Introducing Parag Sheth

Introducing Parag Sheth – Mount Sinai’s Carpal Syndrome Tunnel Expert

This month, with our continued aim of ensuring our patients know and trust our physicians, Mount Sinai presents to you our long-standing Assistant Professor of rehabilitation medicine, Dr Parag Sheth. Dr Sheth holds a certification in Physical Medicine and Rehabilitation; his specialisation lies in Carpal Tunnel Syndrome (CTS).

Dr Sheth’s expertise is grounded in his rich and varied academic career. Beginning his studies receiving honors at Johns Hopkins University, Dr Sheth moved on to study at Stony Brook School of Medicine, and subsequently held the position of Chief Resident at St. Vincent’s Medical Center’s Rehabilitation Residency Program. Dr Sheth is now a fellow of The Mayo Clinic, where he specialised in Musculoskeletal Rehabilitation; and he has been with us at Mount Sinai for over 20 years. During his time practicing with us, Dr Sheth has always gone beyond the call-of-duty to ensure patient satisfaction.

CTS, Dr Sheth’s specialization, manifest itself as a tingling, numbness and sometimes pain in the hand and fingers. This is caused by a compression of the median nerve, which controls sensation and movement in the hand. It can sometimes be hard to identify as the symptoms are common and often go unchecked. Dr Sheth is renowned for his ability to exercise expert judgement on patient’s symptoms, but always communicates in way understandable to the patient; we believe this to be paramount to a patient’s happiness. Dr Sheth has often been praised for his ability to listen carefully, and explain the process of treatment and aftercare in a concise and easy to follow way; this has made him a patient favorite. 

His clinical focus also extends to: back pain, electrodiagnostic testing, epidural steroid injections, herniated disk, knee pain, low back pain, shoulder pain, neck pain, and spine stimulation.

Outside of his professional career with us, Dr Sheth also teaches a yearly cadaveric dissection and weekly musculoskeletal lectures where he has been awarded the Avital Fast Award and the Department Teacher of the Year award. His research has been published in Nature, Lancet, and The American Journal of Sports Medicine. 

Dr Sheth is “Board Certified” and accepts insurance plans. For more details on appointment availabilities and plan coverages, please contact our call center at: (212) 241-6321.

What Causes Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is the compression – and sometimes squashing – of the median nerve that passes through the wrist. Its symptoms can include numbness, tingling and pain in the thumbs, fingers and wrists, which can travel as far as to the arms and even to the shoulder. Modern medicine has a firm grip on what CTS is; what causes it is quite a different story.

Diagnosing CTS can be done through a relatively simple physical examination. One test is called the ‘flick signal’, for which the patient is asked, ‘what do you do when your symptoms are worse?’ If the patient responds with a hand movement that resembles the shaking of a thermometer, there is good reason to suspect CTS. There are plenty of other tests such as Phalen’s Test and Tinel’s Sign – yet, despite the relative wealth of ways to diagnose CTS, there actually isn’t any kind of test to identify the precise cause CTS, and – except for patients suffering from underlying diseases – the biological mechanisms that create this inflammatory disorder remain unknown. 

It is a common story that CTS is caused through repetitive and often high-stress tasks that involve the wrists and hands – typing, using a computer mouse, manual labour to even playing the piano. While the correlation between CTS and tasks of this nature is undoubted, there is minimal evidence to suggest any clear causality.

In fact, most studies today indicate that CTS’ causes go above and beyond mere so-called ‘workplace factors’ and that they are rather linked to ailments that cause swelling in the wrist (osteoarthritis and rheumatoid arthritis) and others that obstruct blood flow (hypothyroidism and diabetes). We also see CTS pop up in clusters within a family, which suggests that something genetic is at play. Lifestyle also appears to play a significant factor, as those who smoke, drink alcohol excessively, consume excessive salt and who are obese all show increased risk of developing CTS. Women are also three times more likely to develop CTS than men, particularly after childbirth and during menopause.

Despite the range of medical, physical, genetic and life-style related items that are linked to an increased risk in developing CTS, their relationship is that of a correlation and not one of cause and effect. A modicum of clarity might be achieved, however, by overlapping both ends of the spectrum – the ‘workplace effect’ with medical/genetic/lifestyle factors. When somebody is susceptible to CTS – whether it be through genetics, a medical condition or an unhealthy or stressful lifestyle – and they also subject their hands and wrist to frequent, repetitive task, the likelihood of suffering from CTS will be at its greatest.

If you believe you are at risk of developing CTS, we would like to encourage you to seek medical advice on how to prevent it; if you believe you might already be suffering from it, we suggest you speak to one of our specialists for a suitable treatment. The earlier CTS is treated, the more likely – and easier – a full recovery will become.

Neuroplasticity – The Brain's Repairing Mechanism

 Injuries to the head can result in long term damage to areas of the brain, varying depending on where on the head the injury was sustained. While a variety of therapeutic services can be employed to regain a certain level of functionality the brain also has a unique response to regional damage – neuroplasticity.

Neuroplasticity is the brain's ability to reorganize itself through lifetime creation of new neuron pathways. From birth developmental plasticity begins, as neuron branches and synapses form to process new sensory information. At the age of two or three, a child's brain has around 15,000 synapses per neuron. This is around twice as many as in the adult brain as neurons strengthen, weaken, and are eliminated with age. While this process slows down, the brain retains the ability to grow new neurons throughout life in response to new stimuli. One such circumstance under which the brain may begin to regenerate in this way is when a certain area of it is damaged.

Known as functional plasticity, in response to an area of the brain loosing functionality, often the surrounding healthy areas will take over those processes, restoring former abilities. Neurons which remain undamaged will grow new nerve endings to create new connections where the original links were broken due to injury. As well as restoring connections, undamaged neuron axons can create entirely new pathways, developing nerve endings that connect with other undamaged neurons, to carry out necessary functions. Especially in children, when damage is sustained in one hemisphere of the brain, the corresponding area in the other half of the brain may take on functions traditionally performed in the initial hemisphere.

One example of when natural adult neurogenesis (formation of new neuron endings) can occur is following a stroke. Strokes are caused either when a blood clot prevents sufficient oxygen flow to the brain or when a blood vessel bursts leading to internal bleeding in the head. If left untreated, a stroke can cause certain areas of the brain to cease to function. Strokes can cause long-lasting physical and psychological problems, however, the brain may attempt to compensate for permanent localized damage by re-routing function pathways.

Head injuries can cause debilitating damage that leave the patient with reduced functionality. Therapeutic rehabilitation, such as physiotherapy, occupational therapy, and speech therapy can go some way to recovering a patient's abilities, however, the body's natural propensity to repair itself, many also contribute to patient recovery following a localized head injury.