• New Ways to Treat Carpal Tunnel Syndrome

      Sir James Paget

      Sir James Paget | Pathologist
      Image: MaterialScientist

      Sir James Paget and James Putnam

      Although we may think that carpal tunnel syndrome is a relatively new disorder, which came about during the computer age, it was actually originally described by Sir James Paget in 1854. James Putnam, a Boston neurologist, published the first clinical study of 37 patients with carpal tunnel syndrome in 1880 and Learmonth performed the first carpal tunnel release surgery at Mayo in 1933.

      Open Carpal Tunnel Release Surgery Or Open Release

      However, up until the 1960s, when carpal tunnel syndrome and its treatment options became fairly well defined, there was still no clear consensus on how to treat the condition. In fact, up until the late 1940s, resection of the first rib was a common treatment for this diagnosis! Once medical opinion coalesced about the cause of the disorder, a standard surgical treatment quickly developed, known as “open carpal tunnel release surgery,” or “open release.”

      Open Release Surgery

      During open release surgery, the transverse carpal ligament is cut, which releases pressure on the median nerve and subsequently relieves the symptoms of carpal tunnel syndrome. A 1 – 1 ½ inch incision is made at the base of the palm of the hand, allowing the surgeon to see the transverse carpal ligament. After the ligament is cut, the skin is closed with stitches. The ligament is left open, and this decreases the pressure on the median nerve in the carpal tunnel. This sectioning of the ligament does not result in any loss of function.

      With the traditional open release surgery, the hand can remain swollen and tender for a couple of months. Full use of the hand, especially during gripping and grasping activities, can sometimes take up to 6 to 8 weeks, or possibly longer.

      Endoscopic Release

      Endoscopic release is a relatively new technique, which uses a thin tube with a camera attached (endoscope). The endoscope is guided through a small incision in the wrist, allowing the surgeon to see the transverse carpal ligament without opening the entire area with a large incision. A miniature blade, inserted through the tube, is used to cut the transverse tunnel ligament.

      SmartRelease Full Assembly

      MicroAire® SmartRelease® Endoscopic Carpal Tunnel Release System Image: microaire.com

      Smart Release Procedure Illustration

      MicroAire® SmartRelease® Endoscopic Carpal Tunnel Release System Image: microaire.com

      Here is a quick video of the endoscopic release procedure.

      Relief Of Symptoms Of Endoscopic Release

      The relief of symptoms of endoscopic release are similar to the traditional open technique. However, you can expect a less post-operative pain and a shorter recovery period after endoscopic carpal tunnel release, because the procedure does not require cutting the palm open and disturbing a large area of the hand. As a result, you can return to work or practicing sports earlier, especially sports that require gripping, such as golf and tennis. Endoscopic release also produces a smaller scar with less swelling and scar-related pain.

      Call Us!

      If you suspect that you have carpal tunnel syndrome, please give us a call and let one of our physician’s determine the cause of your pain, and know that should you need surgery, we will offer you the most innovative and safe treatment available.

      The NY Mets, the Brooklyn Nets, and now you…

      Manhattan Orthopedic New OfficeManhattan Orthopedics & Sports Medicine group has just opened a new Orthopedic and Musculoskeletal medicine facility in the center of Manhattan. But did you know that we also have a state of the art radiology suite, identical to those found in Citi Field (home of the NY Mets), and in Barclays Center (home of the Brooklyn Nets)?

      How’d we do this? We partnered with NY Imaging, one of the largest independent radiographic solution providers in the Northeast.
      They are the x-ray providers for the NY Mets and the Brooklyn Nets.

      Our new x-ray facility features advanced digital technology that creates significantly increased image quality, allowing for sharper x-rays, better image detail and ultimately, better visualization and interpretation of fractures and other maladies.State of the art x-ray machine

      But best of all, the equipment features an integrated generator and cesium digital detector which allows us to deliver x-ray care with a fraction of the x-ray exposure of other, older x-ray facilities.

