Archives for July 2019

Repairing a partial tendon tear in the shoulder’s rotator cuff may simply be a matter of “patching” it, says noted orthopedic surgeon Alejandro Badia, MD. An expert in shoulder surgery, as well as regenerative medicine, Dr. Badia, has been successfully using an all-natural, collagen patch to promote healing of the rotator cuff tendon. Called the REGENETEN◊ Bioinductive Implant system, the patch is made from highly purified Achilles tendon of cows and grafted onto the torn section of tendon in a minimally invasive, arthroscopic procedure. For smaller tendon tears, the patch may be all that the patient requires, thereby avoiding more extensive surgery.

Dr. Badia refers to it a “breakthrough approach.”

“Rotator cuff tears are the most common source of shoulder pain and disability, affecting more than four million people annually in the United States,” says Dr. Badia, founder and chief medical officer of the Florida-based Badia Hand to Shoulder Center and OrthoNOW®. “The bio-inductive implant disrupts progression of rotator cuff degeneration by stimulating growth of new tendon tissue.”

Although longer-term studies are needed, the patch may actually limit the likelihood that a repaired rotator cuff tendon will later fail. That’s because regeneration of tendon tissue reduces strain at the site of the injury. The patch is gradually absorbed by the body, leaving behind “tendon-like” biological material serving as a scaffold that supports the repaired rotator cuff tendon — a significant benefit since larger tears requiring surgery can re-tear more than 40 percent of the time, Dr. Badia explains. 

Patients undergoing patch therapy also tend to resume normal activities more quickly than those undergoing standard treatments. “Recovery from standard surgery is often longer and more painful,” he says. Furthermore, these patients seem to have much less post-op pain and begin moving the arm within days, depending upon the surgeon’s particular protocol, but generally much earlier than with traditional repairs. Nick Mendez, CEO of OrthoNOW®, recently underwent a combined labral repair along with Regeneten® augmentation of a concomitant partial cuff tear noting “I had essentially no post-op pain which I attribute to the technique, implant and the type of anesthetic block used”.

A further usage of the Regeneten® implant is for augmentation of massive tears that are often doomed to failure due to poor tissue quality and retraction of the tendon. Dr. Amy Chappell, a neurologist and prominent lifestyle medicine physician, recently underwent a “double row” rotator cuff repair where even achieving a repair was challenging. Her early clinical outcomes were remarkable due to the reinforcement of that repair with this bioinductive implant. Dr. Chappell notes, “I recovered my functional range of shoulder motion within 6 weeks of the surgery and all of the pre-operative pain is gone. I am now returning to my previous fitness regimen and lifestyle.” 

Dr. Badia calls the shoulder, particularly the rotator cuff complex, a “demanding joint” for both patient and treating surgeon. The cuff consists of a stabilizing confluence of four major tendons from muscles that keep the head of the upper arm bone in the shoulder socket, allowing the arm to be raised and rotated. Partial — or complete — tears of these tendons can occur from normal wear over time; repetitive use as occurs in certain sports, such as tennis, and in occupations like painting or carpentry; and injury from falls or heavy lifting. 

Symptoms of rotator cuff problems can include a dull ache in the shoulder, arm weakness, difficulty in lifting or rotating an arm and disturbed sleep. Partial tendon tears degenerate and become much larger if not resolved quickly. Interestingly, partial tears are often more painful than complete tears causing patients to seek medical attention, but treatment options have been limited until now. 
Dr. Badia indicates that most partial thickness tears – up to 80 percent – increase in size and severity within two years without medical intervention and, if left untreated, might lead to permanent joint problems, including weakness and loss of shoulder motion. 
Researchers have been long seeking a “gold standard” of therapy for rotator cuff repairs. Despite the variety of surgical techniques studied and resulting improvements in repairing tendons and re-fixing them to bone when necessary, healing outcomes have remained relatively stable, with the same high failure rate of tendon re-tears and damage. 

“We have become quite proficient at mechanical repairs of the shoulder, but not the biological aspects,” says Dr. Badia, adding that “biological factors” like tendon degeneration, declining vascularity of tendons, and muscle atrophy are the more likely culprits today for high rotator cuff failure rates following surgery. 

He concurs with scientists who say that regenerative medicine, including use of biologic scaffolds and patches like the REGENETEN◊ Bioinductive Implant, pose exciting new possibilities for enhancing the success of joint repair. 

In fact, all-natural treatments may eventually prove effective substitutes for more invasive surgical techniques, thereby encouraging patients to undergo rotator cuff repairs earlier, before the problem worsens, and opening up the possibility of surgeons performing successful procedures on older patients, those 70 years of age and older, for whom traditional surgery has not always been the best option, Dr. Badia says. 

Of course, prevention is the best medicine. That’s why Dr. Badia offers these tips to prevent shoulder-joint problems:

• Learn how to do stretches – like the sleeper stretch and cross-arm stretch – to strengthen the shoulder’s internal and external rotation.
• Strengthen the rotator cuff specifically, requiring different exercises than traditional “gym” routines that work the more “showy” deltoid muscle seen externally.
• Adequately warm up before playing sports or engaging in other vigorous activities that stress the shoulder.
• Pay attention to proper technique when lifting, especially anything heavy.
• Take breaks when using repetitive arm and shoulder motions like painting; avoid keeping arms raised or out from the side for long periods of time.
• If experiencing any ongoing shoulder pain or weakness, see an orthopedic specialist. “Don’t just blame the problem on arthritis or age.”

