SIMEDHealth

Everything You Need to Know About Carpal Tunnel Syndrome

As temperatures drop this season, you may begin to feel more pain or swelling in your muscles and joints. And if you're like the 86% of American's who work at a desk all day, you might feel the symptoms of carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is considered one of the most common diagnoses in patients that present with hand pain and numbness. Simply stated, it is a condition where one of the main nerves of the hand, the median nerve, is compressed at the carpal tunnel causing symptoms typically seen in carpal tunnel syndrome. Multiple tendons that originate from the forearm that help bend your fingers and wrist and the median nerve pass through the carpal tunnel. The tunnel is composed of the carpal bones (bones of the wrist) and the transverse carpal ligament that forms a band across the base of the palm and wrist. Any condition that results in compression of the median nerve at this location is classified as Carpal Tunnel Syndrome. (see diagram)

The median nerve provides feeling and movement to the "thumb side" of the hand (the palm, thumb, index finger, middle finger, and thumb side of the ring finger).

Symptoms: 

Symptoms of Carpal Tunnel usual start gradually. This includes: pain, tingling, burning and/or numbness in the hand and fingers.  The numbness and tingling is usually first noted in the thumb, index and middle finger. It tends to spare the 5th digit (little finger). You may encounter cramping of the hand and fingers.

Patients often complain of awakening at night with the hand asleep or hand falling asleep when driving or doing a prolonged activity. Patients sometimes mention clumsiness of the hand and dropping things easily. These symptoms may also refer up the forearm and, if severe enough, to the shoulder area. If left untreated, in advanced or chronic cases, it may progress to develop weakness of the hand grip with muscle wasting (loss) under the thumb in the area known as the thenar eminence.

Causes and Risks:

Any condition that results in narrowing of the space inside the carpal tunnel compressing or irritating the median nerve can cause CTS. The most common risks include repetitive activity or trauma; repeated pressure at the wrist like resting the wrist on edge of a keyboard, overuse of the hand with prolonged typing, working in manufacturing line, using power tools that vibrate and cause injuries to the wrist and hand area. 

Additional causes include swelling of the tendons, (known as tenosynovitis), rheumatoid arthritis which causes swelling of local tissue and joints; swelling during pregnancy, (usually during second and third trimester), infections and other space occupying lesions like a ganglion cyst. Women are at higher risk to develop CTS than men and sometimes there is no identifiable cause.

Testing for Carpal Tunnel Syndrome:

The first step in properly diagnosing this condition is a taking a thorough history by your physician followed by a physical exam looking at the different possible conditions that could cause your 

symptoms. This is then followed by an electrodiagnostic study (shown on the right), also known as Nerve Conduction Study and Electromyography (NCS/EMG). There are many conditions that can mimic CTS, so the electrodiagnostic study is essential.

Inform yourself of who is performing your study. Electrodiagnostic studies should be conducted by physicians specialized in physiatry or neurology. If the NCS tests component is performed by a qualified technician, this should be performed in direct supervision of a trained physician in the field of electrodiagnostic medicine, and the EMG should only be performed by the trained physician. Unfortunately, unqualified physicians and non-physicians perform these tests and this may result in erroneous diagnosis which may result in unnecessary discomfort and improper treatment.

Treatment:

Usually begins with the avoidance of the activity causing the problem, such as stopping repetitive motion, and using proper ergonomics in the work station. The use of a wrist splint at night and anti-inflammatory drugs are commonly prescribed in order to relieve pain and swelling. Your physician may order Occupational Therapy (OT). More aggressive intervention would consist of corticosteroid injection in the wrist. If symptoms do not resolve with conservative intervention then your physician may recommend carpal tunnel release surgery. 