      Whether you are center fielder for the NY Mets or a part-time volunteer coach leading a little league team, safe and accurate x-rays are a vital part of orthopedic care.

      state of the art x-ray machineThat’s why we are dedicated to providing our professional athletes and our weekend warriors alike, with the most advanced medical technology, the highest levels of surgical expertise, and the best medical care in Manhattan.

      Lessons from the Doctor 

      A couple of weeks ago, our very own Dr. Klion competed in a mountain bike race. As he had increased his training mileage for the event, he had noticed that his wrist was sore, but didn’t find this unusual as almost all cyclists often experience pain in the hand, wrist, and finger region due to excessive pressure placed on the handle bars. It was only after the event that he learned he had broken a bone in his wrist.

      Other symptoms that can occur from pressure and overuse include numbness and tingling. Common cycling syndromes are described below.

      Ulnar neuropathy – known to cyclists as “handlebar palsy” – results from compression of the ulnar nerve, which controls sensation in your ring and little finger, as well as hand strength with gripping. Holding the lower section of drop-down handlebars can compress the ulnar nerve.

      The constant pressure on the hand’s median nerve that comes when resting one’s hands on the top of the handlebars can lead to carpal tunnel syndrome. In this case, typical symptoms are numbness or tingling in the thumb, index, middle and ring fingers, as well as a general weakness in the hand.

      As with handlebar palsy, the most immediate and effective action is to change your hand position, use well-padded gloves and lessen the pressure by loosening your grip.

      It may take months for the symptoms to resolve; rest, stretching exercises, and anti-inflammatories usually help to relieve the symptoms.

      More importantly, you must adjust your equipment and habits! Proper bike fit is essential; adjusting the handlebars, seat, and pedals to your fit is the key to preventing most cycling overuse injuries, a third of which happen to the hands and wrist.

      By sitting in a more upright position, you will take weight and pressure off your hands and wrists.  During long rides, take rest stops, and change your hand position often. As often as possible, shift your weight from the center of your palms to the outside edge. Padded gloves and good shock-absorbent handlebar grip/tape will help protect your hands from injury.

      Like any other part of your body, your hands and wrists will benefit from a short session of hand and wrist stretches before you hit the road.

      In order to prevent injury, listen to the moral of Dr. Klion’s story; pay attention to any signs of physical discomfort and seek medical advice if the symptoms do not abate.

      We Moved!


      Just in time for the spring thaw, Manhattan Orthopedic & Sports Medicine Group is delighted to bring you:

      • a bigger, roomier waiting area;
      • more comfortable, clean and airy patient exam rooms;
      • heating and air conditioning!
      • a digital X-ray machine to provide real time results on site for patients’ convenience;
      • kiosks to help patient flow;
      • online or phone appointment option;
      • Spear Physical Therapy if you wish to use

      Manhattan Orthopedic new waiting roomWaiting roomAll this and more awaits you at our new location at 57 West 57th Street, 15th Floor. This is the new home of Manhattan Orthopedic & Sports Medicine Group, PC., a state-of-the-art medical facility in the heart of New York. Our new home is a warm and welcoming environment for our patients and friends, and a terrific opportunity for the growth and development of our staff and practice. We are also pleased to have Spear Physical Therapy at this location in order to provide continuity of care.

      Manhattan Orthopedic & Sports Medicine Group, PC still maintains their Queens location at 27-31 Crescent Street, Long Island City, NY 11102. Queens appointments can easily be made by calling 718-204-0548.

      Please call us at 212-289-0700 or use our online form in order to schedule an appointment with one of our Orthopedic Specialists.

      Come see us! We look forward to welcoming you to our new space.

      Osteoporosis and Eggshells

      Many patients experiencing back or joint pain will ask if it is caused by osteoporosis. This common question highlights just how high a profile the disease has gained in recent years. Osteoporosis itself has no symptoms, including pain, but the loss of bone density can lead to degeneration of the spine, Dowager’s hump, and fragile bones susceptible to fracture. While osteoporosis is serious, it is fortunately a treatable condition.

      Orthopedic surgeons only rarely treat osteoporosis, since the disease is readily combatted by diet, exercise, supplements, and when needed, medication. Post-menopausal women should – even in the absence of bone fractures – be tested for osteoporosis, and studies show that men are also increasingly at risk for the disease.

