Five nurses from St. Charles Health System recently earned DAISY Awards for Extraordinary Nurses, recognizing the outstanding, compassionate nursing care they provide patients and families every day. The nurses, who represent all four St. Charles hospitals in Bend, Redmond, Madras and Prineville, were recognized with a ceremony on their respective units and presented with a certificate, a pin and a "healer's touch" sculpture by their hospital’s chief nursing officer. The honorees are:
The nurses earning DAISY awards are:
Ryan Armand-Priefer, a patient care nurse at St. Charles Bend, was recognized for exemplifying the highest standards of nursing care and compassion and demonstrating extraordinary dedication and kindness while providing excellent medical care.
Andrew Baca, a nurse at St. Charles Redmond, was recognized by a fellow caregiver for "consistently demonstrating his selflessness, his compassion and above and beyond effort to go out of his way to help. Andrew truly is a team player who excels in so many ways."
Sadie Larson Robinson, a Nurse Navigator for Cancer Services, was recognized for compassionate treatment and support, and truly caring for her patients. She was specifically recognized for going over and above to help a patient rearrange their first chemotherapy treatment so that their spouse could also attend.
Megan McPhetridge, a wound care nurse at St. Charles Prineville, was recognized for providing awesome, compassionate care to a wound ostomy patient and putting them at ease, as well as providing an effective treatment plan that fit the patient's needs.
Jennifer Wienert, a house supervisor at St. Charles Madras, was recognized for going above and beyond her job responsibilities and during her personal time to anonymously assist a patient with personal matters, including volunteering to care for a patient’s dog.
About the DAISY Awards:
The DAISY Foundation is a not-for-profit organization that was established in memory of J. Patrick Barnes by members of his family. Patrick died at the age of 33 in late 1999 from complications of Idiopathic Thrombocytopenic Purpura (ITP), a little known but not uncommon auto-immune disease. (DAISY is an acronym for Diseases Attacking the Immune System.) The care Patrick and his family received from nurses while he was ill inspired this unique means of thanking nurses for making a profound difference in the lives of their patients and patient families.
This is one initiative of The DAISY Foundation to express gratitude to the nursing profession. Additionally, DAISY offers J. Patrick Barnes Grants for Nursing Research and Evidence-Based Practice Projects, The DAISY Faculty Award to honor inspiring faculty members in schools and colleges of nursing and The DAISY in Training Award for nursing students. More information is available at http://DAISYfoundation.org.
Speaker: Chia‐Ding (JD) Shih, DPM, MPH, MA. Assistant Professor of Clinical Surgery, Dept. of Vascular Surgery, Keck School of Medicine of USC; Adjunct Assistant Professor, California School of Podiatric Medicine at Samuel Merritt University; Chair, Podiatric Population Health Committee, American Public Health Association.
Objectives
Describe the importance of amputation prevention in the case of diabetic foot ulcers.
Differentiate the approaches to an acutely infected diabetic foot ulcer and a chronic non-healing diabetic foot ulcer.
Incorporate resources related to social determinants as part of diabetic foot management.
Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.
The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals.
Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].
Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].
When it comes to injuries that affect our bones, muscles, and ligaments, three common terms are often used: strains, sprains, and fractures. While they may sound similar, these injuries are distinct in their nature and require different approaches for treatment and recovery. Whether you’re an athlete, a fitness enthusiast, or simply going about your daily activities, knowing the difference between strains, sprains, and fractures can be invaluable in understanding how to respond to injuries and promote healing. In this blog, we will delve into the definitions of each injury, their causes, symptoms, and the best practices for managing and treating them effectively.
Strain
A strain is when damage occurs to muscles and tendons as a result of a joint being pulled or stretched too far. Tendons are fibrous cords that attach muscles to the bones and allow our joints to move and be stable. Strains are most commonly seen in the lower back or leg muscles, but can also occur in the wrist, ankle, and other parts of the body where major muscles and tendons are present. Listed below are common strain injuries.
Hamstring strain: This occurs when the muscles at the back of the thigh (hamstrings) are stretched or torn, often seen in sports that involve sprinting or jumping.
Groin strain: Groin strains affect the muscles in the inner thigh or groin area and are common in sports that require sudden changes in direction or kicking movements.
Calf strain: The calf muscles, located at the back of the lower leg, can be strained during activities that involve quick acceleration or intense calf contractions.
Quadriceps strain: The quadriceps are the muscles at the front of the thigh, and a strain in this area can occur during activities like running, jumping, or kicking.
Back strain: This involves the muscles and tendons in the lower back and can happen due to improper lifting techniques, sudden movements, or poor posture.
Shoulder strain: The shoulder muscles and tendons can be strained from repetitive overhead movements or sudden, forceful actions.
Rotator cuff strain: The rotator cuff is a group of muscles and tendons in the shoulder joint, and strain in this area is common among athletes and individuals who perform repetitive arm movements.
Wrist strain: Wrist strains can occur from repetitive use or sudden impact, often seen in activities like typing, weightlifting, or playing racquet sports.
Ankle strain: The ligaments around the ankle can be strained during activities that involve sudden changes in direction or rolling of the foot.
Groin adductor strain: This involves the muscles on the inner side of the thigh, and it is common in sports that require lateral movements and sudden stops.
Pain, swelling, and muscle spasms are all usual symptoms of a strain, but they can usually be treated at home.
The RICE method is a widely recognized first-aid technique used to manage strains effectively. RICE stands for Rest, Ice, Compression, and Elevation. When you experience a strain, it is essential to promptly initiate the RICE method to alleviate pain, reduce swelling, and promote healing so you can get back to normal activities.
Rest involves avoiding any activity that exacerbates the strain, allowing the affected area time to recover.
Applying an ice pack to the injured area in short intervals helps to constrict blood vessels, decrease inflammation, and numb the pain.
