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Downhill Slide-Rule Measures the Number of Injuries in Ski and Snowboard Enthusiasts

Researchers offer a new way to monitor the number of people who are injured while snowboarding, alpine skiing, or telemark skiing. Past analysis has involved counting the number of injuries that happen over a set period of time, usually 1000 days of skiing. But different people can ski or snowboard very different amounts in one day. In this study, the authors added another important measurement, the distance each skier or snowboarder traveled. By counting the number of passes used on an alpine ski hill, the authors could estimate the distance each person skied or snowboarded. The results were then compared to the number of people treated at a local hospital.

Researchers used this information to come up with a set measurement, or index, that could be used to check how often people are injured in each of the three snow sports. According to the authors, the percentages that were tallied in this study suggest “a three-to-four-times higher incidence of injuries requiring hospital treatment among snowboarders than among alpine and telemark skiers.”

Quitters Never Win–Except for Smokers Who Need Spine Fusion Surgery

Cigarette smoking is a well-known risk factor for low back pain. Cigarette smoking also has a negative impact on how well smokers do after spine fusion surgery. It’s a fact: nonsmokers fare better after spine fusion surgery than people who smoke. However, this study is the first of its kind to compare whether quitting smoking could make a difference for those needing spine fusion surgery.

The authors checked the medical records of 188 cigarette smokers and 169 nonsmokers who had spine fusion surgery between 1992 and 1996. All patients were surveyed by telephone at least two years after their surgery date. Smokers were asked questions about how much they smoked before surgery and whether they had stopped smoking before or after surgery. The amount of time they were tobacco-free was also recorded. All respondents were asked whether they’d gone back to work and how satisfied they were with the results of their surgery.

People who smoked the most before surgery had the hardest time quitting. Nearly 80% of quitters who had smoked less than a pack a day before surgery were still not smoking one month after surgery. This compared to only about 40% of people who had been smoking more than two packs per day.

Those who hadn’t quit before having surgery were least likely to quit after their surgery. People who quit before surgery were more likely to be tobacco-free up to six months after surgery. This group also stayed tobacco-free for a longer period of time than those who hadn’t quit before surgery.

A key marker of surgery success is whether the bone graft becomes solidly fused. When the bone graft doesn’t fuse, the complication is called non-union. Nonsmokers had the fewest instances of the bones non-union. Smokers had significantly more problems with non-union than nonsmokers. And there was a trend showing that people who stayed tobacco-free the longest after surgery had better fusion results than those who hadn’t quit.

Going back to work is another way to measure success after surgery. Nonsmokers were more likely to return to work than smokers. However, people who quit smoking for at least six months after surgery showed nearly the same rate of returning to work as nonsmokers. Of people who hadn’t quit smoking, just over half were able to return to work; the other half remained disabled.

People who smoked were generally less satisfied with their results than were nonsmokers. Satisfaction scores among smokers were lowest in those who smoked the most before surgery, and satisfaction improved with the amount of time quitters stayed tobacco-free after surgery.

In view of these results, the authors encourage doctors to make every effort to have their patients stop smoking both before and after surgery. “This effort,” they conclude, “is justified by the expectation for improvement in fusion rate and the likelihood of return to work, as well as an increase in overall patient satisfaction.”

Slipping Back in Time to Keep Spines from Slipping Forward

Spondylolisthesis is a medical term used to describe a vertebral body that slips forward on the one below. The problem is associated with hyperextension of the spine, as often happens in sports like gymnastics and football. This extreme backward bend in the spine focuses stress on a section of the bony ring around the spinal column. In some cases, this can cause the bony ring to fracture, allowing the vertebra to slip forward on the one below.

People with spondylolisthesis may find relief from a combination of treatments like medication and physical therapy. However, if the pain continues, nerve problems start. If the vertebra has slipped too far, surgery might be needed.

Various surgical procedures have been used over the years to help people with spondylolisthesis. History is a wonderful teacher, especially when it comes to finding out which surgical procedures seem to work the best. Unfortunately, there isn’t a lot of information that shows how people are faring many years after surgery for spondylolisthesis. The researchers for this study went back through history to see the long-term benefits of two different types of surgery.