      Why have fragility fractures caused by osteoporosis reached epidemic levels among aging Americans? The two primary causes are our modern diet and sedentary lifestyle.

      Like eggshells and seashells, bones are made primarily of calcium, and are thus strong but inflexible, and with a loss of density, can break just like an eggshell. chicken and eggMerely adding calcium to the diet is not adequate, in that calcium uptake by the body is affected by other substances; for example, despite the fact that the largely fish diet of Eskimo women provides over 2000 mg of calcium a day, and even though exercise is a regular part of their life, they are known to have one of the highest rates of osteoporosis in the world. The excess fat and protein in their diet prevent calcium absorption.

      So in addition to improving your diet, what’s way to avoid becoming a part of this “silent epidemic”? Move! Our sedentary lifestyle is our worst enemy. As you grow older, continue to walk, dance, jump rope; play tennis, basketball, and golf; do Pilates and have fun in a Zumba class. All of these weight-bearing exercises help build strong bones.

      Try some yoga too. yogaSeniorYoga will limber you up, and keeping limber is also great prevention, as nearly 80% of fragility fractures are a result of falls.

      The longer you can stay flexible, balanced, and upright, the better chance you have of avoiding the pain – not of osteoporosis, but of the debilitating breakage of bone they so often cause.

      For treatment of osteoporosis, please consult your PRIMARY CARE PHYSICIAN, GYNECOLOGIST, or ENDOCRINOLOGIST. The orthopedic surgeons at Manhattan Orthopedic and Sports Medicine, ONLY TREAT
      THE UNFORTUNATE CONSEQUENCES of this treatable disease.

      Stay active and avoid fractures!


      Remember the Spine

      Isn’t it strange that we are called “vertebrates,” and yet we rarely think about our vertebrae – i.e., our spine? Forgetting about the spine is a very old habit of ours; though anatomy theaters were filled with articulated skeletons by the late sixteenth century, most Renaissance medical and anatomical studies focused on the skull and limbs rather than the spine.

      In the winter of 1510-11, Leonardo Da Vinci was at the University of Pavia near Milan, where he was able to take part in 20 autopsies that allowed him to make a host of pioneering observations of the mechanics of the body. Though they went unpublished for generations, he made the very first accurate drawing of the spinal column, capturing the delicate curve and tilt of the spine, and the snug fit of one vertebra into another.

      Da Vinci drawing of the spine

      figure drawings

      Our sedentary modern lifestyle causes most of us to forget our spine. Since movement is literally the “backbone” of athleticism and life, and the spine is the foundation of all movement, we would do well to remember the spine. We need to change our daily habits of movement so that we restore the spine we were given at birth. Much attention has been given lately to the dangers posed by excessive sitting, both to our spine, and to our overall health as well.

      Everyone desires freedom of movement, and the wisdom of the body has arranged it so that all of our multiplicity of movements ultimately depends on the most immobile part of our skeleton – the spine.

      Maintaining that mobility requires us literally to re-member our spine, to both be conscious of it as an independent segment of our body needing its own exercise and care, and to integrate its health into our overall exercise and activity regime.

      If you are having back pain and believe that it is an issue of your vertebral column, there are new non-invasive diagnostic techniques we can provide. Just set up an appointment with one of our orthopedists for a consultation.

      Movement is what we should strive to do all the time, moving as well and as often as possible. This will allow us to have fewer injuries, live longer, and have more productive lives. Our spine truly is the backbone of our lives.

      So, remember the spine!

