Dr. Nicholas Cappello

If you thumb makes a squeaky or grating sound, then you may be dealing with a condition known as DeQuervains Tenosynovitis. I predict that with all the SMSs that are sent, that this will become an epidemic. Just watch your teenagers as they text message, their thumb extensor tendons are subjected to repetitive stress.

De Quervain’s Tenosynovitis
De Quervain’s tenosynovitis is inflammation of tendons on the side of the wrist at the base of the thumb. Typical causes include stresses such as lifting young children into car seats, lifting heavy grocery bags by the loops, and lifting gardening pots up and into place.

Symptoms include pain and tenderness at the side of the wrist beneath the base of the thumb. Sometimes there is slight swelling and redness in the area.

It is diagnosed based on the typical appearance, location of pain, and tenderness of the affected wrist.

Treatments can include any combination of rest, splinting, ice, anti inflammation medication, and/or cortisone injection. Cortisone injection is extremely effective and is generally the optimal treatment. Normal activity may be resumed within 3 weeks after an injection. Surgery is only rarely necessary and usually reserved for persisting inflammation after failure of at least one cortisone injection.

The patient can generally return to full function after the inflammation quiets down with treatment. Sometimes bracing is used during future activities that involve repetitive wrist motion.

In February the Osteoarthritis Research Society International (OARSI) released new recommendations on minimizing the grating aches and pains of osteoarthritis. Key among those recommendations was — you guessed it — exercise.

“There have been a slow but steady number of studies in recent years that have looked at exercise for osteoarthritis, and they all agree that it’s very, very important,” says Duke rheumatologist Virginia Kraus, MD. She and Duke pain specialist Francis Keefe, PhD, talked a bit about the new proof behind the old strategy: keep it moving.

Know all the right moves: Kraus says that, in general, the two types of exercise that are the safest and the best tolerated by people with arthritis are aquatics and biking — especially recumbent biking, because the low seat and back support allow the peddler to get good aerobic training without weight or strain on the leg joints.

Try the Y: For years the Arthritis Foundation has supported specialized aquatic and land-based exercise programs for arthritis patients. The programs were developed by rheumatologists and physical therapists, and the classes are offered at most YMCAs across the country.

New studies have proved that patients who followed one of the arthritis exercise programs saw lasting improvements in pain, fatigue, strength, and arthritis symptoms after eight weeks.

Don’t dismiss the NSAIDs: According to the new OARSI treatment guidelines, some doctors and patients may be too quick to spurn nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aleve and Celebrex, because of gastric complications and concerns over possible heart health risks.

The OARSI review of available data led the experts to conclude that short-term use of NSAIDs may be very beneficial in many patients, and the benefits may outweigh the risk of side effects in some people.

Minding the pain: Arthritis pain really is different from other types of pain, according to a small study reported last year. That’s because the pain caused by arthritis is processed in the parts of the brain that also control emotions, including fear and distress.

Accordingly, mind-body techniques such as guided imagery, meditation, and other relaxation-based pain management techniques may be particularly effective in helping to treat arthritis pain, says Keefe.

What I like to do is to look at it this way…

When at work use the stairs , get out of the chair every 20 min and walk around your desk, focus on your biceps and imagine you are doing curls

For health: Regular exercise provides protection against heart attack, stroke, high blood pressure, diabetes, and many other ills. The key is isotonic exercise—activities that use your large muscle groups in a rhythmic, repetitive fashion without making your muscles work against heavy resistance. Isotonic exercises include walking, bicycling, rowing, and the like. You can get all this  using an elliptical machine. 30 minutes daily

For competition: . That means boosting your heart rate to 70% to 85% of its maximum and holding it there for 20 to 60 minutes.

For appearance: You can lose weight with the moderate exercise you need for health—but for faster, more impressive weight loss, do about an hour of moderate exercise a day.
Read more: “How much exercise do you need?”

A new study by researchers from Rush University Medical Center has found that flip-flops and sneakers with flexible soles are easier on the knees than clogs or even special walking shoes. Why care? Because loading on the knee joints is a key factor in the development of osteoarthritis (OA).

The study, which included gait analysis on 31 patients with OA symptoms, was published online in the journal Arthritis Care & Research. Gait was analyzed while patients walked barefoot and with four shoe types: Dansko clogs, Brooks Addiction stability shoes, Puma H-Street shoes, a flat athletic shoe with flexible soles; and flip-flops.

“Traditionally, footwear has been engineered to provide maximum support and comfort for the foot, with little attention paid to the biomechanical effects on the rest of the leg,” said Dr. Najia Shakoor, in the news release. Dr. Shakoor, a rheumatologist at Rush and the primary author of the study, added, “But the shoes we wear have a substantial impact on the load on the knee joints, particularly when we walk.”