Compression with an elastic bandage provides support and reduces swelling.
Lastly, elevating the injured limb above heart level helps to minimize swelling by aiding fluid drainage.
Remember, the RICE method is most effective when used within the first 48 hours after a strain occurs. If the pain persists or the strain is severe, seeking medical attention is crucial.
Sprain
Similar to a strain, a sprain occurs when ligaments are stretched beyond their limit – or even torn. Ligaments are tough bands of fibrous tissue that connect two bones together in your joints. The most common location for a sprain is your ankle, but sprains are also commonly seen in the knee and wrist. Symptoms of a sprain are similar to that of a strain with swelling and pain, but a sprain will also usually bring bruising with it. The majority of all ankle sprains will heal without any need for surgery. Even a complete ligament tear can heal naturally if given the appropriate rest. Rest and protection of the joint are the initial recommendations for a soft tissue injury. Once swelling is reduced, range of motion, strength, and flexibility will be reintroduced through various exercises dictated by your healthcare provider.
Some common sprain injuries include:
Ankle sprain: The most common type of ankle injury, a sprained ankle, occurs when the ligaments around the ankle joint are stretched or torn, often due to rolling or twisting the foot.
Wrist sprain: This type of sprain is a common injury that can result from a fall on an outstretched hand, causing the ligaments in the wrist to stretch or tear.
Knee sprain: The knee joint is susceptible to sprains, especially the medial collateral ligament (MCL) and the anterior cruciate ligament (ACL).
Thumb sprain: A thumb sprain can occur when the thumb is forcefully bent backward, stretching or tearing the ligaments supporting the thumb joint.
Elbow sprain: Elbow sprains typically affect the ligaments on the inner (medial) or outer (lateral) side of the elbow and often result from repetitive overuse or sudden impact.
Shoulder sprain: Shoulder sprains can happen when the ligaments in the shoulder joint are stretched or torn due to traumatic events or excessive force.
Hip sprain: Although less common, the hip joint can experience sprains, particularly during high-impact activities or accidents.
Finger sprain: A finger sprain occurs when the ligaments supporting the finger joints are injured, usually from hyperextension or impact.
Back sprain: The ligaments supporting the spine can be sprained due to lifting heavy objects or sudden movements.
Neck sprain: Neck sprains, also known as whiplash injuries, happen when the neck undergoes rapid back-and-forth movements, such as in car accidents.
Mild to moderate sprains can often be treated with the RICE method (Rest, Ice, Compression, and Elevation), anti-inflammatory medication and appropriate pain management. However, severe sprains may require medical evaluation and possibly imaging to assess the extent of the injury.
Fracture
Unlike strains and sprains, a fracture is when a bone is cracked or broken. The joints and ligaments may also be damaged when a fracture occurs. Symptoms of a fractured bone include sudden and severe pain, swelling, and bruising, and the inability to bear weight or move the injured part of your body. You may not require surgery if the joint remains stable and the fracture is minor. If the fracture is out of place or your joint is unstable, your orthopedic surgeon may need to do surgery. Listed below are common types of bone fractures.
Closed fracture: Also known as a simple fracture, this type of fracture does not break the skin. The bone may be broken, but the surrounding skin remains intact, reducing the risk of infection compared to open fractures.
Open fracture: An open fracture, also called a compound fracture, is one where the broken bone pierces through the skin, leading to an external wound. This type of serious injury poses a higher risk of infection and requires immediate medical attention in an emergency room to prevent complications.
Greenstick fracture: Typically seen in children whose bones are more flexible, a greenstick fracture is an incomplete break, where the bone bends and cracks but doesn’t completely separate. It resembles the way a green branch of a tree would bend but not break completely.
Comminuted fracture: In a comminuted fracture, the bone is shattered into three or more fragments. This type of fracture can be challenging to treat and may require surgery to realign and stabilize the bone fragments.
Transverse fracture: A transverse fracture occurs when the fracture line is perpendicular to the long axis of the bone. It often results from a direct blow or impact on the bone.
Oblique fracture: An oblique fracture has a diagonal fracture line across the bone. These fractures can be unstable and may require surgical intervention for proper alignment and healing.
Spiral fracture: Spiral fractures have a twisting pattern along the bone. They commonly occur due to rotational forces applied to the bone during a fall or accident.
Stress fracture: A stress fracture, also known as a hairline fracture, results from repetitive stress on a bone over time, often seen in athletes and people who engage in high-impact activities. Unlike other fractures, stress fractures may not be immediately noticeable and can develop gradually.
Avulsion fracture: In an avulsion fracture, a small fragment of bone is pulled away from the main bone due to the force of a tendon or ligament pulling on it. This type of fracture is common in sports injuries.
Compression fracture: Compression fractures typically occur in the vertebrae and result from the spine being compressed, often seen in conditions like osteoporosis or high-energy trauma.
Pathological fracture: A pathological fracture occurs when a bone is weakened by an underlying medical condition, such as cancer or osteoporosis. These fractures can happen with minimal force and require specialized treatment.
It is important to have your injuries evaluated and treated by an orthopedic surgeon for an accurate diagnosis to ensure proper healing and avoid complications. Your surgeon will help create a treatment plan for you, as the approach for each injury type varies. It may involve casting, splinting, orthopedic surgery, physical therapy, or other interventions to support bone healing and recovery.
The knee is a complex joint with many different components. Bones, tendons, ligaments, and cartilage all work together to allow the joint to move and bend smoothly. It is also one of the largest joints in your body, making it vulnerable to a variety of injuries. Knee pain can be debilitating and impact your ability to do even the simplest everyday activities. Some of the most common knee injuries include overuse injuries, degenerative conditions, dislocations, sprains, fractures, and ligament tears.
