carpal tunnel syndrome

Bulletproof Vest Technology Could Impact Joint Replacement

/ Thomas Cohn, MD

bulletproofRecently I found an article in Science News on an old material with a new use. The material is polymer that is similar to a fiber used in making bulletproof vests. Apparently, with some modifications, it has been made into a very tough material with similar toughness, stiffness, and water content as cartilage in the body. Cartilage is the material that covers bones and makes up joints in the body. The degenerative type of arthritis one gets as they age, osteoarthritis, involves the deterioration of cartilage. This is also the same wear that people have in their joints that leads to the need for joint replacement.

Artificial Disc Cartilage

Developing an artificial material that would replace the cartilage-on-bone in joints with the same or better properties of current joints is desirable. Instead of preforming total joint replacements, the worn cartilage could just be replaced. This would probably be much simpler and less risky. The artificial cartilage most likely could be used on any joint versus trying to make replacement type specific joints for each joint in the body. It most likely would just be a coating placed on the current cartilage as a replacement without the need to remove the old bone and joint structure. The main problem now is that we do not know yet how to make the material adhere to the bone.

The new material is what is called a hydrogel that is mostly water and contains microscopic aramid fibers. These fibers are what strengthen bulletproof vests. The material is made of either 70 percent or 92 percent water. It was able to maintain its shape when squeezed or stretched.  Best yet it exceeded the toughness and stiffness of real cartilage that is found in our bodies.

The new material is exciting since it has the properties to replace cartilage which is the main problem we have as we age since it deteriorates. Damaged cartilage is what leads to the joint pain that many people suffer. The unique material may also be able to be used in other structures like tendons, ligaments and possibly even discs in the spine. If we can figure out if the material can be integrated into the body without difficulty and can be attached solidly to bone, it has real potential.

Currently we do not know how well it will do in the body. The next phase of research is whether it will be safe and effective for use in animal or human bodies. Whether we have found the solution to age related degeneration or not, it is still too early to know. If the research does pan out it will be a wonderful solution to improve aging.

Pain Care: The Benefits of Pain Management

/ Thomas Cohn, MD

Pain Care BenefitsPain is a complex problem with physical and emotional components. It can affect all aspects of a person’s life. When pain is treated early and aggressively, often it can be cured. Sometimes the injury that has caused the pain cannot be completely reversed and the damage needs to be managed on a long-term basis. Medically, we are always looking to find a diagnosis and treatment for every problem. Pain Care is aimed at finding the individualized, comprehensive diagnosis and management plan for a patient’s symptoms and problems.

Pain Care

Pain Care has been developed to take the next step in managing a patient’s symptoms. A new patient will undergo a comprehensive evaluation by a Board Certified specialist in Physical Medicine and Rehabilitation with a subspecialty in Pain Care. These physicians are medical doctors with extensive special training in the musculoskeletal, medical and neurologic systems, which allows them to better diagnose and treat almost any painful condition.  As Physical Medicine doctors, they are the “Family “ physicians coordinating and delivering care to those with pain.

Since pain often is a complex problem, Pain Care is designed to help the patient move forward with management. Every patient is unique with their own set of important problems. If all the answers were obvious, there would be no need for our services. Unfortunately, pain is the most common problem bringing a patient to the doctor’s office. When it does not resolve in short period of time, consulting a specialist is often extremely beneficial. There is not one solution, one medication, one shot, or one specific intervention that is right for every patient. Pain Care is designed to integrate and coordinate our skills into the community to treat these challenging patients with their current care team.

Pain management is not a new medical field, however there are not many providers with the Physical Medicine and Pain specialty skills. Pain is complex and Pain Care is designed to address these issues and bring a solution to the patient and community.

Hand Pain & Carpal Tunnel Syndrome

/ Thomas Cohn, MD

Genetic Testing PainHand pain can be caused by a number of different ailments. There are a huge number of structures in the hand that allow it to have its functional ability. The bones, joints, muscles, ligaments, tendons, and nerves all may be sources of pain. Trauma can easily damage any of these specific structures.  However, one of the most common syndromes to affect the hands is carpal tunnel syndrome.

Pressure on the median nerve in the wrist may cause pain, numbness, tingling and weakness in the hand. The median nerve and several tendons of the hand travel through a narrow space in the wrist called the carpal tunnel. The median nerve provides sensation and motor function to the thumb and first two fingers. Difficulty with pain, tingling and weakness in these fingers is often from median nerve injury in the carpal tunnel region.

