It’s that time of the year! Students are officially returning back to the classroom and hitting the books as the new school year kicks off. Along with a student’s busy schedule, a backpack filled with books, binders, lunches, laptops, iPods and gym clothes can easily pack on the pounds and lead to improper fit, causing back strain and pain to a child’s back.

According to the U.S. Consumer Product Safety Commission, in 2010, nearly 28,000 people were treated in hospitals, doctors’ offices and emergency rooms for backpack-related injuries including strains, sprains, dislocations and fractures.

To avoid pain and discomfort caused from heavy backpacks, the American Academy of Orthopaedic Surgeons recommends the following safety tips:

·         Always use both shoulder straps to keep the weight of the backpack better distributed.

·         Tighten the straps and use waist strap if the bag has one.

·         Remove or organize items if too heavy and place biggest items closest to the back.

·         Lift properly and bend at the knees to pick up a backpack.

·         Carry only those items that are required for the day.

·         Encourage you child or teenager to tell you about pain or discomfort that may be caused by a heavy backpack, like numbness or tingling in the arms or legs.

·         Purchase a backpack appropriate for the size of your child and look for any changes in your child’s posture when they wear the backpack.

·         Watch your child put on or take off the backpack to see if your child or teenager expresses discomfort.

                                         ·         Talk to the school about lightening the load. Keep the load at 10-15 percent or less
                              of the child’s bodyweight.

                                         ·         Be sure the school allows students to stop at their lockers throughout the day.

For more information about backpack safety, please visit AAOS at: http://www6.aaos.org/news/pemr/releases/release.cfm?releasenum=1014

Photo and Image Credits:

Freedigitalphotos.net- Photostock

Written By Jason Shinn, M.D.

Broken wrists are common work related injuries. Although a “broken wrist” can indicate a number of different injuries, usually it refers to a fracture of the end of the radius bone at the wrist, or “distal radius fracture”. Usually, distal radius fractures are a result of a fall on an outstretched hand.

In the past, orthopaedic surgeons treated most distal radius fractures in casts. This practice is changing due to extensive study of the problem. Although these fractures usually do heal in a cast, they may not heal in the proper alignment. This may lead to long-term problems, including arthritis and wrist instability. To prevent these problems, it is very important for the wrist to heal close to its original anatomic position, and the surest way to guarantee that this happens is with surgery.

The surgery usually involves opening the wrist, putting the bones in the right position, and then holding them in that position with a plate and a number of screws. The plate and screws hold the bone until it heals. After the bone heals, they are no longer necessary. However, because it means additional surgery to take the plate out it is usually left in forever.

Distal radius fractures treated in casts are casted for about six weeks, followed by therapy to restore range of motion. Surgically treated fractures are typically not casted but are protected in a removable splint and begin therapy much earlier. This earlier motion, with less residual stiffness, is one of the advantages of operative treatment.

According to a 2007 study, average return to work time after a distal radius fracture was about nine weeks, although 20 percent of participants reported no lost work time (probably as a result of their specific occupation). The most important predictors of time lost were occupational demands and self-reported disability.

Another study from Canada looked at level of disability six months after a distal radius fracture.  Similar to what has been found in a number of worker’s compensation studies related to orthopaedic injuries, patient factors rather than injury or treatment factors were found to be more predictive of disability. Injury compensation was the best predictor of pain and disability at six months.  Patient education level and initial radial shortening (a measure of fracture severity) were also predictive. The majority of the patients in the study had very low disability levels at six months.

Although most distal radius fractures treated appropriately heal with few functional limitations, some degree of stiffness is common. Other potential complications include infection, carpal tunnel syndrome and arthritis.  As with any upper extremity injury, reflex sympathetic dystrophy is a feared and often devastating complication.  Fortunately, it is rare, but it can result in significant disability when it occurs, even in spite of appropriate treatment.

