Diabetic Neuropathy Elbow

Gtgt LOSING OUR GRIP, NEXT ON CALL WITH THE PRAIRIE DOC. HANDS AND ELBOW INJURIES, TONIGHT ON CALL WITH THE PRAIRIE DOC. gtgt GOOD EVENING, AND WELCOME TO ON CALL WITH THE PRAIRIE DOC. THE HAND, WRIST AND ARM MAKE UP A MARVELOUS SYSTEM. THEY CAN PICK UP A BUTTERFLY WITH TENDERNESS ONE MOMENT, THEN PULL STUBBORN WEEDS OUT OF THE GARDEN THE NEXT. THEY MOVE THROUGH A SERIES OF MUSCLES AND TENDONS THAT CREATE A PULLEY SYSTEM THAT CAN BE CONTROLLED WITHIN FRACTIONS OF AN INCH. WHETHER PERFORMING EYE SURGERY OR THROWING BALES OF HAY TO FEED A HORSE, OUR ARMS, ELBOWS, WRISTS AND HANDS MAKE.

A WORLD OF WORK POSSIBLE. OKAY, LET’S TAKE A LOOK AT THIS WEEK’S PRAIRIE DOC QUIZ QUESTION. CARPAL TUNNEL SYNDROME IS TYPICALLY CHARACTERIZED BY NUMBNESS AND WEAKNESS IN THE A. PINKY FINGER. B. THUMB. C. THE FUNNY BONE OF THE ELBOW VIEWERS WHO CALL IN THE CORRECT ANSWER WILL BE ENTERED INTO A DRAWING TO WIN A SIGNED COPY OF THE PICTURE OF HEALTH. THIS BOOK WAS WRITTEN BY ME WITH WONDERFUL ACCOMPANYING PHOTOGRAPHS BY DR. JUDITH PETERSON. WE WILL ANNOUNCE THE ANSWER AND THE WINNER AT THE END OF THE SHOW.

REMEMBER, YOU ONLY HAVE 10 MINUTES TO GET YOUR ANSWER IN! YOU HAVE THE WHOLE SHOW TO CALL IN YOUR QUESTIONS. WE WILL ANSWER YOUR MEDICAL QUESTIONS ABOUT HAND, WRIST AND ELBOW INJURIES OR CONCERNS AS THEY ARE CALLED IN OR SENT TO US VIA FACEBOOK OR EMAIL. CALL IN QUESTIONS TO 18883766225. OR SEND US AN EMAIL. AND WE NEED YOUR QUESTIONS, SO PLEASE GIVE US THOSE CALLS. JOINING US TONIGHT ARE SCOTT MCPHERSON OF CORE ORTHOPEDICS AVERA MEDICAL GROUP AND ROBERT VAN DEMARK OF SANFORD ORTHOPEDICS AND SPORTS MEDICINE. THANK YOU, GENTLEMEN, FOR JOINING US. gtgt YOU’RE WELCOME. gtgt PLEASURE.

Hand and Elbow Injuries On Call with the Prairie Doc Feb 4, 2016

Gtgt SO, SCOTT, TELL US A LITTLE BIT ABOUT YOU. YOU’RE FROM WHERE ORIGINALLY gtgt SO I GREW UP 30 MILES WEST OF MINNEAPOLIS. IF YOU GO UP TO HIGHWAY 12, TAKE A RIGHT, GO 200 MILES, THAT WAS MAPLE PLAIN, MINNESOTA. gtgt MAPLE PLAIN. gtgt YEAH. gtgt BIG, HUGE CITY gtgt I THINK WHEN I GREW UP THE NAME OF THE TOWN WAS ON BOTH SIDES OF THE SIGN. THEY’RE UP TO A MASSIVE 1,500 NOW, AND THEY GOT A STOPLIGHT. gtgt ONE STOPLIGHT. WHAT DID YOUR FOLKS DO gtgt SO, MY DAD WORKED CONSTRUCTION, GAS PIPELINE FOREMAN AND MY MOM WAS A BANK.

TELLER, BUT AFTER SHE HAD KIDS WAS A STAYATHOME MOM. gtgt OKAY. AND THEN YOU WENT TO MED SCHOOL AT MINNESOTA gtgt UNIVERSITY OF MINNESOTA. AND I HAD THE NAVY PAY FOR IT. AND, SO, AFTER I FINISHED THAT, I GOT ACCEPTED TO ORTHOPEDIC RESIDENCY AT THE NAVY HOSPITAL IN SAN DIEGO. WHICH SEEMED TO BE A SMART MOVE COMING FROM gtgt SOUTH DAKOTA. AND MINNESOTA. gtgt MINNESOTA, SOUTH DAKOTA. gtgt AT THE TIME. gtgt AND THEN HAD A LITTLE OBLIGATED SERVICE, ONE YEAR AS THE ORTHOPEDIC SURGEON ON GUANTANAMO BAY, CUBA, TWO.

YEARS BACK AT THE NAVY HOSPITAL IN SAN DIEGO, AND THEN WENT UP TO UCLA AND DID A HAND FELLOWSHIP, THEN WAS BACK TO MINNESOTA FOR 20 YEARS UNTIL I SAW THE LIGHT AND CAME TO A KINDER, GENTLER PLACE, SIOUX FALLS, SOUTH DAKOTA, FOR THE LAST THREE AND A HALF YEARS. gtgt IT’S BEEN GREAT TO HAVE YOU HERE. gtgt AND, BOB, YOU COME FROM A LONG LINE OF ORTHOPEDISTS. TELL US A LITTLE BIT THAT. gtgt I GREW UP IN SIOUX FALLS. MY FATHER WAS AN ORTHOPEDIC SURGEON AND HIS BROTHER WAS ALSO ORTHOPEDIC SURGEON. AND THEIR UNCLE, GUY, STARTED PRACTICE IN 1907 AS AN.

ORTHOPEDIC SURGEON. gtgt IN SOUTH DAKOTA. gtgt IN SIOUX FALLS, YEAH. gtgt AND YOU HAVE CHILDREN gtgt I HAVE A DAUGHTER WHO’S AN ANESTHESIOLOGIST AT AVERA, SCOTT WORKS WITH HER EVERY NOW AND THEN. AND MY SON’S A FIFTHYEAR RESIDENT OF THE MAYO CLINIC IN ORTHO. gtgt HE’S GOING TO COME AND JOIN YOU gtgt EVENTUALLY WE HOPE. gtgt HE’S NOT DOING HAND. gtgt HE’S GOING TO DO A TRAUMA FELLOWSHIP IN CHARLOTTE, NORTH CAROLINA, NEXT YEAR. gtgt OH, WOW. YOU’LL HAVE ANOTHER VAN DEMARK ORTHOPEDIST COMING DOWN THE LINE. gtgt MY YOUNGEST IS A DENTIST IN ROCHESTER, MINNESOTA. gtgt WOW, THAT’S GREAT. WELL, YOU KNOW, HAND, HAND.

ORTHOPEDICS IS A DIFFERENT BREED OF CAT THAN ALL THE REST OF THIS ORTHOPEDIC STUFF, ISN’T IT gtgt WE LIKE TO THINK SO. gtgt HOW SO gtgt WELL, YOU KNOW, A LOT OF GENERAL ORTHOPEDICS IS DOING TOE, HIPS, TOE, KNEES. THIS IS A LITTLE BIT FINER DELICATE WORK, I THINK. MORE A SITDOWN JOB, TOO. I THINK IT’S A LOT MORE FUN DOING GENERAL ORTHOPEDICS MYSELF. gtgt I MEAN, YOU BOTH TOLD ME IT’S A KINDER, GENTLER TYPE OF AN ORTHOPEDIST.gtgt IT IS. YOU’RE AT A TABLE, THE ANATOMY IS MUCH FINER, PROBABLY A LITTLE MORE DELICATE, SOFT TISSUE HANDLING THAN MAYBE SOME OF OUR GENERAL.

ORTHOPEDIC, BURLY KIND OF GUYS. AND, SO, IT’S A FASCINATING ANATOMY AND IT’S FUN EVERY TIME YOU DO SOMETHING THERE. gtgt I’VE OFTEN BEEN BLOWN AWAY BY THE FACT THAT THE STRENGTH OF THE HAND IS FROM THE FOREARM MUSCLES. AND THE FOREARM MUSCLES CONTROL ALL OF THESE, EACH LITTLE PART OF OUR HAND AND OUR WRIST AND OUR FINGERS HAS A CONNECTION TO THE FOREARM. gtgt RIGHT. gtgt BUT THEN THE HAND HAS ITS OWN MUSCLES. WHAT ARE THOSE gtgt THEY’RE INTRINSIC MUSCLES. AND MOST OF THOSE ARE MADE BY THE ULNAR NERVE, KIND OF THE FUNNY BONE NERVE, FEW ARE THE.

MEDIAN NERVE BUT MOST ARE SMALL INTRINSIC MUSCLES, FINE MOTOR, FINETUNING MUSCLES OF THE HAND. gtgt THEY HAVE TO WORK IN CONCERT, TOO. IF YOU HAVE JUST THE EXTRINSIC, THE FOREARM, THEY KIND OF WILL GIVE YOU KIND OF, YOU KNOW, NOT VERY GOOD MOTION UNLESS YOU HAVE THEM BALANCED WITH THOSE INTRINSICS TO MAKE IT A VERY SOPHISTICATED KIND OF MOTION. gtgt THAT YOU CAN USE. gtgt SO WHAT ABOUT THE THEY SAY THE THING THAT MAKES HUMANS DIFFERENT THAN OTHER ANIMALS, YOU KNOW, THE OPPOSITION OF THE THUMB AND THE FINGER. ANY COMMENT ABOUT THAT.

Gtgt IT’S TRUE. gtgt YES. Laughter gtgt WE’RE THE ONLY ONES WHO CAN DO THAT. gtgt YEAH. gtgt THAT’S THE INTRINSIC MUSCLES OF THE HAND, RIGHT gtgt YEAH. gtgt YOU KNOW, THE THENAR MUSCLES. gtgt IF YOU HURT YOUR THUMBS, YOU REALIZE WHY WE HAVE THUMBS. gtgt YOU KNOW, AND A LOT OF PEOPLE HAVE THUMB PROBLEMS. TELL ME ABOUT THAT. gtgt A LOT OF PEOPLE HAVE THUMB ARTHRITIS, THAT’S PROBABLY WHAT WE MOSTLY SEE, I THINK. gtgt REALLY WHAT DO YOU DO FOR IT ORTHOPEDIC ANSWER gtgt OH, YEAH, THERE ARE A VARIETY OF THINGS YOU CAN DO. MEDICATIONS, SOME THERAPIES,.