Knee ligament sprains and tears are the most common knee injury, often seen in individuals who participate in sports from football to soccer to skiing. Each year in the United States approximately 75,000 people will experience an MCL injury and up to 200,000 will experience an ACL injury.
The anatomy of the knee
The knee is a hinge joint created by the femur (thighbone) and the tibia (shinbone). The patella (kneecap) is the third bone present that covers and protects the joint. In addition to these bones, cartilage, ligaments, and tendons are all present within the knee to help the joint function properly.
Ligaments are the tissues that connect bones to other bones. There are four main ligaments in your knee that hold the bones of the joint together and provide stability:
Anterior cruciate ligament (ACL)
Lateral collateral ligament (LCL)
Medial collateral ligament (MCL)
Posterior cruciate ligament (PCL)
There are collateral and cruciate ligaments. Collateral ligaments (lateral collateral ligament and medial collateral ligament) are found on each side of your knee and control sideways movement, while cruciate ligaments (anterior cruciate ligament and posterior cruciate ligament) are found inside your knee joint and control backward and forward movement.
Understanding ligaments
Your ligaments are made up of fibrous soft tissues that hold your bones and joints together. Picture your ligaments as strong ropes – a small cut in the rope will make it less stable as all of the fibers become loose. This is similar to a tear in one of your ligaments, which occurs when the fibers are partially or fully torn away from each other. As the tissues in your ligaments expand and retract to stabilize your joints, the fibers can tear from certain unnatural movements like a fall or collision.
What is an ACL tear?
The ACL is located inside of the knee joint and connects the top front of the tibia (shinbone) to the bottom back of the femur (thighbone). Together, the ACL and PCL cross each other to form an “X” inside of your knee. The ACL prevents the tibia from sliding too far forward relative to the femur and is important for rotational stability. ACL injuries often occur during sports activities that involve frequent pivoting or cutting, like football, soccer, and basketball. Quickly changing direction or landing from a jump incorrectly can also result in an ACL injury.
What is a MCL tear?
The MCL is located on the inner side of your knee (connecting the bottom of the femur to the top of the tibia) and works to control sideways motion. Injuries to the MCL are usually caused by contact injuries to the outside of the joint that push the knee inward. Football, hockey, and other high contact sports are often responsible for MCL injuries.
It is not always the case, but ACL injuries are generally more complex to treat than MCL injuries, which sometimes heal on their own.
ACL and MCL injury symptoms
Injured ligaments are rated on a scale of one to three. Grade 1 means mild damage where the ligament has been slightly stretched, Grade 2 means a stretch to the point where the ligament is loose (partial tear), and Grade 3 means the ligament has been torn into two pieces.
ACL tear symptoms
Pain and tenderness with swelling
A “popping” noise or feeling of the knee giving out
Difficulty and discomfort while walking
Loss of full range of motion
MCL tear symptoms
Pain and swelling specifically on the sides of the knee
Instability or feeling of the knee giving out
In both cases, you are likely to experience pain and a significant instability of the injured knee. You may still be able to bear weight after a torn ACL, or you may not be able to depending on the severity of your injury. Most people are still able to walk and bear weight after an MCL tear.
ACL and MCL diagnosis
Most ligament injuries can be diagnosed through a physical examination of the knee where your doctor will compare the structure of your injured knee to your non-injured knee. Your doctor may or may not order an x-ray or MRI in order to determine whether the injury is associated with a broken bone or to get a better picture of the soft tissue ligaments.
ACL and MCL treatment
A MCL injury rarely requires surgery and, in time, will heal on their own given proper care. Icing, bracing, and physical therapy are all typical in an MCL tear treatment plan. Icing your injury is extremely important to the healing process and should be done for 15 to 20 minutes at a time with at least one hour between icing sessions.
It is important for your knee to be protected from the same sideways force that caused the injury, so your doctor may recommend a brace or even crutches to support the knee. You may need to adjust your daily activities to avoid bearing weight or risky movements. Strengthening exercises and physical therapy can help to restore function and strengthen the muscles that support the knee joint.
Your doctor may recommend nonsurgical treatment like bracing or physical therapy for an ACL injury, but a torn ACL will not repair itself. Sometimes patients who are elderly or who have a very low activity level and still have overall stability of the knee will not require surgery and can manage their injury with other treatment.
Surgical treatment of a torn ACL usually involves arthroscopy, where a small camera is inserted into the knee through a small incision and connected to a video monitor in the operating room. Your surgeon will use the camera to repair the damaged ACL with tissue from another part of the body – generally a tendon from the knee or hamstring, or from a cadaver. Choosing to use your own tissue or a cadaveric tissue graft is something you should discuss with your orthopedic surgeon, as there are pros and cons to each option. After the torn ACL is replaced with new tissue, it will develop into a ligament over time.
ACL and MCL recovery process
Once your range of motion returns to normal and you are able to walk and bear weight without a limp, your doctor will usually allow a gradual and progressive return to activities. This might look like starting with jogging and slowly progressing to sprinting over time. You may need to continue to wear a knee brace during physical activity depending on the severity of your injury.
ACL reconstruction surgery has a very high success rate. Your ACL rehabilitation plan is likely to include physical therapy, starting with a focus on returning motion to the joint and followed by strengthening exercises to protect your new ligament. After these steps have taken place, then you will follow a functional return to your normal physical activities. Generally, patients may return to sports when there is no longer any pain or swelling, typically a 4-6 month range. Recovery after surgery varies from patient to patient. Recovery time takes at least six months to fully incorporate the new ACL into your body.
ACL and MCL injuries are extremely common and often quite painful. The best thing you can do for a speedy recovery is to visit your doctor immediately following a knee injury to develop a treatment plan that works for you and your lifestyle.
