Dr. Nicholas Cappello

I am an avid tennis player with a terrible back hand technique that has caused lateral elbow epicondylitis (tennis elbow)  .  As a physician/patient I am also constantly seeking newer forms of treatment for my patients,  and myself.
WHATS NEW
platelet-rich plasma (PRP) ..Tiger Woods had  Platelet Rich Plasma (PRP) injections he received from Dr. Anthony Galea,
PRP is created by taking an individual’s whole blood, putting it into a centrifuge, concentrating the platelets, and injecting the platelet-rich mixture into a site of injury. While normal whole blood has about 200,000 platelets per microliter, PRP has about 2,000,000.
PRP is rich in cytokines and other growth factors, but studies have yielded mixed results regarding its effectiveness in repairing various types of injuries, including tendinitis, muscle strains, ligament sprains, and fractures.
The FDA has approved the treatment as a device, but its use is still considered investigational. So orthopedic surgeons are still trying to figure out where PRP will fit into clinical practice — if at all.
A Dutch study presented here at the American Academy of Orthopaedic Surgeons meeting showed that injecting PRP into the elbows of patients with chronic lateral epicondylitis significantly improved pain, function, and disability through one year, compared with a corticosteroid injection.
In the randomized trial, the proportion of patients reporting at least a 25% reduction in pain was significantly higher in the PRP group (76% versus 47%, P<0.001), according to Taco Gosens, MD, of St. Elisabeth Hospital in Tilburg
shock wave” therapy…approved by the FDA for use in each of these conditions.  It is being considered for approval in the treatment of other musculoskeletal conditions such as shoulder tendinitis, Achilles tendinitis, patellar tendinitis and other conditions.  Contraindications for the procedure include “neurological and vascular disease of the foot, history of rupture of the plantar fascial ligament, open growth plates (child), pregnancy, implanted metal in the area (bone screws or pins) and people on medication that interferes with blood clotting, such as coumadin and prophylactic aspirin”.
For several years now a new form of treatment has been tried clinically for patients with tendinitis at various sites such as the foot (plantar fasciitis and heel spurs) and the elbow (tendinitis).  It is called “
What is extracorporeal shock wave therapy (ESWT)?  With a special device “focused shock waves are delivered to the body”…not unlike the shock waves that are used in lithotripsy…to break apart and fragment kidney stones.  The shock waves are either low energy…given in a series of 3 or more treatments…or high energy…given in a single session.  Low energy shock waves are not painful or mildly painful…high energy shock waves can be quite painful, usually requiring some form of anesthesia.  The shock waves work by causing microtrauma to the local tissues… including fragmentation of calcification if present… which initiates a healing response in the affected tissues.
Reports to date vary on the effectiveness of this treatment in musculoskeletal conditions.  Last month,researchers published the results of a controlled clinical trial on the use of ESWT in the treatment of tennis elbow.  Sixty-eight patients were studied…half receiving the treatment and half a sub-therapeutic dose.  They found no differences in the  two treatment groups of patients over a 6 month period.  The authors concluded “our study found little evidence to support the use of ESWT for the treatment of lateral epicondylitis and is in keeping with recent systematic reviews of ESWT for lateral epicondylitis that have drawn similar conclusions”.  They warned “shock wave therapy is not effective for treating tennis elbow…there is currently no place for shock wave therapy in the management of tennis elbow”.
For more information:  1) www.nlm.mih.gov/medlineplus/news/fullstory-70984.html.  2) Staples, et al. A Randomized Controlled Trial of Extracorporeal Shock Wave Therapy for Lateral Epicondylitis (tennis elbow), J Rheumatol, 35:2038, 2008.  3)http://orthopedics.about.com/od/footankle/i/shockwave.htm

WHATS OUT

Now this is my personal opinion I will never give another cortisone injection for Tennis elbow it just does not make sense, is a temporary solution and does nothing to help with the healing of the extensor tendons microtruma.

WHATS EFFECTIVE

To date, nothing has replaced longstanding traditional care…medical or conservative care first…consisting of rest, ice, anti-inflammatory medications, stretching exercises   In each situation I can’t stress enough the importance of stretching exercises to maintain forearm musculature flexibility.

In rare cases…when all forms of treatment fail…surgery is the last resort…consisting of resection and repair of damaged tissue and/or releasing the attachment of the muscles to bone at the elbow.

