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.