Causes

The cause of carpal tunnel syndrome is pressure on the median nerve in that confined space. Swelling in the region of the wrist can cause pressure. Medical conditions such as diabetes, hypothyroid, and rheumatoid arthritis may also be causes. Obesity, hypertension, and pregnancy with fluid retention can also bring about symptoms. Even more commonly, repetitive motions of the hands and wrists, such as typing or the use of a keyboard or mouse, can cause the injury.

The diagnosis can be made by a physician exam with several tests that may reproduce pressure on the nerve and symptoms in the distribution of the median nerve. Confirmation of the diagnosis is made with electrodiagnostic testing of the median nerve and comparing it to other nerves in the hand. If the study is abnormal, the diagnosis is confirmed.

Treatment Options

Treatment of carpal tunnel syndrome depends on the severity of symptoms. Mild symptoms and changes to the median nerve are treated by reducing the repetitive activities and causes. Rest and splints are great at alleviating mild CTS cases. Moderate cases may be helped by anti-inflammatory medications and steroids with hand physical therapy. Severe cases, where significant damage has occurred to the median nerve, usually require surgery to resolve damage or prevent further damage.

Carpal Tunnel Syndrome Treatment Options

/ Thomas Cohn, MD

Carpal Tunnel Treatment st. cloudAs a follow up to our previous post about the causes and symptoms of carpal tunnel syndrome, we have put together this post outlining some treatment options for CTS. Carpal tunnel syndrome can be treated both surgically and non-surgically depending on the severity of symptoms.

Non-Surgical Treatments

For mild forms of carpal tunnel syndrome, non-surgical treatments are usually the best option. Here are some treatments that can help alleviate pain without having to undergo surgery:

  • Icing your wrist and hand. Applying cold to the area can decrease inflammation.
  • Taking breaks from activities that may be aggravating the condition, such as typing on a keyboard.
  • NSAIDs. Nonsteroidal Anti-Inflammatory Drugs (such as aspirin or ibuprofen) can be used to temporarily reduce pain from carpal tunnel syndrome.
  • A wrist splint can be applied at night or during the day when wrist movement is not needed.
  • Corticosteroid injections. These cannot be administered at home, but by a skilled pain management doctor. Injections like cortisone can cut down on inflammation, which in turn, decreases pain.

Surgical Treatments

If none of the above treatment options work for you and your symptoms persist or  worsen, surgery may be the best path.

Generally, surgery for this condition will be endoscopic or open. In endoscopic surgery, a small telescope-like device is inserted through a small incision. This allows the surgeon to perform the operation in the least invasive manner. With open surgery, an bigger incision must be made and the surgeon must cut through ligament to solve the problem.

What Causes Carpal Tunnel Syndrome

/ Thomas Cohn, MD

carpal tunnel syndromeDo you have a constant or recurring pain in your hand, wrist, or forearm? You may have a common condition known as carpal tunnel syndrome. Carpal tunnel syndrome is a condition in which a pinched nerve in the wrist leads to pain in the hand and forearm.

Causes of CTS

The carpal tunnel is a channel on the inside of your wrist that protects a nerve and numerous tendons as they pass into your hand. When this nerve is pinched it can lead to carpal tunnel syndrome. Commonly, carpal tunnel syndrome is caused by one or more of the following:

  • Compressing the nerve by using a computer keyboard and/or mouse for long periods of time.
  • Using your hands to work with anything that vibrates intensely or results in high force impact.
  • Physical injury to the hand, wrist, or forearm.
  • Any other form of repetitive stress.

Symptoms of Carpal Tunnel Syndrome

So how do you determine whether or not you have carpal tunnel syndrome? There are a number of symptoms to watch out for that could indicate the condition, such as:

  • A tingling or numbing sensation in the hands.
  • Pain in your wrist that moves up into your palm and fingers, or through your forearm.
  • Weakness in your hands resulting in an inability to grip objects or make a fist.

Carpal tunnel syndrome is a condition that most people simply live with. But if you find that your symptoms are interfering with your day to day activities, it’s important to consult with a specialist.

Read our follow-up blog on treatment options for carpal tunnel syndrome.