Thursday, December 18, 2008

Carpal tunnel treatment NYC


Carpal tunnel treatment NYC
www.drshoshany.com

DEFINITION

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Carpal tunnel syndrome (CTS) is a disorder caused by pressure on the median nerve in the wrist. Numbness and tingling are characteristic symptoms of the disorder.

DESCRIPTION

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The carpal (pronounced CAR-pull) tunnel is an area in the wrist formed by bones and ligaments. It provides a protected passageway for the median nerve. The median nerve is responsible for feelings and movement in the hand, especially the thumb and first three fingers. When pressure is applied to the median nerve, the hand feels as if it has gone to sleep.

Carpal Tunnel Syndrome: Words to Know
Carpal tunnel:A passageway in the wrist, created by bones and ligaments, through which the median nerve passes.
Electromyography:A test used to measure how well a nerve is functioning.
Median nerve:A nerve that runs through the wrist and into the hand, providing feeling and movement to the hand, thumb, and fingers.
Carpal tunnel syndrome is most common among women between the ages of thirty and sixty. The disorder is a major cause of missed workdays because of the pain it causes. In 1995 about $270 million was spent for sick days taken as a result of CTS-related problems.

CAUSES

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The carpal tunnel is a narrow passageway. Any swelling in this area causes pressure on the median nerve. That pressure eventually makes it difficult for a person to use the hand normally. Some conditions that can lead to pressure on the median nerve include pregnancy, obesity (see obesity entry), arthritis (see arthritis entry), diabetes (see diabetes mellitus entry), certain diseases of the thyroid and pituitary glands, and injuries to the arm and wrist.

One of the most common causes of CTS is repetitive motion. Repetitive motion is any activity that a person performs over and over again. Typing, working at a computer keyboard or cash register, playing some kinds of musical instruments, and working at certain types of factory jobs may involve repetitive motion. Repetitive motion forces a person to use the wrist over and over again and can lead to swelling in the carpal tunnel area, subsequent pressure on the media nerve, and thus to CTS.

SYMPTOMS

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Symptoms of carpal tunnel syndrome include numbness, burning, tingling, and a prickly pin-like sensation in the palm of the hand, thumb, and fingers. Some individuals notice a shooting pain that starts in the wrist and goes up into the arm or down into the hand and fingers. CTS can also lead to muscle weakness in the hand. A person may have difficulty opening jars and holding objects. In advanced cases, hand and thumb muscles may actually decrease in size. If left untreated, CTS can result in permanent weakness in the hand and fingers, loss of feeling, and even paralysis of the thumb and fingers.

DIAGNOSIS

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The first step in diagnosing carpal tunnel syndrome is a simple one. The doctor asks the patient to hold his or her hand in position with the wrist bent for about a minute. The presence of the symptoms described suggests the presence of CTS. The doctor may also perform other simple tests to measure muscle strength and feeling in the hand and arm. Additional tests may be used to rule out other problems. For example, an X ray can show that a tumor is causing pressure on the median nerve.

The doctor may also order an electromyograph (pronounced e-LEK-tromy-uh-graf) of the affected area. An electromyograph measures the speed with which nerve transmissions move through the median nerve. It indicates the amount of damage that has been done to the nerve.



Illustration of the carpal tunnel, tendons, and median nerve (white line running up the wrist). (© R. Margulies. Reproduced by permission of Custom Medical Stock Photo.)

TREATMENT

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The first step in treating carpal tunnel syndrome is to immobilize the wrist, that is, prevent it from moving. A splint around the wrist is used for this purpose. Some people get relief from CTS by wearing the splint at night. Others may also need to wear the splint during the day.

Certain drugs may be prescribed to reduce pain and swelling. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (pronounced i-byoo-PRO-fuhn), are commonly used for this purpose. In advanced cases of CTS, injections of steroids may be necessary. Steroids also reduce pain and swelling.

In the most serious cases of CTS, surgery may be necessary. The doctor cuts a ligament in the wrist, increasing the size of the carpal tunnel. This procedure results in decreased pressure on the median nerve and, therefore, less pain for the patient. This procedure is almost always done in a doctor's office. A local anesthetic is used to numb the hand and wrist. The patient usually recovers quickly.