Because of the many conditions that can mimic CTS, surgery should not be performed unless the diagnosis is verified with an electrodiagnostic study. The surgery is commonly performed in an out-patient surgical center with regional anesthesia by an orthopedic surgeon or neurosurgeon. Note that the surgery is performed in order to release the pressure on the median nerve. The surgeon may decide to do an open surgery, making a larger incision in the palm for direct visualization of surgical field, or an endoscopic surgery, using a small endoscope through a small incision in your wrist or hand. Although carpal tunnel release surgery, in patients with mild to moderate conditions, tend to have a good outcome, it may take several months for the strength and numbness to resolve. In some cases where the condition is severe or not properly diagnosed the condition may not resolve.

If CTS is ignored or not properly treated, it may result in permanent pain, numbness, weakness and impairment. Surgical risks include but are not limited to: no improvement, increase pain due to injury of nerve or vascular structure, bleeding, infection, and scar sensitivity.

The information and recommendations appearing on this article are appropriate in most instances, but are not substitutes for proper medical evaluation and diagnosis.

If you are experience the symptoms of carpal tunnel or need medical advice, click here to request an appointment with one of our physicians, either in our Physical Medicine & Rehabilitation Medicine Division or Neurology Division.

 

This article was written by Dr. Rigoberto Puente-Guzman

 

 

Dr. Ariane Harris Joins SIMEDHealth Rehabilitation Medicine

SIMEDHealth is proud to welcome our newest Physical Medicine & Rehabilitation physician Ariane Harris, MD!

A native of Gainesville, FL, Dr, Harris earned her undergraduate and MD degree from the University of Florida. Dr. Harris completed both her residency in Physical Medicine and Rehabilitation and her Fellowship in Interventional Chronic Pain at the University of Alabama, Birmingham. While there, she served as both chief resident and academic chief resident.

She is currently a member of the American Academy of Physical medicine and Rehabilitation and the Spine Intervention Society. In the future, she hopes to continue researching in the fields of regenerative medicine, ultrasound, botulinum toxin and spinal cord stimulators.

Outside of work, Dr. Harris is an avid equestrian. She is interested in serving her community by participating as a volunteer with equine therapy groups.

Dr. Harris is available to diagnose and treat patients with a wide variety of chronic pain issues. These including those with impaired functional mobility, amputations and performing interventional pain procedures for her patients.

 

Click here to request your appointment with Dr. Harris, or call SIMEDHealth Rehabilitation Medicine at (352) 373-4321.

The Migraine Treatment You Could Be Missing

38 million people in the U.S. suffer from migraines, according to Migraine.com. Of those 38 million, 11 million people say their disability is due to migraines.

June is Migraine and Headache Awareness month. With so many people suffering from migraines, it seems that we’re pretty aware of the problem. However, according to Dr. Gabriel Paulian of SIMEDHealth’s Rehabilitation Medicine, not all headaches and migraines are the same.

First, it’s important to know that a headache is defined as continuous pain, tension, or throbbing in the head and neck area. This can be caused by any number of problems such as dehydration, substance withdrawal, and side effects of another condition. A migraine is normally experienced as a headache but includes additional symptoms such as sensitivity to light and sound, nausea, blurred vision, vomiting, and more.  However, sometimes migraine symptoms can occur without a headache. A migraine can last from a few hours to a few days.

“Migraines manifest differently in every patient. There are multiple types of headaches and migraines as well,” Dr. Paulian said.

In fact, there are about 17 different kinds of headaches and about 24 types of migraines.  

“This is the reason why treatment is different for every patient,” Dr. Paulian said. “Getting a clear diagnosis is the key to guiding pain management.”

There are a number of different treatment methods for headaches and migraines that most commonly involve medications. However, if your migraines are the side effect of another condition, further medication may not be right for you. This is why Dr. Paulian recommends a lesser-known treatment for migraines, acupuncture.

Acupuncture is the process of inserting very small needles in specific locations of the body to release endorphins, the body’s natural painkillers. This process is also used to increase blood flow and stimulate nerves and tissue.

“Acupuncture for migraines is effective and one of the safest treatment options. There are no side effects, unlike other medications. The process at SIMEDHealth’s Rehabilitation Medicine clinic only lasts about 5 minutes and the pain relief is usually a few weeks,” Dr. Paulian said.