This follow-up study reviewed 22 patients who had lumbar surgery for spondylolisthesis between 1968 and 1999. Ten patients had fusion surgery. Twelve patients underwent fusion with metal hardware, known as Harrington instrumentation. On average the patients were 17.9 years old when they had the surgery. As part of the follow-up, the authors had each patient examined an average of 15 years after the surgery. Participants also filled out two separate surveys about their back health. The authors also gave the surveys to a group of people who never had back pain. This allowed researchers to compare the surgery patients and the general population.

Most of the surgical patients showed similar results on the surveys. Their results were even comparable to people who had never experienced back pain. However, this was not true when surgical patients were known to have had a large amount of slippage before surgery. The authors believe these results support the use of surgery in patients with spondylolisthesis.

In the past, some surgeons reasoned that attaching hardware onto the bones of the spine would hold the spine in better alignment, make the fusion more solid, and keep the spine from slipping in the future. They expected people with Harrington implants to fare better over the years. Not so in this case. At the follow-up, complications were much higher among those with the implants.

The authors acknowledge that newer types of hardware are being used with improved success these days. However, their results lead them to conclude that fusion alone gives similar long-term benefits without risking the complications of Harrington implants.

Neck Postures May Pose Risk of Brain Attack at the Hair Salon

If you’re feeling dizzy after having your hair shampooed and styled, there might be an explanation–other than your dazzling new looks. The problem could have to do with a shortage of blood to the brain from having your neck tilted back while getting a hair shampoo, a position commonly used in hairdressing salons.

The vertebral basilar arteries carry blood to the back part of the brain, the cerebellum. In some people, one or both of these arteries can start to get squeezed when the head is tilted back and turned to the side. This squeezing effect can cause a shortage of blood to the brain, leading to dizziness and possibly even a “brain attack,” or stroke. Usually, the symptoms only last a short time. There haven’t been a lot of reports of this problem, but it is common enough that scientists have given it a name–“beauty parlor stroke syndrome.”

In this study, researchers reported the case of a 62-year-old woman who’d had problems with dizziness after shampoo treatments at a hair salon. Along with her feelings of dizziness, she noticed pain in the back of her head and had problems walking. Test results using MRI angiography showed a problem with the blood flow through the left vertebral artery. The doctors also saw markings on MRI scans that showed where a stroke had happened in the tissues of the cerebellum.

People placed in the head-back position for hair treatments at the salon may end up getting more cut off than just their hair. The authors encourage public education in hopes that hairdressers will place their customers in safer neck postures when doing hair treatments and shampoos.

Putting the Squeeze on the Rotator Cuff

The action of throwing requires an athlete throwing overhand to “cock” the shoulder back. When this motion is repeated, soft tissues can get squeezed between the bones of the shoulder, causing the underside of the rotator cuff tendon to rub. When this happens, the athlete may begin to feel stiffness in the shoulder, even after a good warm up. The shoulder pain is usually vague at first but is pinpointed to the back part of the shoulder as the problem gets worse. Pain is most noticeable as the arm is cocked back to throw and when the arm starts to come forward.

The same pain can be reproduced when an examiner puts the shoulder into the cocked position. Other tests, such as MRI scan, may also be required to see if the rotator cuff is rubbing. If the problem is detected early, the athlete is treated by resting the shoulder for one month and then starting a strengthening program for the rotator cuff and the muscles around the shoulder blade. Shoulder surgery may be needed if the athlete has had the problem for a while, shows a positive MRI, and has not gotten better with rest and exercise.

Physical Therapists Give Hands-On Help for People with Knee Osteoarthritis

New evidence shows that special hands-on treatment given by trained physical therapists helps ease pain and stiffness in patients with knee osteoarthritis. The manual treatments used by the physical therapists in this study included hands-on tissue work, graded joint movements, and stretching. These treatments have been shown to calm pain and inflammation, help joints move better, and relax muscles.

