Award Winning Research on Tendon Repairs

Research performed at Maimonides Medical Center Department of Orthopedic Surgery recently won an award for best basic science research at the at the Brooklyn and Long Island chapter of the American College of Surgeons and the Brooklyn Surgical Society. This groundbreaking research evaluated the use of connective tissue growth factor (CTGF) added to a collagen scaffold to help with tendon healing. The ultimate goal of the research is to use biological augmentation in flexor tendon repairs so that early mobilization programs can be utilized. The results showed that adding CTGF to a wound gap led to improved cellular healing, proliferation and angiogenesis. Ultimately this research can lead to stronger repairs of flexor tendons that will improve patient outcome after these devastating injuries. the researchers Kevin Kang M.D., Jinny Jacob MS and Jack choueka M.D. are to be congratulated for their efforts in winning this prestigious award.

Ganglion cysts

Ganglion cysts are extremely common conditions that occur about the hand and wrist. They can be found on on nearly every part of the hand and wrist. Ganglion cysts are usually painless and people may wait long periods of time before noticing them. They can be large or small usually painless but sometimes they can cause problems.

Ganglion cysts usually originate from a joint. Every  joint is covered with a capsule and connected with ligaments and sometimes because of trauma, or for no reason at all, a small hole in the in the covering of the joint develops and the fluids in the joint starts to escape. This forms a balloon or sack with fluid entering the sack.  Over time the sack  can become thickened  and the fluid within it can become thickened as well. In fact the fluid within the cyst becomes gelatinous jelly like.



Volar ganglion cyst



Ganglion cysts that appear in the back of the wrist are called dorsal ganglionic cysts  and those that occur on the palm side of the wrist they are called volar ganglionic cysts. Cysts can occur within the tendons of the hand and these are called retinacular cysts.  When they appear at the tip of the finger beneath the nail they are called mucous cysts.

Ganglion cysts can usually be diagnosed easily with a history and physical examination. X-rays and MRIs are usually not needed however if there is any question your Dr. will likely order an MRI to rule out any other conditions that may be more serious. Often a simple flashlight test can help diagnose the ganglionic cyst. Since the cyst is filled with fluid placing a light at the base of the mass will cause the ganglionic cyst to illuminate and this is helpful in making the diagnosis.

There are a variety of treatments available for ganglionic cysts but the most important decision is whether to treat it at all.  Reasons for treating ganglionic cyst include cysts that are painful, cysts that are causing damage to structures in the area such as nerves, arteries or tendons, uncertainty about the diagnosis, and cosmesis. Many people have the cyst removed because they don't like it or don't like the way it looks and this is reasonable.

The main treatments available for ganglionic cysts include aspiration or excision. Aspiration of the cyst involves putting a needle in the cyst cavity and removing the fluid. As you can imagine while this removes the fluid it leaves the sack in place which is sometimes absorbed by the body but other times it refills with fluid. A more definitive way to remove the cyst is to take it out surgically. This is often done under local anesthesia with a small incision however in certain places it can be done arthroscopically



MRI showing ganglion cyst (white ball)



The most important take-home message about ganglionic cyst is making the correct diagnosis.  If there is any question that it is not a cyst you should see your doctor.

Dr. Jack Choueka

Adult and Pediatric Upper Extremity Surgeon 

Chairman of Orthopaedic Surgery at Maimonides Medical Center. 

Award winning hand surgeon Dr. Jack Choueka provides treatment for

all disorders of the upper extremity, including carpal tunnel syndrome,

arthritis, trauma, rotator cuff disease, and sports-related shoulder, elbow and wrist problems. He performs state-of-the-art surgery, including shoulder, elbow and wrist replacements. Dr. Choueka is a summa cum laude graduate from State University of New York Health Science Center’s Medical School; he completed his residency in Orthopaedic Surgery at theHospital for Joint Diseases Orthopaedic Institute and his fellowship in upper extremity and microvascular surgery at the University of Chicago

 Dr. Choueka can be reached at 718-283-7400.

Arthritis

ARTHRITIS

Osteoarthritis, or degenerative joint disease, is one of the most common causes of pain. This condition is caused by the deterioration of the cartilage at the ends of your bones. As this hard, yet slippery, material wears away, the bone edges can be exposed and can rub against each other, causing swelling, fluid build up, loss of motion and pain. Osteoarthritis can affect all joints in the body, most commonly the hips, knees, shoulders, fingers and spine. Often described as the result of “wear and tear,” this painful grinding sensation may stop people from doing the activities they enjoy.

Diagnosis:

Your doctor will first listen to the story of how the pain affects you. Following this, you will be examined. X-rays are also a main part of the diagnostic process. Your doctor may also order other tests, such as an MRI or blood tests.