SPLINTS, INJECTIONS. SURGERY. gtgt SURGERY. WHAT’S THE DURING DURING LET’S TALK ABOUT THE SURGERY. BECAUSE I’VE SEEN SO MANY PEOPLE WITH THIS, YOU KNOW, YOU TOUCH THEM AT THE BASE OF THEIR THUMB AND THEY JUST OR AT THE BASE OF THE gtgt YEAH, IT’S RIGHT THERE. PRETTY MUCH WITHIN FIVE SECONDS THEY HAVE ARTHRITIS AT THE BASE OF THEIR THUMB, THE PAIN IS RIGHT THERE, IF YOU TAKE IT, GRIND IT, THE SURGERY BASICALLY CONSISTS OF TAKING THE BONE JUST BELOW THE METACARPAL HERE, THE BASE BONE, ABOUT THE SIZE OF A DICE.

CUBE, CALLED THE TRAPEZEIUM, ALMOST EVERY SURGERY INVOLVES TAKING THAT OUT, FIGURING OUT SOME WAY JUST TO SUPPORT THE THUMB SO IT DOESN’T COLLAPSE. AND THERE’S REALLY A VARIETY OF WAYS THAT PEOPLE DO IT. IT’S BECAUSE THEY ALL TEND TO HAVE A PRETTY FAVORABLE, YOU KNOW, THING. IN OUR PROFESSION, IF THERE’S A LOT OF THINGS WAYS TO DO HAD SOMETHING, IT’S BECAUSE THEY ALL WORK WELL, OR NONE OF THEM WORK WELL. THIS IS ONE WHERE THEY ALL TEND TO WORK PRETTY WELL. gtgt THAT’S ONE ORTHOPEDIC HAND SURGERY THAT PEOPLE WHO HAVE WHO ARE REALLY SUFFERING COULD REALLY DO.

SOMETHING ABOUT. I MEAN, THAT’S A TAKEHOME MESSAGE WORTH REMEMBERING. gtgt IT IS. A LOT OF PEOPLE COME AND GO, I DIDN’T KNOW THAT YOU COULD DO ANYTHING ABOUT IT. ALL OF A SUDDEN, HERE IT IS. THOSE ARE SOME OF THE MOST GRATIFYING PATIENTS BECAUSE ALL DAY THEY’RE USING THEIR THUMB, IT’S ACHING, PAINFUL, ALL OF A SUDDEN THEY HAVE A RELATIVELY PAINFREE THUMB WITH GOOD MOBILITY AND FUNCTIONAL STRENGTH, THEY’RE HAPPY PEOPLE. gtgt I’VE OFTEN THOUGHT THAT A LOT OF HAND PROBLEMS ARE RELATED TO THE FACT THAT WE ABUSE OUR HANDS LIKE CRAZY. I FOUND MYSELF USING IT AS A.

HAMMER, TRYING TO DO THINGS. WHY DO PEOPLE GET THAT ARTHRITIS OF THE THUMB I MEAN, IS THERE A REASON gtgt IT’S MORE COMMON IN WOMEN THAN MEN. NO ONE KNOWS WHY. SOME OF MY PATIENTS SAY BECAUSE WOMEN WORK HARDER THAN MEN, WHICH MAY BE TRUE. SOMETHING TO DO WITH THE SLOPE OF THE TRAPEZEIUM, TOO, IS DIFFERENT IN WOMEN THAN MEN. gtgt WHAT’S THE TRAPEZEIUM. ONE OF THE BONES OF THE WRIST. gtgt THEY TAKE THE BONE OUT, YEAH, HIT THE BASE OF THE THUMB. gtgt WHAT I BASICALLY TELL THEM,.

THE JOINT IS KIND OF LIKE A SADDLE JOINT, AND IF OUR THUMBS ONLY WENT LIKE THAT, WE’D BE FINE, BUT THEY’RE ALWAYS GOING LIKE THAT AND CARTILAGE, WHICH IS LIKE THE TEFLON COATING ON A FRY PAN DOESN’T LIKE SHEAR, AND IF YOU KEEP SHEARING IT, IF YOU PINCH HERE WITH TEN POUNDS OF FORCE, IT PUTS 120 POUNDS OF FORCE THROUGH THE BASE OF YOUR THUMB TO STABLIZE THAT THUMB. AND I ALWAYS THINK, THE WOMEN MAYBE HAVE A LITTLE MORE PROBLEM BECAUSE THEIR JOINTS ARE A LITTLE SMALLER, HIGHER CONTACT FORCE, PLUS MAYBE A LITTLE MORE LIGAMENT LAXITY SO.

THEY GET MORE SHEER. THEY GET IT ABOUT A FOUR TO ONE RATIO THAN THE GUYS DO. gtgt AND THEY WORK HARDER. LET’S NOT ARGUE THAT ONE. gtgt NO. gtgt WOMEN FROM WOMAN FROM BROOKINGS, I HAVE A HISTORY OF CARPAL TUNNEL AND I AM EXPERIENCING FREQUENT SYMPTOMS. WHEN DO YOU SUGGEST MAKING THE CALL TO SET UP AN APPOINTMENT AND CONSULT FOR SURGERY SO, WHAT IS CARPAL TUNNEL SYNDROME gtgt COMPRESSION OF THE MEDIAN NERVE AT THE WRIST. AND USUALLY PEOPLE GET NUMBNESS IN YOUR THUMB, INDEX, MIDDLE FINGER, AND HALF OF THE RING FINGER.

Gtgt SO I GUESS WE COULD GET TO THE MEDIAN NERVE. WE WERE JUST TALKING ABOUT THE BASE OF THE THUMB. gtgt RIGHT THERE. TRAPEZIUM. gtgt TRAPEZIUM. AND NOW WE’RE TALKING ABOUT CARPAL TUNNEL SYNDROME. THERE IS A FASCIA THAT GOES AROUND HERE. YEAH. TELL ME gtgt I THINK THERE MIGHT BE A BETTER PICTURE, RICK. gtgt OKAY. LET’S GO TO THE NEXT PICTURE. gtgt DON’T WANT TO TELL YOU WHAT TO DO. gtgt THERE WE GO. THAT’S MUCH BETTER. gtgt RUN THIS gtgt YEAH. gtgt SO THIS IS THE CARPAL LIGAMENT RIGHT HERE.

AND BENEATH THAT RUNS THE MEDIAN NERVE. gtgt YOU CAN SEE IT. OH, NO, THOSE ARE TENDONS. gtgt YEAH. THE FLEXOR TENDONS, WHITE THINGS BENEATH IT. gtgt THE NERVE WOULD BE PRETTY MUCH RIGHT UNDERNEATH THERE. gtgt ALL RIGHT. AND, SO, OF COURSE, YOU CAN PUT THEM IN A WRIST SPLINT SO THEY DON’T OVERWORK IT, PARTICULARLY AT NIGHT, BECAUSE SOMETIMES THEY’LL SLEEP LIKE THIS, RIGHT. gtgt CORRECT. gtgt AND CARPAL TUNNEL WILL GET BETTER. OR YOU CAN INJECT IT WITH STEROIDS. WHAT ELSE DO YOU DO WHERE IS THE SURGERY, WHAT WOULD YOU DO WITH THE SURGERY gtgt THE SURGERY IS BASICALLY RIGHT OVER THE CARPAL.

LIGAMENT. AND THERE ARE A COUPLE DIFFERENT WAYS TO DO IT. BUT THE WHOLE IDEA IS JUST TO RELEASE THE CARPAL LIGAMENT, TO TAKE THE PRESSURE OFF THE NERVE. AND THERE ARE A VARIETY OF DIFFERENT WAYS TO DO IT. YOU CAN DO IT ENDOSCOPICALLY OR DO IT OPEN. gtgt ALL RIGHT. I’M GOING TO ERASE THIS. AND I’M GOING TO GIVE YOU SO TELL US AGAIN. DRAW AGAIN. gtgt SURE. YEAH. SO, INCISION KIND OF RUNS JUST ABOUT HERE, IT’S NOT QUITE THAT BIG, BUT YOU CAN DO ENDOSCOPICALLY. gtgt WHICH MEANS WITH A SCOPE. gtgt WITH A SCOPE, YEAH.

THE RESULTS ARE THE SAME. OPEN OR ENDOSCOPIC. IT’S A PRETTY PREDICTABLE OPERATION AS FAR AS PAIN RELIEF. gtgt NOW, SOME SAY, WELL, YOU NEED TO DO THE STUDIES TO PROVE THAT YOU HAVE IT OR DO YOU YOU JUST HAVE THEY JUST HAVE THE HISTORY, THAT’S ENOUGH Laughter gtgt IT’S A LITTLE BIT OF DEBATE. SO, YOU KNOW, I SPENT, LIKE I SAID, ONE YEAR IN GUANTANAMO BAY, CUBA. I’D THINK LONG AND HARD BEFORE I’D SEND SOMEBODY 2,0 MILES FOR THE ELECTRICAL DIAGNOSTIC TESTING. THE WAY MY TRAINING IS, MAYBE EXPERIENCES OF OUR TRAINING, IF SOMEBODY HAS A CLASSIC.

HISTORY AND THEY HAVE CLASSIC FINDINGS, WHY ORDER AN EXPENSIVE TEST THAT I DON’T THINK’S GOING TO CHANGE THE MANAGEMENT OR HELP ME WITH IT. NOW, IF IT’S SOMEBODY THAT I’M NOT SURE, MAYBE IS IT A CARPAL TUNNEL OR IS IT A NECK PROBLEM OR DO THEY HAVE A DIABETIC NEUROPATHY ON TOP OF THIS, I NEED MORE INFORMATION, THEN I MIGHT USE IT. OR IF IT’S WORKERS COMPENSATION, THE STATUTES ALMOST ALWAYS REQUIRE YOU TO GET A POSITIVE ELECTRICAL DIAGNOSTIC TESTING OR CONFIRM, IF THAT’S NEGATIVE, YOU CAN CONFIRM IT WITH A POSITIVE RESULT WITH A CORTICOSTEROID.

