Archives for May 2019

Upon a backdrop of one of South Florida’s most exciting venues, Miami Hard Rock Stadium, Dr. Alejandro Badia, MD, Course Chairman, Upper Limb Surgeon, and Chief Medical Officer of OrthoNOW invited physicians, physical therapists, athletic trainers, coaches, health professionals, and researchers from around the world to the 2019 STMS Miami Tennis Medicine Conference.

With more than 75 attendees present March 23-24, world-class Sports Medicine Surgeon, Dr. George Branche was also on hand to wow participants with his keynote speech. This Virginia-based specialist has been caring for players on the tour for nearly three decades.

In addition, over 20 faculty including members of the Women’s Tennis Association and other top-rated physicians who have treated current and past tennis pros shared their expertise on techniques of evaluation, management, and training for tennis players including:

• Systemic Issues in the Tennis Athlete
• Biomechanics in Tennis
• Upper/Lower Extremities including Spine
• Mechanical Nuances for the Female Athlete

Conference attendees participated in current didactic lectures from faculty held in a luxurious suite overlooking the main court, which held matches from top-seeded tennis players like Roger Federer. The roar of the crowd as Federer took the court Saturday afternoon during the conference was palatable and the view from the Hard Rock Stadium was spectacular.

Participants not only earned CME and CEU credits for their participation, they also left with the ability to identify medical and musculoskeletal issues specific to tennis;  additional techniques of evaluation, management and rehabilitations of musculoskeletal injuries; and updated evidence-based approaches to tennis specific medical and musculoskeletal conditions

Lunchtime Keynote Speaker Dr. Ben Kibler, editor of the recent textbook Tennis Medicine, shared his expertise on the biomechanics of the serve.

A spectacular evening of networking and socializing with top-notch industry professionals, overlooking the Miami skyline, ended the day on the rooftop of the home of Dr. Badia.

About OrthoNOW
OrthoNOW is defining the future of expert orthopedic healthcare delivery NOW.

Today’s patients demand quicker and easier access to care and are increasingly turning to alternative delivery models such as orthopedic on demand clinics. OrthoNOW is leading the charge. At its state of the art, full-service, walk-in medical centers, they treat patients of all ages. No appointment or referral required, patients can walk in for all things orthopedic, get X-Ray, be evaluated by on-site orthopedic clinicians, and leave fully treated in less than an hour.

This article originally appeared on Merritt Hawkins.

Much has changed during the last 40 years, including an understanding of the importance of physicians and nurses working together, using a team-based approach to improve patient care.

“The relationship between nurses and physicians is vital to the well-being and outcomes for patients and their families,” said Linda Cassidy, MSN, EdM, RN, CCNS, CCRN-K, strategic advocacy manager at the American Association of Critical-Care Nurses (AACN). “Additionally, there is ample evidence spanning decades that supports the importance of nurse–physician collaboration and patient outcomes.”

A study published in Critical Care Nurse in 2015 found collaborative relationships between physicians and nurses decreased rates of healthcare-associated infections in critical care, she explained.

Cassidy noted that team-based care and physician and nurse partnerships are part of a healthy work environment, which can influence patient outcomes and the quality of care delivered across the care continuum.

To that end, here are some tips and reminders for physicians to work effectively with nurses and build strong patient care teams.

SEEKING a new workplace? Check out hundreds of physician jobs across the U.S.

Nine Ways Doctors Can Improve Collaboration with Nurses

1. Build trust and partnership

“Building trust and partnership between clinicians, whether physicians and nurses or allied health professionals, is really important today,” said Tracy Duberman, PhD, MPH, FACFE, founder, president and CEO of The Leadership Development Group in New York.

Duberman described a “trust cycle.” First, everyone must put the patient in the center and remember the goal, then work on finding common ground, having conversations, sharing collective wisdom, and building trust.

“If we start from understanding each other and what value each of you brings to the reason we are here, hence the patient in the middle, it can help to have an open dialogue,” Duberman said.

2. Keep communication open

“Collaboration requires an equal, nonhierarchical partnership between the nurse and physician grounded in open communication, trust and mutual respect,” Cassidy said. “Both nurses’ and physicians’ unique contributions to patient care must be valued and solicited.”

3. Round together

Rounding together helps in providing team-based care and patient perceptions of cooperation. It leads to better handoffs and increased patient satisfaction, Duberman said. Rounds can be time-intensive, she added. A quick scripted review about the patient’s status helps make the rounds go more quickly.