PROGNOSIS

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Without proper diagnosis and treatment, carpal tunnel syndrome may lead to permanent damage to the affected hand. In most cases, splints and anti-inflammatory drugs are able to control the symptoms of CTS. For those who require surgery, about 95 percent will get complete relief from the disorder.

PREVENTION

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The goal of CTS prevention is to reduce the amount of repetitive motion that places stress on the wrist. Ergonomics (pronounced ur-ga-NAHM-iks) can be a major help in reaching this goal. Ergonomics works with the design of machines and other equipment to make them less stressful for humans. For example, research in ergonomics has led to the development of new computer keyboard designs that are easier and less stressful to use. The early use of splints can also help prevent people at risk for CTS from developing the condition.

FOR MORE INFORMATION contact Dr. Shoshany (212) 645-8151

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Books
Butler, Sharon J. Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries. Oakland, CA: New Harbinger Publications, 1996.

Crouch, Tammy. Carpal Tunnel Syndrome and Repetitive Stress Injuries: The Comprehensive Guide to Prevention, Treatment and Recovery. Berkeley: North Atlantic Books, 1996.

Pascarelli, Emil. Repetitive Strain Injury: A Computer User's Guide. New York: John Wiley & Sons, 1994.

Periodicals
Brody, Jane E. "Experts on Carpal Tunnel Syndrome Say that Conservative Treatment is the Best First Approach." New York Times (February 28, 1996): p. 89+.

Glazer, Sarah. "Repetitive Stress Injury: A Modern Malady." Washington Post (March 12, 1996): p. WH12.


Carpal Tunnel Syndrome Description
Carpal tunnel syndrome occurs mostly in middle-aged women, who do repetitive extensive hand work (e.g. typing) and mostly in dominant hand. It is also often seen in production and manufacturing workplaces (with repetitive activities such as cutting meat, dressing poultry and assembling automobiles). The condition is also very common among musicians, who play string instruments and piano. During last 10-15 years people can get this problem as a result of extensive computer work (computer manufacturers now use warning labels to alert consumers that keyboard use may increase the risk of CTS). This is second most common (after lower back pain) for both males and females, reason for seeking for medical attention.

The carpal tunnel is a narrow tunnel on the inner surface of the wrist where tendons for flexing muscles of the fingers travel. When a person does repetitive and long (for hours) work with his wrist or fingers, the tendons became inflamed, which causes their swelling and compression of the median nerve. The same symptoms may occur after wrist trauma (e.g. Colles fracture – fall on extended wrist) or when one of the wrist bones is displaced and the median nerve is compressed.

Carpal Tunnel Syndrome Symptoms
People usually complain about numbness, tingling or pain in their hands along the median nerve distribution. The symptoms mostly occur at night and aggravate with repetitive hand motion. Without treatment hand muscles deteriorate and lose their ability to grip. CTS sufferers may become permanently disabled if they ignore the symptoms.

Carpal Tunnel Syndrome Differential Diagnosis
There are several similar to CTS conditions. One of them is De Quervian’s disease. This problem usually seen in people who do repetitive forceful grasp together with ulnar deviation. E.g. wrist in playing tennis (squash) or repetitive use thumb in work-related situations.

Physical therapy is the corner stone in managing carpal tunnel syndrome. The goal is to avoid the surgery, and in most cases we can do this. Physical therapy is combination of manual therapy with special modalities, which provide reduction of swelling and inflammation as well as relieve pain and other symptoms of carpal tunnel syndrome.

1. Manual therapy to the wrist with massage of neck and shoulders
2. Cold Laser Therapy (Erchonia Cold Laser) together with manual therapy.
3. Graston technique of wrist and hand
4. Kinesio-tape of the wrist and arm.
Dr. Steven Shoshany is a Certified Kinesio taping practioner.
www.drshoshany.com

Saturday, December 13, 2008

Physical therapy NYC

Physical therapy NYC-www.drshoshany.com Our Physical therapist has been a fantastic addition to out group practice in NOHO, NYC Chiropractic/Physical therapy/Medical practice . So many patient need the assistance of a Physical therapist to help Rehab them from injuries.
The combination approach of having several Professionals under one roof has been beneficial to our patient outcomes and convenient to patients.
The other day I ad a new Chiropractic patient come in from Paris, and he was shocked that a Medical doctor, Chiropractor, Physical therapist, Massage therapist and a Acupuncturist all worked together in one office and all agreed with treatment protocols.
He went on to state that in Paris the Acupuncturist and Chiropractor disagreed and the Physical therapist disagreed with both of them and that the MD said that just to rest and take pain pills. This is all very confusing to the patient.
When we put Living Well Medical NYC together I envisioned all the doctors working together and discussing patient care and deciding on what would give the patient the best treatment outcomes.