NEW YORK, July 19, 2011 /PRNewswire/ — U.S. News & World Report has once again named Hospital for Special Surgery the top hospital in the country for orthopedics in its 2011 “America’s Best Hospitals” issue.  The hospital has also ranked as a leader in rheumatology at number two in the nation. In addition, neurology was ranked at No. 19.

“We are deeply honored to be recognized nationally as the best in our specialized fields,” said Louis A. Shapiro, president and CEO of Hospital for Special Surgery. “Our hospital staff consistently exceeds the high standards that we set for ourselves, providing an environment for excellence in patient care and safety.”

Thomas P. Sculco, M.D., surgeon-in-chief of Hospital for Special Surgery added, “This accomplishment reflects a true commitment to excellence by our orthopedic surgeons, rheumatologists, physiatrists, radiologists, anesthesiologists, neurologists, nurses and other health-care professionals who work hard to advance the research and education that translate into unsurpassed patient care.”

In addition to the recognition by U.S. News & World Report, the hospital’s commitment to quality was recognized by Consumer Reports, which rated the hospital the best in New York City for patient satisfaction in a survey of 43 hospitals throughout the five boroughs. The New York State Department of Health also found that of the 169 hospitals in New York State that performed hip replacement/revision surgery in 2009, the most recent data available, Hospital for Special Surgery was the only hospital with a statistically lower rate of surgical site infection compared to the state average.

Currently, physicians from Hospital for Special Surgery’s Sports Medicine and Shoulder Service perform in official capacities for major professional sports teams including the Super Bowl XLII Champion New York Football Giants, New York Mets, New York Knicks, Nets Basketball, New York Liberty Basketball and New York Red Bulls Soccer. HSS sports medicine specialists also served on the U.S. Olympic Committee medical staff team that covered the Beijing Games in 2008.

Another testament to Hospital for Special Surgery’s excellence and consistency is its high ranking in rheumatology. Mary K. Crow, M.D., physician-in-chief and chairman of the Division of Rheumatology explained that, “As specialists in autoimmune and inflammatory diseases, our patients trust us to be able to relieve their pain and to use our expertise to offer individualized recommendations and advice.” By integrating the latest research with comprehensive clinical care, Dr. Crow and colleagues work to “provide the best possible outcomes for our patients with challenging diseases such as lupus, as well as those with inflammatory or degenerative arthritis.”

Last year, more than 25,000 surgeries were performed at Hospital for Special Surgery.  Areas of expertise include joint replacement, spine surgery, sports medicine, orthopedic trauma, hand surgery, foot and ankle surgery, pediatric orthopedics, limb lengthening, osteoporosis and metabolic bone disease. Additionally, the hospital established the Center for Musculoskeletal Outcomes and Patient Oriented Research, an innovative specialty center that will guide experts in preventing, diagnosing and treating musculoskeletal disorders. The Center will work in coordination with the hospital’s other specialty centers and services to enable patients and physicians to make informed decisions based on clinical and functional outcomes, patient-reported quality of life and cost.

Hospital for Special Surgery currently maintains more than 30 research registries for conditions ranging from anterior cruciate ligament (ACL) injuries to lupus to rheumatoid arthritis. The HSS total joint replacement registry, for example, contains data from more than 20,000 patients.  “Through these registries, clinicians and researchers collect more than demographic and clinical information,” said Dr. Sculco. “They also gather patient reports about outcomes after surgery, such as satisfaction with treatment, quality of life and return to activities.”

About U.S. News & World Report’s “America’s Best Hospitals”

U.S. News & World Report’s “America’s Best Hospitals” is a resource for consumers seeking the highest quality care in 16 medical specialties. With more than 5,000 hospitals evaluated nationwide, rankings are based on reputation and measures of quality, such as patient volumes and mortality rates as well as nursing care and technology services.

About Hospital for Special Surgery

Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 2 in rheumatology, No. 19 in neurology and No. 16 in geriatrics by U.S. News & World Report (2011-12), has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center, and has one of the lowest infection rates in the country. From 2007 to 2011, HSS has been a recipient of the HealthGrades Joint Replacement Excellence Award. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Cornell Medical College. The hospital’s research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and

I would like to share a good read…

Myth 1: There is no harm in routine cancer-screening tests.

Screening the general population for breast, prostate or other cancers requires weighing the potential benefit of finding a malignant tumor early on—when it is smaller and generally more treatable—against the very real harm of subjecting a lot of people to invasive and/or expensive follow-up procedures that they do not need.

