Dr. Frank Phillips, co-director of the MOR Minimally Invasive Spine Institute, conducted a study on return to play after spinal fusion that was recently published in SportsHealth. Dr. Phillips found that more than 50 percent of golfers return to play within one year of lumbar fusion surgery and some were even sooner. In general, most golfers returned to preoperative levels of performance (handicap) and frequency of play.
Dr. Kathleen Weber, sports medicine primary care physician and team physician for the Chicago Bulls joined BullsTV host Steve Kashul during Bulls Pre-Game Live on December 19th, 2016. Dr. Weber discussed the NBA’s new Concussion Protocol and the efforts being made to protect all players from returning too soon to the court.
Kashul and Dr. Weber also talked about how the physicians at Midwest Orthopaedics at Rush all work together in treating the Chicago Bulls players.
AlloSource, in recognition of its work with Dr. Steven Gitelis of Midwest Orthopaedics at Rush, recently created the “Dr. Steven Gitelis Inspiration Award,” honoring a doctor or clinician that inspires through his or her work in treating patients with donated human allografts. The first recipient of this award is Dr. Brian Cole, also of Midwest Orthopaedics of Rush, in recognition of his work using allografts to help his patients heal from a variety of injuries.
Dr. Gitelis, one of the founding physicians of AlloSource, specializes in orthopedic oncology and understands the need for donated human tissue to heal patients. Throughout his career as an orthopedic surgeon, Dr. Gitelis has used donated human tissue in complex surgical procedures. He and his patients appreciate and revere the gift of human tissue donation.
“Dr. Gitelis is a thought leader in the area of allograft research. I am honored to receive this award and grateful to all those who have helped make this happen at my office, Gift of Hope and Allosource,” said Dr. Cole.
The award was presented at the Midwest Orthopaedics at Rush offices in Chicago by Tom Cycyota, President and CEO, AlloSource and Anne Gulota, chairperson, Gift of Hope.
By Matt Aaronson
I had never been physically active prior to 2010. In fact, at one point I weighed more than 200 pounds. But with three kids at home, I needed to make some serious changes in my lifestyle and get healthy for myself and my family.
So I started to run for fitness. I was fortunate and began losing a lot of weight. And as I lost weight, I became a faster runner. I signed up for some races and noticed that I was commonly in the top 10 or even in the top three. I got into triathlons to try something different and realized my results were excellent. I even qualified for the World Championships in 2011, in my first half Ironman.
I ran my first marathon in 2013 in under three hours, during which I qualified for the Boston Marathon. However, while I was training for the Boston Marathon my hip started really bothering me. I thought I would be fine if I just ran a little bit less. Initially for my training I was up to 60 miles a week. But once I injured my hip, I went back down to less than 30 miles a week, even in the mid-20s per week. But the pain still got worse and worse.
After seeing a couple doctors without any improvement or definitive diagnosis, I knew I needed to elevate the level of care. So I went to see a sports medicine doctor at Rush’s orthopedics program. The doctor reviewed my prior MRIs and results from the last eight months of battling through physical therapy and other exams, reports and treatments. He ordered an MRI arthrogram to get to a diagnosis of hip impingement.
For me, deciding to have surgery was a really big decision because it made me nervous. I did a lot of research to ensure two things: Did I truly need surgery? And, was Rush’s orthopedics department, where I’d been referred for surgery, the right place to go?
I made sure to consult a variety of different medical professionals, not just surgeons, to make sure that surgery was the right option. I saw seven specialists in all. And one thing I found out through all of those consultations is that the doctors at Rush had steered me in the right direction in terms of a diagnosis and course of action.
The other thing was I met with a number of different surgeons who did this particular procedure and got a feel for how they differed. Through that process I really got a sense that Dr. Nho at Rush would be the best option for me. Dr. Nho was highly recommended by my physical therapist as well as other doctors who were friends of mine who knew him. In addition, Dr. Nho does a high volume of minimally invasive hip arthroscopy procedures, and that made a big difference for me. A lot of the other hip surgeons I met with also operate on knees and shoulders, but Dr. Nho is focused only on hips.
It made me comfortable and gave me confidence that my surgeon was so specialized that he’d probably already seen any complex issues that might arise.
Dr. Nho performed my hip arthroscopy in December 2015. The level of care and responsiveness during the recovery process was amazing. There were a number of times when I sent an email to Dr. Nho or one of his physician assistants, and they responded almost immediately.
In the course of my research, I learned that Dr. Nho’s rehab protocol is very precise and quite conservative relative to the other surgeons I consulted. He is in close communication with the physical therapist to ensure it is being followed and is effective.
And it was effective! I didn’t start running until about five months after the surgery. And when I started running, I was running for one minute at a time and walking for four minutes. However, within six weeks I was able to run a 5K race in just over 19 minutes, only about a minute slower than before I got injured.
After I ran that 5K I was so encouraged with my recovery process that I decided to sign up for a half Ironman, which was about nine months out from surgery. I trained a lot less than typical for a half Ironman because I wanted to ensure no risk to the surgery recovery. But I was able to complete it in just over four and a half hours, which was within a few minutes of my personal best time.
