How to Treat A Jammed Finger

You’re slipping through the defence, dribbling the ball between both your own and the opponents’ legs when a hand comes out of no where and slaps the ball right into your index finger. The pain strikes immediately, you look down – your finger looks fine but there’s an agonising pain running through your hand. Soon after it swells. You stop and realise – you have now succumbed to, undeniably, the most frustrating injury in basketball, sport, or possibly history: the jammed finger.

What’ so annoying is that it seems like such an insignificant injury – but you’ve been chastised from the game of your life by a rebounded ball or a poorly timed catch; and that’s no champion ending. A jammed finger is the worst type of injury. On the other hand, what’s great is, a jammed finger doesn’t have to be the end. Treat it properly, and you’ll be back on the field in no time.

The jammed finger is archetypically swollen, hard to bend, and somewhat painful. As with most minor sporting injuries, RICE treatment is your first port-of-call; that’s of course assuming you don’t have a physiotherapist or orthopaedist to hand. The injury is usually located in the knuckle, where the blunt of the trauma is experienced. The most common form of injury sustained in this field is a volar plate injury.

When the ball hits the finger head on, collateral finger ligament can rear at the attachment at the volar plate (which is a thick ligament on the palm side of the joint) and the middle phalanx. A piece of bone is torn away by a tendon or ligament, which provokes the symptoms aforementioned. Any injury that causes hyperextension of a ligament can end in a tear of the volar plate.

It is important to evaluate the jammed finger quickly as the avulsion fracture may indicate major ligament damage, which if left alone will develop into long-term pain and stiffness. When an accident in the realm of description above occurs, the most important thing to do is check what has happened. If your finger looks crooked, dislocated, or is unbearably painful the chances are you have broken your finger or something more serious. If this has happened, you should contact your physician immediately to avoid any irreparable trauma.

If you suffered from a jammed finger, or if you suspect your finger has sustained more serious damage and would like to speak to one of our physicians, please contact our switchboard at (212) 241-6321

Tips from Coach Sinai – Drills to Prevent Musculoskeletal Disorder

When athletes compete on the world stage we know that their results are dependent on the work, discipline, and commitment they have dedicated “off the field”. We never see them practice, but we know they do. Minimizing sports injuries is just like this. It takes commitment when not in your sports gear to ensure your body is functioning in the best way possible when you are. Musculoskeletal disorder develops as a result of our habitual actions but has a severe impact during sporting activities. It is one of the leading causes of sporting injuries – and it is usually the result of seemingly unrelated facets of our lives, like our jobs (assuming our reader isn’t an Usain Bolt of the world). This week, continuing from last week’s preventative approach to physical health, we are going to outline how you can look after your body in the workplace to reduce the risk of a work-related musculoskeletal disorder.

Musculoskeletal Disorder

Musculoskeletal Disorders (MSDs) are injuries or pain in the body’s joints, muscles, ligaments, nerves, tendons and structures that support the spinal cord (from the upper neck down to the back). MSDs are distinguishable by their deep and dull pain, and numbness or stiffness in joints. Common conditions related to MSD include muscle strain in the neck, pinched nerve, carpal tunnel syndrome, and sprains. It can weaken our spine and supportive muscle groups which are then vulnerable when we engage in sport.

The Warm Up

Some injuries are the result of accidents and poor form during physical activities. Most injuries, however, are the result of or are worsened by, poor habits. That means that lifestyle is often the cause of serious sporting damage.

Experts at Mount Sinai’s Rehabilitation Center have identified that MSD is not necessarily the result of a sudden event but that it gradually develops over a period of time and is often aggravated in our work environment.

Some known factors of work-related MSD include:

·       Performing repetitive actions

·       Lack of physical movement

·       Poor body mechanics when lifting, bending or reaching

·       Poor posture at desks (such as computers and workstations)

Your Off-Pitch Coaching

The Mount Sinai team have compiled these top prevention tips to help avoid long-term problems during your work hours. By following these tips, you encourage a healthier lifestyle and minimise the risk of long-term damage during sports.

·       Take breaks during your day. This is important for people who work on their feet and those behind a monitor all day – ensure you rest your body from repetitive strain or ensure your body has time to move around.

·       Incorporate stretching and movement into whatever you do. Your body is like an engine – and stretching it is like keeping it well-oiled.

·       Practice good posture. Avoid slouching and bending in awkward positions. Always lift heavy objects with a straight and stiff back and avoid straining the neck by resting your phone between your ear and your shoulder.

·       Reduce repetitive or prolonged activities regularly. If this is impossible, then look for time to allow those muscles to rest.

·       Adjust your work area so to reduce awkward bending and stretching. If you are bleeding a radiator make sure your tools are near or don’t strain yourself trying to drag a pen with your foot.