      The Truth About Carpal Tunnel Syndrome

      “My hand hurts; I think I have carpal tunnel syndrome.” Orthopedists all over America hear this from their patients everyday, often followed by the patient’s assertion that their pain has been caused by typing on a computer keyboard all day. Entire mini-industries have sprung up to support this myth that carpal tunnel syndrome is a work-related injury, rather than a medical condition, yet numerous scientific studies have shown that there is no relationship between typing and the incidence of carpal tunnel syndrome. And although using a badly positioned computer keyboard or mouse can lead to wrist pain from strain or tendinitis, it is not necessarily carpal tunnel syndrome.

      anatomy of wristCarpal tunnel syndrome (CTS) is a compression neuropathy – a condition of the peripheral nervous system – that is caused by an increase in pressure on the median nerve in the hand and wrist. The carpal tunnel is actually a space in the wrist surrounded on 3 sides by bone and covered with a ligament through which 9 tendons and one nerve – the median nerve – travel to the fingers. This nerve supplies sensation to the thumb, index, middle, and half of the ring finger, while conducting nerve impulses to the muscles that control the thumb.

      Numbness, tingling, or burning in the hand, particularly at night, localized pain over the carpal tunnel in the palm and wrist, or pain that periodically radiates towards the shoulder are all potential indicators of carpal tunnel syndrome. Symptoms are oftentimes aggravated by grasping activities, such as driving a car, holding a book or newspaper, and grasping a telephone.

      When the median nerve is compressed, it results in increased sensitivity, tingling, pain, weakness, or numbness in the fingers, hand, and wrist; the pinky remains largely unaffected. The predisposing factors that cause median nerve compression and carpal tunnel syndrome are still largely unknown, but there is a higher incidence of carpal tunnel syndrome in patients with diabetes or rheumatoid arthritis. Pregnant women are the group at highest risk for CTS.

      A clinical examination and review of a patient’s history is the best way to diagnose CTS. Your physician may perform simple sensory and strength testing, along with some more specialized diagnostic tests, such as Tinel’s sign, Phalen’s test, or Durkan’s compression test. In some cases, electrodiagnostic examination (EMGs) may be recommended.

      electrodiagnostic examination

      Treatment options range from low-tech solutions – avoiding pressure on the median nerve by altering one’s movements, or splinting or bracing the wrist to avoid prolonged flexion or extension (especially at night) – to corticosteroid injections (in most cases this only provides temporary relief of pain).carpal tunnel splint If these treatments do not resolve symptoms, then surgical release is indicated, which decreases the pressure in the carpal tunnel, thereby improving blood flow and nourishment to the median nerve. Surgical treatment generally leads to excellent outcomes in patients who have failed non-operative therapies, but above all, the key is a correct diagnosis.

      If you suspect you may have carpal tunnel syndrome, feel free to give us a call and let one of our experts determine the cause of your pain. You don’t have to suffer!

      The Top 5 Secrets for Healthy Knees

      X-Ray of inflamed knees
      Knee pain is one of the most common musculoskeletal complaints, afflicting almost 25% of the US population. But there are a number of important secrets, practiced by top trainers and professional athletes, to help protect and preserve the knees. Practicing these 5 tips can help ensure good function and high performance on your knees for years to come.

      1. Quadriceps strength: Along with serving as the prime extensors of the knee joint, the quadriceps muscle group – which form the bulk of the front of the thigh – are at the same time vital for the stability and health of the joint. Even if you are not placing great demands on the knee through running, dancing, or jumping, it is important that the quadriceps remain strong. Otherwise, damage to the knee joint may occur.

      knee stretch2. Flexibility: If your knee muscles are very inflexible or you are new to exercise, start off with basic knee stretches. You should never feel knee pain in any stretch. If you feel pain in your joint, it’s time to stop and seek advice from your doctor.

      3. Cross-training: As with all muscular training, it is crucial to perform a variety of motions that involve the knee joint. A mix of exercise activities – walking, running, biking, tennis, dance, etc. – that create different types of stresses on the knee ensures that different muscle groups are engaged.

      sunset bike ride4. Low impact exercise: High impact sports and exercise – boot camp classes, step aerobics –expose the knee to significant stress, so emphasize low impact activities like cycling and swimming to protect your knees from long term damage.

      5. Maintain a Healthy Weight: Being overweight raises your risk for developing knee injuries, especially osteoarthritis. Excess weight puts additional stress on weight bearing joints, particularly the knee. Losing a few pounds can go a long way toward protecting your knees by reducing the pressure on them. The force on your knee is two to three times your body weight when you go up and down stairs, and four to five times your body weight when you squat to tie a shoelace or pick up an item you dropped. Each extra pound adds to that load!