INJECTION OF THE CARPAL TUNNEL. KIND OF DICTATED TO YOU THERE. gtgt THE WHAT gtgt THE BRITISH DON’T EVEN DO IT. gtgt THEY DO THE SURGERY. NOW, THE QUESTION I WOULD HAVE, SO THEY DON’T DO THE TESTING, THEY JUST DO THE SURGERY. gtgt JUST LIKE SCOTT WAS SAYING, YEAH. gtgt AND BEFORE WE GO ON, IF YOU DON’T FIX IT EARLY ENOUGH, PEOPLE LOSE THEIR MUSCLES PERMANENTLY, RIGHT SO YOU DON’T WANT TO LIVE WITH THIS, RIGHT I MEAN, WHEN IS THE TIME THAT PEOPLE SHOULD COME TO YOU AND HAVE THIS SURGERY.

Gtgt SO GOING TO THIS LADY’S QUESTION HERE, SO, IF YOU’RE STARTING TO HAVE, LIKE, NIGHTWAKING SYMPTOMS, THE FIRST THING USUALLY PEOPLE DO IS THEY’LL TRY THE NIGHT SPLINTS SO THEY DON’T SLEEP WITH THEIR WRISTS FLEXED, WHICH PUTS ABOUT FOUR TIMES THE PRESSURE ON THE NERVE, OFTENTIMES THAT MAKES THE SYMPTOMS GO AWAY. BUT I TELL PEOPLE, WHEN IT’S INTERFERING WITH YOUR ACTIVITIES OF DAILY LIVING OR YOUR NIGHT SLEEP PATTERN, THEN IT’S, I THINK, A GOOD TIME TO COME AND SEE SOMEBODY, CONFIRM THE DIAGNOSIS AND THEN TREATMENT OPTIONS. THE NATURAL HISTORY FOR CARPAL.

TUNNEL TENDS TO BE PROGRESSIVE. IT’S CAUSED BY THE FACT THAT THOSE NINE TENDONS, AS WE AGE, TEND TO THICKEN UP, TAKE UP MORE SPACE, LIKE PUTTING TOO MANY THINGS IN YOUR CLOSET AT HOME, IT KEEPS GETTING FULLER, IT PUSHES THE NERVE UP AGAINST THE LIGAMENT. IT MAY WAX AND WANE, AND IT CONTINUES TO GET WORSE. WHEN IT GETS ENOUGH TO WHERE IT’S BOTHERING YOU, I USUALLY SUGGEST, DO THE CARPAL TUNNEL, BE DONE WITH IT. THE SUCCESS RATE, LIKE BOB SAYS, IT’S HIGHLY SUCCESSFUL. 95 TO 97, IF THEY MEET GOOD SURGICAL CRITERIA.

Gtgt YEAH.I THINK THE NIGHT PAIN IS WHAT DRIVES THEM CRAZY. gtgt YEAH. gtgt CAN’T SLEEP AT NIGHT. gtgt YEAH. gtgt YEAH.gtgt WHAT BRINGS MOST PEOPLE IN, I THINK. gtgt YEAH. AND IT’S A PERMANENT SOLUTION. gtgt USUALLY. gtgt TYPICALLY. gtgt AND IT’S PREVENTIVE OF A PERMANENT LOSS. gtgt YEAH. I USUALLY TELL PEOPLE, ABOUT 2 RECURRENCE RATE. gtgt YEAH. gtgt IN THE LITERATURE. gtgt OKAY. IT ISN’T UNCOMMON FOR A FOOTBALL PLAYER TO BREAK A BONE DURING A GAME WITH THE HITS AND TACKLES THEY GO THROUGH. BUT FOR MOST OF US, A BROKEN BONE ARRIVES WHEN WE LEAST EXPECT IT.

AND FROM THE MOST MUNDANE OF CIRCUMSTANCES. gtgt I WAS RIDING MY BIKE BACK FROM THE POST OFFICE. I WENT TO GO GET THE MAIL FOR WORK. I WAS ON THE SIDEWALK, AND I TURNED ON THE SIDEWALK, AND WHEN I TURNED, I WENT ONTO THE GRASS A LITTLE BIT. AND AS I WAS TRYING TO COME BACK ONTO THE SIDEWALK, IT WAS A SPOT WHERE THE DIRT HAD SETTLED, SO MY BIKE TIPPED OVER. AND WHEN IT TIPPED OVER, YOU KNOW, INSTINCTUALLY I WANTED TO STICK OUT A STRAIGHT ARM.

AND THE STRAIGHT ARM IMPACTED. THE FORCE WENT UP THE ULNA AND IT SHATTERED THE DISTAL HUMERUS. AND IMMEDIATELY I COULD NOT MOVE IT VERY WELL SO I CALLED MY BROTHERS. AND HAD THEM COME GRAB ME. AND I WENT TO THE CLINIC AND AT THAT POINT ALL THEY DID WAS SPLINT ME UP AND TOOK XRAYS AND I WAS REFERRED TO AN ORTHOPEDIC SURGEON. AND I WAS AMAZINGLY CALM. I MEAN, IT HURT A LITTLE BIT, BUT IT WAS MORE SO WANTING TO, I NEED TO FIGURE OUT THE NEXT STEP. I DIDN’T WANT TO MOVE IT ON MY OWN.

I WANTED TO HAVE SOMEONE EXAMINE IT. BEFORE I TRIED FORCIBLY MOVING IT BACK AND FORTH. I THOUGHT ABOUT, LIKE, SHOULD I TRY TO STRAIGHTEN IT BUT I DECIDED JUST TO SUPPORT THE WEIGHT BEST I COULD. UNTIL AN XRAY COULD BE TAKEN. AND THEY COULD TELL ME WHETHER OR NOT THERE WAS DAMAGE AND IF IT WAS SAFE OR NOT TO MOVE. I ULTIMATELY WENT TO GO SEE A GENERAL ORTHOPEDIC SURGEON. THEY WERE THE ONES THAT SAID, THIS IS QUITE SERIOUS AND YOU’LL NEED TO SEE A HAND SURGEON TO HAVE IT DONE.

I WAS ON PERCOSET AFTERWARDS. WHICH HELPED MANAGE THE PAIN. BECAUSE THEY REALLY WANTED ME TO MOVE IT RIGHT AWAY AND KEEP THE RANGE OF MOTION. AND THAT WAS THE MOST PAINFUL PART, JUST TRYING TO GET IT TO MOVE. AT HOME IT WASN’T TOO BAD. YOU HAD TO ADJUST TO MOVING THINGS ONEHANDED. AND IT WAS A LOT FOR ME, PERSONALLY, IT WAS A LOT EASIER FOR ME TO HAVE MY MOM AND LITTLE BROTHER AROUND, OTHERWISE I LIVE IN AN APARTMENT BY MYSELF. I’M SURE I COULD HAVE MANAGED, BUT GIVEN I CAN WORK REMOTELY.

FOR THE MOST PART, WAS HELPFUL HAVING SOMEONE TO MOVE STUFF AROUND THE HOUSE. AND HELP ME OUT WITH TASKS THAT WOULD OTHERWISE BE VERY DIFFICULT WITH ONE ARM. MUSIC gtgt SO THAT’S AARON PETERSON, WHO IS WHO WORKS WITH US ON THE HEALING WORDS FOUNDATION. HE WORKS WITH US. AND IT’S GREAT THAT HE WAS WILLING TO DO THIS TYPE OF A THING. AND THANK YOU FOR SHARING YOUR STORY, AARON. SO LET’S TALK ABOUT THIS FRACTURE. THIS IS THE PICTURE WE HAVE OF HIS CLINIC PICTURE OF THE FRACTURE.

SHOW US WHERE THE FRACTURE IS, SCOTT. gtgt SO AARON CAME IN WITH THIS FRACTURE. THE PLAIN XRAYS LOOK PRETTY BENIGN. YOU KIND OF LOOK AT THEM, YOU CAN SAY, OH, NOT A BIG DEAL. IF YOU LOOK, HERE’S KIND OF THE FRACTURE LINE, PROBABLY RIGHT THROUGH HERE. BUT YOU CAN SEE IT PROBABLY A LITTLE BIT BETTER WHEN WE MOVE TO THE LATERAL, THE SIDE VIEW, AND NOW YOU CAN SEE THAT FRACTURE LINE COMING THROUGH HERE. BUT THE WAY TO REALLY KIND OF ASSESS THESE BETTER IS IF YOU.

GO ON TO GET A HERE YOU CAN SEE IT AGAIN, A LITTLE BIT BETTER THERE, BUT TO GET A C.T. SCAN. SO THIS IS A C.T. SCAN WHERE THIS IS LIKE TAKING CUTS LIKE YOU PUT YOUR ARM NOW IN THE TABLE SAW AND IT KEPT KIND OF SLICING IT THROUGH. THIS IS THE FRACTURE FRAGMENT, FRACTURE FRAGMENT, FRACTURE FRAGMENT. gtgt THAT’S THE HUMERUS. gtgt THE END OF THE HUMERUS BONE, YEAH. SHOULD BE HERE. SHOULD BE ONE PIECE AROUND HERE LIKE THAT. SO HERE’S JUST ANOTHER EXAMPLE AGAIN. HERE’S THE OUTSIDE END OF THE HUMERUS BONE, CRACK THERE,.

CRACK THERE, EXTENSION THERE. NOW IF WE LOOK AT IT FROM THE SIDE VIEW, HERE WE CAN SEE THE FRACTURE LINE GOING THROUGH THE END OF THE HUMERUS HERE. THAT’S THE PART THAT MAKES THE ARM HINGED UP AND DOWN LIKE THAT. AS YOU MOVE ACROSS, IT KEEPS TAKING SECTIONS, YOU CAN SEE THIS WHOLE THING SHOULD BE UP HERE, THIS SHOULD BE MATCHING UP TO THERE. AND THE JOINT IS LIKE PUTTING A PISTON IN A CYLINDER, IF IT’S OFFSET, IT MIGHT RUN FOR A WHILE, BUT IT’S GOING TO WEAR OUT ON YOU. SO HERE AGAIN SHOWS YOU HOW MUCH THIS PIECE HERE SHOULD BE.

BACK UP ON TOP OF IT MORE LIKE THAT. SO, IT’S AND THEN ONE MORE VIEW RIGHT FROM THE STRAIGHT FRONT TAKING CUTS THROUGH IT, YOU CAN SEE THE FRACTURE. HOW MUCH IT’S PUNCHED THIS SHOULD BE KIND OF COMING RIGHT ALONG HERE LIKE THAT. SO AN INNOCENTLOOKING XRAY AND A BADLOOKING C.T. SCAN AND THE JOB IS TO GET THIS SITUATED SUCH THAT IT LINES IT BACK UP AGAIN. HERE’S THE EXAMPLE THEN. WHAT YOU DO, YOU HAVE TO EXPOSE THIS, YOU USUALLY CUT THIS BONE RIGHT HERE. YOU FLIP THIS OUT OF THE WAY AND THEN YOU CAN GET TO THE JOINT SURFACE AND LINE IT UP,.