Researchers at Penn State College of Medicine in Hershey, Pennsylvania, studied interprofessional rounding and found the use of scripts and staff support was associated with more team-based rounding.

4. Involve mid-level providers

Improving collaboration among physicians, nurses and other medical providers is “an excellent opportunity for mid-level providers to get involved in a process, so that physicians can focus more on clinical decision making and allow some of the legwork to be done by their mid-level providers,” said Alejandro Badia, MD, a board-certified hand and upper extremity orthopedic surgeon with Badia Hand to Shoulder Center in Doral, Florida. “This can be the group that perhaps most interacts with nurses who are the first line of actual patient care.”

5. Build a collaborative culture

Collaboration begins at the top of an organization and should be carried through and modeled by everyone.

“Achieving effective nurse–physician collaboration requires a focused effort that is supported throughout the healthcare organization,” Cassidy said. “A culture of collaboration must be the expectation and role modeled by leaders. All must be held accountable for assuring that true collaboration is the norm.”

Duberman described an effective coaching model to help foster physician and nurse partnerships. It requires active listening, asking questions about the topic, challenging assumptions and giving feedback. Ask to help you understand, without being judgmental.

6. Participate in team training

All members of the health care team training together, perhaps in a simulation lab, can help ensure better teamwork when a crisis situation develops. A 2011 Mayo Clinic study found enhanced patient-care decision making and greater physician–nurse collaboration when the professionals participated in high-fidelity simulation training.

7. Use mobile communication

Badia noted that there is “an absolute need to increase the use of mobile communication between physicians and nurses, which is done in many sectors outside of health care, but we need to catch up in this area. Physicians are now communicating through their smart phones to a great extent, but I believe more of this needs to be done with nursing colleagues.”

8. Contain the urge to yell

Yelling at a nurse, because the nurse disturbed your dinner or sleep with a report of a change in a patient’s condition, is a good way to shut down collaboration. The next time a patient has a change in status, that nurse may hold off calling, which could harm the patient.

Nurses should effectively communicate the situation, using standard tools and be prepared to answer questions by having all of the facts at hand.

Controlling your speech volume and tone is important in other situations, as well. Both sides need to learn “to effectively resolve conflicts that naturally occur in complex environments such as healthcare,” Cassidy advised.

9. Recognize diversity as good

A difference of opinions is helpful when doctors and nurses work together.

“You usually come up with better solutions when you ask lots of people for input,” Duberman said.

“Remember the mission, vision and values,” Duberman advised. “If you go back to that, it creates a better environment to work in.”

This article previously appeared on Upjourney.

Every day we text, type, and do our daily chores, we might be placing a whole lot of stress on our hands and wrists which may lead to carpal tunnel syndrome.

So, what are the ways to prevent and reduce the risk of CTS?

Dr. Allen Conrad, BS, DC, CSCS

Owner, Montgomery County Chiropractic Center | Team Chiropractor, Blackthorn Rugby Team

What Is CTS?

Carpal Tunnel Syndrome (CTS) is a condition which causes wrist pain, weakness, and numbness from compression of the median nerve as it passes through the carpal tunnel in your wrist. This small area develops scar tissue or degenerative arthritis from repetitive wrist motions like typing. CTS can cause numbness, pain, weakness, and can require surgery if left untreated.

How Do You Prevent CTS?

CTS occurs from repetitive wrist motions done for long periods of time without rest. Frequent rest breaks between long sessions of typing, or working on your car can help. If rest doesn’t do the trick, our office recommends a combination of chiropractic care, massage therapy, therapeutic exercise and therapeutic ultrasound for CTS.

Chiropractors can adjust any of the carpal bones that are misaligned and maintain that your wrist has a full range of motion. Massage therapy is effective for helping break up scar tissue associated with tight and sore muscles.

Therapeutic wrist extension exercises can help strengthen the wrist so it is less likely to become sore with repetitive activities. Therapeutic ultrasound is a machine that uses ultrasound waves while applied to the wrist to decrease inflammation that is associated with CTS.

Other helpful ideas include proper wrist ergonomics while typing.

