3 Signs You May Have Carpal Tunnel Syndrome

by TOI Admin February 10, 2017

By Rodger Powell, M.D.

Carpal Tunnel is the most common nerve compression in the upper extremity and one of the most common problems seen today by hand surgeons. Compression neuropathy as its name implies is a pressure applied to a nerve from any of a variety of reasons.

The signs of carpal tunnel can be varied, but the most common and classic findings are:

  • Numbness and tingling at night that often awaken you from sleep.  Patients also describe getting up and shaking their hands or "shaking them down by the bedside to restore circulation".
  • Numbness while driving, doing your hair, applying makeup, reading, writing, typing or any other repetitive motion.  Many times vibratory instruments such as chainsaws, weed eaters or motorcycle riding make it worse.
  • Pain radiating into the forearm and occasionally all the way to the shoulder, mimicking shoulder problems.

Diagnosis can be made by physical examination and/or neurological studies such as nerve conduction studies. Underlying diseases such as diabetes and thyroid problems need to be excluded as well. Non-surgical treatments include splints, nonsteriodal anti-inflammatory medications such as Advil and carpal tunnel exercises.

When choosing a hand surgeon the patient should consider the surgeon's qualifications including training, experience and board certification, as well as a certificate of added qualification in hand surgery.

How to Keep Your 2017 New Year’s Resolutions

by TOI Admin January 2, 2017

The 2017 resolutions have begun! Most resolutions will focus on better eating habits, losing weight and being a happier, more centered person. If you identify with these...keep reading! If you don't... keep reading! Here's some advice on how to stick to your resolutions, whatever they may be. 



Be realistic: Once the ball drops on New Year’s Eve, many of us feel a burst of excitement and inspiration about the year ahead – and that’s great! But don’t let all that enthusiasm lead to setting a New Year’s resolution that’s so extreme or beyond your reach! You’ll wind up feeling overwhelmed or disheartened when you inevitably fall off track. If you give yourself enough time and resources to accomplish your resolution, you’ll set yourself up to be successful.

Write your resolutions down: When you put pen to paper and write down your New Year's resolutions, you automatically turn your thoughts into something tangible. Post your goals in a place you'll be forced to look at them regularly, and as you re-read them again and again, the words will form a stronger impression in your mind. 

Measure Up: If you don’t set a goal that’s measureable in some way, how will you know when you’ve achieved it? Your New Year’s resolution should also include some smaller mini-goals to function as progress checkpoints along the way to the main goal. 

Get Others Involved: Having friends and family on board is such a huge motivator. Research has shown that people who have support are the most successful at diet and exercise programs. Plus, when you make a commitment to improve your lifestyle along with someone else — a close friend, your significant other, a child — you're more likely to stick with it.

Reward Yourself: Sometimes staying motivated requires a little incentive. Hey — there's nothing wrong with that! When you get through a really tough workout or follow your healthy-eating plan flawlessly for a week, give yourself a well-deserved pat on the back. Or go pamper yourself!


Source http://www.everydayhealth.com/denise-austin/10-tricks-for-setting-and-sticking-to-your-healthy-new-years-resolution.aspx#09


The Dangers of Hoverboards

by TOI Admin December 27, 2016

Courtesy of Stop Sports Injuries by Lance LeClere, MD, and Brian Gerstenlager, BS

One of the most popular gifts this year was a “self-balancing scooter,” more commonly known as a hoverboard. Just like any vehicle or toy, hoverboards can be fun and entertaining, but some safety concerns have arisen, including the toy catching fire and injuries such as concussions, fractures, cuts, bruises, and internal organ damage.

The American Association of Pediatrics (AAP) recently issued a statement on the use of safety equipment while hoverboarding, and advises against allowing children under the age of 16 to ride. 

The source of the fall risk from hoverboards may not as obvious as it seems. The mechanics of the self-balancing scooters themselves, and not necessarily rider error, may be a major contributing cause of the high rate of falls. Specifically, the devices may not accurately account for the weights of different riders, and therefore, the hoverboard can lurch forward or backward unexpectedly. This may not come as a surprise when considering that self-balancing scooters support weight ranges from 45 pounds to up to 300 pounds.

In addition, many hoverboards are capable of tackling steep inclines. Most  of the two-wheeled transportation devices claim to climb an incline of around 30 degrees. For reference, a parking garage ramp is normally about 4 degrees and the typical max incline for pedestrians is about 7 degrees. So riders can easily climb any ramp in an urban area. But this ability may also increase the risk  of falling because as the degree of incline or decline becomes larger, so too can the tilt.

Hoverboard top speeds are variable between different brands, ranging from about 6 mph up to 12 mph. Faster devices can lead to falls with more serious injuries, especially if the falls are from unexpected, sudden movements of the hoverboard coupled with a high degree of tilting.

With the potential hazards of hoverboarding, many experts recommend wearing a helmet, elbow and knee pads, and wrist guards, and avoid riding on excessive inclines and near roads.

www.cpsc.gov/en/About-CPSC/Chairman/Kaye-Biography/ Chairman-Kayes-Statements/Statements/Statement-from-the- US-CPSC-Chairman-Elliot-F-Kaye-on-the-safety-of-hoverboards

www.aappublications.org/news/2016/01/11/Hoverboard011116 www.orthoinfo.org/topic.cfm?topic=A00039

www.cpsc.gov/en/About-CPSC/Chairman/Kaye-Biography/ Chairman-Kayes-Statements/Statements/Statement-from-US- CPSC-Chairman-Elliot-F-Kaye-on-the-Safety-of-Hoverboards- and-the-Status-of-the-Investigation

www.cnet.com/how-to/buy-a-hoverboard www.aia.org/aiaucmp/groups/aia/documents/pdf/aiab089264.pdf


Ankle Pain and Arthritis

by TOI Admin December 20, 2016

By: R. James Toussaint, M.D.