There is a spectrum of treatments and outcomes for distal radius fractures. It may require some time to accomplish healing, but most patients return to their previous occupation uneventfully.

“Surgical treatment” refers to the release of the transverse carpal ligament. The surgery itself is called a “carpal tunnel release.” Structurally, this allows for an expansion in the area of the carpal tunnel, thus decreasing the pressure on the median nerve. It is a relatively short, surgical procedure that is performed by a qualified surgeon. Common symptoms after surgery are pain, swelling, stiffness, and weakness. To manage these symptoms and guide your recovery, the physician will often send you for therapy.

Here at The Orthopaedic Institute, we have a specialized hand therapy center that currently staffs 5 occupational therapists that specialize in rehabilitation of the hand and upper extremity. No matter which course of treatment is chosen by you and your physician, our goal is to assist you through your recovery in a caring and professional manner. It is our mission to help you achieve the best possible outcome and resume your appropriate role in your normal daily activities.

Written by Rodger D. Powell, M.D.

Carpal Tunnel Syndrome represents one of a group of disorders in the body collectively known as compressive neuropathies. It 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. According to the Bureau of Labor statistics, approximately 0.1% of the population in the United States has carpal tunnel syndrome in any given year. Even more common is the perception by patients that any hand pain or disorder is carpal tunnel syndrome.

The term carpal tunnel relates to a region in the wrist that is bounded on three sides by the carpal bones or wrist bones. The roof of this semi-circular shaped bone canal is covered by a very thick ligament called the transverse carpal ligament. Through the tunnel formed by this strong ligament and bones courses the tendons that flex the fingers and the thumb, as well as the median nerve that gives sensation to the thumb, index finger, middle finger and half of the ring finger. In addition, the median nerve supplies the nerve that allows the thumb to pull across your palm to the small finger by innervating the abductor pollicis brevis muscle. For a number of reasons, the space in the carpal canal may become filled, either with fluid, a mass such as a ganglion, or a swelling of the flexor tendon sheath. Any of these situations begins to crowd the tendons and the nerve within this canal. Obviously, the bones will not yield to give any increased space nor will the transverse carpal ligament. The result is increased pressure in the carpal canal. As this pressure increases, the tendons, which are solid structures, can usually tolerate the pressure very well. But, the nerve, which has the consistency of spaghetti, reacts to the pressure by flattening and losing the ability to transmit nerve impulses. This leads to tingling in the fingers and in extreme cases, loss of motion in the thumb. It would be the equivalent of parking your car on the garden hose. Obviously, you cannot water the garden until you take the pressure off the hose. And, in most cases you will not regain sensation until the pressure is removed from the nerve.

The signs and symptoms of carpal tunnel can be varied, but the most common and classic findings are complaints of numbness and tingling at night that often wakes you from sleep. Patients also describe getting up and shaking their hands or “shaking them down by the bedside to restore circulation”. Other complaints include parasthesia or 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 on the back of the hand, thumb or back of the forearm, usually does not come from carpal tunnel syndrome. However, carpal tunnel symptoms can cause 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, carpal tunnel exercises and in some cases Vitamin B6 (although the usefulness of this vitamin is controversial).

If the patient does not respond to non-surgical treatment, it is recommended that a surgical release of the transverse carpal ligament be performed to prevent permanent changes in the nerve. This is done as an outpatient procedure, and the procedure itself usually takes fifteen to twenty minutes. Most patients, through internet information, know of the endoscopic release which is done using a small scope and a blade placed adjacent to the scope through a very small puncture mark in the skin. The more common approach is called a mini open incision which involves making a slightly larger incision in the palm but not crossing the wrist crease. The decision to undergo this procedure, either endoscopically or open, is best made after discussion between the patient and the surgeon. The patient can expect fairly rapid resolution of the symptoms; although, literature has indicated that recovery can occur for up to 14 months following the surgery. It is felt that complete relief of symptoms and return to normal activities can be expected in greater than 90% of the patients.