A brain aneurysm is a bulge that forms in the wall of a weakened artery in the brain. If an aneurysm ruptures, blood spills into the space between the skull and the brain, causing a serious type of stroke known as a subarachnoid hemorrhage (SAH). Thinning of the arterial wall can occur gradually over time, and aneurysms most commonly develop at the base of arterial branches of the brain as the arteries are their weakest at these points. A ruptured aneurysm requires prompt medical treatment as it can quickly become life-threatening. However, not all brain aneurysms rupture and in some cases may be treated to prevent any rupturing in the future. These are often detected during tests for other conditions. Speak with your doctor to determine the best treatment plan for your specific needs.
Facts about aneurysms
Aneurysms vary in size. A small aneurysm is between 1/8 inch to almost 1 inch. It’s estimated that 50-80% of small aneurysms will not rupture. An aneurysm that is greater than 1 inch is considered a “giant” aneurysm, which is at a much higher risk of rupturing and can be difficult to treat.
An estimated 6.5 million people in the United States have an unruptured brain aneurysm, or 1 in 50 people.
Women are more likely than men to have a brain aneurysm (3:2 ratio).
Brain aneurysms are most prevalent in people ages 35 to 60, but can occur in children as well. Most aneurysms develop after the age of 40.
Women, particularly those over the age of 55, have a higher risk of brain aneurysm rupture than men (about 1.5 times the risk).
What symptoms should you look out for?
Brain aneurysms that have not ruptured typically have little to no symptoms. These aneurysms are most often smaller in size, and most are found incidentally when tests are being done to screen for other conditions.
If a small aneurysm grows larger and begins to press on nerves in the brain, such symptoms may be experienced.
Blurred or double vision
A drooping eyelid
A dilated pupil
Pain above and behind one eye
Weakness and/or numbness
If you experience these symptoms, seek immediate medical attention.
Ruptured brain aneurysms are much more dangerous and not all of the symptoms listed below may be present at once. When an aneurysm ruptures, bleeding in the space around the brain usually occurs causing sudden symptoms. These sudden symptoms may include the following.
Sudden and severe headache, often described as “the worst headache of my life”
Nausea/vomiting
Stiff neck
Blurred or double vision
Sensitivity to light
Seizure
Drooping eyelid
A dilated pupil
Pain above and behind the eye
Loss of consciousness
Confusion
Weakness and/or numbness
If you experience any of the above symptoms of a ruptured aneurysm, call 911.
Causes and risk factors
Although the causes of a brain aneurysm are unknown, many other factors may increase your risk. Brain aneurysms are more common in female adults. Other common risk factors include:
Drug abuse
Hypertension
Older Age
Cigarette smoking
Excessive alcohol consumption
Head trauma from an injury
Complications
When a brain aneurysm ruptures, the pressure inside of the skull increases and the bleeding can cause irritation to the lining of the brain, damaging cells. When your skull experiences that amount of pressure, the blood and oxygen levels to your brain are disrupted causing loss of consciousness or even death.
Other complications that can develop after a brain aneurysm rupture include:
Subarachnoid hemorrhage (SAH): A life-threatening type of stroke caused by bleeding in the brain.
Hydrocephalus: Confusion, lethargy, and loss of consciousness caused by increased pressure in the skull that forces the brain to shift and herniate.
Vasospasm: This occurs 5-10 days after the rupture when the walls of the artery begin to spasm and narrow, reducing blood flow to the part of the brain, causing a secondary stroke.
Your orthopedic doctor has assessed your injury and decided that a cast is the best treatment option…now what? Casts are used to protect and immobilize bones and joints in order to support injured limbs while they heal. Although casts can feel awkward at first, they play a big role in how fast your injury can heal. Here’s what to expect from your time spent in a cast.
If your injury is suspected to be a break or fracture, your doctor will usually order an x-ray to confirm the injury and determine the exact type and location of the injury. On some occasions, splints will be worn for a few days before the cast to reduce swelling, ensuring that your cast will provide the best fit. Splints are usually held in place by fabric fasteners, Velcro, or tape.
Getting your cast
When it’s time to get your cast put on, you’ll be taken to our cast room where an orthopedic technician will put on the cast for you. Your cast will be made in four parts:
Sock – a soft sock will be placed on your limb first to help with itching and keep your cast smooth and edge-free.
Cotton wrap – a cotton wrap will be placed over the sock to help with padding.
Casting material – a casting material containing fiberglass is applied next. Once the material has been properly wrapped, the technician will need to mold the cast to your limb to ensure it has the best functionality and heals your limb correctly. With this step, you also get to choose a fun color for your cast!
Caring for your cast
It’s extremely important to keep your cast in good shape so it can do its job and your bones can heal properly. The way you treat your cast can play a big role in how quickly you heal. By following the cast care tips below, you can make this phase a little more pleasant.
Keep your cast dry. All casts are made primarily of plaster or fiberglass. A wet cast will become soft, and may not hold your limb in place. It can also cause infections and/or rashes. Bathe as directed by your physician and keep your cast out of the water. Covering your cast with plastic can help. If your cast gets damp, pat it dry with a towel. A hairdryer on the cool setting can also do the trick!
Keep foreign objects out. Never slide anything inside the cast or put lotions/powders inside the cast. To relieve itching, try raising the cast or changing positions. Air from a blow dryer on the cool setting also works.
Don’t alter the cast. Keeping your cast in good shape will ensure your cast does the best job possible at healing your bones. Do not cut the cast or pull it apart. Allowing friends and family to sign or decorate is okay!
Elevate and wiggle. Elevate the cast above your heart whenever possible to reduce swelling and help your injury heal. Wiggle your fingers or toes as much as you can to help with circulation.
Cast caution signs
Be sure to call the clinic if you develop any of the following symptoms:
Pain or swelling, or inability to wiggle your fingers or toes.