When the topic of arthritis comes to mind, people usually think of the hip and knee joints. Indeed, ankle arthritis is less common than hip and knee arthritis. However, it can be just as painful and debilitating. Arthritis of the ankle is different from the hip and knee. It is usually the result of a past traumatic event such as an ankle fracture or major ankle sprain. Eventually, the damage to the joint leads to cartilage loss and progressive discomfort within the joint. In addition to pain, ankle arthritis usually results in joint swelling and stiffness. The pain may radiate up into the shin or down into the foot. 

When you come for a consultation in my clinic, it is my responsibility to you as your orthopaedic surgeon to rule out other causes of your pain. During the course of your workup, we will also obtain weight-bearing ankle X-rays to correlate with the diagnosis. Depending on the extent of the arthritis,
the images may show bone-on-bone changes.

During our appointment, my goal will be to educate you on non-operative treatment options for pain relief. The range of non-operative treatments includes activity modification (i.e., swimming instead of jogging), anti-inflammatory medications, and sturdy protective shoes. Some people may find that specific shoes, called rocker-bottom shoes, are useful because they help to propel you forward with less stress on the ankle. In many cases, an over-the-counter ankle brace is sufficient for relief. However, for severe arthritis cases, a custom brace may be needed for added stability and support. Additionally, a fluoroscopic ankle joint injection (where we use an X-ray machine to locate the joint and inject steroids directly into the joint) can be an excellent source of pain relief that can have a lasting effect. Although these non-operative options are preferred, they may not work for everyone. If your arthritis does not respond to these conservative non-surgical treatments, surgery may be an option for you. 

When is surgery the right option for you?

If you have daily pain that interferes with your quality of life and you’ve tried the above non-operative treatments, then we may consider surgery for your ankle. The type of surgery will vary depending on the extent of your arthritis. For example, early arthritis cases may be treated with a debridement, which is a type of “clean out” procedure that removes some of the inflamed tissue. End-stage arthritis will require a more extensive procedure such as an ankle fusion or a total ankle replacement. There are pros and cons to every surgery and I welcome the opportunity to discuss them in further detail with you and your family.

April’s Journey through Knee Surgery

by TOI Admin December 13, 2016

At 60 years old, April could not remember a time she was not active throughout her life. “I love to walk and have been power walking most of my life. I enjoy working out, walking our dog, hiking, and strength training.”

But then April began experiencing pain and difficulty after walking a short distance it began to negatively affect her quality of life. “The pain made me reserved and it slowed me down and it’s not my lifestyle to be slowed down. It finally got to the point where I wasn’t enjoying my life because I couldn’t do the things I loved to do.” It was time to see a doctor. April chose The Orthopaedic Institute’s Edward Jaffe, M.D. as her doctor and surgeon.

April needed a partial knee replacement. “One reason I chose Dr. Jaffe is because he performs the MAKOplasty knee surgery. There is no room for human error.”

“When Dr. Jaffe walked into the OR, he was smiling, happy, and confident. I knew everything was going to work out. I wanted to feel the best I can feel and Dr. Jaffe helped me achieve that. And I feel like TOI was there for me. I say TOI because I mean everyone at TOI made me feel like I belong, like I was a family member.”

At 7 weeks post-surgery, April resumed all her normal activities. “This may seem small, but since surgery I can easily go up and down stairs and step off curbs with confidence. I got my balance back! And more importantly, I got my life back.

April’s Advice on getting MAKOplasty knee surgery:

    • Do it! Get your life back. Don’t put it off!
    • Do your research
    • Choose the surgeon that is right for you and right for the job
    • It’s ok to get a second opinion  
  • Follow all post-operative instructions given to you by your doctor and medical staff
  • After surgery you have to push yourself and be determined to succeed
  • Go to physical therapy!

What is MAKOplasty?

MAKOplasty is used to enable surgeons to plan partial knee or total hip replacement procedures by using three-dimensional computer imaging based on a CT scan.[2] This allows them to determine optimal implant size, position, and alignment for each individual patient, and to map out accurately the areas of bone they want to remove. During surgery, the robotic arm system provides visual, auditory, and tactile control to help assure that surgeons cut away only the bone planned to be resected prior to surgery. The procedure is said to take the guesswork out of surgery, resulting in accurate and reproducible results.1

For partial-knee replacements, MAKOplasty allows surgeons to remove only the diseased portions of the joint, preserving healthy tissue and ligaments, resulting in a more natural feeling knee. The procedure can be performed on the medial compartment, the lateral compartment, the patello-femoral compartment or on a combination of the medial and the patello-femoral compartments of the knee. Patients with bicompartmental MAKOplasty have improved function over those with total knee replacement surgery, and demonstrate better post-operative range of motion and quadriceps strength compared to total knee arthroplasty.2

  1.  Doyle, Karen (March 2012). "MAKOplasty Improves Surgical Precision and Patient Outcomes at Quincy Medical Center". MD News. pp. 6–8.
  2.  Jump up^Conditt, Michael; Kreuzer, Stefan; Jones, Jennifer; Dalal, Sam (October 3–6, 2012). "Functional Recovery After Bicompartmental Arthroplasty, Navigated TKA and Traditional TKA". The Bone and Joint Journal.

Welcome to TOI's Blog!

TOI's Blog is dedicated to patient education with topics addressing current issues in health and medicine. We will also blog about some of our other favorite things, like community events, our wonderful employees, helping the environment and whatever else comes to our minds! We hope the information contained in our blog is fun to read, assists you in making educated decisions regarding your health, and supports your decision to select TOI when you are in need of quality musculoskeletal care.


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