Good morning. Have you ever thought about how silly it is that health insurance deductibles reset every year on January 1?
It makes Q4 our busy season. I currently have people pouring into my clinics with some version of 'I already met my out-of-pocket deductible for the year with other health issues...can you take this bump off my wrist that's been there for five years?'
Something about the whole thing just feels off. Come on health system, let's find a better way.
Welp, now you know why orthopedic surgeons cringe around monkey bars.
This is called a supracondylar humerus fracture. It's an elbow fracture that mostly happens in kids between the ages of about 2-10 years old.
A fall from a height onto an arm (trampoline, monkey bars, slides) will usually result in this injury.
Many of these will need surgery to fix. Some, like the one above, are so extreme they disrupt blood flow to the hand. And thus require emergent surgery.
I'm sweating here just remembering a few of these from residency training...
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:
"What's the deal with carpal tunnel injections? Can an injection prevent me needing surgery?"
Evidence:
If you simplify the evidence, there are 3 treatments that work for carpal tunnel syndrome: nighttime bracing, steroid injections, and surgery.
But if you look closer, it's a bit more complicated. While steroid injections 'work' for carpal tunnel syndrome, they rarely result in a cure.
Meaning that within 3-6 months of the injection, most patients will have improved symptoms. But a year after? 90% have had symptoms return. And the majority of these patients have actually already thrown in the towel and had carpal tunnel surgery by one year.
What would I do?
When a patient asks me this in clinic, I will typically recommend against injections.
As a surgeon, I have to recognize my own bias, but this really comes down to risk vs benefit. I don't find the risk of masking ongoing nerve damage (that carpal tunnel nerve may still be compressed even if the steroid injection is helping you feel better) to align with the benefit of temporary relief.
That being said, there are many great situations for a carpal tunnel injection. You have an upcoming surgery on your back and you need temporary relief. Or a dream vacation is in two weeks. Or you're taking care of an ill parent for a period of time. All these make sense on the risk/benefit scale to buy yourself a little more time prior to surgery.
🕰️ Meme Time 🕰️
🩸 Finger on the Pulse 🩸
🧑🔬 An MS breakthrough: This is a pretty big deal. Any clue we can uncover about autoimmune disease and how to potentially stop it is massive in my book.
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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.