Wednesday, December 10, 2008

Chiropractor NYC-Kinesio taping NYC

Video
Watch video of Dr. Steven Shoshany a NYC Chiropractor discuss the benefits of Kinesio tape in treating injuries like Rotator Cuff injuries.
CKTP- Certified Kinesio Tape Practioner visit the Kinesio taping website at www.kinesiotaping.com

Tuesday, December 02, 2008

Spinal Decompression In New York City, DRX 9000

www.drshoshany.com
Spinal decompression-What should patients expect with Spinal decompression treatment
I have been using spinal decompression in my NYC Chiropractic Clinic for over 6 years and have treated several hundred patients with spinal decompression. I also wanted to share patient outcomes(names withheld for patient privacy.)
Will every patient experience a positive outcome with spinal decompression and the DRX 9000?
Spinal decompression is a great tool that I utilize in my treatment protocol for patients that have Sciatica, Herniated discs, and spinal stenosis. It is by no means a guaranteed patient outcome. Studies conducted by the Mayo Clinic and a John Hopkins professor report a 75%-88% positive outcome.Visit my website to see those studies at www.drshoshany.com
There is always going to be a group of patients that meet all the criteria and seem to be perfect for treatment and they do not respond. In my years of practice and utilizing spinal decompression I have also seen patients that respond amazingly well to the treatment.
I can think of one recent case:
She came in severely antalgic (lean to one side) on disability from work and having to have her sister bathe her in the tub because she couldn't stand for more than 5 minutes without shooting pain down her leg. She brought in her recent MRI, a nerve test that confirmed nerve involvement. She already had three epidural injections,(they will not do more after 3 usually) and was told she needed a microdisectomy.
She is only 39!Surgery was not an option.
I accepted her case and made it clear that this is not a guaranteed success and she told me the surgeon said the same thing.It was both a financial commitment and time commitment. She improved so much that now she is back to work, no longer taking bathes with her sister and recently joined a kickboxing class. She was diligent with her treatment protocol that involved spinal decompression, SOT blocking,Physical therapy on the SpineForce, Custom made corrective orthotics and home exercise.
I really feel that a patient must involve themselves after the treatment is complete and become aware of the core muscles(not just the abdominal's.) This refers to the muscles that run up the back and strech down the butt and front and inner thighs.This group of muscles is where much of the body's strength comes from,you use it to kick a ball, lift a heavy box, and even stand up straight.
She is the perfect example of a positve outcome. This treatmet was non-invasive and produced excellent pain relief when nothing else was working.

When should I know treatment on spinal decompression is working?

The treatment protocol that has been shown to be the most effective calls for approximatly 20 visits over a 6 week period.
I have seen patients respond by the fifth visit and I have also had patients that completed treatment and really didn't feel results until weeks after the decompression sessions have stopped.
This reminds me of the first patient that I had that started on the DRX 9000.
He is a well nourished male with foot drop on his right foot and calf pain.
He had a MRI that confirmed presence of a disc herniation on his L5- S1 disc putting pressure on his nerve root and a NCV confirming nerve involvement.
He was diligent with his appointments and showed little progress throughout treatment. I was confused as to why he was not responding but we both where determined to make this treatment work.
He finished all his vists and still not much improvement expect a "looser back" he still had a foot drop and calf pain.Three weeks later I get a call and he was elated that all his symptoms have disappeared several weeks after we completed treatment.
I was relieved that he was better, and ordered a post MRI but instructed him to wait at least 3 months( blood supply to the disc is slow) and it showed a significant decrease in disc herniation size and a increase in canal height and increase in disc height! The point I am trying to make is that some patients respond quickly, some don't respond until after treatment is complete and some do not respond at all.

