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.

Living With Osteoarthritis – Managing the Symptoms

 As we get older the cartilage covering our joints become worn, resulting osteoarthritis. This condition manifests itself in the form of joint pain and stiffness and, while there is no cure for this chronic disease, there are treatments and measures that can be taken to reduce suffering.

It may seem counter-intuitive to reduce joint pain by increasing your movement, however, exercise is proven to be incredibly beneficial in reducing osteoarthritis symptoms. Rather than wearing down the cartilage further, strengthening exercises will alleviate pain, through building up the surrounding muscles, reducing strain put on the joints. Exercises that focus on range of motion are also excellent for improving the condition, as they encourage flexibility of the joints and reduce stiffness. Choose exercises that work the joints but that aren't too strenuous. Taking a brisk walk, or joining a relaxing class such as yoga or tai chi, that gently uses your muscles, will keep your body working to support your bones and joints. For less impact while working out, swimming or water aerobics both engage muscles while avoiding putting force on the joints.

Linked to exercise, maintaining a healthy weight is integral to relieving osteoarthritic symptoms. Excess weight can add additional pressure to weight-bearing joints such as the hips, knees, feet and back bone. Losing this extra weight, and then maintaining a healthy one, will reduce pain and restrict further damage to cartilage. Combined with living an active and healthy lifestyle, medications are available that can reduce symptoms, such as pain and inflammation around the joints, making it more manageable.

Physical, or occupational, therapists can teach osteoarthritis patients the best ways to use, and move, joints to prevent further wear and tear of the cartilage. As well as introducing range of motion and flexibility exercises, thermotherapy treatments may be suggested to mediate symptoms. Cold treatments are effective at numbing pain, decreasing swelling, and blocking nerve impulses to the joints while heat therapy will improve blood circulation and relax muscles, removing tension. Often a combination of the two techniques are used, applying heat in the morning to loosen up joints, followed by cold treatment later in the day to reducing any swelling that builds up.

Although steps can be taken to reduce osteoarthritic suffering, assistive devices may become necessary. These can range from walking aids, such as walking sticks or specially modified shoes, to devices that help in carrying out everyday activities. Kneelers for gardening, extenders for door knobs and taps, and clothing that is easier to fasten are all available so that patients can keep their everyday lives as normal as possible.  

The Long-Term Effects of Sports-Related Head Trauma

 At least 300,000 sports-related head injuries occur in the United States every year. The short-term effects of sports head injuries have long been known. Concussions, as the result of a blow to the head can cause headaches, dizziness, and nausea in the short term. More recently it has been discovered that head injuries can cause problems long after the initial incident.

Post-Concussion Syndrome (PCS)

Around 15% of people who have suffered a single concussion develop persistent, injury-related symptoms. These can last anywhere from a couple of weeks, to a few months, up to a year. While the immediate symptoms of concussion are fairly mild, PCS can manifest itself in the form of noise sensitivity, concentration and memory problems, depression, and anxiety. It is thought that this condition can be exacerbated by pre-existing psychological conditions, being female, and being an older individual. While PCS cannot be treated as a whole, medications can be administered to alleviate certain symptoms, while psychotherapy and neurotherapy can be carried out to improve mental health and brainwave activity.

Chronic Traumatic Encephalopathy (CTE)

Another, more extreme consequence of repeat head injuries is CTE. This syndrome only manifests itself around 8 to 10 years after injury, and is most prevalent in professional athletes in sports such as football, boxing, wrestling, and ice hockey.

Symptoms develop in four stages- the first stage is characterized by a deterioration in attention, increased disorientation, headaches and dizziness. Later this condition develops to cause memory loss, social instability, erratic behaviour, and poor judgement. In the final two stages, patients may suffer from progressive dementia, reduction in muscle activity and control, vertigo, deafness, and, in extreme cases, suicidal tendencies.

The reasons behind why this happens are largely unknown and currently the only method of diagnosis is through post-mortem direct tissue examination. Treatments may include the use of speech and language therapists, and occupational therapists, however, as there is currently no cure, most treatment revolves around supporting the patient, and making him or her comfortable.

There is presently little conclusive research on the prevention of CTE, however, it is thought that immobilizing the head during a blow may prevent the future memory loss and learning difficulties associated with CTE. Of course, the best preventative action is to reduce the risk of head injuries, and to allow time to fully recover following any concussion which, for 85% of cases is up to three weeks.