For the clogs and stability shoes, the loads on the knee joints were up to 15% greater than with the flat walking shoes, flip-flops or barefoot walking. Knee loading was roughly the same whether the subject wore flips-flops or walked barefoot.

“Heel height is one factor, and may explain why the stability shoes and clogs in our study, both of which had higher heels, produced greater knee loads,” Dr. Shakoor added.

She continued, “Stiffness is also a factor. We’ve shown in earlier studies that barefoot walking is associated with lower knee loads than walking with conventional footwear. It may be that the flexible movement of the bare foot is mechanically advantageous. The natural flex of the foot when it contacts the ground probably attenuates the impact on the joint, compared to the artificial ‘stomping’ movement created by a stiff-soled shoe.”

In the news release, Dr. Shakoor cautioned, “For the elderly and infirm individuals, flip-flops could contribute to falls because of their loose-fitting design. Factors like these need to be taken into account.”

Based on this study , we can say that the type of shoes people wear can affect their knees and that it is possible that flat, flexible footwear may be beneficial in terms of knee loading.

The incidence of shoulder and elbow injury in young baseball players has risen significantly during the last decade.  American Sports Medicine Institute have reported at least a five-fold increase in serious shoulder and elbow problems in high school and younger baseball players.

We found that even in children as young as 8, shoulder adaptations occurred in response to repetitive throwing. The growth plate of the throwing shoulder changes, leading to an increase in external rotation, meaning that with the arm out to the side, the hand can be rotated further back.

The gradual adaptations of the shoulder to throwing can protect against future injury and may increase throwing velocity. It appears that starting baseball at a young age may allow the body to gradually develop positive changes. The key, however, is that these adaptations to throwing should occur slowly over time, with adequate periods of rest. Indeed, Little League Baseball officials have tried to address some of these concerns by

2.  LIMIT THE NUMBER OF INNINGS

3.  NO CURVE BALLS UNTIL 14 IN MOST

4.   participation in sports, with a youngster playing, say, soccer or football in the fall, ice hockey or basketball in the winter and baseball     in the spring.

It can save your life!! Remember you will be inhaling an aesthetic gas that will have a negative affect on your lungs, by adding the residue of cigarette smoke you are creating double trouble.

Those who smoked during the last 24 hours before surgery with general anaesthesia were having episodes of inadequate oxygen supply to the heart 20 times more than those who were non-smokers, or ex-smokers.

The lack of oxygen leads to heart irritability which can trigger a premature beats that can be fatal …got your attention now?

The problem is that smoking reduces the amount of oxygen available to the cell for healing. It happens when nicotine makes the small blood vessels shrink, the amount of haemoglobin available to move oxygen around the body and by interfering with the special chemicals that allow the release of oxygen to the cells reduces.

Bones are especially sensitive because their blood supply is a micro environment and there will be delayed healing of not only bone but also ligaments and tendons. There is evidence that smoking in those around you – second hand smoke – may also delay healing or cause problems.

Smokers who undergo surgery suffer complications, such as wound infections and poorly healing wounds, more often than non-smokers.

The coughing post op can not only be painful but can disrupt the suture repair and lead to return to operating room.

Research has shown that the risk of complications is reduced if the patient stops smoking four weeks ahead of the operationMost doctors prefer that their patients would stop smoking for several weeks before surgery.

Unfortunately, the use of nicotine gum is helpless around the time of surgery. The nicotine can interfere with healing in the same way as nicotine in cigarettes.

I have always enjoyed being athletic and have stayed in the forefront of the latest news to help me and my patients stay in shape and prevent injuries.

The truth about stretching has changed over the years. I remember when the “STATIC STRETCH” (holding a stretch for 10 to 20 seconds) was a must before an athletic activity.

SPORTS MEDICINE DOCTORS now know that the static stretch actually causes the muscle to lose 30% of its strength as well as inhibiting the opposite extremity as well.

The static stretch causes a decrease in blood supply during this time as well as buildup of various metabolites. The right way to treat your MUSCLES AND TENDONS is to warm them up before sports activity.

A slow jog around the tennis court or soccer field will accomplish this, (shoot for 30 % of heart rate and don’t spent more than 5 to 10 minutes) as well as getting you joints through a range of motion. A warm muscle is a happy muscle…it has dilated blood vessels which can deliver more O2 and remove waste.

On the other side stretching muscles while moving, a technique known as “dynamic stretching” or dynamic warm-ups, increases power, flexibility and range of motion, as well as core tempt. Of the muscle. It alerts the nervous system to prepare for the upcoming activity.

Dynamic stretching should be sport specific, just watch any pro tennis or soccer match.  I have included a link to a great site for more information. http://www.squidoo.com/dynamic-stretching-exercises