Carpal Tunnel Release

Now that is a hand I would NOT like to do a carpal tunnel release on in the operating room. Instead of having to stand on to step stools like I typically do when operating, I would need a full-fledged extension ladder.

Carpal tunnel syndrome is a condition where the retinaculum, which is a structure that lies over your median nerve, gets inflamed and thickened. When this occurs the inflamed retinaculum can push on the median nerve which irritates it. This causes pain, numbness and tingling involving your thumb, index finger and middle finger. Pain can shoot up to your elbow with carpal tunnel syndrome.
The treatment starts with physical therapy, wearing a night brace, taking B vitamins and sometimes a cortisone injection. Diagnostic imaging includes a plain x-ray and an EMG/nerve conduction study.
If this treatment fails surgery is an option.

Can a Torn Meniscus be Repaired?

Yes, but not often, only less than 5% of the time. Why?

The meniscus is divided up into three zones. Two of the three zones have a very poor blood supply. Blood is needed to aid in a repair. Sutures can be placed to hold the torn meniscus together, but if there is no blood supply the meniscus will not heal.

Most meniscus tears occur in the area where there is poor blood supply. Therefore repairing the meniscus is not an option, only removing the torn portion is the treatment. The majority of people when they have their knee scoped are NOT getting a meniscal repair they are undergoing a partial menisectomy.

Those that can get their meniscal tear repaired usually have tears that occur at the same time an ACL injury occurs. The meniscal tear pattern in that injury tends to occur in the region of the meniscus that has a good blood supply.

This image with red circle reveals a tear in the red zone of the meniscus.


The blue arrow in this image indicates the white zone, while the red arrow points to the red zone.


The blue arrow in this next image shows the white zone of the meniscus while the red arrow indicates the red zone.


This shows an ACL tear.

Does Removing a Torn Meniscus Harm the Knee Joint?

The meniscus is a shock absorber in the knee. The part of the meniscus that tears no longer has shock absorber properties.

The torn part of the meniscus causes pain, irritation to the knee and on occasion mechanical symptoms such as catching and locking. By removing the torn part of the meniscus it doesn’t not harm the knee because the torn part of the meniscus was not functioning.

If large portions of the meniscus are torn, that can lead to early onset osteoarthritis because a large portion of the meniscus is missing and therefore a larger portion of the shocker absorber is gone. The knee scope just removes the torn portion of the meniscus removing the pain source.

Below are tools I use to remove the torn portion of the meniscus.

Snowboarder Vs. Skier

The skier lost …

Image on left is a normal pelvis. Image on right with red circle and arrows points to the fracture of the inferior and superior pubic rami.

What is that area in the bone?

What is that area in the bone that is white, where the red arrow is pointing ?

This patient fell and has acute onset pain involving her ankle. She has a bone cyst also known as a aneurysmal bone cyst. She was most likely born with this cyst and never knew it until she had a trauma. We took an x-ray in the office which showed the cyst and then obtained an MRI scan. The arrow is actually pointing to where she broke through the bone where the cyst is located. This does not appear to be malignant. This will heal with immobilization in a cast boot.

Five Signs You Have Torn Your Meniscus

1. Sharp, stabbing pain located in your knee joint.
2. It is easy to localize the pain in the knee and it is consistently in the same place.
3. No pain occurs when resting. Pain occurs with a plant and a twist, lateral motion or flexion of the knee.
4. Slight swelling is present and the knee can feel tight with a slight limit of motion.
5. Clicking, locking of the knee and popping may occur.

Girl Bosses

Attended a great meeting this morning on girl bosses at the Kentucky Derby Museum with my two amazing hard working and motivated #girlbosses! An amazing panel of women: Tonya Abeln, Raeshanda Johnson, Iris Wilbur and Elizabeth McCall.

My favorite quote of the morning was from Raeshanda, “If somebody closes a door, I go back and buy the building.” Tonya is the director of Community Relations at Churchill Downs. Raeshanda owns and runs her own fashion house: All is Fair in Love and Fashion. Iris is the Director of Government Affairs and Public Policy at Louisville Inc. Elizabeth’s an Assistant Master Distiller at Woodford Reserve. Amazing women!!!

Five Ways to Prevent Tennis Elbow as a Tennis Player

1. Purchase a racket that is flexible. Stiff, high power level rackets will transmit the force the ball produces when it strikes the racket up to the elbow area, irritating the common extensor tendon.
2. Use strings that are poly filament. A monofilament string tends to increase the force on the players elbow.
3. Have your tennis pro string your racket about 2 to 3 pounds lower than normal.
4. Over wrap the grip on your racket by one or two layers. A smaller grip encourages and transmits more tension on the common extensor tendon when holding the racket.
5. Take a lesson from your friendly tennis pro. How many times have you watched a major tennis tournament on television or live and saw one of the pro players wearing a tennis elbow band. You don’t. Because they have perfect technique. Hitting the ball late can contribute to tennis elbow.

What to Do if You Have Anterior (front side) Knee Pain When Cycling

1. Raise your seat slightly by half an inch.
2. Lower your gear so you are pushing an easier gear with higher cadence.
3. Focus on using your hamstrings not just your quads.  During your pedal stroke pull back instead of just pushing down.
4. Check your clip-less pedals to make sure they are in a neutral position and not too internally or externally rotated.
5. Consider clip-less pedals that allow for some float. This gives some movement with internal and external rotation.
6. Wear shoes with stiff sole.
7. Consider a bike fit if the above fails. If in Louisville, Kentucky, Curtis Tolson is a certified bike fitter.