It seems unintuitive that seemingly unrelated activities can have such a major effect on our part-time sporting careers, but they do. Reclaim your health by following these tips and ensure you do not create the musculoskeletal conditions that subsequently lead to serious damage.

If you have suffered a sports-related injury or would like to discuss a bespoke plan for dealing with MSD, please contact us at Mount Sinai Department of Rehabilitative Medicine. Contact our switchboard at: (212) 241-6321

Sports: How To Look After Yourself "In Season"

Being involved with sports brings a wealth of health to your life. Regular exercise increases our average lifespan, helps with mental health difficulties, and generally keeps our body well-oiled. There isn’t much regular exercise doesn’t have a positive effect on. From children to the elderly, we all can benefit from a daily dosage of activity. However, being involved in sports and exercise regimes does bring with it some risk, especially considering games like American Football, and Ice Hockey, which of course are considerably more perilous than going for jogs around the local park or lifting light weights at the gym.  Let’s take a look at how we can take a preventative step toward long-term damage in sports and other exercise regimes by taking some precautionary steps.

Stretching

From Grandpa-Joe to Hulk Hogan, everyone needs to stretch both before and after exercise. Stretching make our muscles suppler, increases heart-rate, and increases long-term flexibility. Most importantly, stretching reduces injuries such as ligament tears, muscle tears, and strains and sprains which can have a lasting effect on your body, and take months of rehab to fix. Stretching, therefore, is an important part of any exercise regime or sports. Make sure your warm-up is suitable for the sport you are doing, and don’t overdo the warm-up. There is nothing worse than tearing a hamstring during your hamstring stretch because you rushed into sprints.

Knowledge and Self Awareness

Some sports-enthusiast-readers will be uber-keen to improve fast. Whether that means getting stronger, faster, or fitter you should be aware of your current level of fitness and work to improve and excel and not jump the limit. Do not push your body beyond its current level of fitness as it is dangerous and unnecessary. Even if you feel that you are quickening the path to your goal by pushing yourself like this, you will harm yourself. Be aware of the level you should be training at and stick to it to avoid serious damage. It is also useful to understand and use the correct equipment.

It is important for runners to wear the right-soled shoes, and American Football Players to wear gum-guards. Increase your knowledge and understanding of exercise so you can reap the benefits and avoid the perils. A fantastic way of doing this is listening to your coach. They usually have a wealth of information stored to reduce risk when engaging in sports. They can also advise you on different aspects of maintaining your health, from the best ways to warm-up and cool-down to the correct diet. Bathe in their wisdom.

 

Eating Well.

Mount Sinai is a huge advocate for healthy diets. Eating well and drinking plenty of water can reduce the risk of damaging yourself in sports. A nutritious diet allows muscles to repair and regenerate after exercise reducing the risk of harming or overusing a muscle group which can lead to tier-3 tears, and months of rehab. Knowledge of your sport can help you ascertain what kind of diet you should be following.

These three top-tips are the most effective preventative steps you can take to seriously harming yourself whilst engaging in sports. Precautionary steps can save you time in the long run by reducing the risk of severe damage and rehab.

If you have suffered a sports-related injury, please contact us at Mount Sinai Department of Rehabilitative Medicine for a bespoke rehab plan. Contact our switchboard at: (212) 241-6321

Olympic-Level Care With Dr. Gerardo E. Miranda-Comas

This week Mount Sinai is proud to introduce you to Assistant Professor of Rehabilitation Medicine, Dr. Gerardo E. Miranda-Comas. Trained in Physical Medicine and Rehabilitation, Dr. Miranda-Comas has sub-specialized in Sports Medicine, with a clinical focus on a vast range of sports-related injuries. His medical interests include the diagnosis and non-surgical management of musculoskeletal injuries, sport-related injuries, exercise prescription, electrodiagnosis, regenerative medicine, and diagnostic-therapeutic musculoskeletal sonography. With every injury case, Dr. Miranda-Comas believes that the best intervention lies in increasing patient awareness and education, and he aims to aid early return to function, and improvement in the patient's quality of life.

Dr. Miranda-Comas' interest in sports medicine began while completing a fellowship in the field at the University of Puerto Rico School of Medicine. Since then he has been involved in sports medicine at every level, being invited to lecture at scientific meetings at both national and international levels, as well as having published many articles on the subject. His interest in sports stretches beyond his professional life, to his involvement in covering sporting events from high school-level, right through college sports and up to elite-level events.

A true testament to his expertise within the field, Dr. Miranda-Comas was selected to be a member of the medical team at the 2016 Olympic and Paralympic Games in Rio. Only the best physicians are selected to become a member of the Olympic medical team, following a long application process, and are required to have an intimate and expansive knowledge of athletic injuries. However, this is not the only mass participation event that Dr. Miranda-Comas has contributed his medical knowledge to, being present in a professional capacity at both the New York City Marathon and the Pan American Games.