Treatment:

Many treatments exist for arthritis. Doctors most often start with non-operative treatment, including oral or topical medications, activity modification, assistive devices that include a brace or cane, and physical therapy (exercises to strengthen muscles, keep the joint limber and keep your whole body in shape). Often, with a combination of settling the inflammation with medication and exercise to strengthen the muscles around the joint, the pain from mild to moderate arthritis can be controlled. Eventually your doctor may offer an injection, either of a steroid containing mixture (a “cortisone shot”), or a series of synthetic joint fluid supplementation into the joint.

Ultimately, there is no way to build up diseased cartilage once it is diseased. As pain progresses, surgery might be an option. Arthroscopy (minimally invasive surgery with a camera) is sometimes used in arthritis to “clean up” an inflamed joint. Eventually, joint replacement will be offered as a solution. In this procedure, the diseased cartilage is removed, and both sides of the joint are capped with metal. Patients often feel relief within weeks, and are back to their previous level of activity in a month or two.

Knee Replacement Surgery

What you can do:

• Stay active: walking and low impact exercise keeps joint mobility, blood pumping and good general condition. Start with a slow warm up and rest frequently
• Eat well: This can help reduce your weight (which will decrease stress on your joints) and help prevent other health problems
• Stop smoking
• Talk to your doctor about all aspects of treatment

Dr. Howard J. Goodman

Adult and Pediatric Musculoskeletal Oncology and Joint Replacement Surgery

Telephone:  718-283-7450

Dr. Goodman is an orthopaedic surgeon who is specially trained in taking care of benign and malignant bone and soft tissue tumors in both children and adults. He has experience in limb preservations techniques, including massive endoprostheses, expandable prostheses for growing children, and allograft. He also performs hip and knee replacement and revision surgery. Dr. Goodman treats hip, knee, and shoulder arthritis, malignant and benign bone tumors, bony metastatic disease from other cancers, soft tissue “lumps and bumps” – benign and malignant masses in the extremities, and salvage of “accidental sarcoma resections.”

 

Fluoroscopy better than x-rays in diagnosing certain wrist conditions

Fluoroscopy Vs. X-rays

Fluoroscopy using a low radiation dose mini C-arm has many advantages.  It is easier to manipulate and position the injured arm in order to obtain the necessary images. It is more efficient and safer than traditional x-rays since it uses less radiation, and now researchers at Maimonides Medical Center have shown that fluoroscopy is better at diagnosing ligament injuries in the wrist compared to traditional x-rays.

Dr. Jack Choueka,  Chairman of the Department of Orthopedic Surgery at Maimonides Medical Center in collaboration with one of his residence Dr. Philip Lahey evaluated 26 patients to determine which allowed for a better diagnosis of a ligament tear in the wrist. Dr. Choueka says "fluoroscopy allowed minor corrections in the position of the wrist that made diagnosis of ligament tears much more apparent"

Flouroscopy of the wrist

The study was presented at the American Academy of Orthopedic Surgery Las Vegas. Dr. Choueka now uses fluoroscopy almost exclusively for diagnosis of these conditions in his office. "There's less radiation, no processing time and it allows perfect positioning of the wrist to make an accurate diagnosis"

The research showed that gaps in the bone as small as 2mm could be diagnosed with the fluoroscopy and not with standard x-rays.

Dr. Choueka positioning the wrist for flouroscopy

As for the use of fluoroscopy in other areas Dr. Choueka says "is has become an invaluable tool for the safe accurate diagnosis of innumerable conditions in the upper extremity". It is used to diagnose fractures, ligament injuries, look for tumors and makes comparison to the other arm much easier. For kids it makes the x-ray experience much easier and even fun since the kids can see their bones moving on the screen.

Dr. Jack Choueka

Adult and Pediatric Upper Extremity Surgeon 

Chairman of Orthopaedic Surgery at Maimonides Medical Center. 

Award winning hand surgeon Dr. Jack Choueka provides treatment for

all disorders of the upper extremity, including carpal tunnel syndrome,

arthritis, trauma, rotator cuff disease, and sports-related shoulder, elbow and wrist problems. He performs state-of-the-art surgery, including shoulder, elbow and wrist replacements. Dr. Choueka is a summa cum laude graduate from State University of New York Health Science Center’s Medical School; he completed his residency in Orthopaedic Surgery at theHospital for Joint Diseases Orthopaedic Institute and his fellowship in upper extremity and microvascular surgery at the University of Chicago

 Dr. Choueka can be reached at 718-283-7400.

Scoliosis....Early detection can prevent late problems

SCOLIOSIS

The sooner it’s detected, the better the chances of correcting it

Scoliosis is a common condition found in both children and adults, and it is most often diagnosed in adolescence.  Fortunately, it can usually be treated, especially when it’s diagnosed early.

