Fluoroscopic guided procedure at Mount Sinai

 Although at first it may sound a new deep-clean toothpaste or a strange form of horticulture, a fluoroscopy is an important diagnostic tool we use at Mount Sinai’s Department of Rehabilitative Medicine. You may have recently been, or potentially be referred for one of these treatments with one of our specialists. This week, we want to walk you through this vital piece of equipment and some of important procedures.

Firstly, What Is A Fluoroscopy Guided Procedure?

Before we answer that, we need to tell you what a fluoroscopy is. It’s nothing scary, your physician safely injects a dye into an area which allows them to investigate localized problems – which as you can imagine is much better than any alternative which may involve surgery. Our physicians can move joints, check organ health, locate a foreign body, amongst many other things. When the dye is inserted into the numbed area you may be asked to move or remain still depending on the nature of the investigation. From this point, your physician can study moving body structures as an x-ray like beam is passed through the examined part of the body which is then transmitted onto a monitor.

A fluoroscopy guided procedure in that case is the practice using a fluoroscopy to aid in providing relief to arthritis, especially in the hip joint. The physician can use the guidelines and information feedback to inject numbing agents or anti-inflammatory medications with maximum accuracy.

Why Have A Fluoroscopy or A Fluoroscopic Guided Procedure?

More often than not, your physician will recommend you for this procedure as an investigative procedure that will further increase their understanding of symptoms, underlying problems, and recovery. Sometimes however, we use the guides alone as a diagnostic or in conjunction with other diagnostic or therapeutic media or procedures. The reason therefore varies depending on your situation.

Risks and Additional Notes

There is very little risk associated with fluoroscopic procedures, whether it investigative or procedural. However, if you are – or think you are – pregnant please divulge this information with us before the exam. Other options will hitherto be discussed.

You may be asked to change into patient clothing, and all provision will be provided. Remove all piercings and leave all jewellery. We suggest leaving valuables at home.

Eat/Drink – specific instructions will be provided based on the examination you are scheduled for.

Please notify the radiologist or technologist as to your allergies or sensitivities to medications.

If you have been recommended a fluoroscopic procedure and would like to do it with us at Mount Sinai, or if you are having one with us soon and would like more information, please contact us on (212) 241-6321) to see if our physicians can further help.

What Is An EMG/NCS And How Can It Change Your Life?

At Mount Sinai’s Department of Rehabilitative Medicine, we will sometimes refer patients to complete an Electrodiagnostic test when an underlying muscle issue is unobvious. These tests are helpful in evaluating weakness, numbness, and pain; and there are two main components in the examination – the electromyographic examination (EMG) and the nerve conduction study (NCS). 

While the EMG and NCS are different tests, they’re often used together as the information from each test synergises with the other, giving a more complete analysis.

The tests will inform our physicians on unexplained muscle weakness, twitching, paralysis, and find the cause of numbness and pain the patient may be experiencing. Most importantly, it informs your physician on whether there is a muscle disorder in the muscle itself, or within a nearby nerve.

The EMG and NCS are considered non-invasive imaging tests, although there will be a needle involved. Your physician will insert a very fine needle, which acts as an electrode through the skin and into the problematic muscle. You will be asked to begin contracting the muscle by moving the area local to your symptoms. For example, the needle will be placed into the tricep, and the patient will slowly extend the arm, contracting the tricep with increased force as the electrical activity is recorded. Activity within the localized area will be visualized and available to watch on an oscilloscope and played audially through a speaker. These results can inform our physicians on the muscles ability to respond to nerve stimulation.

Nerve stimulation is often reported to causes a tingling sensation however there are no long-term effects. The EMG and NCS usually require an hour to complete and there are no restrictions in activities or meals before or after the test. Patients however do frequently feel some minor discomfort, similar to an injection, when the needle is inserted – with examined muscles feeling sore for a few days. There may also be light bruising in the affected area.

The results will also be able to help us diagnose neuromuscular diseases, and motor control disorders such as carpal tunnel syndrome or muscular dystrophy. From this point, there is no general direction as results will vary, and diagnosis will simply point you toward the optimal rehabilitation.

If you are suffering from an undiagnosed muscle issue and think you could benefit from a EMG/NCS diagnosis please contact our switch on (212) 241-6321) to see if our physicians can further help.

Defining Knee Injury, what is the ACL, and how do you damage it?

One of the more common knee injuries is a tear in the ACL, a tough band of tissue that joins the thigh bone to the shin bone. This damage can occur from a number of scenarios; however, they are more often than not sport injuries. 

At Mount Sinai, we have noted that the most frequent causes for a torn ACL is a sudden change of movement, landing badly from a jump or fall, or the result of a collision in a tackle – scenarios which usually arise in high demand sports like soccer, football or basketball.

Outside of competitive sports, we find that people develop ACL damage by changing direction rapidly, stopping suddenly, and slowing down while running. These are all movements that are exaggerated when playing sports, which is why you are less likely to tear the ACL when not participating in high-level sport.