Ergonomic Recommendations for Good Desk Posture

1. To keep the wrist in the proper posture for alignment, the wrist should be slightly extended during typing, but not more than 15 degrees from a lateral view. This neutral position with slight extension will help alleviate additional stress on the muscles and tendons of the wrist and elbow. The chair height from a lateral view should be equal to the keyboard, with the elbow/forearm angle at 90 degrees.
2. All ergonomic keyboard are not equal, due to the fact that all wrists and arms are different sizes. Important factors for an ergonomic keyboard include a comfortable feel during use, with a reinforced cushioned wrist pad. The keyboard should have a slight elevation that angles towards the person typing.
3. Tablets can cause additional stress on the wrist, elbow, and shoulder since they do not allow the same ergonomic posture as the traditional keyboard. For extended periods of typing, stick to the old fashioned keyboard and use the tablet for occasional uses.

Dr. Eugene Charles, D.C., DIBAK

Chiropractor | Specialist in Applied Kinesiology | 
Author, Journey to Healing: The Art and Science of Applied Kinesiology

Many people are not aware that there is a medical specialty known as Applied Kinesiology that uses muscle testing and integrates various procedures such as chiropractic, medical massage, acupuncture, nutrition and exercise to help you with most conditions, Here is an example of a woman with carpal tunnel syndrome.

Carpal Tunnel Syndrome

Cindy was a cashier at Costco. She had been experiencing severe hand and wrist pain for months that has progressively been getting worse. She had taken to wearing a brace, tried the prescribed drug Neurontin, did her physical therapy faithfully and had one cortisone shot, all of which did not remedy her condition.

The company offered her disability or a job change but she thoroughly enjoyed her work and respectfully refused both. A coworker told Cindy about her success seeing an Applied Kinesiologist for the same condition and gave her the name of her doctor.

Carpal Tunnel Syndrome is a condition whereby the median nerve that travels down from the neck into the hand is compressed at the carpal tunnel. The main symptoms are pain, numbness, tingling, and increasing hand weakness. Patients will often complain of dropping things or being unable to open containers that they used to open with ease.

The patient consultation, which included Cindy wearing a very large and immovable wrist splint, and standard orthopedic tests all pointed to a clear diagnosis of carpal tunnel syndrome (CTS). The Applied Kinesiology (AK) examination went further to specific muscle test the main muscle in the hand controlled by the median nerve, the Opponens Pollicus. This is the muscle that moves the thumb towards the pinky and begins to waste away (atrophy) depending on the chronicity of the problem.

A hallmark of AK muscle testing is the ability to ascertain where the cause of muscle dysfunction is occurring. In Cindy’s case, as in all cases of CTS, if the median nerve is being compressed and affecting the function of the thumb muscle (Opponens Pollicus) AK muscle test can reveal where the compression is occurring.

The carpal tunnel is a narrow passageway located in the area of the palm and wrist. An arch comprised of carpal bones on three sides and a ligament in the front forms this tunnel that your median nerve traverses through. Theoretically, the tunnel becomes compromised and compresses the nerve causing the symptoms of pain, numbness, and weakness.

Currently, the surgical treatment consists of opening the tunnel by severing the ligament. Applied Kinesiology protocol is predicated on the belief that the more likely cause of the collapse of the tunnel is from one of the carpal bones slipping out of place. Applied Kinesiologists prefer to restore the integrity of the tunnel by realigning any of the carpal bones that may have slipped into the tunnel.

The AK procedure is to test the thumb muscle if it is shown to be weak to then proceed to have the patient activate the carpel tunnel by pressing on the various carpal bones and see if this causes an improvement in the function of the affected muscle. If a positive response is noted then the doctor performs a static challenge by pressing the specific carpal bones to see which is the culprit.

When the offending bone is found that is collapsing the tunnel the patient’s hand muscle will test dramatically stronger. Treatment is to restore the tunnel to its normal patency by realigning the misaligned bone to its former proper position through a chiropractic adjustment either by hand or by using an adjusting devise known as an Arthrostim®.

In Cindy’s case, the doctor made the anatomical correction to the carpal bones and gave rubber band exercises to strengthen the neglected finger extensor muscles to help keep the tunnel open.

Since the patient did not want to miss work the treatment required twelve sessions to restore and maintain the integrity of the tunnel because she continued to use the hand throughout therapy. The patient went on to completely recover full strength and pain-free use of her hand.

Brian Zafonte, MD, PhD

Orthopedic Surgeon, Ascension Medical Group

Carpal tunnel syndrome is a common condition that causes numbness, tingling, and pain in the hand and wrist and affects many people of all ages.

It is caused by pressure on your median nerve, which controls movement and feeling in almost all your fingers. Individuals who spend more time using technology including mobile phones, tablets, and computers, report more pain in their wrists and hands than their peers who spend less time each day using electronic devices.