      If you’d like to review your exercise program, or want individualized tips to help optimize your knee health, give us a call at Manhattan Orthopedics to make an appointment.

      Heading (Gently) Into Fall

      For runners, the arrival of fall means more than just shorter days and longer sleeves. Fall foliage signals a critical time of the year, when our bodies deserve special attention. Especially for those anticipating marathon or other demanding competitive events, there is a tendency to increase mileage on training runs, which can be a recipe for disaster. In these first weeks of autumn, we should take a lesson from the trees – cut back, slow down. As the trees drop their leaves, you can afford to drop a few miles from your weekly mileage, as a safeguard against injury.

      We often see an increase in injuries at this season, and you should be vigilant in heeding any early warning signs – swelling, mild discomfort, tenderness – that suggest you are exceeding your body’s limits. Resist the temptation to push through when pain arises; it is always better to adjust your training schedule modestly now, rather than lose your momentum altogether due to an injury. Early recognition is a key to maintaining health.

      Not all warnings come in the form of pain. Irritability, insomnia, or a change in appetite can be signs of impending injury or illness. A simple rule-of-thumb is to measure your resting heart rate in the morning, then gear your workout in relationship to this. Autumn is a good time to assess your equipment, after a full summer season. How are your shoes? 300 to 500 miles, or 3 to 6 months, is the normal duration before replacing your running shoes.

      At any season, Achilles tendonitis and plantar fasciitis represent particularly painful challenges to the runner. A patient recently reported that a fellow runner recommended a Castor oil compress to facilitate heeling of a sore Achilles. A much more effective remedy is a night splint, which, by holding the foot in a dorsiflexed position, provides a passive stretch through 8 hours of sleep. Other treatment approaches might include supportive footwear, arch taping, and physical therapy.

      dorsiflexed position

      dorsiflexed position

      Remember though, if you have persistent pain, we are here to help you. Just give us a ring!

      The Aging Athlete: Modify, But Never Give Up!

      At age 70, most of us find that we have slowed down in our physical activity: no more 4-mile runs 3 to 5 times per week; no more tennis twice a week; nor a round of golf on the weekends. Bit-by-bit, we reduce our exercise program. We cut back on our running distance or frequency, or perhaps trade in our running shoes for a bicycle. We switch from singles to doubles. We play 9 holes of gold instead of 18 – or, heaven forbid, use a golf cart!

      Ready for workoutEven with this reduced activity, we often find aches and pains that were not there when we were younger – our rotator cuffs are worn; our discs have lost their elasticity; our cartilage in some joints may be worn. For all the pain and stiffness we feel, this is no reason to give up regular exercise.

      We just need to alter our rhythms, and add new strategies in order to maintain a sufficient range of motion and strength. For some of us, the simple addition of alternative therapies – chiropractic; acupuncture; supplements – will be enough to maintain our health; for others, we may need regular PT visits, or injection therapy.

      Our primary care physician should make sure there are no more serious issues – rheumatoid arthritis; Lyme disease; vitamin deficiencies; even muscle weakness arising from the commonly prescribed lipid-lowering drugs – to which we should stay alert. Following this a visit to your orthopedic surgeon is in order.

      Active Senior Adult Man Working Out in the Gym.No part of our body has served us so faithfully through a lifetime of movement than our joints, and an orthopedic surgeon can insure that they keep serving us. Most suggested orthopedic treatments will be non-surgical, but there may be occasions where an arthroscopic procedure, a trigger finger release, a carpal tunnel release or a microdiscectomy would allow us to return to a high level of activity. The physicians at Manhattan Orthopedic and Sports Medicine Group are available to evaluate all your aches and pains.

      The mantra for the aging athlete of all abilities is: “Modify, but never give up!” With the assistance of our doctors and other health care professionals, all of us greying golfers, tennis players, cyclists, and rollerbladers can achieve this.

      Age brings wisdom, and following this wise path of modified activity, we can all keep exercising right into our 90s!