Female athletes have a significantly higher incidence of ACL injury than male athletes, this is believed to be due to physical conditioning, strength, and neuromuscular control. It is also believed to be linked to differences in pelvis and lower extremity alignment, increased looseness in ligaments and the effects of oestrogen in the body.

What is the ACL?

The anterior cruciate ligament runs diagonally through the middle of the knee and prevents the tibia sliding out in front of the femur as well as providing rotational stability to the knee. You can imagine it as an X running through the knee.

You also have collateral ligaments, which are found on the sides of your knees. These control the sideways motion of your knee and brace it against unusual movements.

Damage to the anterior cruciate ligament (ACL) may require surgery to regain full function of the knee – but this will be dependent on several factors such as the severity of the tear.

How severe is the damage?

As usual, we class the sprains into 3 classes which increase in severity incrementally.

·        Grade 1 – The ligament is mildly damaged. It has been stretched, nudged, or pushed ever so slightly out of its comfort zone. You will still be able to keep the knee joint stable.

·        Grade 2 – The sprain will have stretched the ligament to the point in which it has become loose and will most likely mean there is a partial tear to the ligament.

·        Grade 3 – This type of sprain is commonly understood and referred to as a complete teat of the ligament. It will have split into two pieces and completely destabilized the knee joint.

It is worth noting that partial tears are usually rare – most ACL injuries are near complete tears.

If you have recently torn your ACL and would like to speak to one of our physicians, please contact our switchboard at (212) 241-6321 to discuss options.

Manage A Broken Leg with Mount Sinai

In previous blogs, we at Mount Sinai’s Department of Rehabilitative Medicine have often focused on nuanced physical damage and therapy like ACL tears and rectifying damaged ligaments. This week,we are shifting our focus toward more serious damages: broken bones.

Your leg is comprised of four bones, the femur, patella, tibia, and fibula which work together alongside tendons and muscles to allow bending at the hip, knee and ankle. You won’t need to be told that you’ve broken something, a leg fracture or break is severely painful – and will likely be swollen or bruised. You will rarely be able to walk on it.

One of the key indicators of a broken bone in the leg is the leg being out of shape, oddly shaped, or differently shaped than before the incident. Likely, there will have been a crack when the leg was broken and the shock and pain of breaking your leg will likely cause you to feel faint, dizzy, or sick.

Unfortunately, as with many broken bones – you need to immediately make your way to a local A&E department. If the injury seems severe, call for an ambulance service. While you are on your way there are three key points you should always bear in mind.

Movement – stay put and do not move the injured leg unless absolutely necessary. Avoid moving the leg as much as possible by keeping it straight or wedging it with a soft object like a cushion.

DIY – do not attempt to realign or fix the bones yourself, and do not let a friend or passer-by attempt at doing so either. Seek professional attention immediately to avoid long term problems and worsening the situation.

Plastering – attempt to cover wounds with sterile dressing and any clean item you might have on your person (like a clean t-shirt). This will ensure that the wound has the best chance of avoiding infection.

When you arrive to your doctor, they will most likely give you painkillers and may fix a splint to your leg. This will secure it into position and prevent further damage. If the bone is broken, but still in position, you will most likely be recommended a plaster cast which will hold the damaged area together until healed. Large amounts of swelling will mean that you will need to wait a few days until your cast is fitted.

In severe cases, surgery will be required to ensure that the bones heal properly and are fully realigned. This is especially important if you play sports.

If you, or a friend, has damaged or broken a bone in their leg recently and would like to discuss a physio plan – please contact our switch board on (212) 241-6321 to discuss options.

Blood Injuries in Boxing

Although a physical, high impact (and let’s face it somewhat violent) sport – boxing comes in as having the fewest blood injuries. In American Football or Rugby for example, most players will come out with cuts all over their bodies – some worse than others. The problem with boxing is, when there’s blood there’s a lot of it as there are no middle ground scrapes (usually) as found in other impact sports. Blood in boxing means that someone is going to need towel to clean up after.

When going toe-to-toe, if the head is the target – the nose is the bullseye. If you get a good swing onto the opponent’s nose there is a very high chance you’re in for a win. The same goes with the eyes which can puff up badly and bleed profusely. Without putting you off your favourite sport, let’s take a look at how you can deal with bleeding in boxing.

If someone makes it through your guard and catches you in a groggy state, there will most likely be bleeding. The quicker the blood is stopped the less likely you or others around will be exposed to potential infection. You, or your coach, should have First-Aid supplies at hand to stop the bleeding until you can get to A&E or more help can get to you.

A nosebleed can be dealt by doing the following.

·       Pinch the nose bridge and lean forward – and probably try to avoid expensive equipment. The usual thought is to tilt the head backwards, but this is not recommended as it allows blood to flow down the throat and into the stomach.

·       Plug the bloody nostril with cotton nose plugs or cotton balls to help stop the flow of blood. Replace plugs as needed if blood flow continues. Carefully remove them as large blood clots may stick to the end.

