The sometimes development of arthritis at the base of the thumb – the 1st carpometacarpal or 1st CM joint near the wrist – is the price humans pay for having a thumb that can be apposed to other fingers. The base of the first metacarpal bone rotates with respect to the wrist bones to allow this apposition. However this is not a fully developed joint, lacks durability, and overuse of the hand by any repetitive manual tasks (carpentry, golf, guitar, frequent texting etc) can cause painful arthritis of this joint. While we have good success treating arthritis of this joint with PRP (platelet rich plasma) most patients can be treated by a simple activity modification regimen based on the so-called “simian grip.”. This refers to the fact that other primates either have smaller thumbs which they use much less often than humans or in the case of some, like the spider monkey, do not have a functional thumb at all. Instead of wrapping their thumb around objects they grip, they use only their four fingers to encircle objects. This mode of use works well for almost all activities in humans as well. In patients with mild to moderate thumb (1st CM) arthritis, in most cases the discomfort will go away completely or at least substantially such that no other treatment is needed by employing this simian grip method. It is important also though to discontinue use of any pain killers or anti-inflammatory medicines because they mask pain and can also interfere with healing.
Health Care News
Hot mineral baths have been used for millennia to treat arthritis, injury and the skin. The Roman baths were well known in antiquity and healing baths have been used worldwide in Asia, Europe and North and South America as well. Now an elegant scientific study published in a peer-reviewed medical journal has shown that they really work. Here is a link to the study which was done in Budapest Hungary. The picture below is of baths in Budapest. The study showed that after 15 baths 80% patients had substantial relief that listed for 3 months, whereas in the control group only 30% of patients did well. Their outcomes included multiple indices of improvement including pain and stiffness.
PRESERVING THE BICEPS TENDON WHEN REPAIRING THE ROTATOR CUFF SHOWS BETTER RESULTS THAN CUTTING THE BICEPS TENDON
As the above picture shows the long head of the biceps tendon attaches directly into the shoulder joint. The rotator cuff tendons are located very nearby. While it is controversial, many surgeons will cut the biceps tendon if it has damage and then implant it into the top of the humerus or arm bone: a procedure called biceps tenodesis. The rationale is that cutting the biceps eliminates a potential pain generator after surgery. But now a new study shows that there may be a price to be paid in some by doing so.
UNIVERSITY OF VIRGINIA RESEARCHERS FOUND THAT PRIOR ANTIBIOTIC USE IMPAIRED SUBSEQUENT IMMUNE CELL FUNCTION IN CHILDREN. They first noticed that amebic colitis, a potentially fatal illness, was more severe in Bangladeshi children who had altered gut bacteria, usually occurring from prior antibiotic use. They then studied the problem in mice and found that antibiotic use impaired the ability of white blood cells to fight infection. The message is to only use antibiotics when they are necessary because their use can actually make subsequent infections worse.
NSAID or Non Steroidal Anti-Inflammatory Drug (EG Motrin, Aleve, Meloxicam) Use Before Rotator Cuff Surgery Increases Failures
Although the general public is generally not aware of it, it is well established in the medical literature that NSAID drugs interfere with healing. For this reason in particular I never use them when I perform reparative surgery where they might compromise the surgical repair. This has been well shown in various animal studies but there have few studies in humans where it has been looked at. However in a new study from Norway the use of NSAIDs before surgery was correlated with a greater chance of failure afterward. This is quite significant in that the drug use did not have to be during the period of healing to impair healing later. The most common drugs in this class are Ibuprofen (motrin, advil), Naproxen (Aleve), and Aspirin over the counter and Diclofenac, Meloxicam and Celebrex by prescription.