Understanding Carpal Tunnel Syndrome

By: Alan Gotesman, MD

Are you experiencing pain in your hand waking you up at night?  Do you have tingling in the fingers when you are driving or holding your phone? Is it getting difficult for you to manipulate small objects like buttons or clasps? You may have carpal tunnel syndrome. 

Carpal tunnel syndrome occurs when the nerve crossing your wrist is compressed, usually due to swelling of the tendons, which can cause pain and diminished sensation in your hands, particularly the thumb, index, middle and half of the ring finger. Typical symptoms are pain that wakes people up at night that needs to be “shaken out”, numbness and tingling as well as weakness and difficulty performing activities requiring fine manipulation. The diagnosis can usually be made with a detailed history and physical examination but confirmation can be performed with a nerve test called EMG’s that can determine the severity of the nerve compression and rule out other causes.

In milder forms, carpal tunnel syndrome can be treated with bracing, anti-inflammatories and cortisone shots. Once the compression is more severe, releasing the pressure on the nerve can be crucial to relieve the symptoms and prevent permanent nerve damage which can occur with chronic compression of the nerve. Newer minimally invasive techniques are available that allow the procedure to be done through a quarter-inch incision with the assistance of a camera. This technique allows for a quicker recovery process as well as less postoperative discomfort.  Results of surgery are generally excellent with many patients going back to all of their activities within 6-8 weeks.

If you think you may be suffering from carpal tunnel syndrome, the first step is to have an evaluation so schedule your appointment with one of our board-certified specialists today for an evaluation. 

Hudson Valley Top Docs 2019

Northeast Orthopedics and Sports Medicine is beyond proud to announce that twelve of our physicians have been named Top Doctors by Hudson Valley magazine. Congratulations to our doctors for this recognition of their commitment to exceptional care!

Hudson Valley Magazine Top Doctors 2019

Orthopedic Surgery

  • Kenneth Austin
  • William Davis
  • Barry Kraushaar
  • Mark Medici
  • Patrick Murray
  • Steven Renzoni
  • Richard Semble
  • Jordan Simon

Physical Medicine & Rehabilitation

  • Michael Robinson

Rheumatology

  • Shivani Purohit Mehta

Sports Medicine

  • Mark Berezin
  • Richard Popowitz

Where Tech Meets Tech Can Help Your Knee

By: Dr. Barry Kraushaar

Total knee replacement is evolving in ways that will improve outcomes for our patients in the future. While around 95% of knee replacements are good or excellent at five years, there is still room to reduce problems with Total Knee cases in the future. Two areas where technology is guiding surgery outcomes are in the precision for positioning components and in eliminating the need for acrylic bone cement, which sometimes crumbles or loosens.

Component Positioning with Surgical Robot

One advancement over the past few years is the use of a surgical robot as a tool to optimize the precision in the process of putting the implant in the best position possible. We at NEOSM have been using this device with great success since 2017, and our results have been incredible. The surgeon can make real-time adjustments to their preoperative plans during the case, measuring each decision against the robotic feedback that technology gives us. This decreases the likelihood of the knee being too loose or too tight, and allows the surgeon to test stability before the end of the case.

Cementless Knee Replacements with Robotic Guidance

The precision of robotic surgery helps us meet another need for future knee replacement patients. In total knee replacements, acrylic bone cement is applied to the undersurface of the metallic components and acts as a cement to provide stability.  The downside is that bone cement is a brittle substance. It does not flex and deform with motion. Rather, it tends to crack and does not heal itself. Over time pieces can break off and act as particles to create debris in the joint which can be abrasive. If the use of cement can be avoided then there will only be a bone-metal connection with no debris. Robotic surgery provides a predictably precise surface upon which to rest a “press-Fit” total knee replacement, allowing for a cleaner match and better outcome. The immediate stability is achieved by the pegs and surface shapes of the total knee implant components, and, in the long term, the porous inner surfaces of the devices provide a way for bone to grow into the tiny spaces and form a long term bond.

Cementless knee replacements are not new. They have been around for decades, but recently the popularity of this technology has grown when used alongside robotic guidance. Currently only a small number of patients who have ideal circumstances receive cementless total knee replacements, but that number may grow if it becomes apparent in the long run, there are even better outcomes in the future. NEOSM surgeons remain attentive to emerging trends and we are applying these advances to our patients with careful consideration.