Eighty-three patients were randomly placed in either a treatment group or a control group. Both groups were given a survey about their pain. They were also tested to see how far they could walk in a six-minute period. Then the patients went to therapy two times each week for a total of four weeks.

Along with manual therapies, the patients in the treatment group also did standard knee exercises in the clinic and at home. Participants in the control group were only given mock ultrasound treatments set at the lowest possible level, too low to really help their knee problem. This group was also told not to do anything different in the way of exercise or activity.

In the first few visits, people given manual treatments reported feeling 20 to 40 percent better. All patients again took the survey and did the walking test at eight weeks and then at one year after starting the therapy. Participants in the treatment group showed significant improvements according to the survey, and they walked further during the six-minute walk test. Compared to the control group, the patients treated with manual and exercise therapies had less pain and stiffness and fewer problems with activity, even up to one year later. The authors consider that manual therapy for knee osteoarthritis might help patients avoid, or at least postpone, the need for a new knee joint.

Pregnancy: More Than a Walk in the Park

Some of the changes that happen in a woman’s body during pregnancy are obvious. Others are not. Body weight is usually the most obvious change. Expectant mothers generally gain about 24 extra pounds, accounted for by the growing fetus and the tissues needed to support healthy development.

Less obvious are the changes that occur in the tissues of the mother’s body. Joints and ligaments become looser from the hormones that are released in preparation for delivery. Abdominal muscles tend to get stretched out and weakened as the baby grows.

Pregnancy is a time when aches and pains can start–problems like low back pain, carpal tunnel syndrome, leg cramps, and hip pain. It is not entirely understood why these problems happen during pregnancy. Fortunately, most of these problems go away after the delivery. Women who stay active during pregnancy generally have fewer problems and are less prone to injury.

Past research seemed to indicate that changes in walking patterns during pregnancy might be a reason for problems of overuse. However, new evidence in this study shows that walking patterns don’t actually change that much during pregnancy. Even the so-called “waddle” of late pregnancy wasn’t actually found to happen. The authors did see that calf and hip muscles showed more activity while pregnant women walked, a possible explanation for problems of overuse. According to the authors, this extra muscle activity might be why some pregnant women have painful cramps in their calf muscles and why they often have pain in their back, pelvis, and hips.

The Lighter Side of Preventing Overuse Injuries in Runners

“Pain free.” These two words sum up a desire of every runner. And thanks to a steady flow of helpful research, runners are better able to stay one step ahead of potential injury. Two new discoveries have recently been added to this growing body of knowledge. First, it has been found that runners who land with higher impact have a greater tendency toward overuse injuries. Second, runners are at risk if the foot isn’t correctly positioned to cushion the impact when it hits the ground. This can happen when the foot stays arched while in contact with the ground.

Normally, the foot will keep its arch until the moment the heel hits the ground. Then the arch lowers as the sole of the foot makes contact with the ground. This motion is called pronation, which is needed to help the foot absorb shock during impact. After pronation, the foot immediately starts to arch again as a way to power the next stride. If the foot doesn’t start to pronate as the heel hits the ground, the foot remains rigid, putting the runner at higher risk for overuse injury.

The authors used a special platform to measure the forces and foot positions of two groups of runners. The first group had past problems with one or more overuse injuries. The other group had no history of injuries. Measurements were recorded while each person ran on the platform. People in the injury group showed higher forces on impact. Also, their feet were sluggish when moving from the arched to the pronated position. As a result, the authors recommend that injured runners slow their stride during training as a way to lessen the impact.

The authors recognized that training habits can also be a source of overuse injuries. But modifying training routines are only one way–and often an oversimplified way–to address the problems of overuse. The authors are convinced that foot alignment and the way the foot works mechanically while running are what determine safe training levels. They also hope that future research along these lines will offer other new and helpful ways to prevent overuse injuries before they happen.

Forearm Fracture after Menopause May Mean Osteoporosis

Recent studies show that when a post-menopausal woman fractures the lower end of her forearm radius bone, there’s a 90% chance she has osteoporosis. If she does have osteoporosis, the chances double that she’ll eventually have a hip fracture. And the odds are 50% that her hip fracture will result in death.