Acupuncture can also be used to treat other areas of the body experiencing pain such as the lower pain, neck, knees and other joints. 

If left untreated, headaches and migraines can affect your overall mood, sleep patterns, and stress levels. These symptoms may lead to additional physiological problems in the future as well. For complex headaches and migraines, Dr. Paulian also recommends a referral to a SIMEDHealth neurologist to find the right treatment plan. 

“If you say you are having bad headaches, you should see someone in our clinic right away,” Dr. Paulian said.

Click here to learn more about SIMEDHealth Rehabilitation Medicine or click here to request an appointment. 

Dr. Vance Elshire Featured in Local Magazine

Photo by Jimmy Ho Photography

Photo by Jimmy Ho Photography

If you flip through this month's edition of Wellness 360, a North Central Florida magazine focused on complete wellness, you may come across a familiar face. 

The Spotlight 360 section, titled "On the Quest for Adventure," features Dr. Vance Elshire of SIMEDHealth's Interventional Pain Management. Here he talks about his recent completion of the 2018 Everglades Challenge and how to live a consistently-healthy lifestyle while working and caring for a family. 

All of us at SIMEDHealth are proud of Dr. Elshire's accomplishments and excited to see where his next quest for adventure takes him.

You can read the shorter version of this article here. To view the full article and additional photos, pick up a copy of this free magazine in and around the University of Florida campus, at local retailers and at a SIMEDHealth location near you. 

 

 

8 Tips to Avoid Heat Exhaustion and Heat Stroke

The summer sun can be intense in Florida, especially in Alachua County, Lake County and Marion County, and every year people are seen by Southeastern Integrated Medical (SIMED) physicians for heat-related symptoms.

Dr. Quang “Wayne” Nguyen, a practicing Physical Medicine and Rehabilitation and Interventional Pain Management physician at SIMED, said heat exhaustion and heat stroke are especially common in Florida during June, July and August.

“If people aren’t careful in the sun, it can be dangerous,” Dr. Nguyen said. “It’s not just high school football players who can get heat stroke. People should be especially careful with seniors and toddlers as their ability to regulate their body temperature is impaired.”


Heat Exhaustion vs. Heat Stroke

Heat exhaustion symptoms include dizziness, heavy sweating, fatigue, faster than usual heart rate or breathing rate, nausea, headache and vomiting. Heat exhaustion can eventually lead to heat stroke. The symptoms of heat stroke include a fever of at least 103 degrees, red hot dry skin, absence of sweating, throbbing headaches, confusion or changes in behavior.


Follow Dr. Nguyen’s top summer health tips to stay safe in the heat and prevent heat stroke and heat exhaustion:

8 tips to avoid heat stroke and heat exhaustion infographic

1. Wear sunscreen.

You should wear sunscreen that’s at least SPF 30, Dr. Nguyen said.

“When you block out the UV rays, it’s not just going to affect your tanning,” Dr. Nguyen said. “It actually decreases the amount of energy from the sun that goes into your skin.”

2. Wear the appropriate clothing.

“Wear light colored, lose fitting clothes. Make sure to wear a hat and cover yourself,” Dr. Nguyen said. “Clothing with SPF ratings are ideal.”

3. Drink a lot of water daily.

“That’s really key,” Dr. Nguyen said. “Make sure to drink a lot of cool water.”

4. Drink at least 24 ounces of fluid in the two hours prior to outdoor activities or exercise.

“You have to pre-hydrate so once you’re out in the heat losing fluid, you’re ahead of the ball,” Dr. Nguyen said.

5. Stay hydrated while you exercise.

“Drink at least 6 - 8 ounces of fluid every 20 minutes while exercising,” Dr. Nguyen said.

When Dr. Nguyen rides his bike, every five miles he drinks from his water bottle.

“The key to preventing heat stroke is you never want to get thirsty,” he said. “You want to drink before you’re thirsty.”

6. Schedule Your Outdoor Activities During Non-Peak Times.

Dr. Nguyen recommends you avoid spending time outside between 11 a.m. and 4 p.m. From 6:30 a.m. to 10:00 a.m. is the best time to do outdoor sporting activities or host outdoor events.

