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Good morning. A little bit of fun news for Rules of Thumb. This week, it was featured in a newsletter about newsletters. How meta is that?
Pretty shocking given I couldn't even send out a working link to my article last week (sorry to those of you who noticed!).
Speaking of, if you like newsletters as much as I do, here's a free service I've used for years to find the most interesting stuff on the internet. Plus, anything you subscribe to supports Rules of Thumb, at no cost to you.
Explore your options here
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☝️ First Hand
This week is all about Dupuytren's (read it here)!
Huh?
This hand condition is, quite frankly, a really bizarre condition that is (mostly) limited to the hand.
And I bet you've seen it before.
The best example in pop culture is Bill Nighy. He's the actor who plays the Dad in "About Time" (yes, I teared up in this movie, leave me alone ok?). He also had prominent roles in "Love Actually" and "Pirates of the Caribbean."
Anyways, he has really severe Dupuytren's contractures in both hands. His right-hand ring and small finger are permanently stuck down in that flexed position. And his left hand doesn't look much better.
Clearly, he has decided not to pursue hand surgery...though we could make those fingers better...
Unfortunately, the condition is more common than you might think. It starts to show up in your 50s and 60s.
Fortunately, not all cases progress to severe contractures like this.
Either way, you ought to learn what to look out for, when to seek care, and how 'at risk' you might be to develop Dupuytren's in your hands.
Fun fact: This used to be known as Viking Disease and is most common in people of Northern European descent.
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👀 X-ray of the Week 👀
Don't step on a crack or you'll break your mother's.....ouch.
Can you spot the fractured vertebra here?
(Bonus points if you locate the broken sternum as well).
This is yet another consequence of high-speed car accidents. Think about this the next time you're feeling reckless on the freeway!
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A New Addition to the Newsletter
To build on last week's discussion around 'hack culture,' and the fact that most answers in medicine are far more grey...I thought it would be a good time for a new section.
Let's try this.
Whenever I get them, I'll answer reader questions. Just reply to this email if you have any.
The general format will be a few points about the medical evidence. Some weeks it will be rock-solid evidence, and others will just go off the best we have.
Then I'll sum it up with what I would do or what I would recommend to the average patient.
That way, at least you have some concrete takeaways to ponder on your own.
👇👇 Without further ado 👇👇
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Rules of Thumb Q&A
**Reminder. This is not medical advice. No patient-doctor relationship is formed. This content is for educational purposes only.**
Reader Question:
"Lately I've been experiencing shock-like feelings in my hand and was told I have carpal tunnel syndrome. Do I need surgery?"
Evidence:
- Each year, 400 per 100,000 Americans develop carpal tunnel syndrome. Of those, about 100 have a carpal tunnel release surgery.
- Which theoretically means about 75% of people improve or are cured without surgery (though in my experience, many patients ignore ongoing symptoms rather than achieve a true cure).
- PT and injections rarely cure carpal tunnel syndrome. The evidence-backed non-operative cure is to wear a wrist brace at night (all night, every night) for at least 6 weeks.
What would I do?
- To the average patient with classic carpal tunnel syndrome that does not improve with nighttime brace wear after 6-8 weeks, I typically recommend surgery.
- The risk of permanent nerve damage is too high. Once carpal tunnel progresses beyond the ability to improve with braces, it usually slowly worsens over time.
- Most carpal tunnel surgeries are quick, minimally painful, and have short recoveries (think 3 weeks with heavy lifting restrictions).
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Support "Rules Of Thumb"
If you're enjoying "Rules of Thumb," it would be a huge help if you'd consider doing one of two things to support it:
- Share! Just forward this email to a friend or send them to rulesofthumb.nickgolinvauxmd.com/join. The more this grows, the more I can invest in it!
- Support! Rules of Thumb is a completely free resource to all those who want to learn more about the human body. Support Rules of Thumb here 🙏.
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Feeling particularly grateful for all my readers this week. Thank you for being here every Saturday!
Have an awesome weekend.
-Dr. G
**Please do not use this email to try to obtain medical advice. I cannot legally or ethically provide that. If you are having a medical emergency, please call 911 and do not attempt to contact me through email.**
Rules of Thumb Archive • www.nickgolinvauxmd.com
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Disclaimer (because, you know, lawyer stuff)
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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