PUT THESE PLATES AND SCREWS ON IT. THEN YOU HAVE TO FIX THAT BONE THAT YOU MADE GET IT OUT OF THE WAY. HERE’S THE FRONT VIEW OF IT AGAIN. SO HERE’S THE A FRACTURE LINE THROUGH HERE. THIS IS A DIFFERENT EXAMPLE. SAME KIND OF HARDWARE, ONE PLATE ON ONE SIDE, ONE ON THE OTHER SIDE AND SCREWS ACROSS THE JOINT SURFACE TO GET IT LINED UP BACK WHERE IT BELONGS AND THEN FIX THAT BONE YOU TOOK DOWN TO EXPOSE THE JOINT THERE. WHEN YOU GET ONE OF THESE, YOU JUST KIND OF KNOW, WHENEVER I LEAVE THE HOUSE, I JUST TELL.

MY WIFE, THIS IS FOUR HOURS, IT’S LIKE FOUR HOURS OUT OF YOUR LIFE. Laughter gtgt ANY COMMENT, BOB gtgt NO. TOUGH FRACTURE. gtgt WHY DID IT HAPPEN A LOT OF PEOPLE WHEN THEY COME DOWN, THEY BREAK AT THE WRIST INSTEAD OF AT THE ELBOW. WHY DID HE NOT BREAK AT THE gtgt IT’S JUST WHERE THE FORCE KIND OF TRANSMITS. SO MAYBE HIT WITH A PRETTY NEUTRAL WRIST, BUT THEN THAT BONE, THE FOREARM BONE THERE JUST ACTS LIKE A WEDGE, IN THAT IT GOES UP THERE, JUST SPLITS, YOU KNOW, KIND OF PUNCH THAT IN THERE.

SO OFTENTIMES JUST DEPENDS ON THE ANGLE YOUR ARM WAS AT, WHERE THAT FORCE FINALLY HAS TO EXIT. YOU’RE RIGHT. MOST OF THE TIME WE CATCH OUR HAND, WE GO BACK HERE. THE MOST COMMON UPPER EXTREMITY IS THE FRACTURE, THE DISTAL RADIUS FRACTURE BECAUSE YOUR WRIST ONLY GOES BACK SO FAR, THAT BREAKS. BUT IT CAN BE THE FOREARM OR IT COULD BE HERE, YOU KNOW, YOUR HUMERUS. WHERE THE MAXIMUM FORCE TENDS TO FRACTURE. gtgt SPEAK ABOUT THE COLLEGE FRACTURE, THE SILVER FORK DEFORMITY, THAT RIGHT gtgt CLOSE. IT’S A PRETTY COMMON THING, MUCH MORE COMMON IN OLDER.

PATIENTS THAN YOUNGER PATIENTS. I THINK THE WHOLE TREATMENT NOW HAS BEEN KIND OF CHANGED SINCE WE HAVE NEW IMPLANTS TO FIX THE FRACTURES. IN THE PAST IT WAS SORT OF A HIT AND MISS KIND OF POTPOURRI OF DIFFERENT THINGS. NOW YOU CAN PUT A NICE PLATE ON THE DISTAL RADIUS AND GETTING THE PATIENTS MOVING A LOT QUICKER. SOMEONE DID A STUDY, PATIENTS WHO HAVE THE BESTLOOKING XRAYS HAVE THE BEST RESULTS. THEY GOT THAT PUBLISHED. gtgt THAT IS TRUE. gtgt THAT’S TRUE. SO THE SILVER FORK, SO THIS IS THE SILVER FORK.

SO THIS IS THE HAND, AND THERE’S THIS DEFORMITY, IT MOVES FORWARD, SO THAT THE YOU KNOW, WOULD YOU DRAW IT ANY DIFFERENT gtgt NO. gtgt AND, SO, THIS IS THE PALM OF THE HAND AND THEN THIS IS THE FOREARM. AND THIS DEFORMITY HERE IS THE SILVER FORK DEFORMITY BECAUSE IT BREAKS THERE. gtgt AND THE BONE IS SO IT’S LIKE AN EGG SHELL, THE BONE IS VERY HARD ON THE OUTSIDE BUT USUALLY THERE’S NOT MUCH BONE INSIDE. SO ONCE YOU CRACK THAT OUTER SHELL, THERE’S NOTHING TO SUPPORT IT. gtgt AND PARTICULARLY IF YOU’RE.

AN OLDER PERSON, NOT USING A LOT OF WEIGHTS, NOT WORKING, YOU KNOW, PHYSICALLY VERY HARD ANYMORE, AND THERE IT IS. gtgt RIGHT. gtgt OKAY. SO, LET’S TAKE SOME QUESTIONS. 60YEAROLD 62YEAROLD WOMAN OKAY. LET’S START HERE. gtgt SUFFERING A FRACTURE IS PAINFUL AND INTERFERES WITH NORMAL DAILY LIFE, BUT SOMETIMES THE THERAPY THAT FOLLOWS THAT IS DESIGNED TO ENSURE THE BEST RESTORATIVE OUTCOME CAN BE AN ADDITIONAL CHALLENGE. gtgt SO I HAVE FULL ROTATION IN THE WRIST, SO THE THERAPY WAS FOCUSED EXCLUSIVE ON FLEXION AND EXTENSION OF THE ELBOW. gtgt AGE IS ALWAYS A FACTOR. GENERALLY THE YOUNGER YOU ARE,.

THE BETTER OFF YOU ARE IN TERMS OF YOUR RECOVERY. AND THEN JUST THE NATURE OF THE INJURY. IN THIS CASE, AN ELBOW INJURY, THERE’S A MILLION DIFFERENT WAYS YOU CAN INJURE YOUR ELBOW. DID IT REQUIRE SURGERY DID IT NOT REQUIRE SURGERY IS THERE A FRACTURE INVOLVED DISLOCATION A FRACTURE AND A DISLOCATION IS THERE HARDWARE INVOLVED WITH THE SURGERY SO, IT’S REALLY HARD TO SAY THOSE ARE THE KIND OF VARIABLES THAT CAN AFFECT THE OUTCOME. BUT THE OUTCOMES CAN AND DO VARY AND THE EXPECTATIONS CAN AND DO VARY. DEPENDING ON ALL THOSE THINGS. LIKE I SAY, AGE AND THE COMPLEXITY OF THE INJURY.

Gtgt HAD ME PUT THE ARM ON THE TABLE. THE POINT IS TO REENGAGE THE MUSCLE. AFTER THE SURGERY, YOU LOSE MUSCLE MEMORY, SO EVERYTHING FROM HIM PULLING ON THE TOWEL, FORCING ME TO WORK, PUSHING AGAINST HIM OR PULLING AGAINST HIM. gtgt WELL, THE TREATMENT IS A PROGRESSION. YOU KNOW, RIGHT NOW THE PRIMARY GOALS ARE MOVEMENT. WE’RE TRYING TO INCREASE THE RANGE OF MOTION AT THE ELBOW. AS TIME GOES BY, AS THAT MOTION GETS BETTER, AS THE HEALING PROGESSES, THEN STRENGTH IS GOING TO BECOME MORE OF AN ISSUE IN THE TREATMENT AS WELL. AND WE’LL HAVE TO WORK ON, YOU KNOW, RESTORING STRENGTH TO.

THE MUSCLES THAT POWER THAT JOINT. gtgt PART OF THE REGIMEN INITIALLY WAS USING A C.P.M. MACHINE, CONTINUOUS PASSIVE MOTION, AS YOU COULD GUESS THERE’S PASSIVE MOTION AND ACTIVE MOTION. THE PASSIVE MOTION IS YOU WOULD JUST SIT THERE AND IT WOULD PASSIVELY MOVE. THAT’S JUST TO KEEP SOFT TISSUE LOOSE. AS YOU’RE ENGAGING THE MUSCLES ITSELF. I WOULD TYPICALLY DO FOUR SESSIONS FOR AN HOUR EACH. I DID THAT FOR I BELIEVE THE FIRST TWO MONTHS. AND AFTER THAT, I MOVED TO STRICTLY ACTIVE MOTION. THE ACTIVE MOTION IS WHERE I’M.

ENGAGING THE MUSCLES TO TRY TO IMPROVE THE FLEX ONAND EXTENSION. AT ANY RANGE YOU DON’T WANT TO LOSE RANGE OF MOTION, BUT PARTICULARLY AT THE AGE OF 25, I WOULD PREFER NOT TO LOSE AN EXTENSIVE AMOUNT OF RANGE OF MOTION. I LOOK AT EVEN, THE LAST FOUR MONTHS, AND PROBABLY AN ADDITIONAL SIX MONTHS TO A YEAR OF THERAPY AND WORKING OUT THIS ON MY OWN IS GOING TO BE RATHER DIFFICULT. I WOULD PREFER TO PUT IN THE TIME NOW AND NOT AND HAVE AS CLOSE TO FULL RANGE OF MOTION BACK AS POSSIBLE. FOR THE REST OF MY LIFE. gtgt WELL, WE APPRECIATE AARON.

DOING THAT FOR US. AND, YOU KNOW, PEOPLE IN THE STUDIO SUGGESTED THAT WE GIVE HIM A HAND. OR MAYBE AN ELBOW FOR HIS WORK THERE. THANK YOU. SO, HOW IMPORTANT IS PHYSICAL THERAPY AND OCCUPATIONAL THERAPY AND REHABBING A PERSON, BOB gtgt IT’S PROBABLY MORE IMPORTANT THAN THE SURGERY SOMETIMES, I THINK. THEY REALLY MAKE US LOOK GOOD. gtgt DO THEY gtgt YEAH. IT’S JUST IT’S AMAZING. gtgt I KNOW THAT THERE ARE PEOPLE WHO HAVE KNEE SURGERY AND IF YOU DON’T GET THEM MOVING, THEY WILL HAVE CHRONIC PAIN.

IT’S THE MOVEMENT THAT HURTS INITIALLY THAT BREAKS THEM FROM THE PAIN CYCLE. gtgt SO WHEN I USED TO TEACH RESIDENTS, I’D TELL THEM, A PERFECT SURGERY AND OUTCOME IS 100 POINTS. YOU GET FOUR POINTS FOR PATIENT SELECTION, FIVE POINTS FOR YOUR SURGERY, AND FIVE POINTS FOR YOUR REHAB. AND YOU MULTIPLY THEM TOGETHER. SO, YOU KNOW, LIKE IF YOUR REHAB’S ZERO, ZERO, ESPECIALLY THINGS LIKE FLEXOR TENDON REPAIRS, ELBOW INJURIES, IT STIFFENS UP, IT’S TIGHT, YOU NEED THAT TRAINED PERSON TO REALLY WORK WITH THEM ON A FAIRLY REGULAR BASIS TO GET.

