Immediately Post-op Carpal Tunnel release
Carpal Tunnel Syndrome (CTS) is common and is the result of the median nerve becoming squeezed or “entrapped” as it passes through the wrist down into the palm of the hand. Because this is a sensory nerve, the compression causes tingling, burning and itching numbness in the palm of the hand and fingers. A different nerve goes to the little finger and the lateral half of the 4th finger so the sensation there would feel normal. There is often a sensation of swelling even though there is rarely any true edema that can be seen in CTS.
The symptoms of Carpal Tunnel Syndrome usually start at night when people sleep with flexed wrists. As it progresses, the tingling and numbness can be felt on and off during the day. It can cause decreased grip strength and weakness in the hands.
CTS can be worsened by medical conditions like rheumatoid arthritis, diabetes, pregnancy or wrist trauma. Women are three times more likely to develop CTS than men, and it is rare in children. Most of the time no cause is found. The space that the median nerve traverses is very tiny and it doesn’t take much to compress the nerve. Even small amounts of tissue swelling such as occurs in pregnancy can cause severe symptoms.
The treatment for Carpal Tunnel Syndrome starts with Read more »
*This blog post was originally published at EverythingHealth*
This is the second in a series of posts on Bending the Cost Curve in Cancer Care. We should consider the proposal, published in the NEJM, gradually over the course of this summer, starting with “suggested changes in oncologists’ behavior,” #1:
1. Target surveillance testing or imaging to situations in which a benefit has been shown. This point concerns the costs of doctors routinely ordering CTs, MRIs and other imaging exams, besides blood tests, for patients who’ve completed a course of cancer treatment and are thought to be in remission.
The NEJM authors consider that after a cancer diagnosis many patients, understandably, seek reassurance that any recurrence will be detected early, if it happens. Doctors, for their part, may not fully appreciate the lack of benefit of detecting a liver met when it’s 2 cm rather than, say, just 1 cm in size. What’s more, physicians may have a conflict of interest, if they earn ancillary income by ordering lab and imaging tests.
It’s clear that some and possibly most cancer patients get too many and too frequent post-treatment surveillance tests. Read more »
*This blog post was originally published at Medical Lessons*
Back to the subject at hand.
To those who are relatively new to this blog, one of the most popular…uh…tolerated series of posts has been my series on the physical exam. If you haven’t done so already, you may want to go back and read the posts to get in the proper mindset (or destroy enough brain cells).
Astute readers will note that doctors are not the only professionals to examine the hand.
Long before we knew anything about carpal tunnel syndrome or the thenar eminence, we had Madam Linda and her cohorts looking at the hand for signs of what the future will bring for the individual that happens to be connected to the hand in question. Just as stars and planets can have a peculiar interest as to whether a person will run into money, the lines on a person’s hand can foreshadow a person’s future. Read more »
*This blog post was originally published at Musings of a Distractible Mind*