“Once it hits 11:00 a.m. in Florida, it’s all downhill when it’s the middle of the summer,” Dr. Nguyen said.

7. Make sure your urine is light colored.

“If your urine gets dark, that’s a sign you’re dehydrated so be sure to drink enough fluid that its light colored,” Dr. Nguyen said.

8. Avoid fluids with caffeine or alcohol.

Dr. Nguyen said caffeine and alcohol will only further dehydrate you.


If you follow these tips, you should be able to stay out in the heat all day, Dr. Nguyen said, but if someone shows signs of heat exhaustion, make sure to get them into the air conditioning and drinking fluids. You can also put ice packs on their head, give them cool blankets and have them take a cool shower.

If you start to develop heat stroke symptoms, you should contact an urgent care facility like SIMED’s First Care in Gainesville at 4343 Newberry Road for treatment.

You can reach First Care at 352-373-2340 or walk in without an appointment between 7 a.m. and 6 p.m. Monday through Friday.

Dr. Nguyen sees patients with physical medicine, rehabilitation and interventional pain needs at SIMED’s Ocala and Lady Lake campuses. For an appointment in Ocala, call 352-732-3110, or in Lady Lake, call 352-732-0028 or request an appointment through SIMEDHealth.com.

 

What is a Physiatrist?

SIMED Rehabilitation Medicine, Physiatry, Physical Medicine, PM&R, Sports Medicine,
SIMED Rehabilitation Medicine practices what is known as Physiatry or Physical Medicine. Physical Medicine is centered around the prevention, diagnosis, treatment, and management of disabling diseases, disorders, and injuries. 

Our Board Certified physicians offer a variety of non-surgical treatment solutions to back pain, joint pain, musculoskeletal injuries and more.
 

 
What Is a Physiatrist? 

A physiatrist is a medical or osteopathic physician specialist who focuses on medical conditions that can interfere with function, specializing in the field of physical medicine and rehabilitation (PM&R). Their focus is on diagnosing, treating, preventing and mitigating the effects of illnesses that can cause disability. Their goal is to restore a patent’s function and their reintegration into all aspects of life, including the medical, social, emotional, occupational and vocational aspects. Their mission is to promote a person's quality of life and improve functional outcomes for individuals limited by disease, trauma, congenital disorders or pain.

What Do Physiatrists Treat?

This specialty cares for patients of all ages with acute and chronic conditions. Common conditions that are treated include:

  • sport injuries
  • work injuries
  • personal injuries
  • pain
  • musculoskeletal problems like back and neck pain
  • tendinitis
  • pinched nerves
  • osteoarthritis and fibromyalgia
They also treat people who have experienced catastrophic events resulting in:
  • paraplegia
  • quadriplegia
  • traumatic brain injury
  • strokes
  • orthopedic injuries
  • amputations
  • cardiopulmonary debility
Neurologic disorders such as:
  • multiple sclerosis
  • polio
  • ALS
They also perform diagnostic studies (electrodiagnosis) to determine conditions that result in body, head and extremity weakness, pain and numbness. They diagnose and treat conditions resulting in pain and functional impairment, using a multidisciplinary team approach. Although this list is not complete, one can see that physiatrists offer comprehensive care for people with diverse medical conditions. 

What Is The Training For a Physiatrist?

Typically the physiatrist will work with both inpatient and/or outpatient setting, in a holistic, comprehensive, team-oriented approach. To become a physiatrist a physician must complete medical or osteopathic school (4 years) and then attend an internship (1 year) of internal medicine, surgery or equivalent. Then they complete the PM&R residency (3 years). Some will further sub-specialize in spinal cord injury medicine, sports medicine, pain medicine, electro-diagnostic medicine, neuromuscular medicine, traumatic brain injury and pediatrics adding 1 to 3 more years to their training.
 

For more information please visit us at SIMED Rehabilitation Medicine or request an appointment online.