Each case is different, so we encourage you to schedule your consultation with one of our orthopedic surgeons today to discuss options available to you.

NEOSM Staff Go ‘Pink for Hope’

October is Breast Cancer Awareness Month and NEOSM is proud to celebrate survivors, bring awareness to early detection and support research efforts to find a cure.

On October 18th, our staff participated in our ‘Pink for Hope’ day by proudly wearing pink and contributing to the American Cancer Society.  We’re so thankful for their show of support!

Together, we stand behind all the mothers, daughters, sisters & friends who are survivors or soon-to-be survivors!

Is the sport you love causing you pain? Understanding Tennis/Golfer’s Elbow

By: Dr. Neal Shuren

Tennis and golf are two of the most popular sports, especially amongst adults. As enjoyable as they are to play, overuse can lead to pain of the elbow, commonly called Tennis or Golfer’s Elbow. Both tennis and golfer’s elbow are very common and affect both men and women, mostly between the ages of 40 to 50 but can occur at any age. It can also arise from activities not related to sports, such as household chores or work that requires repetitive gripping, like painting, but can also occur form a traumatic injury, such as a blow to the elbow.

Symptoms 

Pain with activities such as lifting, gripping and grasping that starts in the elbow but often radiates down the forearm to the hand. 

Diagnosis and Treatment  

The diagnosis of tennis or golfer’s elbow is usually made clinically by a thorough history and physical examination by your doctor. Sometimes your doctor may order different images such as X-Rays or MRIs to rule out other conditions.

Prevention and Treatment

  • Activity Modification 

If the pain is from playing tennis or golf it is often recommended that you be evaluated by a tennis or golf professional to make sure you are using proper equipment and have proper technique. 

  • Rest & Ice

It may be necessary to stop the aggravating activity all together, for a period of time to allow the soft tissues to heal. Try to avoid heavy lifting, pushing, pulling or repeated hand shaking. Using two hands for heavier lifting can help protect the injured arm. Apply ice 2 to 3 times a day for 15 to 20 minutes at a time when the condition first starts or after actively using the arm to help diminish the inflammation.

  • Stretching 

Stretching can help with tendonitis by keeping muscles and tendons flexible and preventing stiffness. It can also help break down scar tissue that may have formed.

  • Physical/Occupational Therapy

Therapy can help in many ways. Initial treatment is aimed at diminishing inflammation and stiffness while subsequent treatment helps strengthen forearm muscles, which can help prevent future episodes from occurring.

  • Medications 

If there are no medical contra-indications, over-the-counter pain medication, like Advil, Aleve or aspirin, can be taken to help reduce inflammation and pain.

  • Bracing

The counter-force brace is a padded strap that can be worn on the forearm, just below the elbow. By putting gentle pressure on the muscles, tension is released on the tendon. Bracing can be used for treatment and can be used to prevent recurrence in the future by wearing for all activities that put a lot of stress on the arm.

  • Cortisone Injections

Cortisone injections usually reduce the pain in the arm for an extended period of time but do not always diminish the time it takes for the elbow to fully heal. 

  • Platelet Rich Plasma (PRP)

PRP is a procedure where blood is withdrawn and then is processed to concentrate the platelets so they can be re-injected into the area of tendonitis. This procedure can usually be done in the office. This is a newer technique and research on this treatment modality continues.

  • Surgery

Surgery is the last resort. If conservative treatment fails and symptoms have been present for at least a year then surgery can relieve the pain. The aim of surgery is to remove degenerated or worn out tissue from the tendon and release tension on the tendon. Symptoms can take several months to fully resolve and a small percentage of people may still have some symptoms, even after surgery.

Prognosis 

Most cases of tennis and golfer’s elbow will resolve with conservative care but can take a long time to fully resolve.

If you have been suffering from symptoms of golf or tennis elbow, schedule a consultation with one of our talented physicians for an evaluation and treatment plan. 

NEOSM Annual Backpack Drive

Once again, NEOSM has had the honor to support the amazing team at the East Ramapo Central School District Family Resource Center by providing school supplies and backpacks for the children of our community. Our physicians and employees contributed a countless number of back-to-school basics that are necessary for the students in our area to succeed. We wish all of them a wonderful year full of learning! 