That’s why it is critical that people at risk of osteoporosis get evaluated and treated sooner rather than later. Even small improvements in bone health can lower the possibility of future fractures due to osteoporosis. According to the authors, these facts should signal doctors to immediately start an evaluation and treatment plan when a post-menopausal woman fractures the lower part of her forearm radius bone.

But the results of this study showed that these patients only received adequate evaluation and treatment 24% of the time. The authors reached this conclusion by studying the medical claims of 1162 female patients over the age of 55 who had fractured their radius, a bone in their forearm. The study showed that doctors did tests to check the bone health in only 33 patients. They prescribed medication in only 262 cases.

The results showed a trend of fewer treatments as the age of the patients increased, presumably because doctors felt it was too late to do anything about the problem. However, the authors emphasize that administering treatment for elderly patients can still provide benefits to offset some of the problems caused by osteoporosis.

It doesn’t take a rocket scientist to guess that a postmenopausal woman with a fracture of the radius bone probably has osteoporosis. Doctors need to take this opportunity to check for osteoporosis, and treatments can begin right away if the diagnosis is made. “Medical treatment for these patients,” conclude the authors, “could have a profound public health impact by decreasing the burden of future osteoporotic fractures.”

Seniors, Put Your Money Where Your Knee Is

How FAST can you decide which is a more cost-effective treatment for knee osteoarthritis? To help answer this question, researchers designed a FAST study: the Fitness and Arthritis Seniors Trial.

Information about cost-effective treatment is needed to help identify the best treatments and, ideally, to lower costs of medical care. Calculating the benefits of preventive treatment is a challenge, especially when trying to decide the monetary value of less pain, better movement, or longer life. This study measured the benefits of various types of treatment for knee osteoarthritis (OA), along with the costs for each treatment.

After screening nearly 5000 people, the authors included 439 seniors in the study. Participants were randomly placed in one of three groups. One group did only aerobic exercise. Another did only resistance exercises. The third group served as a control group and received only education. To begin, participants completed a questionnaire about their knee condition. Then they were scored in their ability to do various daily activities, such as a six-minute walk, going up and down stairs, lifting and carrying, and getting into and out of a car. They also reported their pain levels.

The aerobic and resistance exercisers did their first three months of training in the clinic. They continued doing their program at home for another 15 months. Aerobic exercisers warmed up, walked, and then did a cool down for a total of 60 minutes, three times each week. People doing resistance exercises worked their major muscle groups using nine different strengthening exercises for the upper and lower body. The control group received monthly education classes for three months, each lasting 1.5 hours. A nurse contacted each person in the education group at regular intervals over the next 18 months.

The same questionnaire, scored tests, and pain reports were completed after the test period. The findings showed that costs were slightly less for resistance training than aerobics. And both types of exercise cost less than the education format. Looking at the benefits that were gained for the amount of money spent, resistance training had a bigger effect on overall knee health compared to the other two groups.

Even though the differences were small between aerobic and resistance exercise, the authors conclude that “resistance training is more economically efficient than aerobic exercise in improving physical function, when self-reported disability and various measures of physical function are the outcome variables considered.”

Smooth Ways to Soothe the Problems of Osteoarthritis

The squeaky wheel gets the grease. In the same way, the joint that aches from osteoarthritis gets the attention. Certain joints in the body are bathed in synovial fluid. This vital fluid contains hyaluronon, which works like grease to lubricate the joint. It also cushions the joint from extra strain and shock. Osteoarthritis results in less hyaluronon in the synovial fluid. As a result, the joint surfaces don’t get lubricated and are more likely to get injured from daily stresses and strain on the joint.

Scientists have studied the effects of injecting hyaluronon into arthritic joints in animals. The authors list numerous studies that show benefits from this type of treatment. The treatments reportedly soothed pain, slowed damage to the joint, and even protected the bone below the joint lining.

Scientists use caution when applying the results of animal studies to treatments in humans. However, there are now a host of studies showing that people with osteoarthritis get good benefits, too. The benefits seemed to be strongest in people over age 60 who had mild to moderate osteoarthritis problems and who were given a series of these types of treatments.

