Newswise — Beth Israel Deaconess Medical Center orthopedic hand and upper extremity surgeon Charles S. Day, MD, is offering two new techniques to ease the pain of patients with aching wrists caused by either arthritis or carpal tunnel syndrome.
Day is the premier surgeon in Boston to perform total wrist replacements using a new prosthetic device that provides patients with a functional range of motion, better wrist balance and better stability.
Today, the most common treatment for people suffering from wrist arthritis is total wrist fusion, which eliminates pain but prevents wrist movement. Although total wrist arthroplasty has been offered in the U.S. since the 1970s, most implants have not proven to be clinically effective due to design issues and the complex biomechanics of the wrist.
"This procedure offers patients an option for painful wrists other than the fusion. The benefits of the procedure make it more attractive option to all patients with wrist arthritis," says Day.
The orthopedic hand and upper extremity surgeon also offers an improved minimally invasive option for people dealing with the pain of carpal tunnel syndrome (CTS), an ailment that affects up to 8 million people with pain, weakness, or numbness in the hand and wrist, radiating up the arm.
CTS occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. That nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move.
The carpal tunnel " a narrow, rigid passageway of ligament and bones at the base of the hand " houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and compressing the nerve and causing pain.
Although minimally invasive procedures have been available since the 1990s, the earlier versions of the procedure has been out of favor because surgeons could not clearly see the nerves and arteries in the palm, Day says. This new procedure offers not only a much better view for the surgeon, but both pain relief and a quicker recovery than traditional surgery for the patient.
BODY CONTOURING FOLLOWS GASTRIC BYPASS SURGERYBOSTON " After losing 120 pounds from weight reduction surgery, Jodi Carnes' new body was trapped under layers of excess skin.
"It was frustrating because you lose all this weight and you still have this extra skin hanging," says Carnes, 33. "I was literally tucking my loose skin into my clothes." Like most patients who undergo weight reduction surgery, Carnes was dismayed at how her body looked like after major weight loss: excessive sagging skin that can cause low self-esteem and other problems, such as poor circulation and rashes.
As the demand for weight reduction surgery increases, so has the demand for body contouring procedures to correct skin malformations, says Loren Borud, MD, a plastic surgeon at Beth Israel Deaconess Medical Center (BIDMC).
According to a recent study by the American Society of Plastic Surgeons, the body contouring procedures have increased 77 percent during the past five years."When you lose 100 pounds or more your skin becomes distended beyond its ability to retract," Borud says. "These patients could work out every day for the rest of their lives without achieving success."
Plastic surgeons have modified and developed new procedures to address the aesthetic needs of people who achieve massive weight loss and for whom minimally invasive procedures, such as liposuction or traditional procedures like the "tummy tuck" are not appropriate.
Radical body contouring involves cutting away excess skin around problem areas, such as the upper arms, lower body, abdomen and breasts. Over the course of two years, Carnes had close to 20 pounds of skin removed from her abdomen, inner thighs and buttocks.
Borud, who has performed more than 200 body contouring procedures over the past three years, says patients must wait one to two years for their weight to stabilize before undergoing a contouring procedure. Insurance companies typically pay for procedures that involve the front of the abdomen, but others are considered cosmetic.
GO AHEAD AND ASK: BIDMC PLANS NEW PATIENT-DRIVEN HAND HYGIENE PROGRAMBOSTON " Patients at Beth Israel Deaconess Medical Center (BIDMC) are being told to "Go Ahead and Ask," whether their doctor or nurse has washed their hands before conducting an exam.
Using brochures, buttons, room placards and other materials, medical personnel are encouraging patients and family members to ask physicians, nurses and other staff, "Have you cleaned your hands?" The question is encouraged each time a health care worker is about to make contact with the patient or touch items involved in care. The program is designed to help reduce the incidence of infection and to raise awareness of good hygiene not only among staff, but among the patients and family members.
"Good hand hygiene is the single most important step health care providers can take to prevent the spread of infection," said Sharon Wright, MD, MPH, BIDMC's director of infection control/hospital epidemiology unit. "Nationwide, 2.5 million patients develop infections annually. The Center for Disease Control (CDC) recently reported that 30,000 deaths in the U.S. were directly caused by infections. An additional 70,000 patients had infections that contributed to their deaths. The inclusion of hand hygiene in several governmental and clinical organization guidelines is further testament to the critical nature of this infection-control activity."
Patient-driven hand hygiene programs has been shown to increase hand hygiene performance by at least 34 percent, was developed at the University of Pennsylvania and is recognized by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as a technique to increase hand hygiene and is referenced in the 2002 CDC Guideline for Hand Hygiene as a "proven method for increased hand hygiene."
A nurse will review the brochure with a patient after admission, stressing the importance of hand hygiene and encouraging the patient to read the materials. Data will be collected to provide an analysis on how the program is working and allow a comparison of BIDMC's hand hygiene performance with other institutions.
Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and ranks fourth in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit http://www.bidmc.harvard.edu.
RSS