A special THANK YOU to the ERCSD Family Resource Center for all that they do throughout the year!

Thumb Arthritis

By: Dr. Doron Ilan

Do you have?

  • Pain in thumb and/or wrist with activities that involve gripping, grasping or pinching, such as opening a jar, turning a key, or taking milk out of the fridge
  • Swelling and tenderness at the base of the thumb (fleshy part)
  • An aching discomfort after prolonged use such as writing 
  • Loss of strength in gripping or pinching activities
  • An enlarged, “out-of-joint” appearance
  • Development of a prominence or bump over the joint at the junction of thumb and wrist

If you are experiencing these symptoms, you may have arthritis at the base of your thumb, or “Basal Joint Arthritis”, the wearing out of the cartilage at the joint that allows you to oppose your thumb (the human joint).

Thumb arthritis can start as early as 40 years old and is more frequent in women. With proper diagnosis by an Orthopedic Surgeon/Hand Specialist, you can begin to gain some relief through various treatment options, depending on severity of symptoms and effect on activities of daily living.

Treatment of Thumb Arthritis

  • Initial treatments may involve activity adjustments, rest, bracing, oral or topical anti-inflammation medications, specific exercises and hand therapy.   
  • Most people are successfully managed without surgery but eventually symptoms may no longer respond to treatment and at that point surgery may be considered 
  • There are many conditions that can mimic arthritis (tendinitis, cysts, sprains, joint inflammation, rheumatoid arthritis, Lyme disease, trigger finger, carpal tunnel syndrome) so it is important to see an Orthopedic surgeon/hand specialist to confirm the diagnosis.

Diagnosis is the first step, so reach out to us to schedule your appointment with one of our board-certified doctors today for an evaluation.

Arthritis: Defined

By: Dr. Arup Bhadra

What is the second most common health problem after the common cold? Arthritis. About 54 million adults are diagnosed with a type of arthritis*, the inflammation of one or more of your joints.

Arthritis can occur in any joint in the body, but most often, it develops in weight-bearing joints like knee and hip. Because pain, swelling, and stiffness are the primary symptoms, arthritis in these joints can make it hard to do many everyday activities, such as walking or climbing stairs. It is a major cause of lost work time and a serious disability for many people.

There are more than 100 different forms of arthritis, but the most common types of arthritis are osteoarthritis and rheumatoid arthritis. Let’s dive into what an arthritis diagnosis means.

Osteoarthritis

Osteoarthritis is the most common form of arthritis in the knee and or hip. It is a degenerative, “wear-and-tear” type of arthritis that occurs most often in people 50 years of age and older, but may occur in younger people, too. In osteoarthritis, the cartilage in the knee/hip joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone and produce painful bone spurs. Osteoarthritis develops slowly and the pain it causes worsens over time.

Arthritis can occur in any joint in the body, but most often, it develops in weight-bearing joints like knee and hip. Because pain, swelling, and stiffness are the primary symptoms, arthritis in these joints can make it hard to do many everyday activities, such as walking or climbing stairs. It is a major cause of lost work time and a serious disability for many people. Don't wait any longer...Contact Northeast Orthopedics and Sports Medicine TODAY!

(Left) Healthy Knee joint and (Right) worn cartilage and arthritic knee joint

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body, including the knee joint. It is symmetrical, meaning that it usually affects the same joint on both sides of the body.

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. The immune system damages normal tissue (such as cartilage and ligaments) and softens the bone.

Posttraumatic Arthritis

Posttraumatic arthritis is a form of arthritis that develops after an injury to the knee or hip. For example, a broken bone may damage the joint surface and lead to arthritis years after the injury.

Treatment for Arthritis

Although there is no cure for arthritis, there are many treatment options available to help manage pain and keep people staying active. Non-surgical treatments include adjustment of lifestyle and activities, pain management, cortisone and/or viscous supplement injection. Should a joint replacement be necessary, there are many advances to ensure successful outcomes. Surgical treatment options include traditional and robotic-assisted knee and hip replacement utilizing the latest minimally invasive techniques.

If you are suffering the symptoms of arthritis, contact us today for a consultation with one of our providers to ensure the right diagnosis and treatment to help you.

*Source: Arthritis Foundation