·       If the blood flow continues take a small bag of ice and place it on the nose bridge for at least five minutes. If bleeding continues, the nosebleed may be more serious and need a doctor’s care to be cauterized.

If you’re sweaty a band aid won't stick. Or if the cut is too large (laceration) it may be hard to completely cover it. Keep the cut or laceration clean. Stop bleeding by applying pressure using a towel or gauze to stop blood flow so it can be covered.

Although boxing injuries tend to heal on their own, there are instances in which the injury could become infected, or necessary to receive stitching. Please contact our switchboard at (212) 241-6321 to discuss options if your sustained injury needs looking at.

Head, eye, and body damage from boxing

Muhammad Ali is renowned for many things, from his showman style of boxing, to his stoicism in the face of adversity, and his mind-blowing right hook. The Legend went on to develop Parkinson’s later in life because of the physical trauma his head received throughout his life, or at the very least, antagonised a pre-existing condition. His tragic ending gave rise to the Muhammad Ali Boxing Reform Act that seeks to minimise the dangers of the sport. This week, in a concerted effort to maximise safety within the sport we are going to focus on how you can honour the greats by staying safe in the ring.

It goes without saying that any activity that involves blows to the body, and especially the head, is high-risk. This means that boxing can have serious effects on the health of most people who are involved in the sport, and this goes especially for men. The American Association of Neurological Surgeons say that around 90% of boxers at some stage sustain a brain injury of some kind as any blunt trauma to the head can damage the surface of the brain.

The punches boxers spend most of their time perfecting are not usually going to knock someone out, except for in rare and bizarre circumstances, and that is the jab. Jabs are great for set ups and counter-attacked but aren’t exactly “haymakers”. Your brain sits suspended in fluid, when your head whips around, the brain whips around too which means the tissue stretches and compresses. This trauma leads to concussion. Repeated concussions over time eventually lead to serious brain damage, and this has been shown time and time again. Concussion is currently a huge theme in the current sporting climate, with many contact and impact sports focusing on ensuring sportspeople are safe.

What should you do if you become concussed? It depends on the severity of the concussion. Sometimes concussions need emergency treatment and sometimes it will be minor, either way – you need to have specialists around to ensure no long-term damage is done. Signs of concussion usually appear within a few minutes or hours of a head injury – occasionally, they won’t be obvious for a few days, so it’s important to look out for any problems in the days following a head injury.

Symptoms include

Dizziness

Headache’s that aren’t relieved with painkillers

Feeling sick or vomiting

Confusion

Changes in vision

Trouble with balance

Memory loss

If you suffer one or more of these symptoms are a blow to the head, then you should consider it a priority to speak with your coach or anyone nearby as you are at high-risk of long term damage.

If you have suffered from concussion and would like to contact one of Mount Sinai’s dedicated teams, please contact our switchboard at (212) 241-6321

Defending Your Guard

Boxers face numerous risks when training and in the ring. But there’s one injury that rings truly rings bells of fear in the Mike Tysons and Alis among us – that’s right, an injured hand. Not only does damaging these tools mean you can’t box anymore, it is also the least glamourous of all the boxing injuries. And nothing seems like more of a cop-out than missing a fight because your hand hurts. This week, we are going to focus on how to make sure you guard is always up by showing you the best ways of looking after the most undervalued asset of any boxer – their hands.

The most common fracture in boxing is a break between the small bones in the palm of your hand, usually located between the ring and pinkie. This damage is usually the result of punching immovable objects. While the larger bones in the hand absorb blunt trauma well, the smaller, more fragile bones don’t. The sportsman will feel a sharp pain in the hand immediately after the punch before it becomes swollen, discoloured, and immobile.

Another injury we often see here at Mount Sinai is carpal bossing, identifiable by a massing at the back of the palm. Patients tend to report some discomfort depending on the repetitive strain put on your head prior to your injury. Interestingly, this injury seems to occur mostly in males above the age of 20 but under the age of 40.

To prevent these common hand issues, it is imperative that you take care of your hands. Having good equipment will ensure you minimize the risk of severely damaging an area or extremity. This applies mainly to good boxing gloves that appropriately fit your hand and quality wraps (and wrapping) that support your wrists and smaller bones. Finally, ensure you give your body enough rest between sessions and after bouts. You should ice the damaged area immediately and speak to your coach.

In some cases, it may be necessary to seek medical attention and ensure you get an X-Ray to confirm the diagnosis, and the sooner you get this done the better. If you have damaged a few smaller bones in the hand you can be saved with ice and rest and usually broken fingers that are immobilized will be allowed to heal. Most recovery takes between 6-10 weeks. Although you may experience slight loss in grip strength, the rate of recovery is excellent at around 85%.

In extremely rare cases your doctor will prescribe anti-inflammatory medication, steroid injections, and in rare cases surgery.

If you believe you are suffering from one of the problems discussed in this piece and would like to speak to one of our physicians, please contact our switchboard at (212) 241-6321