Another recent example is a young girl that tried Physical therapy, Epidurals, Chiropractic, Acupuncture and Vicodin, Cortisone.. basically everything expect surgery.
This was her last resort,
Today was her 20 visit, She went from being a overly medicated unhappy 34 year old women to a functional person that has returned to her normal activities without pain.
www.drshoshany.com

I wanted to post a clinical study below that was done on DRX 9000

Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Safety/Efficacy Study

Official Title: Pilot Study to Evaluate The Effectiveness And Safety Of Axiom Worldwide Drx9000™ Spinal Decompression System For Treatment of Low Back Pain


Further study details as provided by NEMA Research, Inc.:


Study Start Date: December 2006
Study Completion Date: April 2007
Primary Completion Date: April 2007 (Final data collection date for primary outcome measure)


Eligibility
Ages Eligible for Study: 18 Years and older
Genders Eligible for Study: Both
Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

Male or female, greater than 18 years of age
Able to understand possible risks and benefits and provide written informed consent (ICF) to the IRB approved clinical multimodal protocol
LBP with an intensity level of greater than 4 on an eleven point numerical pain rating scale (VRS) of 0-10 (with 0 - no pain and 10 - worst possible pain)
Completed the necessary diagnostic and medical history evaluations as described in the protocol to confirm the patient's diagnosis and eligibility for the study and DRX9000 treatment protocol.
Willing and able to complete a six week 20 session of DRX9000 outpatient treatments and a minimum of 6 months follow-up
Exclusion Criteria:

Pregnancy
Evidence of neurological motor deficits on clinical examination
Evidence of spinal cord compression, metastatic cancer, tumor, hematoma, infection or compression fracture
Evidence of severe central stenosis with neurological deficits or nerve root entrapment
Litigation for health-related claim (in process or pending), Worker's Compensation, or Personal Injury
Previous spine fusion surgery, insertion of hardware or artificial disc
Hemiplegia or paraplegia
History of severe cardiovascular or metabolic disease, or abdominal aortic aneurysm
Unwillingness to postpone other types of therapy for LBP during the 6 week treatment sessions
Known alcohol abuse or drug abuse
Height less than 4 feet 10 inches (147 cm) or greater than 6 feet 8 inches (203 cm)
Body weight greater than 300 pounds (136 kg)
Contacts and Locations


Please refer to this study by its ClinicalTrials.gov identifier: NCT00414596

Locations


United States, California
Vibrance Medical Group
Beverly Hills, California, United States, 90212

United States, Florida
Active Health and Wellness Center
Tampa, Florida, United States, 33614
Naples Anesthesia and Pain Associates
Naples, Florida, United States, 34108


Sponsors and Collaborators


NEMA Research, Inc.


Investigators


Principal Investigator: John Leslie, MD Mayo Clinic Arizona

Study Director: Charlotte Richmond, PhD NEMA Research, Inc.

Study Chair: Joseph V Pergolizzi, MD Naples Anesthesia and Pain Associates

More Information


click here for more information about the DRX9000

Nema Research website


Study ID Numbers: P-AXW01
First Received: December 19, 2006
Last Updated: February 14, 2008
ClinicalTrials.gov Identifier: NCT00414596
Health Authority: United States: Institutional Review Board


Study placed in the following topic categories:
Signs and Symptoms
Neurologic Manifestations
Low Back Pain
Pain
Back Pain




Additional relevant MeSH terms:
Nervous System Diseases



ClinicalTrials.gov processed this record on December 02, 2008
Another study underway
To administer the MSDR® (Musculoskeletal Disorder Reporting) instrument to document the musculoskeletal profile of patients with chronic low back pain, a prospective, non-randomized, multicenter treatment trial



Condition Intervention
Chronic Low Back Pain
Other: MSDR



MedlinePlus related topics: Back Pain

U.S. FDA Resources

Study Type: Interventional
Study Design: Screening, Randomized, Open Label, Parallel Assignment

Official Title: This is a Study is for the Purpose of Quantifying Function of the Back and Lower Extremities, and to Assess the Inter-Regional Biomechanical Relationships of the Neck, Upper Extremities, Back, and Lower Extremities in Patients Suffering From Chronic Low Back Pain.