Your fingers or toes change color or tingle.
The cast is too tight or loose, or has something stuck inside of it.
Your cast becomes wet, cracked, dented, or has soft spots.
You get a rash or chafing on the skin around the edge of your cast.
You get a bad odor or itching that will not go away.
What to expect after cast removal
Pain, swelling, and stiffness
After having a cast removed, it is normal to have some pain, stiffness, or limited range of motion. Being immobilized for weeks or months can cause your muscles and joints to weaken. Over-the-counter medications can be used for pain and swelling (ask your doctor which medication is right for you). Elevating the extremity, above the heart can also help to decrease swelling.
Dry skin
Your skin may also be flaky, discolored, or dry from being hidden under a cast. Start by gently washing with soap and water and moisturize with an alcohol-free lotion. It’s also important to avoid picking at the skin as it will cause further irritation. Dry skin can take a few days to a week to go back to normal.
When to resume activities
It’s important to speak with your doctor about when you can return to activities. It’s typically advised to refrain from running, jumping, or sports for a few days to a few weeks after removal. After that, you are usually able to return to activities as tolerated.
Carpal Tunnel Syndrome is a common condition that causes pain, numbness and tingling in the hand and wrist. This is caused when the tunnel becomes narrow or when the tissues surrounding the flexor tendons become inflamed and swell causing pressure on the median nerve.
Symptoms can include the following:
Tingling and numbness in fingers – primarily in the thumb, index, middle and ring fingers.
Pain or tingling that travels up the arm toward the shoulder.
Lack of strength in grip and finger coordination – this may make it difficult to participate in normal activities such as buttoning your shirt.
Dropping things due to weakness or numbness
Nighttime symptoms are very common and may awaken you from sleep.
What is carpal tunnel release surgery?
During a carpal tunnel release, your surgeon will either make one incision or several small incisions on the palm of your hand and cut the ligament that is putting pressure on your median nerve. The release of this ligament increases the size of the tunnel and decreases the pressure placed on the median nerve. This usually improves pain and function of the nerve.
If you are preparing to undergo carpal tunnel release surgery, you may be wondering what to expect in the coming weeks and in the months post-surgery. The outcomes of open surgery and endoscopic surgery are similar, and for patients who are eligible to utilize wide-awake local anesthesia rather than general anesthesia, recovery times and potential risks decrease. Wide-awake local anesthesia is surgery performed with only local anesthesia, allowing the patient to avoid grogginess, and even drive him or herself home after surgery, if necessary.
After your surgery, you may be encouraged to do the following:
Elevate your hand above your heart and move your fingers to reduce swelling and prevent stiffness.
Ice the surgical site for a given amount of time, a few times a day.
You may need to wear a splint or wrist brace for several weeks.
Follow your doctor’s specific instructions on when it’s okay to return to work and whether you will have any restrictions on your work activities.
If you experience increased pain and weakness for more than two months following surgery, you may be referred to a hand therapist to help improve your recovery.
Carpal tunnel surgery recovery time can look different depending on who you are and in what condition your median nerve is in before surgery. Age, health factors, and your ability to follow post-surgical care guidelines can all affect recovery times. “It’s important to massage the palm in the horseshoe area of the hand, to minimize scarring, decrease pain, and help desensitize the area,” says Dr. James Verheyden, orthopedic surgeon at The St. Charles Center for Orthopedic and Neurosurgery.
It is likely that surgery will improve your previous symptoms, but recovery can be gradual, and in some cases, can take up to one full year. Other factors that can contribute to longer recovery times are preexisting conditions, such as arthritis or tendonitis, which could also be contributing to pain and stiffness. “Most patients note dramatic and immediate improvements in their symptoms, but it frequently takes about three months after surgery before their grip strength returns. Patience may have difficulty opening doors and jars of food up to three months after surgery,” says Dr. Verheyden.
Carpal tunnel surgery recovery milestones
Carpal tunnel surgery aftercare and milestones you can expect to meet with carpal tunnel release vary depending on the factors stated above, but this is one example of how your recovery could progress.
Around one week after surgery:
Removal of bandages and stitches will take place. Physical therapy may be suggested to improve stiffness and restore range of motion.
Weeks 2-4:
You may gradually resume activity in the affected hand. Pain and soreness in the palm are expected to slowly decrease.
4 weeks post-op:
You will likely regain full mobility of the digits or will be working with a therapist to regain mobility.
6-8 weeks post-op:
You may still experience soreness in your palm and sensitivity to deep pressure or touch, but you should be able to participate fully in daily life and sporting activities.
One year post-op:
Grip and hand strength usually come back within 2-3 months after surgery, but it can take up to a year to fully recover. By one year, you should be receiving all the benefits of your surgery.
The good news is that this condition is very treatable. It is important to be evaluated by your orthopedic surgeon in the early stages to slow or even stop the progression of carpal tunnel syndrome. The sooner you start treatment, the better your chances of preventing long-term damage to your median nerve and recovering fully.
Rock climbing and bouldering are popular sports in Central Oregon. It’s no surprise since the birthplace of American sport climbing, Smith Rock State Park, is located just 30 miles north of Bend. In addition, there are many other outdoor and indoor options available for climbers of all abilities. While there is always a risk of falling or traumatic injury in this sport, avid climbers more frequently experience overuse injuries at some point in their climbing careers.
Should injuries
Rotator cuff injuries are common for climbers because of the amount of time they spend with their arms overhead pulling up their body weight. The rotator cuff provides stability for the shoulder. It is comprised of tendons in the shoulder that attach to the humerus, as well as the four major muscles that surround the shoulder joint. A weak rotator cuff and/or poor biomechanics can contribute to a tear or tendonitis. Common symptoms include pain, weakness when lifting or lowering the arm, limited range of motion, and hearing clicking or popping sounds.