THAT OPTIMAL OUTCOME. gtgt YOU KNOW, INTERESTING, FOUR POINTS FOR THE PERFECT PATIENT. gtgt YEAH. SO IT COMES OUT TO 100. I ONLY GAVE THEM FOUR. gtgt BUT IF YOU LOOK AT WHAT HE’S DONE, I MEAN, HE CAME TO WORK AFTER HE WENT TO THE CLINIC, HAD THE XRAY, PUT IN A SPLINT, CAME TO WORK, I MEAN, IT WAS A NIGHT WHERE WE WERE HAVING A TELEVISION SHOW. I CAN’T REMEMBER WHICH. AND HE WAS THERE THE WHOLE NIGHT, YOU KNOW. AND THEN IT HURT. YOU KNOW, IT HURT HIM. AND I KNOW THAT THIS WHOLE THING HAS HURT HIM A LOT. gtgt YEAH.

Gtgt BUT I DON’T HEAR A LOT OF COMPLAINTS. THAT’S KIND OF A FOURPOINT FOR THAT GUY. gtgt THAT’S RIGHT. gtgt LET’S GO TO THE STORY. 62YEAROLD WOMAN FROM EUREKA WITH SURGERY FOR CARPAL TUNNEL. HOW LONG ARE PEOPLE UNABLE TO USE THEIR WRIST AND WILL THEY HAVE THE ABILITY TO USE THEIR WRIST IN THE SAME WAY BEFORE THE SURGERY gtgt WELL, MY POSTOP REGIMEN, IT’S ABOUT A TENMINUTE OPERATION, I DO MINE OPEN, AND THEN AFTERWARDS SOFT DRESSING. I TELL THEM THEY’RE GOING TO MOVE THEIR THUMB, FINGERS, IMMEDIATELY. THEY CAN USE IT FOR NORMAL ROUTINE USE RIGHT AWAY,.

EATING, WRITING, DRIVING, TEXTING, KEYBOARDING. AND JUST KIND OF INCREASE IT AS IT FEELS COMFORTABLE. I USUALLY TELL THEM, IF THEY’RE KIND OF HEAVY, INTENSE WORK, ABOUT SIX WEEKS BEFORE YOU’RE READY TO PUT, YOU KNOW, A ROOF ON YOUR GARAGE OR SOMETHING LIKE THAT. BUT THEY SHOULD GET BACK FULL WRIST MOBILITY BY ABOUT THREE MONTHS, THEY SHOULD MAX BACK OUT ON THEIR GRIP STRENGTH. gtgt IF THEY HAVEN’T HAD SOME SIGNIFICANT LOSS. gtgt YEAH. IT’S AMAZING HOW IT’S ALL CHANGED BECAUSE WHEN I STARTED PRACTICE, WE PUT PEOPLE IN CASTS FOR TWO WEEKS.

Gtgt YEAH. gtgt REALLY gtgt YEAH. SO, OF COURSE, NOW YOU HAVE THIS ILLNESS, YOU’VE HAD THE SURGERY, SO NOW IT’S LIKE A BIG DEAL, AS OPPOSED TO NOW, BANDAIDS, NEXT COUPLE DAYS, DO WHAT YOU WANT TO DO. IF IT HURT, DON’T DO IT. gtgt RIGHT. I HEARD THIS IS KIND OF LIKE RADIO HEAD FRACTURES, YOU KNOW, THE RADIUS IS THE BIG BONE AT THE WRIST. AND IT’S SMALL AT THE ELBOW. THE ULNA IS BIG AT THE ELBOW AND SMALL AT THE WRIST. SO THE RADIAL HEAD, THEY BREAK THE RADIUS, SO IT’S HARD TO DO THE ROTATION THING.

AND THERE’S NO SURGERY TO DO, CORRECT ME IF I’M WRONG, YOU JUST GOT TO GET IT MOVING OR THEY’LL LOSE MOTION. gtgt IT DEPENDS. I MEAN, IF IT’S A NONDISPLACED, OR MINIMALLY DISPLACED, EARLY MOTION, HOLD THEM THREE, FOUR, FIVE DAYS, TELL THEM, START MOVING IT. IF IT’S DISPLACED, THEN YOU MAY GO IN AND FIX IT, TO MAKE THAT JOINT SURFACE CONGRUENT OR IF IT’S JUST SHATTERED, YOU CAN TAKE IT OUT AND IF THE ELBOW IS STABLE, PUT IN NOTHING. OR NOWADAYS MOST PEOPLE PUT IN A RADIAL HEAD REPLACEMENT, KIND OF IMPLANT. SO IT JUST DEPENDS ON HOW BAD.

THE FRACTURE, IF THERE’S OTHER ASSOCIATED INJURIES WITH IT. gtgt THAT’S ADVANCEMENT SINCE I WAS DONE WITH MY gtgt YUP. WHEN I STARTED, IT WAS, YOU JUST TOOK IT OUT AND THAT WAS IT, YOU WERE DONE. gtgt THERE WE GO. SO, 77YEAROLD FROM SIOUX FALLS, WONDERING ABOUT JOINT REPLACEMENTS FOR KNUCKLES IN THE FINGERS. BOB gtgt THEY CAN BE DONE. KIND OF DEPENDS ON WHAT THE PROBLEM IS. IS IT OSTEOARTHRITIS OR RHEUMATOID ARTHRITIS gtgt EITHER ONE, YOU COULD DO THE KNUCKLES, THOUGH. gtgt YOU CAN. KIND OF DEPENDS, THE P.I.P.

JOINTS, THE MIDDLE JOINTS OF THE FINGERS ARE BIT TOUGHER TO DO THAN THE BIG JOINTS OF THE FINGERS. gtgt SO THE M.C. IS THE KNUCKLE. gtgt RIGHT. gtgt BUT THE P.I.P. IS THE MIDDLE. gtgt YUP. gtgt AND THEY’RE HARDER. AS IT GOES OUT. AND, OF COURSE, YOU DON’T DO ANYTHING WITH THE DISTAL. THE TINY. gtgt SOME PEOPLE HAVE TRIED. BUT USUALLY NOT. gtgt YEAH. SO NORMALLY IF IT’S THE END JOINT THAT GETS KIND OF, LET’S SAY, ANGLED, DEVIATED, PAINFUL, THEN YOU FUSE THAT JOINT, AND WHEN YOU LOOK AT YOUR, YOU KNOW, MOTION,.

BETWEEN THESE TWO JOINTS, 85 COMES FROM YOUR P.I.P. AND ONLY 15 HERE. SO, A STABLE D.I.P. JOINT THAT’S NONPAINFUL, VERY FUNCTIONAL, PEOPLE DON’T MISS IT QUITE A BIT. BUT THE P.I.P. IS WHERE YOU NEED THE MOTION. gtgt 85 ON THE P.I.P., WHICH IS THESE gtgt YUP, YUP. gtgt MIDDLE JOINTS. gtgt THAT’S THE CRITICAL ONE TO KEEP MOVING. BUT LIKE BOB SAID, THERE ARE JOINT REPLACEMENTS SOMETIMES IT’S HIGH REWARD, HIGH RISK, BECAUSE THEY CAN WORK VERY WELL, BUT IF THEY KIND OF FAIL ON YOU, THEN IT’S KIND OF PROBLEMATIC. AND WIND UP USUALLY THEN HAVING TO FUSE THE JOINT IN A STABLE POSITION.

Gtgt I HAVE A FRIEND WHOSE DISTAL FINGER, I CAN’T REMEMBER WHICH, COMES UP, AND THEN IT JUST GOES OUT AT A 45DEGREE ANGLE. DO YOU EVER FIX THOSE OR LEAVE THEM gtgt IS IT PAINFUL gtgt NO. gtgt I’D LEAVE IT ALONE. gtgt THEY SAY IF IT DOESN’T BOTHER THEM. IF IT’S FUNCTIONALLY A PROBLEM, THAT WOULD BE SOMETHING YOU’D FUSE, BRING IT INTO A PROPER ALIGNMENT, FUSE IT INTO A BETTER FUNCTIONAL POSITION. gtgt ALL RIGHT. 67YEAROLD FROM LAKE PRESTON, MOTORCYCLE ACCIDENT, CAUSED BOUTINEER FINGERS ON TWO FINGERS. WHAT SHOULD I DO WITH THIS gtgt SHE SHOULD SEE BOB. gtgt NO GOOD TREATMENT FOR THAT. gtgt NO, THERE ARE.

Laughter gtgt BOUTINEER, YOU KNOW. gtgt TELL ME WHAT TO DO, BOB. gtgt HERE’S A BOUTINEER. HERE’S WHERE YOU PUT THE BOUTINEER, FLOWER, STICK IT THROUGH THE HOLE. THAT’S A BOUTINEER. gtgt THE FRENCH CALL IT THE BUTTON HOLE DEFORMITY. gtgt IS THAT RIGHT WE CALL IT THE FRENCH NAME, THE FRENCH CALL IT A BUTTON HOLE. SO EXPLAIN WHAT IT IS. gtgt THERE’S A TENDON, EXTENSOR TENDON THAT GOES ON THE BACK OF THE FINGER, TO THAT MIDDLE JOINT, P.I.P. JOINT WE TALKED ABOUT. gtgt RIGHT HERE. gtgt AND THAT GETS RUPTURED SO THAT ALLOWS THE TENDON TO DROP DOWN, FINGER DROP THIS WAY,.

AND THEN THE OTHER TWO TENDONS ON THE BACK OF YOUR FINGER, CALLED LATERAL BANDS, AND IT CAUSES HYPEREXTENSION OF THE END JOINT. SO, IT’S A REAL PROBLEM. gtgt HERE’S YOUR BOUTINEER DEFORMITY. gtgt IT’S THIS KIND OF A THING. gtgt IT IS, IT IS. gtgt AND YOU CAN SEE THAT THE BANDS GO ACROSS, SO THERE’S A CENTRAL DEPRESSION THAT LOOKS LIKE THE BOUTINEER. gtgt POPPED OUT. AND THE PROBLEM IS, PEOPLE CAN’T MAKE A FIST. BECAUSE THE END JOINT IS SO HYPEREXTENDED THEY CAN’T GET TO THEIR PALM. gtgt HOW DO YOU WHAT DO YOU.