Studies have shown that as many as half of healthy women will receive a false-positive result for breast cancer after 10 years of routine mammogram tests. (A false positive occurs when a diagnostic test tells you that you have a particular ailment, but in reality you do not.) Most of the false-positive group will then have to undergo a more detailed imaging scan and a significant fraction will undergo a biopsy—not to mention dealing with the anxiety of awaiting results.

Mammograms have helped to lower the risk of death from breast cancer. The prostate-specific antigen (PSA) test to screen for prostate cancer, however, cannot even lay claim to such a benefit. Originally developed to help track the recurrence of prostate cancer after the original tumor had already been diagnosed and treated, PSA tests are now widely used as a screening test to pick up unsuspected cases. The only trouble is that two studies (one from the U.S. and one in Europe) have shown that using the PSA test to screen for prostate cancer in this manner does little to decrease death rates in men aged 55 and older. Indeed, the discoverer of PSA has campaigned for years to get people to stop using the PSA test to screen for prostate cancer. (It still makes sense, however, for many men who have a strong family history of the disease or who have actually developed prostate cancer in the past.)

Basically, the more screening tests for different kinds of cancers you undergo, the greater your risk of getting a false-positive result. One study found that half of all people who received at least 14 tests for some combination of prostate, lung, colorectal and ovarian cancer had been given a false-positive result. And men and women with a false-positive test had a one-in-four chance of having to undergo a surgical procedure—with its own attendant risks—to find out that they were okay after all.breast cancer

I came across a good tip from NPR..Low back pain is second only to cold
symptoms when it comes to complaints that send people to the doctor. Sooner or
later, back pain seems to get most of us.A Comparison of Massage Therapy and
Usual Medical Care for Chronic Low Back PainNow,
a study in the July 5 issue
of the Annals of Internal Medicine shows that massage is an effective treatment for lower back pain. In some cases, researchers report, the benefits of massage lasted for six months or longer.Researchers headed by epidemiologist
Daniel Cherkin, a senior investigator at Group Health Research Institute in Seattle, enrolled 401
people with chronic low back pain and no identifiable reason for the pain.
In relaxation massage, often referred
to as Swedish massage, a variety of maneuvers are used to promote a feeling of
relaxation throughout the body and muscles. Structural massage, commonly
referred to as deep tissue massage, targets specific pain related tissues,
ligaments and joints.”We found that both types of
massage were equally effective in helping people improve their function and
diminish their symptoms,” Cherkin says. He says massage relieved the pain
for six months or more.

No one knows exactly how massage works
to relieve pain, says Dr. Richard Deyo of Oregon Health
Sciences University,
who also took part in the study.”It may be that it helps with
relaxation of muscles that are tense,” Deyo says. “But it may also be
there are simply more generalized effects of relaxation — in the caring and
attention and someone laying hands on — that may all be important.”

I was watching an Anti Aging show on The Discovery Chanel and would like to share some of the take away points.There is proven results in the lab that calorie restricted mice could live 4 times longer then their over fed controls. There is an ingredient in red wine, Resveratrol is found in the skin of red grapes and in other fruits. Red wine contains a high level of it and some scientists believe it is one of the factors behind the French Paradox. 2 to 3 glasses a day is suggested.

With this procedure a surgeon places a tiny camera in the knee, then inserts small instruments through other incisions to repair torn or aging cartilage. Studies show the operation works well when patients have in fact torn their meniscal tissue, but it is no more successful than noninvasive remedies in treating osteoarthritis of the knee. In a 2008 study, 178 patients with osteoarthritis received either physical and medical therapy without surgery, or therapy plus surgery. After two years the two groups had nearly identical outcomes, reporting less pain and stiffness and more mobility.

Alternatives to surgery
If you have knee pain, “start with the least harmful and invasive treatment and work your way up the ladder,” says Colin Nelson, a senior research associate at FIMDM. This includes lifestyle changes such as exercise, as well as medication and cortisone injections.

I want to pass along some advice from the AARP..With spinal fusion, a surgeon places bone grafts that “weld” two or more vertebrae together to prevent motion and stop pain. The procedure is often used to treat back pain from spinal stenosis, which occurs when the soft tissues between the vertebrae flatten out, creating pressure on the spinal cord or nerves that go to the back, arms, neck, shoulders, and legs. There is little consensus on how best to relieve pain from stenosis, so doctors tend to develop their own preferences, says Richard Deyo, M.D., professor of medicine at Oregon Health and Science University.