People in the running and triathlon community who know me always ask me for recommendations when they are injured. They know I have seen many doctors for injuries over the years. I recommend the orthopedics department at Rush without hesitation.
We explain the symptoms, causes and treatment options including surgery available.
Symptoms usually increase gradually over time and may initially only be present at night. It can occur in one or both wrists at the same time. A dull ache in the wrist and forearm is felt with pain which may radiate into the thumb and four fingers of the hand, but not the little finger.
The patient may feel sensations of tingling or burning in the hand or four fingers. Pain is often worse at night and can radiate into the forearm, elbow or shoulder. In addition weakness in the fingers and hands may be experienced.
Carpal tunnel tests
Specific tests can be done to reproduce symptoms and help diagnosis:
- Phalen’s sign is where the patient bends the wrists to push the backs of the hands together, holding for 1 minute. If the test is positive then tingling that radiates into the thumb, index finger and the middle half of the forth finger will be felt.
- Tinel’s sign is where the therapist taps with two fingers over the palm side of the wrist. Carpal tunnel syndrome could be considered if there is a tingling sensation or other symptoms are reproduced.
- Investigations may also be performed to confirm the diagnosis including MRI scan, ultrasound imaging, electromyography or a nerve conduction study.
Symptoms are caused by compression of the median nerve in the wrist as it passes through a narrow channel in the wrist called the carpal tunnel along with the tendons of the flexor digitorum superficialis and flexor pollicis longus muscles of the forearm. The tunnel can narrow creating pressure on the nerve for a number of reasons:
- Traumatic wrist injury such as wrist sprains and broken wrists.
- Repetitive strain injury or RSI caused by over use of the wrist.
- Pregnancy which causes fluid retention in the wrist.
- Use of vibrating machinery which may cause damage or inflammation to the soft tissues.
- It may be congenital meaning some people naturally have a smaller, narrower carpal tunnel.
All of these conditions can cause a narrowing of the space through which the median nerve passes. Symptoms are three times more common in women, probably because they have a smaller carpal tunnel. It also has a higher prevalence in people with diabetes and other conditions which directly affect the nervous system. It usually occurs first in the dominant hand and sometimes but not always occurring as well in the non dominant hand. Some professions are more at risk of developing carpal tunnel syndrome, especially people working on an assembly line, who are continually repeating the same movement.
Carpal tunnel syndrome treatment
Treatment should initially be conservative which means without surgery. If after conservative treatment has been tried for a few weeks and not been successful then surgery is often considered.
Rest from activities which cause pain or make it worse. Continuing to use a painful wrist will not allow inflammation to settle down and soft tissues to heal. This may include work related activities such as typing at a keyboard, DIY or sport specific training including racket sports. If you are an athlete then use this opportunity to work on another aspect of your game or maintain fitness with aerobic exercise.
Carpal tunnel wrist splint
A carpal tunnel wrist splint can be worn to immobilize the wrist joint helping you to rest the joint whilst allowing some function of the hand. The wrist splint is usually made of a thick supportive neoprene material and have a metal spoon or support along the wrist to prevent movement.
Ice or cold therapy
If there is inflammation and swelling present, using a form of cold therapy will help to relieve this. Applying ice or a specialist cold wrap to the wrist area for 10 minutes at a time can be done hourly in the early stages, reducing in frequency as required.
Your Doctor may also prescribe anti-inflammatory medication such as ibuprofen to reduce inflammation, or diuretics to clear fluid retention.
Following a period of immobilization, stretching and strengthening exercises can be used to help prevent symptoms returning. All exercises should be performed pain-free. If pain occurs, go back a step or rest for longer. Initially mobility and gentle stretching exercises should be done to restore full pain free range of motion at the joint. Later static strengthening exercises can begin which do not involve movement and finally normal strength can be restored by dynamic exercises involving movement with resistance bands or dumbelle weights.
Other treatments, which may be worth trying include acupuncture which has been linked to an improvement in carpal tunnel syndrome symptoms. Acupuncture is performed by inserting needles of various lengths and diameters into specific points over the body. The needle is usually inserted, rotated and then either removed immediately or left in place for several minutes.
If symptoms do not improve other options include Corticosteroids or lidocaine injections. If all of this treatment fails and symptoms persist over a 6 month period, surgery may be required.
A carpal tunnel release is a very common operation, which involves cutting the carpal ligament to make more space for the median nerve. This can either be done as an arthroscopic operation (keyhole), or as an open release, where a 5-6cm incision is made. It is a straightforward procedure which is usually carried out on an outpatient basis. Your hand and wrist will be bandaged and may be placed in a sling for a few days to help it rest and reduce swelling.
John J. Fernandez, M.D., Hand, Wrist & Elbow Orthopedic Surgeon, Assistant Professor, Rush University Medical Center.
Dr. Fernandez has created and innovated some of the advanced surgeries currently popularized in the treatment of the hand, wrist, and elbow. His original research has led to techniques minimizing surgical trauma while maximizing outcomes. As an inventor, he holds patents in some of the very implants developed for these minimally invasive surgeries.