Treatment for rotator cuff injuries
Conservative treatment can be effective in treating tendonitis and small tears. This includes rest, ice, anti-inflammatory medications, corticosteroid injections, or physical therapy. If symptoms don’t go away or there is a large rotator cuff tear, surgery may be necessary to repair the tendon.
Elbow injuries
Tennis elbow, or lateral epicondylitis, is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. Because climbers use motions that include repetitive gripping and lifting, this is another common overuse injury. Symptoms include tenderness on the outside of the elbow, pain or weakness when using the affected elbow, and pain with resistance.
Treatment for tennis elbow
Most cases of tennis elbow can be resolved without surgery. Conservative treatment options include rest, ice, anti-inflammatory medications, bracing, or physical therapy. If symptoms do not improve over 6-12 months, your doctor may advise surgery to allow you to return to comfortable, normal activity.
Finger injuries
Rock climbers use an excessive amount of force on their fingers, especially when a climber’s foot slips and their hand grip tightens. An A2 pulley strain is the most common finger injury for climbers and most often occurs in the ring or middle finger. Each finger has tendons and ligaments that helps the finger bend, move, and grip. This network of tendons and ligaments runs under a sheath called a pulley that helps hold them near the bones of the fingers. There are five pulleys on the palm side of every finger. The A2 pulley is located in the first finger segment (proximal phalanx) closest to the palm. The most common symptom is hearing or feeling a pop in the finger while pulling down, followed by pain, bruising, swelling, and difficulty forming a fist. Injuries can range from a mild sprain or a complete tear. Rest, ice, splinting, and physical therapy are common treatment options. After the pulley heals, most people use tape on that finger to provide additional support when climbing.
Treatment for flexor tendon tear
The flexor tendons that run underneath the pulleys can also tear or stretch when climbing. When a flexor tendon tear occurs, pain is felt between the palm and the wrist, as well as tenderness, numbness, and an inability to bend one or more joints in the finger. Surgery is often necessary to repair complete tendon tears.
Collateral ligament strains usually occur with sideways loading, such as when you are throwing one hand out to a hold with the other. It most commonly occurs in the middle joint of the middle finger. The collateral ligaments surround each finger joint. Symptoms include pain, swelling, and tenderness at one or both sides of the finger joint. Treatment for this type of strain is usually nonsurgical and includes rest, ice, anti-inflammatories, and taping the finger for support.
Trigger finger is a common overuse injury that occurs when the flexor tendon becomes irritated and begins to thicken, eventually creating nodules that make it difficult for the joint to bend and straighten.
Treatment for trigger finger
If symptoms are mild, your doctor may suggest resting the finger or placing it in a custom splint. If there is pain and discomfort, taking a non-steroidal anti-inflammatory medication or injecting the area with corticosteroid can be effective. If pain does not subside after conservative treatment, surgery may be recommended.
Wrist injuries
The most common wrist injury in climbers occurs when there is damage to the triangular fibrocartilage complex (TFCC). This is a cartilage structure located on the pinky side of the wrist that sits between the end of the ulna (forearm bone) and the carpal bones of the wrist. It provides stability and support when the hand grasps or the arm rotates. When a climber feels the onset of wrist pain and continues to climb, the TFCC can degenerate and even tear. Symptoms include a dull, achy pain on the side of the wrist and sometimes a sharp pain is felt when bending the hand toward the pinky finger.
Treatment for triangular fibrocartilage complex (TFCC).
When diagnosed early, rest, anti-inflammatory medication, and using a splint can typically heal the injury. After the TFCC heals, taping the wrist while climbing can help provide additional stability and support, as well as prevent re-injury. In more severe cases, surgery is necessary to remove the damaged tissue and clean off the torn edges; this is also known as debriding. Recovery from this procedure includes wearing a cast for several weeks followed by physical therapy to regain range of motion and strength.
What causes climbing injuries?
Climbing injuries are caused by a variety of factors including but not limited to the following:
Overuse injuries:
Finger and hand injuries: Climbers frequently place a lot of stress on their fingers and hands, especially when gripping holds tightly. This can lead to conditions like pulley strains or tears, tendonitis, and overuse syndromes like climber’s elbow or wrist tendinitis.
Elbow injuries: Elbow injuries, particularly medial epicondylitis (also known as golfer’s elbow), can occur due to repetitive stress on the tendons that connect to the inner side of the elbow. This can be aggravated by frequent gripping and pulling motions.
Shoulder injuries: Climbing can place significant strain on the shoulders, particularly in moves that require overhead reaching or dynamic movements. Overuse or poor technique can lead to conditions like rotator cuff injuries or impingement syndrome.
Back and spine issues: Prolonged arching of the back or twisting movements can lead to strains, sprains, or even more severe spine-related injuries.
Inadequate warm-up or stretching:
Muscle strains: Without proper warm-up and stretching, muscles may not be adequately prepared for the stress of climbing. This can lead to strains, particularly in the legs, back, and upper body.
Limited range of motion: Inadequate stretching can limit a climber’s range of motion, potentially leading to awkward movements and increased risk of injury.
Inadequate training or technique:
Muscle imbalances: Inadequate training can lead to muscle imbalances, where some muscles are stronger than others. This can lead to overuse injuries or improper movement patterns.
Improper weight distribution: Failing to distribute weight properly during climbs can lead to unnecessary strain on certain muscle groups, potentially causing injuries.
Foot placement and technique: Incorrect foot placement or not utilizing proper techniques for balance and stability can lead to slips, falls, or putting excessive strain on leg muscles.
To mitigate these risks, climbers should focus on building strength and flexibility in a balanced manner, engage in specific training to target climbing-related muscle groups, and practice proper climbing techniques. Additionally, incorporating warm-up routines and regular stretching can help prevent overuse injuries.
