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.

Curing Golfers Elbow

Last week we focused on what Tennis elbow was and how we can get it “on the mend”. This week, we are going to take a look at the inverse – golfers elbow and explain how you can treat it. Both these elbow problems occur frequently to baseball players due to overuse, strain, and the repetitive motions found in pitching and batting.

What is Golfer Elbow?

Golfer’s Elbow, known as Epicondylitis, causes the inner side of the elbow joint to feel tender and painful – you are more prone to this condition when involved in throwing motions (or playing golf), yet those with manual occupations can also be affected.

The affected tendon is the common flexor tendon which attaches the flexor muscles of the forearm to the inner side of the elbow. These muscles have a myriad of responsibilities from throwing to allowing your fingers to curl up. Golfers elbow occurs due to microscopic tears that cause the tendon to degenerate. The condition becomes chronic or long-lasting if the tendon that attaches to the bone calcifies – and in rare cases, larger tears can develop causing more issues. The vast majority of cases, however, are not serious and can be self-managed.

Symptoms include pain and tenderness on the inner side of the elbow. Pain is usually felt just over the bone and is triggered by gripping, squeezing, or pulling. The symptoms are extremely telling which means no extra investigation is usually required.

How Can You Manage the Symptoms?

If the elbow is sore after physical activity, apply ice for 15 minutes every few hours. We highly recommend you follow our tips on PRICE that can be found by clicking this link.

Most cases of Golfer’s Elbow can be managed just by modifying activities. That may mean, depending on the severity of pain, you must stop playing and or training until your physician or physio gives you the go-ahead to get back on the field. A small number of more severe cases may require a steroid injection. In very rare cases surgery may be necessary.

Anatomically guided Corticosteroid injections can also be a solution. This involves steroids being injected around the tendon and its insertion into the bone. Although this is minimally invasive, there are risks and possible side-effects you should consider with your physician. 

If you have suffered from Golfer’s elbow, please contact us at Mount Sinai Department of Rehabilitative Medicine for a bespoke rehab plan. Contact our switchboard on: (212) 241-6321

What Are the Symptoms of Brain Injury?

What is Brain Injury?

Brain injury is a deterioration of the cells inside the brain. There are two distinct types of brain injury that can cause the symptoms. These are Traumatic Brain Injury and Acquired Brain injury. The former is caused by an external force – such as concussion – which causes the brain to bruise against the wall of the cranium. The latter is more commonly associated with pressure on the brain. This could come in the form of a tumor or a stroke. Often, the two terms are used interchangeably.

But What Are the Symptoms?

Moderate and severe instances of TBI are easier to diagnose. Problematically, mild cases often go unnoticed as symptoms scale with the severity of injury. With ABI it is difficult to judge the severity of damage caused as a judgement is made post damage. With TBI, we are able to judge the severity using a time-scale of unconsciousness after an impact.

The Glasgow Coma Scale

                        GCS                                         PTA                                          LOC

Mild                13-15                                       less than one day                    0-30 mins

Moderate       9-12                                         1 to 7 days                              30 mins to 24 hours

Severe             3-8                                           more than 7days                    more than 24 hours

Where GCS = verbal rating after damage, PTA = how long post-trauma amnesia lasts, and LOC = period in which the victim is unconscious.

From here, let’s walk through the main symptoms we can look out for. There are two prominent behavioural symptoms that can manifest after a brain injury: emotional and memory.

Emotional Behaviour

Brain injury is associated with a number of emotional challenges such as depression, self-control, anger management. Victims can also find themselves struggling in social situations where they did not before, that is, they may have lower levels of self esteem and anxiety. These psychological manifestations can lead to isolation, a reduced ability to function in society, martial difficulties, and keeping his or her job.

Memory

The most common post-brain-trauma experience is a loss of memory, or at the very least, a reduced capacity for memory. As memory is intrinsically linked to attention, it can be difficult to diagnose the symptom as physicians need to be careful to distinguish between memory loss and poor attention. Almost all cases of brain trauma come with a reduced memory capacity compared to people who have not experienced brain trauma; and, although patients usually experience significant recovery during the initial recovery phase, there is often an element of permanent damage.

There is a myriad of ways of dealing with this patterned change of behaviour, but it is best to contact your physician to ensure a bespoke plan that will deal with your specific case. Brain injury recovery plans are not one-glove-fits-all. The brain is a complex organism, and no two people can be expected to experience the same difficulties. As it controls every aspect of human life, when it is damaged any part of a human life could be affected.

If you would like a plan on how to deal with a recent brain injury, please contact us as it is important you speak to your physician as soon as possible. Contact our switchboard on: (212) 241-6321