On Target with Steroid Medication–A Heel of a Deal

The most common cause of heel pain is proximal plantar fasciitis (PPF). PPF involves inflammation in the tissues where the arch connects to the heel bone. Up to 10% of runners have it at some point in their running careers. The pain usually gets better with rest, anti-inflammatory drugs, and ice treatments. When it doesn’t, doctors may inject steroid medication into the sore spot under the heel.

These injections are not simple to do because it isn’t always easy to feel exactly where to put the injection. This may mean the doctor has to do the injection more than once to get the medicine into the sore spot. Steroid medicine tends to make connective tissue become soft. In the heel, repeated injections can actually cause the tissue to tear. Injections may even hurt the fat pad that sits just under the heel. That’s why it is especially important for the medicine to hit the sore spot.

For this study, doctors examined 14 patients with PPF. Their pain and swelling levels were measured before they got a steroid injection. Ultrasound images were used to guide the point of the needle into the heel. The patients’ pain and swelling levels were then tested again two weeks later and at three months.

The results show that ultrasound can help the doctor guide the needle into the correct spot on the heel. Every one of the patients in the study had significantly less swelling and pain when they came back in for a recheck. None of them showed any signs of damage to the heel pad.

Ultrasounds are affordable, radiation-free, and easy to use. This study indicates that ultrasound technology helps doctors guide needle placement in patients with PPF. The study also indicated that ultrasound can effectively help track progress in patients with PPF.

Using the Eyes: Compensating for Balance in People with Rheumatoid Arthritis

Balance is difficult for people with injuries to their legs. It can be especially difficult for patients with arthritis. And poor balance can lead to more falls. Vision is one of the senses that can help patients compensate for balance problems caused by arthritic knees, and so can paying extra attention to balancing. How exactly do people with arthritis control their balance?

Researchers tested 18 patients with severe rheumatoid arthritis (RA) who were scheduled for total knee replacement surgery. These patients were compared with 23 other people who didn’t have arthritis.

First the researchers tested for knee stability. They had everyone stand on a special force plate to measure how much they swayed back and forth. The amount of fluctuation in movement is called center of pressure (COP). The researchers found that the RA patients had an average of 80% more fluctuation in COP than the control group. This showed that the RA patients had knees that were much more unstable and difficult to balance.

Next, everyone was tested for balance with eyes closed and again while doing math problems. The RA patients weren’t particularly affected by having to focus their attention on doing math problems. But with their eyes closed, they had a much more difficult time balancing than the control group. The more severe the RA, the more patients tended to rely on visual information.

This suggests that people with severe knee RA may end up getting fewer sensations about position and balance from their affected knee. It also indicates that people with severe RA are at greater risk for falling if for some reason vision is a problem. This can happen if eyesight isn’t sharp, if an obstacle blocks the view, or in the dark.

The authors recommend future research on whether people with RA show better balance after having total knee replacement surgery.

Existing Drug Offers Hope in Easing Chronic Pain

Gabapentin, also known by its brand name, Nerontin^TM, may play a role in helping people with chronic low back pain. Doctors at Northwestern University reported success after using this medication to treat a woman with chronic pain in her legs. Gabapentin is already being used to treat neurological problems, but this case suggests it should also be considered in some cases of chronic pain.

The case involves a 30-year-old woman who had to use a wheelchair ever since her spinal cord was injured by a gunshot wound 13 years earlier. The injury caused her to suffer chronic pain in both legs, from her hips to her feet. She described her pain as “throbbing, aching, and stabbing.” These symptoms didn’t go away, even when she tried strong pain medications called opioids. She had problems sleeping, partly because of the pain. As a result, she described her moods as “angry, frustrated, and anxious.”

Her doctors prescribed gabapentin three times a day. Within one week, her pain levels were dramatically lower. Her mood improved, and so did her sleep. Her pain symptoms continued to get better as time went on.

Gabapentin is a fairly new anticonvulsant drug that was designed to help people who have partial seizures. Although it doesn’t have a lot of side effects, about 25% of people using gabapentin say it makes them feel sleepy. Some people have reported having headaches. Others feel dizzy, although clinical trials have shown that these problems don’t happen very often.