This article originally appeared on LifeHacker.

If you’re reading this at work, you are probably worried that something you’re doing right now is slowly killing you. The accumulated years of slouched spinal posture, squinting at a screen and sitting (“the new smoking”) are sources of health paranoia for the 80 per cent of the workforce whose jobs do not regularly require physical activity.

And then there’s typing.

The anxiety over long sedentary workdays is often crystallised in fears of carpal tunnel syndrome (CTS), a wrist ailment that is so associated with repetitive hand activities that the image attached to the Google medical information profile for it is an intently focused woman in an open-office plan sitting at a desk with one hand on a mouse and the other typing.

However, capitalism is probably off the hook for CTS: There is scarce data that excessive keyboard work causes carpal tunnel syndrome.

What carpal tunnel syndrome is

CTS is a condition in which the carpal tunnel—the part of the wrist containing the median nerve that runs from the forearm into the palm — becomes pressed or squeezed, causing burning, tingling, numbness and/or stiffness.

The cause is often due to inflammation. Sprains, fractures and injuries to the wrist can instigate CTS. Metabolic factors, like an overactive pituitary gland or an underactive thyroid gland, can also induce that kind of bodily reaction. Fluid retention during pregnancy or menopause are also possible culprits, and this is one reason women are three times more likely to experience CTS than men. Onset typically occurs sometime between ages 30 and 60.

While wrist injuries can start a bodily reaction leading to CTS, clicking and typing themselves don’t put much stress on the carpal tunnel.

Numbness, not pain, is the surest sign of carpal tunnel syndrome

Alejandro Badia, MD, co-founder and chief medical officer of the Badia Hand to Shoulder Center near Miami, says he often sees patients with wrist pain who are sure their 9-to-5 is the source. “I have patients come in so hell bent on what’s causing it,” he said.

Misconceptions about computer posture cause patients to mistake pain around the wrist for CTS, Badia said. “But the tell-tale sign [of carpal tunnel syndrome] isn’t pain; it’s numbness.”

Pain and shock-like sensations are not unheard of in CTS cases, but numbness, tingling and burning are more common effects of the carpal tunnel nerve misfiring and struggling under pressure. These feelings often come when the patient is trying to sleep, a time when wrists are often bent.

Many of Badia’s patients who think they have CTS actually have tendonitis, a painful repetitive stress injury caused by overuse of the tendons in the wristsame ligaments, including ones in the wrist. Overuse causes inflammation or irritation of a tendon, which connect the muscle to bone. Depending on the area affected, tendonitis has a variety of nicknames, including “tennis elbow” and “swimmer’s shoulder.”

The treatments are drastically different. An injury to the tendon may require a combination of rest and physical therapy. Carpal tunnel syndrome requires a different approach, so see a medical professional to figure out what the problem really is.

What to do if you think you have carpal tunnel syndrome

If you feel numbness and tingling and think you have CTS, “the first thing to do is call a doctor,” said Christopher Stevens, an orthopaedic surgeon who specialises in upper extremities at the Tucson Orthopaedic Institute. There is a vast range of courses of actions one should take depending on the severity of the problem and a professional can guide you through them.

Your best treatment could be a specialised splint that takes pressure off the carpal tunnel. For mild cases, wearing such a splint puts the nerve back in working order after a few weeks. More extreme cases may require an anti-inflammatory medication or hand surgery. Severe CTS can cause one to lose control over one’s hands.

Who actually gets carpal tunnel syndrome?

There isn’t much you can do to prevent carpal tunnel syndrome. Biological and metabolic factors rule the categories of known causes.

The research that explores the role of hand overuse actually shows that people in blue-collar jobs are somewhat more likely to suffer than those tied up in a cubicle all day. A British study found that packers, assembly line and food processing laborers and workers who used vibratory power tools were the most likely types of employees to have CST, not data entry professionals or administrative assistants. They put the greater strain on their hands and risk injury.

Still, with being female increasing one’s chances of getting CTS threefold, biology is a greater factor than lifestyle for the ailment.

The gender ratio of CTS offers a historic reason why carpal tunnel came to be misunderstood as a white-collar ailment. “If you think of the population who first showed up with signs of carpal tunnel syndrome, it was middle-to-late-age females,” said Stevens.

In the mid-20th century, when carpal tunnel syndrome was first widely recognised and diagnosed, women had been shoehorned into secretarial work. So began the misconception that typing and repetitive hand tasks cause CTS. Actually, it was probably pregnancy or menopause that was causing inflammation and fluid retention that put pressure on these women’s carpal tunnel nerves. “I think it’s one of those myths that has never really been dispelled,” said Stevens.

Some state’s and country’s worker compensation laws still mistakenly associate typing with CTS or use vague language, said Stevens, causing greater confusion.

Also, for someone lifelessly twiddling their life away at some Dunder-Mifflin-like company, there is a psychological magnetism to the notion their job is causing them literal pain. “That’s part of it,” said Stevens. “If your work is unsatisfying you are going to attribute ailments to it.”

So your job may be killing you, but only on the inside.