Tips to keep your brain young and healthy

Changes in our brain functions are a very common consequence of ageing and mental decline may be one of the most feared results of getting old. According to research more than 16 million people in the United States suffer from cognitive impairment, which means they have trouble remembering, focusing or even learning new things.

If you are noticing some of the early symptoms of cognitive impairment such as forgetting appointments and recent events or having trouble making sound decisions here are a few tips to keep your brain healthy and young.

Exercise

Physical exercise can help the brain become more efficient and adaptive to change.  According to Harvard Medical School “research shows that using your muscles may also help your mind. (…) Exercise lowers blood pressure, improves cholesterol levels, fights diabetes, and reduces mental stress, all of which can help your brain as well as your heart.” Exercising 3 times per week is a great way to start.

Eat healthy

A healthy diet can help both your body and mind. Eating foods that are low in saturated fat and keeping your calorie intake balanced will keep your brain younger. Also, vitamins B6, B12 and folic acid, which can be found in cereals and grains have proved to reduce homocysteine levels that are linked to cognitive impairment.

Mental Exercise

Engage in activities that challenge and stimulate your brain. Try solving math problems or crosswords, painting, or learning a new craft or language.

Socialize 

By having friends and going out, you are open to new experiences and challenges. They are also a great motivation when it comes to getting involved in several activities.

Avoid tobacco, alcohol and other drugs

Excessive abuse of tobacco, alcohol and other drugs can reduce your ability to remember, focus or execute tasks.

Keep your emotions balanced

Even though extreme anxiety and depression are not linked to cognitive impairment, it is always beneficial for your metal health to keep your emotions balanced.

Maintain social connections

 Constant communication and interaction with others is very important in maintaining social connections. The ability to bond with others over a period of time is associated with lower blood pressure and better mental health.  

Avoid injuries

Head injuries such as concussions can affect your brain’s activity while getting older. Reduce the risk by protecting your head.

These are just some simple tips and tricks to help your brain stay young and healthy. They are easy to incorporate in your everyday life, and will also improve your physical and mental health. 

A man who started as an athlete and became a Physical Medicine specialist. An interview with Dr. Herrera. 

We sat down with Dr. Joseph Herrera, a Rehabilitation and Physical Medicine specialist at Mount Sinai, to learn more about his specialism, career, passions and hobbies. Hope you enjoy!

Q: Why did you decide to become a doctor?

A: My overall purpose and why I get up in the morning is to help others get back to life. I love problem-solving and developing strategies for patients to overcome disabilities.  Whether it's knee pain and developing a plan to get back on the field to play soccer or if it is shoulder pain and developing a plan to put on a shirt, getting a patient back to their maximal function is my ultimate goal.

Q:  Could you tell us a little more about your specialties?

A: Physical medicine rehabilitation is such a broad field that covers all aspects of disability. Physiatrists can practice in several different subspecialties such as pediatrics, spinal cord injury, traumatic brain injury, sports medicine, pain management, and neuromuscular diseases to name a few.  The overall goal of the field is to maximize function and minimize disability. It is one of the most rewarding fields to be in. 

Q:  Where did your interest in fluroscopy/electrodiagnostic testing/sports injuries etc. begin?

A: I have always been active playing both recreational and competitive sports. I was a college athlete that suffered an injury and was treated. The process of return to play intrigued me. 

 My interest in electrodiagnostics and fluroscopic procedures occurred during residency.  I became especially intrigued in the ability to help people with pain through injections. 

Q: What is it that interests you in rehabilitation medicine specifically?

A: The ability to get people back to living their life is what interested me in rehabilitation medicine.

Q: How did you get into this field?

A: I was  introduced to the field in medical school. 

Q: Why Sports injuries?

A: Prior to medical school I was a crew coach and an athlete. Having the knowledge of biomechanics and knowing the mechanism of injury has helped me diagnose and treat various athletic injuries. 

Q: Favourite sport?

A: I love a number of sports rowing, baseball, football, basketball.

Q:   Favourite team?

A: Yankees, Giants, Knicks, Rangers and, of course, Rutgers University sports.

Q:  Favourite thing to do in New York City?

A: The Restaurants scene!

Q: Fun Fact about yourself.

A: I was a coach before going to Med school.