How to prevent climbing injuries?
Preventing common climbing injuries requires a combination of physical conditioning, proper technique, and careful attention to safety measures. Here are some key strategies to help minimize the risk of injuries while rock climbing:
Gradual progression and conditioning:
Start with climbs that match your current skill level and gradually progress to more challenging routes.
Incorporate strength training and flexibility exercises focused on the muscles used in climbing, including fingers, forearms, shoulders, core, and legs.
Proper warm-up and stretching:
Begin each climbing session with a thorough warm-up to increase blood flow and prepare muscles for the demands of climbing.
Incorporate dynamic stretches that target key muscle groups, including wrists, forearms, shoulders, and lower body.
Technique and form:
Seek instruction from experienced climbers or certified instructors to learn proper climbing techniques, including footwork, balance, and efficient movement.
Focus on precise hand and foot placements to reduce unnecessary strain on muscles and tendons.
Listen to your body:
Pay attention to any signs of fatigue, discomfort, or pain. Rest when needed and avoid pushing through excessive strain.
Recognize the difference between normal muscle fatigue and the early signs of overuse or acute injuries.
Use quality gear and check equipment:
Regularly inspect and maintain climbing equipment, including harnesses, ropes, carabiners, and belay devices, to ensure they are in good working condition.
Invest in high-quality climbing gear from reputable manufacturers to minimize the risk of equipment failure.
Rest and recovery:
Allow for adequate rest days between climbing sessions to give muscles and tendons time to recover and repair.
Incorporate active recovery techniques like stretching, foam rolling, and gentle exercises on rest days.
If you experience an injury while climbing, it’s crucial not to delay seeking care. Our team of upper extremity specialists is dedicated to evaluating and addressing climbing-related injuries.
With so many medical specialties, it’s important to understand what type of specialist to see when trying to get diagnosed for a medical condition. A neurosurgeon and a neurologist both specialize in the treatment of medical problems affecting the central nervous system. The central nervous system controls most of the functions of the body and mind, consisting of the brain and spinal cord.
Neurologist vs. Neurosurgeon
What is a neurologist?
A neurologist treats diseases and conditions of the brain and nervous system, but they do not perform surgery. They are trained to diagnose and treat a wide range of conditions, including but not limited to:
Neurological disorders: Such as epilepsy, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, and other forms of dementia.
Neuromuscular disorders: Such as muscular dystrophy, myasthenia gravis, and peripheral neuropathy.
Headaches and migraines: Including chronic and severe forms.
Stroke: Both ischemic (caused by a blood clot) and hemorrhagic (caused by bleeding).
Movement disorders: Such as tremors, dystonia, and restless leg syndrome.
Seizure disorders: Including epilepsy and other types of seizures.
Neurodevelopmental disorders: Such as autism and attention-deficit/hyperactivity disorder (ADHD).
Neurological injuries: Such as traumatic brain injury and spinal cord injury.
Neurologists may perform a variety of tests and procedures to help diagnose and manage these conditions, including neurological examinations, imaging studies (like MRI and CT scans), electroencephalograms (EEGs), electromyography (EMG), and nerve conduction studies.
It’s worth noting that neurologists often work closely with other healthcare professionals, including neurosurgeons, physical therapists, occupational therapists, and speech therapists, to provide comprehensive care for patients with neurological conditions.
What is a neurosurgeon?
One common myth is that neurosurgeons are just brain surgeons. However, according to the American Association of Neurological Surgeons (AANS), they typically spend a lot more time on spine conditions and procedures than brain conditions and procedures.
Common conditions neurosurgeons treat are back pain, neck pain, sciatica, herniated disks, degenerative diseases of the spine, cerebrovascular disorders, brain and spinal tumors, and stroke. In addition, since the nervous system extends from your brain to your spine and your nerves branch out into your entire body, they treat conditions that present symptoms in one part of your body that are actually related to a problem in the central nervous system. For example, carpal tunnel symptoms are sometimes related to a problem in your cervical spine (neck area).
Although they can perform very complex surgeries, neurosurgeons typically use non-operative treatment plans before performing surgery. If surgery is required, minimally invasive techniques are used whenever possible. Neurosurgeons are also on call for emergency room physicians when a patient has trauma involving the brain and spinal cord.
What do neurologists and neurosurgeons have in common?
Neurologists and neurosurgeons have several things in common including:
Specialization in Neurology: Both neurologists and neurosurgeons specialize in the field of neurology, which focuses on the diagnosis and treatment of disorders related to the nervous system.
Medical Doctors: Both neurologists and neurosurgeons are medical doctors who have completed medical school and obtained a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree.
Advanced Training: After completing medical school, both neurologists and neurosurgeons undergo additional, extensive training in their respective fields.
Diagnostic Skills: Both professions are skilled in conducting neurological examinations, interpreting imaging studies (like MRI and CT scans), and performing specialized tests to help diagnose neurological conditions.
Collaborative Approach: Neurologists and neurosurgeons often work closely together in the care of patients with complex neurological conditions. They collaborate to develop comprehensive treatment plans and determine whether surgical intervention is necessary.
Degree and training
Neurologists undergo four years of pre-medical education at a college or university, four years of medical school resulting in an MD or DO degree, one year of internship, and at least three years of specialty training in a neurology residence program. Some neurologists elect to take additional training in an area of interest such as stroke, movement disorders, or sleep medicine.
A neurosurgeon’s training is the longest training period of any medical specialty. In addition to four years of pre-medical education, four years of medical school, and a year of internship, their residency is five to seven years. After that, many pursue a fellowship to specialize in an area such as spine, pediatric neurosurgery, or peripheral nerve surgery.