Scoliosis usually presents itself as some form of asymmetry, from uneven shoulders to an uneven waist or hips.  An X-ray can confirm the diagnosis and help the doctor assess the shape and the degree of the abnormal curvature.  Often, the cause of the scoliosis is idiopathic (no underlying cause); however, it typically runs in families and girls are more prone to this than boys.   Most children with scoliosis do not require treatment because the curve in their spine is so minor.  However, they should still be checked by a physician on a regular basis as they continue to grow to make sure that the condition does not worsen. 

A back brace, which is a common treatment for scoliosis, does not reverse the condition, but can prevent it from progressing.   Severe scoliosis, if allowed to progress, can cause serious problems down the road, from back pain to pulmonary problems that cause difficult breathing.  In rare cases, surgery may be necessary.  In the surgical procedure, the spine is encouraged to fuse so that it will stabilize and not continue to curve abnormally.

The key to fixing scoliosis is early detection and intervention.  The younger and more flexible a spine is, the better the chance of encouraging it to keep its normal shape. 

Dr. Juan Carlos Rodriguez

Adult and Pediatric Spine Specialist

Tel: 718-283-6520

Trained in complex spine surgery, Dr. Juan Carlos Rodriguez treats pediatric and adult patients with pain or back deformities. Dr. Rodriguez graduated with MD and PhD degrees from Universidad de Salamanca and Universidad Complutense de Madrid, respectively. He is fellowship trained in Surgery from the Hospital for Special Surgery and in Spinal Surgery from New York University Hospital for Joint Diseases.  Dr. Rodriguez specializes in treating scoliosis.

Is too much texting dangerous...

  

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Do you over-text?   Will your thumb, hand, arm and neck suffer due to the “must send” messages that you type on the tiny keypad of your phone daily?    Orthopaedic hand surgeon David Edelstein claims that avid texting may cause pain not only to your thumbs, but also to your hand, arm and neck.

Because of the nonstop usage of phones, laptops and handheld gaming devices, repetitive stress injuries are more common than ever.   In the predigital age, people took breaks from typing; nowadays people don’t stop typing (or texting).  People are on the computer all day at work, text at their lunch break, and go online at home.   Excessive texting and typing can lead to pain in hands (especially the thumbs), arms, shoulders and neck.

To prevent pain from texting, Dr. Edelstein recommends:

• Avoid sitting in the same position for extended periods.
• Get up and take breaks.
• Pay attention to posture. When seated at a desk, your monitor should be at eye level, your arms should be bent at a 90-degree angle, your knees should be bent at 90 degrees and your feet should rest on the floor.
• Many people hunch over when texting because they're trying to see the tiny keyboard. To keep from putting added pressure on your neck and upper back, rest the mobile device on your desk and lean against the chair's backrest.
• Use both thumbs and give your thumbs a break when typing long messages.
• If you experience soreness, stop texting. Anti-inflammatory medications such as Advil or Motrin can also help.

Dr. David Edelstein

Upper Extremity Surgeon

Tel: 718-283-8927

Dr. David M. Edelstein specializes in orthopaedic surgery of the hand and upper extremity and treats arthritis, broken bones, congenital hand problems, tendon injuries, and pain in hands, wrists, or elbows. Having graduated from Albert Einstein College of Medicine, Dr. Edelstein completed his Orthopaedic Surgery Residency at Maimonides Medical Center and his Fellowship in Hand Surgery at the Hospital for Joint Diseases. Because of Dr. Edelstein’s expertise, he was quoted by Forbes and MSN in articles about text messaging.

Simultaneous Cardiac and Hip Surgery

 Simultaneous Cardiac and Hip Surgery at Maimonides Medical Center

Patients with cardiac disease have double the risk of developing hip fracture and hip fractures often occur in patients that have symptomatic heart disease. These patients often need cardiac surgery before their hip fracture can be addressed. This requires patients to have two major operations in one hospital stay. Since it is imperative that patients undergo hip surgery as quickly as possible in order to decrease complications, having to  undergo cardiac surgery first can increase complication rates. There is a theoretical benefit of combining both cardiac and hip fracture procedures. This can decrease exposure to anesthesia, decrease the hospital stay and decrease the time of patient immobilization. The prospect however of doing both surgeries simultaneously is daunting for patients and surgeons as well.

At Maimonides Medical Center patients identified with needing both surgeries have been having them simultaneously with excellent results. A total of eight patients in the last several years have gone through this procedure combining the cardiac and hip surgery during the same operation. The results have been excellent with no increased complications seen in this group of patients and no extended hospital stays were needed. These results have been presented at several National Orthopedic Meetings. Maimonides Medical Center continues to stay on the cutting edge of both cardiac and orthopedic surgery providing even the most complex of patients with exceptional state-of-the-art care.

Dr. Jack Choueka Chair of Orthopaedic Surgery at Maimonides Medical Center.