DO TO FIX IT gtgt USUALLY SURGERY IS NOT THE ANSWER. IT’S BEEN TRIED. SO USUALLY DO A THERAPY PROGRAM TO TRY TO GET YOUR FINGER OUT IN EXTENSION AND THEN TRY TO MOBILIZE THE LATERAL BANDS. gtgt WOULDN’T YOU BE BETTER IF YOU JUST FROZE IT AT A PHYSIOLOGIC HALFBENT POSITION gtgt ACTUALLY, WHAT YOU’LL DO SOMETIMES, IF THIS IS THE MAIN PROBLEM, THAT HYPEREXTENSION, JUST GO AND CUT THE TENDON ON TOP A LITTLE BIT TO KIND OF REBALANCE IT. THAT DOES WORK PRETTY GOOD FOR GETTING BACK BETTER MOTION. SO, YOU TRY SPLINTING THIS.

ON RARE OCCASIONS, I’VE TRIED TO, YOU KNOW, KIND OF DO A RECONSTRUCTION, BUT IT’S JUST SUCH A HARD BALANCING ACT. AND AFTER EVERY TIME I DO IT, I KIND OF SAY, THIS MIGHT BE THE LAST TIME gtgt WHY DID I DO THAT gtgt JUST RELEASING THE TERMINAL TENDON TO GET THIS OUT OF THE HYPEREXTENSION. THAT SEEMS TO WORK PRETTY WELL FOR PEOPLE. gtgt MOTORCYCLE ACCIDENT, THAT’S A QUESTION THAT I WOULD HAVE, OF COURSE, WE’RE NOT GOING TO SAY ANYTHING NEGATIVE ABOUT MOTORCYCLES. gtgt NO. gtgt BUT DO YOU.

Gtgt 77 YEARS OLD. GOOD FOR HIM. gtgt GOOD FOR HIM. DO YOU HAVE ANY COMMENT gtgt OR HER. gtgt MOTORCYCLES ANDOR SAFETY WITH MOTORCYCLES RECOMMENDATIONS gtgt I THINK RIDING A BIKE IS DANGEROUS. SO. gtgt RIDING A BIKE IS THE FIRST MOST DANGEROUS ACCIDENTAL DEAL AND PEOPLE SHOULD BE WEARING HELMETS, THEY SAY. gtgt THEY SHOULD BE WEARING HELMETS. MOTORCYCLES, YOU KNOW, SHOULD BE WEARING HELMETS, OBVIOUSLY. BUT THE NAVY HOSPITAL IN SAN DIEGO, WE HAD A WHOLE OPEN BAY OF MOTORCYCLE RIDERS, ENLISTED GUYS, SAN DIEGO, THEY ALL HAD MOTORCYCLES, AND THEY WOULD, YOU KNOW, HAVE THEIR ACCIDENTS. SO, YOU KNOW, IT’S A GREAT.

INSTRUMENT YEARROUND, IT’S GREAT FUN, BUT, UNFORTUNATELY, IT CARRIES RISK AND EVEN IF YOU’RE DOING THE WORLD’S BEST JOB ON IT, YOU’RE STILL AT RISK. SO IT’S JUST NO GOOD ANSWER, IF YOU’RE GOING TO RIDE IT, YOU’RE JUST AT RISK. gtgt ANYTHING CORRECT, ARTHRITIC FINGERS ANYTHING TO CORRECT ARTHRITIC FINGERS WHERE THE JOINTS HAVE BEEN ENLARGED A LOT OF PEOPLE, OSTEOARTHRITIS, INFLAMMATORY OSTEO, THEY HAVE THE BIG, SORT OF LIKE THE HANDS OF THE WICKED WITCH OF THE WEST, YOU KNOW. WHAT DO YOU RECOMMEND FOR THOSE BIG, FAT JOINTS.

Gtgt PARAFIN BATH IS GOOD. THEY CAN DO THAT. ANTIINFLAMMATORIES. THERE’S REALLY NOT MUCH SURGICALLY TO DO IT, YEAH. gtgt SURGICALLY, IF THE JOINTS BECOME ARTHRITIC AND PAINFUL, THAT’S AN INDICATION TO FUSE THE JOINT, WHICH YOU’LL GET RID OF THE BIG NODULES AND YOU’LL STRAIGHTEN IT OUT, BUT gtgt THEN YOU CAN’T BEND IT. gtgt BUT MOST OF THE TIME BY THE TIME THEY GET THERE, THEY’RE NOT BENDING IT MUCH ANYWAY. IF YOU TRY TO JUST GO IN THERE, PEOPLE WANT YOU TO TAKE OUT THE BIG KNOBBY THINGS AND THEY COME BACK, AND NOW YOU.

HAVE A SCAR AND A KNOBBY AREA SO IT’S NOT USUALLY WORTH IT. gtgt SOMEBODY FROM MARTIN SAID, WHY WOULD THE SURGEON OPERATE AT THE ELBOW FOR CARPAL TUNNEL SYNDROME gtgt I’M NOT SURE IF THEY’RE TALKING ABOUT ACTUALLY MEDIAN NERVE AT THE ELBOW. THERE WAS AN OPERATION, IT’S CALLED THE PRONATOR SYNDROME, IT CAN CAUSE CARPAL TUNNELLIKE SYNDROMES. gtgt THE MEDIAN NERVE IS CAUGHT SOMEWHERE IN THE ELBOW, NOT AT THE CARPAL TUNNEL. gtgt I ASSUME THAT’S WHAT WE’RE TALKING ABOUT. THE CUBITAL TUNNEL, THE ULNAR NERVE AT THE ELBOW. gtgt FUNNY BONE, PROBABLY NAMED AFTER THE HUMERUS. I DON’T KNOW. gt NOT FUNNY AT ALL.

IT’S A NERVE THAT CRANKS RIGHT THROUGH THIS PART OF THE ELBOW. AND IT COMES DOWN, INNERVATES THE FIFTH FINGER AND HALF OF THE FOURTH. THAT’S NOT ELBOW CARPAL TUNNEL SYNDROME. gtgt NO. BUT THEY MAY HAVE YES, SO THEY MAY HAVE JUST MISSPOKEN, WHEN THEY MEANT TO SAY CUBITAL, BECAUSE THEY’RE BOTH TUNNEL SYNDROMES, CARPAL TUNNEL, THE MOST COMMON, CUBITAL TUNNEL THE SECOND MOST COMMON. gtgt THAT’S CALLED A CUBITAL. gtgt CUBITAL TUNNEL, FROM LATIN, CUBITALI, THE PILLOWS THAT THEY WOULD REST ON. YEAH. gtgt NEVER HEARD THAT. I THOUGHT I KNEW EVERYTHING. WHAT DO YOU RELEASE THE NERVE.

AND JUST TAKE IT OUT, JUST PUT IT OUTSIDE IN THE gtgt YOU KNOW, THERE’S A PENDULUM ON THAT OF JUST FREEING IT UP, VERSUS MOVING IT TO THE FRONT, VERSUS ACTUALLY TAKING OFF THAT KNUCKLE OF BONE, BUT I THINK MOST PEOPLE, WHAT I DO, I JUST FREE IT, I JUST RELEASE THE ENDS, YOU LIKE DOING A CARPAL TUNNEL, THAT SEEMS TO WORK WELL. CARPAL TUNNEL. SOMETIMES BECAUSE OF THE ENVIRONMENT OR PREVIOUS TRAUMA, YOU MIGHT BE BETTER OFF MOVING IT TO THE FRONT OF THE ELBOW TO GET RID OF IT. gtgt VERMILLION, CARPAL TUNNEL SYNDROME, BUT THE THUMB STILL HURTS.

IS THERE ANYTHING ELSE THAT CAN BE DONE I WOULD GUESS THAT IT’S NOT JUST CARPAL, THAT THE GUY’S GOT ARTHRITIS OF THE THUMB AND IT SHOULD BE FIXED. gtgt AND COMMONLY WHEN YOU RELEASE THE CARPAL LIGAMENT, IT’S NOT STRANGE TO HAVE MORE PAIN IN THE JOINTS. gtgt IN THE WHICH JOINT gtgt THE CARPAL METACARPAL, THE TRAPEZIUM, THE JOINT HAS BEEN RELEASED, THE BONE IS ROTATED, SO THERE’S MORE STRESS AT THE BASE OF THE THUMB. gtgt IT’S NOT UNCOMMON gtgt NO. gtgt WHAT DO YOU DO FOR IT.

Gtgt TREAT THEM FOR THE CMC ARTHRITIS. gtgt TAKE THE SURGERY AS WE TALKED EARLIER gtgt SPLINT, STEROID INJECTION. THE OTHER THING THAT PEOPLE CAN CAUSE, THE THUMB THAT GOES ALONG WITH CARPAL TUNNEL, THE TRIGGER SYNDROME, IT DOESN’T GLIDE THROUGH THE PULLEY VERY WELL THERE. THAT’S KIND OF THE SAME PATHOLOGY THAT CAUSES CARPAL TUNNEL, THE SAME THING FOR PEOPLE TO GET THE TRIGGER FINGERS, WHERE THEY KIND OF LOCK DOWN, SOMETIMES IT DOESN’T LOCK COMPLETELY, BUT EVERY TIME THE TENDONS’S GLIDING THROUGH THERE, IT’S KIND OF RUBBING AGAINST THAT PULLEY IT GOES THROUGH. gtgt CATCH.

Gtgt AND YEAH YOU’LL SEE THAT OCCASIONALLY, TOO, PEOPLE HAVE THE CARPAL TUNNEL RELEASE, A FEW WEEKS LATER, THEY GET THE THUMB TRIGGER SYMPTOMS. SO, THEY NEED A DIAGNOSIS IS WHAT THEY NEED, THEN DECIDE HOW TO TREAT IT. gtgt LET’S TALK ABOUT TRIGGER FINGERS BECAUSE A LOT OF PEOPLE DO HAVE THEM. I SENT ONE TO A HAND SURGEON JUST THE OTHER DAY. SHE HAS AND IT LOOKS LIKE IT MIGHT BE FIXED. I DON’T KNOW IF SHE CAN EVER STRAIGHTEN IT. SHE THINKS THAT SHE CAN. AND THEN SHE SHOWED ME HOW SHE.