There is no one proven strategy to prevent carpal tunnel syndrome but as technology continues to play a greater role in our daily lives, here are seven ways to minimize stress on your hands and wrists:

1. Pay attention to your posture. For most of us who work on computers all day, this is especially important. Practice good posture to prevent your shoulders from rolling forward, which can affect your wrists, fingers, and hands.
2. Make sure your workstation is set up correctly. Adjust the placement of your desk, chair, and computer monitor to meet ergonomic guidelines. Keep your keyboard at elbow height or slightly lower.
3. Take frequent breaks and stretch often. Even a short break to stretch your hands, wrists and neck can help.
4. Alternate your motions. One of the most common ways of developing carpal tunnel is repetitive, resistive wrist activities. Avoid doing the same motions repeatedly to give your muscles a break.
5. Keep your hands warm. Hand pain can develop more often if you work in a cold, environment.
6. Keep glucose levels under control. Individuals with diabetes are 15 times more likely to develop carpal tunnel syndrome. Prevent type 2 diabetes with a healthy diet and regular exercise.
7. Ease up your grip. Hit the keys on your keyboard softly and if you work with tools for a living, try loosening your grip.

Dr. Daniel Paull

Orthopedic Surgeon | Founder & CEO, Easy Orthopedics

When most people think of carpal tunnel syndrome, they usually just think about the median nerve being compressed. There are also 9 tendons (all of the tendons that flex your fingers and thumb), right alongside the nerve making the carpal tunnel, making it a rather cramped space.

If the tendons are irritated then the nerve can also be irritated, so prevention comes down to two basic tenets: keeping your wrist in a neutral position will create more space in the tunnel, and keeping your tendons and nerve gliding will prevent them from getting irritated. Here are some specific things that someone can do to prevent carpal tunnel syndrome:

1. Don’t lean your hands on the keyboard wrist pad while you are typing. This will force your wrist into extension, and place strain on the nerve and tendons. The best position for typing is to have your elbows at 90 degrees, and your hands hovering over the keyboard while typing. The wrist pad is for resting your wrist when you are NOT typing.
2. Avoid any positions that cause your wrist to be flexed or extended for long periods of time. Movement is good, but staying static in these positions can irritate the nerve or tendons
3. Stretch your hands and wrist regularly. These are also referred to as nerve gliding exercises and can be a treatment as well as a prevention technique. The carpal tunnel wrist stretch is when you put your palm upwards and bend your fingers and thumb back. Hold this for 10 seconds a few times a day, and do not do it if it causes pain.

Dr. Stephen O’Connell

Orthopedic Surgeon | Board Member, Eisenhower Hospital

Carpal Tunnel Syndrome

Although not typically considered a sports injury, the pervasive nature of carpal tunnel syndrome warrants a brief discussion. Classically, patients experience numbness, tingling and/or pain in one or both hands. Pain is often worse at night and will frequently disrupt sleep.

Positional symptoms are also common and may occur with activities such as driving, holding a book or newspaper, and talking on the phone. The source of this problem is a compressed or “squeezed” nerve in the carpal tunnel located in the wrist. Incidentally, the most common cause of this problem is inflammation of the tendons in the tunnel, thus increasing the pressure on the nerve.

Treatment

There is a popular misconception that as we age, aches and pains are to be expected, and when they occur, tolerated. While it is true that overuse injuries are more prevalent as we age, aging, in and of itself, is not the cause nor the diagnosis.

Many times, individuals will not seek medical attention for an overuse injury because they fear the treatment. Concerns over lengthy and perhaps painful treatments, coupled with the fear that they may have to give up the activities they enjoy, impede early diagnosis, treatment, and restoration of full function.

However, the majority of conditions such as carpal tunnel syndrome can be treated with simple modalities. These include rest, modification, therapy and anti-inflammatories — oral, topical and injectable.

In cases that are not amenable to these conservative therapies, a minimally invasive surgical procedure may be recommended. These procedures are typically done in an outpatient surgical center, rarely requiring general anesthesia. Comprehensive follow-up ensures a speedy recovery and an optimal outcome, guaranteeing a quick return to everyday life.

Alejandro Badia, MD, FACS

Hand and Upper Extremity Orthopedic Surgeon

Get rid of hormones that cause fluid retention and thickening of the extracellular matrix. It is a metabolic problem. If prone, wearing a splint to minimize flexion of the wrist, mainly at night, will stave off systems.