The authors conclude that gabapentin should be considered to treat chronic pain, especially in combination with other medications. If the success reported by this patient is any indication, gabapentin might give helpful pain relief for others who’ve had a traumatic spinal cord injury.

Fibromyalgia and Exercise

Fibromyalgia syndrome (FMS) is the third most common rheumatological disease in the United States. However, doctors don’t know very much about it. No one treatment seems to work for all patients. Exercise clearly does seem to help reduce the symptoms of FMS. The problem is, there have been no conclusive studies about what kinds or intensities of exercise help the most.

Recently, researchers did a pilot study to help determine how a 24-week walking program affected patients with FMS. They divided patients into a group who did low-intensity exercise, a group who did high-intensity exercise, and a control group who did no particular exercise.

The exercisers were given a walking schedule to follow. Everyone started walking for 12 minutes, three days a week. By the end of the 24 weeks, everyone was walking 30 minutes, three days a week. The high-intensity group needed to push their heart rate higher, which they did by walking faster. Throughout the study, patients gave written answers to questions about their FMS symptoms.

The original study group only included 21 patients. Only eight of them finished the walking program. Still, the researchers derived some valuable information from the study. It showed that FMS patients are capable of exercising at enough intensity to improve fitness. It also suggested that exercise helped patients do their daily tasks with less difficulty.

High-intensity exercise tended to increase patients’ symptoms. On the other hand, low-intensity exercise seemed to decrease the symptoms over time. This study did not show reductions in pain or depression from the walking program, but other studies have.

This study was inconclusive for many reasons. Its main benefit will be to help researchers design future studies. But it does suggest that until more research is done, FMS patients should consider only low-intensity exercise programs.

Bah, Bah, Back Sheep: Effects of Stimulating Sheep Spines

Electrical currents have been shown to help bones heal faster when used after certain types of surgeries. Nearly 160,000 people underwent spine fusion surgeries in 1995, and many of these patients were implanted with special cages between their spinal bones. Could electrical stimulation have benefits after spine fusion surgery too?

Medical researchers recently tackled this question by studying the effects of electrical stimulation in the spines of 22 sheep. The researchers chose to use sheep spines because of their similarity to human spines. Each sheep had a discectomy and fusion surgery done on the lower part of the spine. A titanium cage was packed with bone and placed between the bones of the lower spine. The sheep were divided into three groups. One group didn’t get any electrical current. The other two groups received two different levels of current through a device attached to the titanium cage.

The sheep were tested every day for the first week, two months after surgery, and four months after the surgery. They went through neurologic exams, X-rays, and biomechanical testing. Tests showed that the group with the highest current had the quickest fusion rates. Healing was slowest in the group that didn’t get any electrical treatment.

Human spines won’t necessarily react to electrical stimulation the same way as a sheep’s spine. But this research suggests that electrical stimulation may help speed healing and improve the rate of fusion in certain types of back surgeries.

Measuring Low Back Pain Disability

The number of people who suffer lower back pain (LBP) is staggering. In fact, it is one of the most common causes of disability and missed work days. These costs add up for individuals, employers, and society. Even with all the advanced technology now available, the medical world is still working hard to be able to understand LBP and the disability it causes. In more than 80% of LBP cases, doctors are unable to find any particular physical cause.

Getting an accurate measurement of the disability caused by LBP is not an easy task. Canadian researchers recently did tests to see whether spine movement and speed could be used to measure disability from LBP. Called kinematics, these analyses are part of the study of biomechanics. Spine kinematic tests study the motion of the spine in movements such as bending over to touch your toes. Many doctors do these tests to get an idea about disability status, but no one really knows how accurately these test results measure disability.

The researchers tested spine kinematics on 175 patients who missed four weeks of work because of LBP. Patients also filled out a survey with questions about their back problem. The kinematic scores were compared to the work status of the patients and to their reports about pain, sleep, and ability to do self-care and daily activities.

