovered the "magic bullet" – so called COX-2 inhibitors such as Vioxx and Celebrex. This new class of medication held a theoretical advantage over traditional anti-inflammatory medications in that they were less likely to cause damage to the lining of the gastrointestinal tract. This was a major problem of the old pain medications such as ibuprofen, naproxen, and diclofenac. Ingestion of these older drugs in high doses in as little time as one week was shown to cause stomach ulcers and often serious complications such as GI bleeding.

So drug companies designed multiple trials to show that COX-2 inhibitors gave adequate pain relief without the dangers of GI side effects. The Pharmaceutical industry even started to investigate whether these wonder drugs could prevent such maladies as colon cancer.

What, unfortunately, these trials showed was that yes COX-2 decreased the risk of GI bleeding but at the significant cost of increased incidence of heart attacks and death. This unexpected finding made headline news when announced a few years ago and led to the FDA’s removal of all but one COX-2 from the market and left the remaining drug, Celebrex, with a dreaded "black box" warning. Thus, both patients and their doctors were left to figure out how to manage their debilitating pain.

So over the past few years clinical researchers have conducted their own clinical trials to determine the optimal way to provide GI protection while delivering the needed pain relief. While no formal recommendations from the government have been made, several medical societies have put forth their own consensus guidelines.

In general, the use of a proton-pump-inhibitor (PPI), a medication that is extremely effective in reducing the strength of acid produced in the stomach, along with a traditional non-steroidal anti-inflammatory agent is safe for patients at high risk for GI bleeding. COX-2 inhibitors appear to be safe for short-term use in patients with a low risk for heart disease. Most importantly, talk to your doctor about your use of any prescription or over-the-counter anti-inflammatory drugs and your risk of GI and cardiovascular side effects.

Before you know it, you will be back on the tennis court, the pain in your knees will be gone, and your mother’s hands will be pain free!

People with Heart Failure Have Increased Risk of Fractures

It is already known that heart failure is a leading cause of hospitalization and death. Now, it appears that people with heart failure have a higher risk of fractures. Researchers found that people with heart failure had 4 times the risk of fracture and 6 times the risk of hip fracture than people with other types of heart conditions.

The reasons for the increased risk of fractures among those with heart failure are not clear. The investigators suspect that lack of exercise and poor nutrition may play a role. In the meantime, people with heart failure should be screened and treated for osteoporosis, a bone weakening disease that can contribute to fractures.

US Veterans with Diabetes & Mental Health Issues at Higher Risk for Amputation

Diabetes can lead to many health complications, including toe, foot, and lower leg amputation. People with diabetes need to vigilantly work to control their blood sugar levels and monitor their feet for any changes. Researchers have found that US Veterans with diabetes and mental health issues have a higher risk of major amputations (toes, foot, and ankle or above).

Investigators at the VA New Jersey Health Care System leading this first study of its kind found that veterans with diabetes and below average mental health scores had a 0.5% rate of major amputations compared to a rate of 0.3% for those with average mental health scores and 0.2% for those with the highest level of mental health functioning. The researchers suspect that mental health issues may interfere with good diabetes care and good foot care. More research is underway to determine the best way to help US Veterans with diabetes and mental health issues to avoid amputation.
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