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March 1, 2025 | SUBSCRIBE | SHOP | ARCHIVE
Written by Dr. Nick Golinvaux
Good morning. And just like that, it's March. Time to get out those tools and gear up for springtime overuse injuries of the wrists, elbows, and knees!
Not that I've ever seen an ambitious spring cleaning or gardening project turn out more painful than hoped...
**This newsletter has occasional affiliate links (at no cost to you). These small commissions will always be re-invested into Rules of Thumb to improve the experience for all.**
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FIRST-HAND KNOWLEDGE
Feeling Hangry? You're Not Alone
As time passes, I have found it's far easier to weather discomfort if I understand 'the why' behind what is happening.
In fact, I often think that might be the primary driver of anxiety in my clinic. Once patients understand their condition, many are perfectly fine living with it.
Which brings me to today's article. Why can't you eat the night before surgery?
That midnight cutoff for food before surgery isn't just another arbitrary medical rule — it's a critical safety measure that could mean the difference between a routine procedure and weeks in the ICU.
While that pre-surgery hunger might feel unbearable, the alternative is far worse, as one young mother discovered when a simple ankle surgery turned into a two-week coma.
Today, I'll explore exactly why an empty stomach matters so much, what happens when patients break this rule, and how to make those fasting hours more manageable.
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X-RAY OF THE WEEK
Soccer on wet fields might...hurt
If you've ever wondered what it looks like when an elderly patient 'falls and breaks their hip,' most of those injury x-rays will look something like this.
This particular x-ray, however, comes from a younger person who was in a high-speed car accident.
Stronger, younger bone takes greater force to shatter.
Typically this would happen when the knee strikes the dash. In most cases (though never say never), either the knee or the hip will break, rather than both.
Believe it or not, modern technology allows the majority of patients with fractures like these to be up and walking, at least via partial weight-bearing, within a few hours of surgery.
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RAISE YOUR HAND IF YOU'RE A: SPRING CLEANER
A year battling tendinitis lurks...
As the weather starts to warm, most of us look to our garden and see the mess of foliage and sticks that need to be cleared to make way for new life.
But gardener beware. This is a prime setup for conditions such as tennis elbow (lateral epicondylitis), trigger finger, and arthritis exacerbations.
Think about it. You almost certainly haven't done any of the repetitive motions like raking, weeding, and pushing over the winter months.
What's more, when you do finally get around to it, you may not love the clean-up stage, so you try to rush through it.
I'm telling you. Please take the extra few minutes to use slow, controlled motions. No flailing, no ripping, no jerking. Those poor tendon insertions and cartilage buffers are not ready to go from 0 to 60!
Instead, use controlled, ergonomic movements, just like you might do if you were in the gym. Use those muscles the way they were designed!
And a warm-up is never a bad idea before a Saturday in the yard.
I know I sound like a broken record with these things. Nagging over and over. But I see allllll the people in my clinic struggling with tennis elbow for 9-12 months.
Not 6 weeks like the internet tells you. 9-12 months.
What they wouldn't give to take back that day when they overdid it...
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MEME TIME
Map Wars 🤦♂️
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9:58 AM • Feb 15, 2025
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🩸 FINGER ON THE PULSE
What are your fingernails telling you?
As you might imagine, I get asked about fingernail conditions all the time. But did you know that fingernail health is managed by dermatologists?
Unless they need surgery — then that's me.
In the spirit of helping you better understand your health, here's a reasonably helpful guide to what your fingernails might be trying to tell you.
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IF YOU'RE HURTING, I CAN HELP
Your Guide: Carpal Tunnel Syndrome
This is my masterclass on carpal tunnel syndrome. In this short book, I share everything you ever wanted to know about numb hands and how to fix them.
It's more education than the average visit to a specialist — for less than the average co-pay.
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Thank you for reading and engaging with Rules of Thumb! Subscribe for free to receive new posts.
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Nick Golinvaux, MD
Hand & Upper Extremity Orthopedic Surgeon
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PS. If you enjoyed this newsletter, please forward it to a friend! If you’re the lucky friend, subscribe here.
PPS. Rules of Thumb is a completely free resource for all those who want to learn more about the human body. Support Rules of Thumb here 🙏.
***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 my employer.
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