USED IT, HOLDING A GLASS WITH IT FIXED, STUCK, IN THIS POSITION. DO YOU REPAIR ALL OF THEM gtgt YOU KNOW, I WAS AT A MEETING LAST WEEK AND TALKING TO A SURGEON FROM CANADA, AND THEY HAVE A SEVENMONTH WAIT TO GET YOUR TRIGGER FINGERS DONE. AND HALF THE PATIENTS GOT BETTER WITHOUT SURGERY. YEAH. BUT I THINK THE PEOPLE WHO NEED SOMETHING DONE ARE ONES WHO CAN’T GET FULL EXTENSION. gtgt RIGHT. gtgt ESPECIALLY IF THEY’VE HAD IT FOR A LONG PERIOD OF TIME. I MEAN, YOU CAN TRY A CORTISONE SHOT, BUT I THINK.

IT’S TIME TO PROBABLY DO SURGERY FOR IT. gtgt YEAH. IF THEY GET A FLEXION CONTRACTURE, YOU CAN RELEASE THAT, TOO. gtgt USUALLY THE P.I.P. JOINT WILL STILL BE STUCK IN FLEXION. gtgt WITH SOME THERAPY, WORK ON IT, YOU CAN GET IT STRETCHED OUT. USUALLY IT’S NOT ENOUGH TO WARRANT, LIKE, A SURGICAL PROCEDURE. BUT SOMEBODY LOCKED DOWN LIKE THAT, IF YOU GO AND RELEASE THAT PULLEY WHERE IT’S STUCK, THEY’LL GET THEIR MOTION BACK AND THEY’LL HAVE A GOOD RESULT. gtgt IF YOU GET IT SOON ENOUGH. gtgt EVEN IF THEY STAY DOWN FOR A WHILE, YOU’LL PROBABLY STILL IMPROVE.

BUT, YOU’RE RIGHT, YOU MAY WIND UP WITH A PIT OF YOU BIT OF A P.I.P. CONTRACTURE THERE. gtgt 82YEAROLD MAN, DIABETIC, WOOD CUTTER, IN THE EVENINGS, HANDS FALL ASLEEP, OFF AND ON. WHAT COULD BE THE CAUSE gtgt CARPAL TUNNEL, COULD HAVE A DIABETIC NEUROPATHY, THOSE TWO CAN SUPERIMPOSE ON EACH OTHER. IT COULD BE WORTHWHILE, NIGHT SYMPTOMS, NIGHT WAKING, NUMBNESS, TINGLING, TYPICALLY GETTING THE PRESSURE OFF THE NERVE WILL TAKE CARE OF THAT COMPONENT AND WILL FEEL BETTER. gtgt IF YOU HAVE A DIABETIC NEUROPATHY, YOU SHOULD NOT DO CARPAL TUNNEL, ONE OF THE GUYS.

LOOKED IT UP, ONE YEAR IN CARPAL TUNNEL PATIENTS IN DIABETICS, 85 SAID THEY’D DO IT AGAIN. gtgt THEY’D HAVE THE SURGERY gtgt YEAH. gtgt LAST WEEK, I HAD A NEUROLOGIST ON AND WE ASKED THAT QUESTION ABOUT NEUROPATHY. AND I SAID, HAND NUMBNESS, IT COULD BE DIABETIC NEUROPATHY, AND HE SAID IT’S ALMOST ALWAYS IN THE FEET AND LAST IN THE HANDS AND, SO, YOU HAVE TO REALIZE THE NEUROPATHIES HAVE GOT TO BE SIGNIFICANT IN THE FEET BEFORE THEY’LL GET TO THE HAND. VIA EMAIL, 72YEAROLD FROM HURON, I CROCHET QUITE A BIT AND HAVE MY ENTIRE LIFE, MY LEFT WRIST IS GETTING TWINGES.

JUST BELOW THE PALM ON THE LEFT WRIST SORT OF IT TO THE OUTSIDE, THAT AREA SEEMS TO BE THICKER TO THE RIGHT SIDE. WILL A BRACE HELP I DON’T REALLY WANT TO QUIT CROCHETING. THAT’S INTERESTING. DO YOU HAVE ANY CLUES THE LEFT WRIST, THICKER ON THE RIGHT SIDE. DID YOU GET THAT I DON’T QUITE UNDERSTAND WHAT IT MEANS. gtgt SO I’M JUST WONDERING IF MAYBE SHE’S GETTING LIKE PALMER FIBROMATOSIS, THE TWINGE CERTAINLY COULD BE, YOU KNOW, MAY BE EARLY CARPAL TUNNEL OR SOMETHING LIKE THAT. gtgt IF YOU SEE THICKNESS ON THE.

PALM OF THE HAND, DUPUYTREN’S CONTRACTURE IS A REAL DEAL. TELL ME ABOUT THAT. gtgt DUPUYTREN’S CONTRACTURE, PALM SIDE OF THE HAND, IT’S NICE AND TOUGH BECAUSE RIGHT UNDERNEATH THE SKIN WE HAVE THE CANVASY LAYER KNOWN AS THE PALMAR FASCIA, THAT’S WHY WE CAN STAND UP, HIT, DON’T GLIDE MUCH, HERE YOUR SKIN GOES ALL OVER THE PLACE HERE, IT’S PRETTY FIXED. BUT FOR WHATEVER REASON, THAT FASCIA WILL START TO GET A SINGLE SIGNAL WHERE IT STARTS TO REPLICATE ITSELF, BEEF ITSELF UP, FORMS THE NODULES, THEN THEY FORM THE CORDS OUT INTO THE FINGERS THAT CAN START TO DRAW THE.

Gtgt THE FIFTH DOWN, AND THEN IT’S THE FOURTH. gtgt YUP. gtgt THEY’RE THE MOST COMMON. gtgt YEAH. gtgt AND IT’S THERE’S NOTHING YOU CAN DO ABOUT IT, IF IT GETS, I CALL IT THE TABLE TOP TEST, IF IT GETS BAD ENOUGH, WE USED TO OPERATE ON THEM, TRIED TO TAKE IT ALL OUT, THAT DIDN’T WORK. WE TRIED TO DO LIMITED SURGERY. NOW, WE USE AN ENZYME THAT PRETTY SPECIFIC FOR THE TISSUE, SO YOU CAN INJECT IT TO KIND OF DISSOLVE THAT CORD AND BREAK IT APART SO YOU CAN.

GET THE FINGER STRAIGHT. STILL DOESN’T MAKE ALL THE STUFF GOING GO AWAY. BUT IF THE FINGERS ARE STRAIGHT, THEY SHOULD BE HAPPY WITH IT. gtgt I LEARNED FROM VAN DEMARK LAST TIME HE WAS HERE, IT HAS NOTHING TO DO WITH THE CORDS THAT COME FROM THE FOREARM, IT HAS ALL TO DO WITH THAT FASCIA. gtgt YEAH. gtgt NOW YOU’RE DOING MORE OF THE ENZYMES. gtgt THE ENZYMES ARE AMAZING. YEAH, IT’S REALLY COOL. gtgt SO IF YOU’RE I GENERALLY SAY, IF YOU CAN PUT YOUR HANDS.

IN YOUR POCKET, I KIND OF PREFER THAT TO THE TABLE TOP. gtgt YUP. gtgt SLIDE THEM IN THE TOP POCKETS, YOU’RE OKAY. gtgt GET YOUR GLOVES ON. gtgt GET YOUR GLOVES ON. gtgt THAT’S RIGHT. gtgt BUT IN THIS CASE, DON’T STOP CROCHETING BECAUSE THAT’S PROBABLY NOT CAUSING ANY OF THE PROBLEMS, IT’S JUST MAYBE MANIFESTING YOUR SYMPTOMS. BUT CROCHETING ISN’T HARMING ANYTHING. gtgt IT’S THE MOST IMPORTANT THING YOU CAN DO IS TO KEEP USING THOSE JOINTS. gtgt KEEP USING THE HAND. gtgt HOW EFFECTIVE IS GABAPENTIN IN TREATING THE INITIAL STAGES OF CARPAL TUNNEL AND WHAT ARE THE BEST HAND, ARM EXERCISES.

IF YOU’RE ON A COMPUTER ALL DAY IN. gtgt SO, IN MY EXPERIENCE, GABAPENTIN IS NOT HELPFUL FOR CARPAL TUNNEL BECAUSE IT’S A COMPRESSIVE NEUROPATHY, PRESSURE ON THE NERVE, AND I HAVEN’T FOUND THAT THAT’S BEEN OVERLY EFFECTIVE. IT’S MORE WHEN IT’S KIND OF THAT SMALLER NERVE KIND OF LIKE A DIABETIC NEUROPATHY OR A REFLEX SYMPATHETIC PAIN SYNDROMETYPE THING. SO FOR CARPAL TUNNEL I HAVEN’T FOUND THAT TO BE USEFUL. IF YOU’RE ON THE COMPUTER, AND THAT’S A BIT OF A MISNOMER, PEOPLE THINK, COMPUTER KEYBOARD, NO STUDIES, IN FACT,.

ALL STUDIES INDICATE THAT KEYBOARD USERS IN THE GENERAL POPULATION ARE EXACT SAME gtgt AS THE NONKEYBOARD USERS. gtgt THERE’S NO REAL RELATIONSHIP. IT MAY MAKE YOU MANIFEST YOUR SYMPTOMS. BUT LIKE PEOPLE GET CARPAL TUNNEL AT NIGHT, AND I DON’T THINK SLEEPING CAUSES, YOU KNOW, CARPAL TUNNEL. BUT IT’S, YOU KNOW, STRETCHES, TAKE BREAKS, MAKE SURE YOU’RE NOT POUNDING TOO HARD, YOU KNOW, HAVE GOOD ARM POSITION. JUST TRY TO BE KIND OF SMART. SOMETIMES YOU CAN SEE A THERAPIST, THEY CAN GIVE YOU SOME KIND OF ERGONOMIC ADVICE ON HOW TO SET UP YOUR STATION,.

HOW TO KIND OF POSTURE YOURSELF WELL TO AVOID THOSE THINGS. SOME OF IT, TOO, YOU’RE GOING TO HAVE CARPAL TUNNEL AND YOU’RE GOING TO HAVE IT IF YOU DON’T KEYBOARD OR DO KEYBOARD. gtgt YOU USE GABAPENTIN MUCH gtgt A LITTLE BIT. MOST OF THE PEOPLE I SEE WHO NEED SURGERY ARE ON GABAPENTIN. gtgt ALREADY gtgt YEAH. gtgt IT’S AN ANTISEIZURE DRUG, BRING YOU DOWN A NOTCH, A LITTLE BIT OF A TRANQUILIZER, NEVER MORE ALERT ON IT. LESS ALERT. gtgt IN THE HISTORY OF CARPAL TUNNEL, FIRST PRESCRIBED IN 46, CALLED ACRO PARATHESIA.

