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Good morning. Though I hadn't traveled since late winter, this week marks the second time in three weeks! Fortunately, it's for some much-needed family fun this time rather than an exam...
But of course, the experience thrust me right back into my favorite people-watching environment of all time. It just never fails.
Would you take your shoes off on the plane (like my neighbor did — for all 4 hours of the flight)?
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☝️ First Hand
As a hand surgeon, carpal tunnel syndrome is the second most common condition I treat (trigger finger is #1).
And somewhat surprisingly to many, the non-operative options to get rid of that darn pinched median nerve (aka, carpal tunnel syndrome) are limited. At best.
So far this year, I've performed 57 carpal tunnel release surgeries. Though these patients are happy to be relieved of their symptoms, it also means there's a second group left behind — those who I saw for the condition but were able to avoid my scalpel.
Today's article dives into the secrets of these patients.
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👀 X-ray of the Week 👀
Here's a crazy little case. This person jammed their finger so hard, that not only did they break that piece of the joint off, they fully dislocated the joint as well (it was already popped back in before this x-ray).
While it may not look like much, this is a huge injury. The fracture has disrupted the smooth joint surface (think arthritis if you've been following along), many of the stabilizing ligaments have been torn (think the joint will glide wobbly), one of the main tendons of the finger is attached to that tiny fracture piece...and so on.
Not only do we have to get that fracture fixed, but if we don't also get the finger moving as soon as possible, this person will have permanent stiffness in this finger.
Guaranteed.
So here are the goals of surgery. Get the fracture back in place and if possible fix it there in such a stable way that they can safely move the finger immediately.
And voila. A tiny little plate and screw construct that accomplishes the above goals.
Highly stressful but incredibly satisfying surgery to a hand surgeon.
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🙋 Raise your hand if you're a: Primary Care Provider
Did you know that in-office diagnosis of carpal tunnel syndrome via ultrasound is now a thing?
Rather than sending patients for (⚡️often⚡️) painful EMG nerve studies, we can now measure the median nerve in the carpal tunnel on ultrasound.
If the patient has a positive CTS-6 score (linked here), ultrasound is just as accurate as the gold-standard EMG that we've been using for decades.
Except the ultrasound is fast (takes me about 90 seconds), cheap, doesn't require an additional referral to neurology, and painless!
I just love it when medicine actually advances...
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Electrolytes and Protein Discount
** This section features an affiliate link: I will earn a small commission (at no cost to you) if you use this code **
A reminder that BioSteel has so kindly partnered with me if you're into protein powders or electrolyte drinks. Use this link or enter code: NICKGOLINVAUXMD at checkout to get 20% off your entire order.
Any proceeds go right back into funding this newsletter — so it's better each and every week.
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Rules of Thumb Archive • www.nickgolinvauxmd.com
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If you are having a medical emergency, call 911. Do not attempt to contact or obtain medical services through this site. This content is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this site or materials linked from this site is at the user's own risk. The content of this site is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their healthcare professionals for any such conditions. The content is my own and does not necessarily reflect the views of OCC.
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