Further study details as provided by MedAppraise, Inc.:


Primary Outcome Measures:
To document the musculoskeletal profile of patients with low back pain [ Time Frame: 1 year ] [ Designated as safety issue: No ]



Secondary Outcome Measures:
To determine if a particular lower back diagnosis or MSDR® score can predict which patients will respond particularly well to the DRX9000™ treatment protocol and spinal manipulative therapy. [ Time Frame: 1 year ] [ Designated as safety issue: No ]


Estimated Enrollment: 200
Study Start Date: August 2008
Estimated Study Completion Date: January 2010
Estimated Primary Completion Date: August 2009 (Final data collection date for primary outcome measure)


Intervention Details:
Other: MSDR
The MSDR® questionnaire establishes an individual's musculoskeletal functional status using information gathered from 1) a questionnaire the patient fills out regarding medical history, chronic medical conditions, and health risk factors; 2) anatomic pain survey completed by the patient; and 3) evaluation by a trained researcher of various patient biometric parameters related to range of motion. Stratifying an individual into a risk category with this evidence-based assessment tool then permits an assessment of which patients respond long term to therapy.

MSDR® demonstrates the ability to benchmark specific musculoskeletal findings (both clinical and sub-clinical) to ICD-9 Diagnoses supported by diagnostic, radiographic and/or MRI findings where clinically indicated.

Eligibility
Ages Eligible for Study: 18 Years to 65 Years
Genders Eligible for Study: Both
Accepts Healthy Volunteers: Yes

Criteria

Inclusion Criteria:

Must have Informed Consent Signed
Lumbar Disc Herniations under 5mm without Sequestered Fragments
Lumbar Disc Bulging
Lumbar Degenerative Disc Disease (mild and moderate severity)
Non-pregnant Females and Males suffering from Chronic Low Back Pain from 18 to 65 years of age
Segmental Dysfunction Secondary to Dyskinesia
Unresolved Nerve Entrapment Syndrome
Patients must be able to comply with study protocol
Joint Fixation Syndrome
Premenopausal Female Patients, excluding patients who have undergone a hysterectomy, oophorectomy, or tubal ligation, must have one of the following methods of contraception and must have a negative serum or urine b-HCG pregnancy test performed within 48 hours before initiating protocol specified treatment.
Exclusion Criteria:

Contraindications to Spinal Manipulative Therapy
Lumbar Canal Stenosis resulting in significant neurological comprimise
Any Spinal Cord Compression resulting in significant neurological comprimise
Cauda Equina Syndrome
Infection
Osteomyelitis

->65 years of age

History of Back or Neck Surgery
Acute Arthritis
Signs or Symptoms of Arterial Aneurysm
History of Active Cancer with Bone Metastasis
Widespread Staphyloccal and/or Strepococcal Infection
Acute Gout
Serious unstable medical illness such as cardiovascular, renal, respiratory, endocrine, gastrointestinal, or psychiatric.
Unstable Spondylosis, Spondylolisthesis, or Spondylolysis
Prior adverse experience with Spinal Manipulation Therapy
Uncontrolled Diabetic Neuropathy
Gonorreal Spinal Arthritis
Tuberculosis to the Bone
Maligancy with Metatasis to Bone
Excessive Spinal Osteoporosis
Osteomalacia
Ankylosis
Syphlitic Articular or Peri-Articular Lesions
Active Low Back Injury Resulting from a Motor Vehicle Accident or Work Related Injury
Contacts and Locations


Please refer to this study by its ClinicalTrials.gov identifier: NCT00732394

Contacts


Contact: Eric K Groteke, DC 727-797-0500 egroteke@medappraise.com

Contact: Damon J Stafford, DC 727-797-0500 drdamon7@aol.com


Locations


United States, Florida
Back2Life of Florida, Inc. Recruiting
Clearwater, Florida, United States, 33761
Contact: Tammy Cravotta 727-797-0500
Contact: Matt Erickson, DC 727-797-0500


Sponsors and Collaborators


MedAppraise, Inc.


Investigators


Study Chair: Eric K Groteke, DC MedAppraise, Inc.

Principal Investigator: Luis Crespo, MD Crespo and Associates

Study Director: Mark Scinico, MD Concentra

Principal Investigator: Damon J Stafford, DC Back2Life of Florida, Inc.

More Information


MSDR


Responsible Party: Back2Life of Florida, Inc. ( Damon J. Stafford, D.C. )
Study ID Numbers: TCT06-002
First Received: August 8, 2008
Last Updated: August 8, 2008
ClinicalTrials.gov Identifier: NCT00732394
Health Authority: United States: Institutional Review Board


Study placed in the following topic categories:
Signs and Symptoms
Neurologic Manifestations
Low Back Pain
Pain
Back Pain