Finding the right specialist
There is some overlap between these two types of specialists and the conditions they treat. Sometimes these doctors work collaboratively; a neurologist can refer their patients to a neurosurgeon when surgery is required (such as for a brain tumor) and then the patient returns to the neurologist for long-term management. If you have a condition or symptoms that you think require a brain and spine specialist, ask your primary care physician about which type of specialist to see. Our multidisciplinary team of physicians at The Center are equipped with the latest technologies and have the experience to treat any injury or condition that affects your musculoskeletal system.
Neurosurgeon at The Center, Dr. Ray Tien, explains the differences between a neurosurgeon and a neurologist in the video below.
Who should you visit first: A neurologist or a neurosurgeon?
The decision of whether to visit a neurologist or a neurosurgeon first depends on the specific nature of your symptoms and the suspected or diagnosed neurological condition. Here are some general guidelines:
Visit a neurologist first if:
You are experiencing neurological symptoms: If you’re dealing with symptoms like headaches, seizures, numbness, weakness, difficulty with coordination, or other neurological issues, it’s often best to start with a neurologist. They specialize in diagnosing and managing a wide range of neurological conditions and can determine if surgical intervention is necessary.
Your condition does not require immediate surgery: If your condition does not require urgent surgical intervention, a neurologist is typically the first point of contact. They will conduct a comprehensive evaluation, order appropriate tests, and initiate non-surgical treatments if needed.
You have been referred by a primary care physician: If your primary care doctor suspects a neurological issue, they will likely refer you to a neurologist for further evaluation and diagnosis.
You have a known or suspected neurological disorder: If you have already been diagnosed with a neurological condition (such as epilepsy, multiple sclerosis, or Parkinson’s disease), or if you suspect you may have one, a neurologist is usually the initial specialist to consult.
Visit a neurosurgeon first if:
Your condition requires urgent surgical intervention: If you have a neurological emergency, such as a severe head injury, a spinal cord injury, or a brain hemorrhage, it’s crucial to seek immediate attention from a neurosurgeon. They are trained to perform emergency surgeries and interventions.
Your condition has been specifically identified as surgical: If you have a known neurological condition that is likely to require surgery, or if you have received a recommendation for surgical treatment from a neurologist or another healthcare provider, it may be appropriate to see a neurosurgeon directly.
You have a complex neurological issue that may require surgery: In some cases, particularly for complex or difficult-to-treat neurological conditions, it may be beneficial to consult with a neurosurgeon early in the diagnostic process to explore potential surgical options.
Ultimately, in many cases, the decision of whether to see a neurologist or a neurosurgeon first will be guided by a referral from a primary care physician or another specialist. It’s important to communicate with your healthcare provider about your symptoms and concerns so they can help guide you to the most appropriate specialist for your specific situation.
How neurologists and neurosurgeons work jointly through patient care
Neurologists and neurosurgeons sometimes work together to provide comprehensive care for patients with neurological conditions. This collaborative approach ensures that patients receive the best possible care, combining the expertise of both specialties. Here’s how neurologists and neurosurgeons work jointly through patient care:
Consultation and referral: When a patient presents with a neurological issue, they may initially see a neurologist. The neurologist will conduct a thorough evaluation, which may include a neurological examination, review of medical history, and ordering of diagnostic tests. If surgical intervention is deemed necessary, the neurologist may refer the patient to a neurosurgeon.
Case discussions and treatment planning: Neurologists and neurosurgeons often engage in discussions about complex cases. They review the patient’s medical history, examination findings, and diagnostic test results to collaboratively determine the best course of action. This may involve deciding whether surgery is the most appropriate treatment or if non-surgical interventions should be pursued.
Preoperative assessment: Before surgery, the neurologist plays a crucial role in preparing the patient for the procedure. They may conduct preoperative assessments to ensure that the patient is medically optimized and able to undergo surgery safely. This may involve managing any underlying medical conditions and adjusting medications as needed.
Intraoperative collaboration: During surgery, neurologists and neurosurgeons work closely together in the operating room. The neurosurgeon performs the surgical procedure, while the neurologist may be present to provide expertise on neurological anatomy and function. This collaborative effort ensures that the surgery is conducted safely and effectively.
Postoperative care and follow-up: After surgery, the neurosurgeon takes the lead in managing the patient’s immediate postoperative care, including monitoring for any complications and overseeing the recovery process. The neurologist remains involved, providing input on neurological status and helping to manage any ongoing neurological issues.
Long-term management: In cases where a patient requires ongoing care for a neurological condition, the neurologist and neurosurgeon continue to work together. They collaborate on long-term treatment plans, which may include medication management, rehabilitation, and periodic follow-up visits to monitor progress.
Multidisciplinary team collaboration: In complex cases, neurologists and neurosurgeons often work with other healthcare professionals, such as radiologists, anesthesiologists, physical therapists, and occupational therapists, to ensure comprehensive care for the patient.
Open communication: Effective communication between neurologists and neurosurgeons is essential for successful patient care. They regularly share updates on the patient’s condition, treatment progress, and any changes in the care plan.
By combining their specialized knowledge and skills, neurologists and neurosurgeons provide a holistic approach to patient care, addressing both non-surgical and surgical aspects of neurological conditions. This collaborative effort ultimately leads to the best possible outcomes for patients.
The surgeons and staff at the St. Charles Center for Orthopedics & Neurosurgery have created this educational video series to help you prepare for knee or hip replacement surgery. Our ultimate goal is to support your recovery and get you back to the activities you enjoy pain free. We highly recommend that your coach or caregiver watch all of the videos to support your recovery.
Please watch the eight-video series below in its entirety. Take notes in your Guide to Total Joint Replacement, so you can ask questions at your next appointment. When you are finished, click the “Complete” button to confirm you watched the entire series.