Some studies have shown stretching helps (nerve gliding exercises) as well as Vitamin B6 and perhaps antioxidants like Turmeric.

This article originally appeared in Brickell Magazine.

What is emerging in healthcare bears little resemblance to its previous form. Longer life expectancies, emerging markets, increased regulatory scrutiny and healthcare reform are driving industry change. As traditional boundaries dissolve and the new system emerges from its old form, ideas that innovate, inspire and ignite change — such as OrthoNOW — are creating the blueprint for the new millennium. “OrthoNOW is defining the future of expert orthopedic healthcare delivery now,” says Dr. Alejandro Badia, M.D., OrthoNOW Founder & Chief Medical Officer and Founder of the Badia Hand To Shoulder Center. “It used to be that patients with acute orthopedic issues endured long wait times in the local Emergency Room (ER), or wait days, or sometimes even weeks to get an appointment with an orthopedic specialist. Today’s patients — such as busy executives, business owners and attorneys, etc. who don’t have time to waste going thought this treatment journey to get to the right person, are demanding quicker and easier access and are increasingly turning to alternative delivery models such as orthopedic urgent care clinics. OrthoNOW, founded in Miami, recognized these opportunities and set out to lead the disruption of the traditional, multi-billion-dollar orthopedic healthcare delivery system.”

Their handy, easy-to-use mobile app lets patients notify an OrthoNOW Center that they are in route, the reason they are going, and what time they expect to arrive. Additionally, the app locates the nearest OrthoNOW Center, provides contact interface to the Center, can connect to Facebook and Twitter accounts, and supplies information about conditions treated as well as a section for FAQ’s. Patients are able to send a custom injury alert to the orthopedic experts at a Center with pictures of the injury in advance of their arrival. What’s more, users can create multiple patient profiles — a feature designed to help parents or coaches build a system for rapid decision-making and notification at the time of injury, when every second counts. To make the process even more seamless — something that’s critical in emergency situations — the OrthoNOW app is now integrated into the Uber app.

An internationally renowned hand and upper extremity surgeon, Dr. Alejandro Badia has long been a go-to resource in hand and upper limb care for patients in many countries. In any month, he sees dozens of patients from all over the world including Canada, Mexico, Barbados, Peru, Colombia and Brazil…patients who fly in for complex procedures with technology or techniques that may not be available in their homeland. “I knew I wanted to be a hand surgeon at age 8 when I accompanied my grandmother with debilitating rheumatoid arthritis of the hands and wrists to see a prominent hand specialist at Columbia University in NYC, one of only two hand surgeons in New York at that time due to it being a burgeoning specialty,” he says.

The Badia Hand To Shoulder Center manages all types of hand and upper limb issues under one roof including assessment, diagnostic testing, surgery and rehabilitation. The OrthoNOW Services are even more comprehensive since these outpatient centers, four in the Miami area, cover the entire gamut of Orthopedic care: Preventive, Emergency and Rehab Care. Covering the hand & wrist, hip & knee, foot & ankle, shoulder & elbow and cervical & lumbar spine. “I was frustrated seeing patients for the first time long after their injury, sometimes a month later, because they went to the emergency room or a general urgent care center first,” he says. “Too often, by the time the patients got to me, the injury worsened because it didn’t have the right attention early on. And patients wasted a lot of time and money seeing general doctors when what they needed was a specialist. That’s precisely the reason why I started OrthoNOW, a pioneer in the field. As Americans grapple with the state of the healthcare system and spiraling costs, the OrthoNOW model allows patients to see the right clinician at the right time.”

With all these weighty accomplishments to his name, Dr. Badia says that what he takes most pride in is being able to “give back” via medical mission trips. “In Late March 2017, I was humbled to share the experience of co-leading a surgical team to Koforidua, inner Ghana, West Africa,” he says. “The trip was largely organized by Dr. Philippe Cuenod, of Geneva, Switzerland, and his team, who had been there several times before and developed an effective infrastructure at the St. Joseph Orthopedic Hospital so that our goals could be efficiently met. We were serving under the auspices of GICAM founded by an Italian colleague and friend some years ago, committed to restoring hand/upper limb function in underserved countries.” Dr. Badia has also completed similar work in other countries in Latin America and hopes to do this with more frequency in the future. Other plans include growing OrthoNOW into a global service. Currently, it is a national go-to resource for orthopedic issues that is poised to have a major footprint in orthopedic care across the nation.