The results of the kinematic tests didn’t relate very well to either the questionnaire or the patients’ work status. Remarkably, the kinematic results didn’t always seem to improve, even when patients started to report feeling better and as they went back to work. The researchers conclude that spine kinematics, while useful in other ways, are not helpful in determining the level of disability in patients with LBP.

Spine Fusion Surgery in Diabetes Patients

Medical professionals have long been concerned that patients with diabetes mellitus don’t do as well after spine surgery. To date, however, there has been no research to prove–or disprove–this theory.

In this study, researchers looked at the records of 32 diabetic patients who had lumbar fusions. All patients had type I (insulin-dependent) or type II (non-insulin-dependent) diabetes for over a year. They were also diagnosed with lumbar stenosis or herniated discs that didn’t respond to conservative treatment. They all underwent decompression and fusion surgery using the same techniques.

Researchers followed up on these patients at least two years after their surgeries. At follow-up, 78% of them reported less back pain, and 74% had less leg pain. Ten patients had problems caused by the surgery, including delayed healing, prolonged drainage, and infections. Significantly, 91% of the patients had X-rays that showed successful fusion.

Insulin-dependent patients fared the worst. About half of them had a fair or poor outcome. Patients with other medical problems also had more complications and a less successful outcome.

Despite the complications for some groups, the researchers conclude that lumbar spine surgery can be safe and effective in patients with diabetes.

Getting a Grip on Treatment Choices for Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) has become one of the most common job-related injuries. About 1.9 million American workers develop CTS each year. It causes enormous disruptions for workers and employers, and the financial impacts are huge.

For the most part, workers tend to think that medical treatment offers little help for their CTS. They especially doubt that surgery can help. But according to a recent study of Workers Compensation cases, these perceptions are wrong.

The study compared the results of surgical and conservative treatment of CTS in 182 Workers Compensation cases. Surgery was performed on just over half of these patients. The rest received conservative treatment. The authors conclude that both kinds of treatment are effective. Overall, 82% of the workers returned to full employment. The others retained some disability.

However, workers who underwent surgery had even less disability than workers who received only conservative treatment. Over 87% of the workers who had surgery returned to work with no disability. This compares to about 75% of the workers who got conservative treatment. In both cases, patients who had severe CTS were less likely to recover completely.

The authors’ main conclusion is that surgery seems to be the most effective way to treat occupational CTS. And surgery is possibly more cost-effective for the injured workers, their employers, and the Workers’ Compensation system.

Smoking Is B-B-B-Bad to the Bone

You know the nicotine in cigarette smoke is bad for your heart and lungs. Well, it’s also bad for your bones.

Orthopedic surgeons have long known that smoking affects the health of the skeleton. The evidence has been so conclusive that many surgeons now encourage patients who smoke to at least try to quit before having surgery.

The authors of this study summarized the available research. How does smoking hurt your skeleton’s health? Let them count the ways.

Smoking worsens bone mineral density, leading to osteoporosis. This is especially true in women, but it’s also holds true in men. People who smoke have higher rates of bone loss and seem to have more fractures than people who don’t.

Smoking is related to low back pain. Studies find that people with low back pain are much more likely to be smokers–especially smokers with a chronic cough. Researchers don’t know if this is directly related to smoking or because smokers tend to be in worse physical shape.

Smoking worsens the health of the disks in the spine. This is probably due to lower blood flow and changes in the blood caused by the nicotine in cigarettes.

Smoking slows wound healing. Poor wound healing in smokers seems to be related to higher levels of infection after surgery. In one study, cigarette smokers were classified as high risk for post-operative wound infections, along with patients with systemic diseases and patients who were immune compromised.

Smoking slows the healing of bone. It has been well documented that smokers have much poorer outcomes after certain types of joint surgeries. In one study, 40% of smokers who had lumbar fusion surgery had poor outcomes, compared to 8% of nonsmokers. Some studies suggest that nicotine slows down the formation of new bone. One study suggested that a nonsmoker can make one centimeter of new bone in two months, compared to three months for a smoker.

So if you don’t smoke, don’t start. If you smoke, quit. Your bones will be the better for it.