THEN, LONG BEFORE THERE WERE COMPUTERS AND MOUSE. gtgt YEAH. gtgt I TELL MY PATIENTS THAT, AND SOME THINK THAT’S NICE AND SOME DON’T THINK IT’S SO NICE. Laughter gtgt THAT’S GOOD. gtgt TRUE. gtgt 70YEAROLD WOMAN HAVING SWELLING AT THE END OF MY RIGHT ELBOW A COUPLE OF WEEKS, NOT RED OR LIMITED MOTION OF THE ARM, BUT THERE’S THIS ELBOW SWELLING AND TENDERNESS. NOT THAT TENDER. BUT WHAT ABOUT THE TREATMENT AT THE END OF THE ELBOW THERE’S A LOT OF CAUSES, OF COURSE. gtgt SOUNDS TO ME LIKE SHE’S.

DESCRIBING A BURSITIS, WHERE YOU GET THE BURSAL SACK’S GOT A LITTLE INFLAMED, SWOLLEN, MOST OF THE TIME DO NOTHING OR PUT A PAD ON, PUT AN ACE WRAP TO PROTECT IT, TRY NOT TO IRRITATE IT. gtgt IT’S ONE OF THE THEY GENERALLY DO IT BECAUSE THEY’VE BEEN DOING A LOT OF THIS. gtgt YEAH. gtgt GIVE IT A FEW WEEKS AND IT MAY GET BETTER. NOW, gtgt IF IT’S HOT. IF IT’S RED HOT, I’VE HAD A NUMBER OF THEM TURN HOT. gtgt IT COULD BE GOUT. BUT ONLY PROBABLY IF YOU’VE.

HAD A HISTORY OF GOUT SOMEWHERE ELSE. gtgt YOU CAN HAVE RHEUMATOID NODULES, YOU CAN HAVE GOUTY NODULES. ANY OTHER COMMENT gtgt AND IF YOU CAN HAVE AN EFFECTIVE BURSITIS, BUT THOSE THEY RAMP UP QUICK. YOU’RE GOING TO KNOW IT. gtgt DO EITHER OF YOU PUT NEEDLES, INJECT THOSE LEAVE IT ALONE gtgt RARELY DO I TRY TO CORTISONE. gtgt QUICKLY, NOW, ULNAR SURGERY ONE YEAR AGO, NUMBNESS IN MY LITTLE FINGER, SHRINKAGE OF THE MUSCLES, SO HE HAD ULNAR NEUROPATHY. gtgt ATROPHY. gtgt NO IMPROVEMENT IN EITHER. STILL HAD A CHANCE OF IMPROVEMENT. SHOULD YOU DO IT.

SOUNDS LIKE HE HAS ENOUGH SYMPTOMS. YES gtgt SO HE HAD THE SURGERY ALREADY A YEAR AGO. gtgt HE HAD THE SURGERY. gtgt BUT HE STILL HAS A CHANCE FOR IMPROVEMENT BECAUSE, WHAT I TELL PEOPLE, TOO, IF YOUR NERVE, IF IT’S KIND OF BEEN IF IT’S OUT, IT’S BEEN SQUEEZED HARD ENOUGH WHERE IT’S NOT WORKING ANYMORE, THEN IT HAS TO SOMETIMES JUST REGROW ITSELF. WHILE NERVES GROW AT ABOUT AN INCH PER MONTH. IF YOU DO THE MATH, FROM YOUR ELBOW TO YOUR FINGERTIPS, YOU KNOW, YOU CAN GET MAYBE SOME.

IMPROVEMENT FOR UP TO A COUPLE YEARS OR SO. AND THE OTHER THING THAT’S HELPFUL, THOUGH, EVEN IF YOU DON’T SEE MUCH IMPROVEMENT, HOPEFULLY YOU KEEP IT FROM GETTING WORSE. BECAUSE MOST OF THE TIME IF YOU DON’T DO SOMETHING, IT’S JUST GOING TO PROGRESSIVELY GET WORSE. BUT THEY CAN BE PROBLEMATIC. gtgt AND NOW FOR THE WINNER OF TONIGHT’S PRAIRIE DOC QUIZ QUESTION. CARPAL TUNNEL SYNDROME IS TYPICALLY CHARACTERIZED BY NUMBNESS AND WEAKNESS IN THE A. PINKY FINGER. B. THUMB. C. THE FUNNY BONE OF THE ELBOW THE ANSWER IS B. THUMB. IT ALSO MAY INCLUDE THE SECOND POINTER FINGER, THIRD MIDDLE FINGER, AND THE INSIDE HALF OF.

THE FOURTH RING FINGER. SUSAN BROWN FROM OLDHAM WHO ANSWERED THE QUESTION CORRECTLY. I WONDER IF SHE’S THE SAME SUSAN BROWN WHO GREW UP WITH ME IN DeSMET. THANKS FOR PARTICIPATING AND A BOOK WILL BE IN THE MAIL TO YOU SOON. WE’LL BE RIGHT BACK AFTER THIS. gtgt STILL FEELING LOUSY, SWEETHEART gtgt TERRIBLE. DAY FOUR OF ACHES, CHILLS, SWEATS. gtgt OH, POOR THING. YOU’RE JUST NOT YOU WHEN YOU HAVE THE FLU. gtgt I DON’T FEEL LIKE ME AT ALL. DO I LOOK SICK gtgt YOU LOOK DIFFERENT. gtgt OH! YOU’RE SO SWEET. WHISTLING.

Gtgt THAT’S NOT YOUR PRETTY FACE. gtgt FEEL LIKE YOURSELF. GET VACCINATED BECAUSE STOPPING THE FLU STARTS WITH YOU. gtgt THE RUNNER WAS FACING TRAFFIC, COMING DOWN A STEEP SWITCHBACK ASPHALT ROAD AFTER A RECENT RAIN. AS HE CAME AROUND A TIGHT CORNER, HE SLIPPED, JUST AS AN APPROACHING CAR WAS TURNING INTO HIM. HE CAUGHT HIMSELF WITH THE PALM OF HIS HAND, AND IN THAT SPLITSECONDTHATCOUNTS CRANKED DOWN HARD ON THE WRIST IN ORDER TO AVOID SLIPPING UNDER THE CAR. AFTER THE CAR PASSED, HAPPY TO BE ALIVE, THE RUNNER WENT ON WHILE THE WRIST SLOWLY BEGAN TO DECLARE ITS IRRITATION FOR BEING TREATED WITH SUCH DISRESPECT.

THERE ARE EIGHT CARPAL BONES IN THE HUMAN WRIST ALONG WITH LIGAMENTS, TENDONS, CARTILAGE, AND FIBROUS TISSUE. THESE ALL CONNECT THE HAND TO THE FOREARM ALLOWING FOR THE MUSCLES OF THE FOREARM TO WORK THE HAND. THE HAND, WRIST, AND FOREARM CAN MAKE POWERFUL HOLD AND RELEASE MOVEMENTS LIKE THROWING LONG AND ACCURATE SPEARS OR FOOTBALLS, POUNDING OR HAMMERING CORN MEAL OR NAILS, AND PULLING AND HAULING LINES, SHEETS, OR WHEELBARROWS. THOSE SAME HANDS CAN MAKE TINY, INTRICATE MOVEMENTS LIKE FORMING SMALL STITCHES FOR A GARMENT OR A LACERATION, MAKING SUBTLE HAND MOVEMENTS FOR TURNING THE PERFECT CLAY JAR, PAINTING A MASTERPIECE ART WORK, AND PLAYING THE.

EMOTIONAL STRAINS OF A BEETHOVEN OR BEATLES PIANO OR GUITAR RHAPSODY. THE DOCTOR NOTED THE RUNNER’S WRIST WAS NOT DEFORMED LIKE A DINNER FORK. THE DINNERFORK SHAPE IS TYPICAL AFTER BREAKING THE RADIUSFOREARM BONE AN INCH BACK FROM THE WRIST AFTER A FALL FORWARD. THIS TYPE OF FRACTURE IS THE SECOND MOST COMMON FOR THE ELDERLY NEXT TO A COLLAPSED VERTEBRAE. OFTEN BALANCE FAILS AND BONES GET SOFTER AS PEOPLE GET OLDER, MAKING THIS TYPE OF FRACTURE TOO COMMON. BALANCE AND BONE STRENGTH ARE LOST IN THOSE WHO ARE INACTIVE AND PRESERVED IN THOSE WHO REGULARLY STRESS MUSCLES AND.

BONES WITH MOVEMENT AND LIFTING. FOR THE RUNNER, XRAYS CONFIRMED NO FRACTURE OF THE WRIST, HAND, OR FOREARM, MEANING IT WAS A SOFT TISSUES SPRAIN AND A WRIST SPLINT AND IBUPROFEN WERE PRESCRIBED. TAKEHOME MESSAGES. DON’T RUN ON WET ASPHALT ON STEEP HILLS WITH ONCOMING TRAFFIC, OR, MORE IMPORTANTLY, DON’T WALK ON DANGEROUS SPOTS SUCH AS ICY WALKWAYS OR SLIPPERY WOODEN FLOORS WITH SOCKS OR RUGS THAT CAN SLIDE. KEEP BONES STRONG WITH ADEQUATE VITAMIN D, ENOUGH CALCIUMRICH FOODS, AND REGULAR WEIGHT BEARING EXERCISES. AND, 3, ENHANCE BALANCE BY STRENGTHENING YOUR LEGS, ARMS, AND CORE, BACK AND ABDOMINAL,.

MUSCLES WITH DAILY WEIGHTBEARING ACTIVITIES THAT YOU ENJOY. gtgt I SINCERELY WANT TO THANK OUR GUESTS TONIGHT, DR. SCOTT MCPHERSON AND DR. ROBERT VAN DEMARK. THEY HAVE BROUGHT GREAT INSIGHT TO OUR QUESTIONS. THANK YOU SO MUCH. NOW ONTO OUR FLU SEASON UPDATE. SO FAR THIS FLU SEASON WE ARE DOING GREAT. THERE HAVE ONLY BEEN 21 CASES CONFIRMED AS OF THE THIRD WEEK OF JANUARY. IT MAY BE THAT THIS YEAR’S FLU VACCINE IS PROVING TO BE SPOTON WITH THE STRAINS IT COVERS. IN PREVIOUS YEARS WHEN WE STARTED OUT WITH FEW CASES THE PEAKS STILL WENT VERY HIGH THOUGH THEY WERE DELAYED TO MARCH OR EVEN APRIL.

Leadboard Category: Uncategorized

Leave a Reply