On top of his real-world experience with sports injuries, Dr. Miranda-Comas has earned four board certifications in Physical Medicine and Rehabilitation, Sports Medicine, Electrodiagnostic Medicine, and Musculoskeletal Ultrasound. Holding roles as the Associate Program Director of the Mount Sinai Sports Medicine Fellowship, and as a core member of the of the Physical Medicine and Rehabilitation Program faculty, Dr. Miranda-Comas is extremely qualified to treat a range of sports-related complications. But don't take our word for it – take a look at his customer experience rating of 4.8 out of 5 stars on our website as a true testament to his knowledge and skill in the field!

To book a consultation with Dr. Gerardo E. Miranda-Comas, request an appointment here

The Best Exercises for Strong Bones

 With advancing age the risk of developing osteoporosis rises. This risk may be increased by having lower than normal peak bone mass, and subsequent greater than normal bone loss. The chances of this happening can be lessened by doing exercises that involve weight bearing. This is because when you do weight bearing exercises your bones adapt to the impact exerted by this extra weight and the pull of your muscles by building more cells, and thus become denser and stronger. The type of exercises that are most beneficial vary depending on age.

Children

For children, bone strengthening exercises can start before they can even walk. Crawling and active play begin the gaining of muscle mass. After they have learnt to walk unaided, activities such as climbing, walking and running, and jumping all contribute to the development of strong bones.

Teenagers and Young Adults

As children reach adolescence an active lifestyle is crucial to increasing bone mass. It is around this age that the most can be done to achieve a high peak bone mass in their early twenties. All sorts of competitive sports, from soccer to tennis to martial arts are beneficial, as are more individual exercises. Skipping, body weight exercises and high-energy activities such as aerobics and dance can strengthen muscles, while putting weight on the bones, encouraging them to increase cell production. In order to build up strong bones children should aim to undertake 60 minutes of exercise a day.

 

Adults

From your mid-thirties natural bone loss begins to occur. In order to reduce the rate of this, muscle-strengthening activities should be done at least twice a week. This can include doing some of the activities that young adults do, but also less exercise-focussed pursuits, such as brisk walking, stair climbing, carrying groceries, gardening and moderate-resistance weightlifting. These activities are less aimed at building bone mass as they are at maintaining muscle strength. Adults need less frequent exercise than children, but should aim to do at least 150 minutes of cardiovascular exercise a week, on top of muscle-focussed exercises.

Elderly

For elder individuals, or those at high risk of osteoporosis and fragile bones, it is advised to avoid particularly high impact exercises. However, maintaining a healthy, active lifestyle is beneficial. Going for a walk or doing necessary housework are both good ways of keeping active throughout the day. Swimming can improve stamina and joint flexibility in a low-weight environment, while tai chi is recommended as it is low impact but can improve balance and posture while strengthening muscles in the legs.

Until a bone is broken, there are no symptoms of osteoporosis. As the likelihood of developing it increases as you age the best preventative method is to build up strong bones at a young age and to sustain beneficial exercises throughout life.

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.

Introducing Dr. Spinner

Last month we met Dr. Joseph Herrera. This month we introduce you to Director of Pain Medicine and Minimally Invasive Spine Surgery for the Department of Rehabilitation Medicine, Dr. David Spinner.

Dr. Spinner has always had a keen interest in sports, specifically baseball, basketball and the winter Olympics. Besides being a fan of various teams, he has also participated in many sports over the years, including volleyball, skiing, tennis, and most preferred of all, baseball. This interest in sports directly links to his current particular interest in sports injuries and the related field of musculoskeletal medicine. Musculoskeletal medicine is left largely unexplored in most medical sectors and it was his interest in this niche topic which led him to eventually specialize in Rehabilitation Medicine.

The medical education leading towards Dr. Spinner's eventual specialization began at Emory University, before being continued at the New York College of Osteopathic Medicine. Following this he completed an internship at Maimonides Medical Center, Brooklyn and subsequently embarked on a residency at the Icahn School of Medicine. In 2015 he won an award for pain medicine fellowship excellence for his work during a fellowship in Interventional Pain at the Beth Israel Deaconess Medical Center and the Harvard Spine Center. He has made contributions to furthering the field of Rehabilitation Medicine through investigating new ways to advance procedures and improve patient care. Dr. Spinner is one of the first physicians in the country to be certified in diagnostic musculoskeletal ultrasonography, and performs many musculoskeletal pathologies. His focus lies in ultrasound guided interventions, advanced spine interventions, and minimally invasive spine surgery, and he has written several publications concerning these techniques. The list of other interventions that Dr. Spinner performs also includes spinal cord and peripheral nerve stimulation, kyphoplasties, endoscopic rhizotomies, and disectomies.

As a specialist within his field, Dr. Spinner lectures on musculoskeletal ultrasonography across the country and was the lead editor for the Atlas of Ultrasound Guided Musculoskeletal Injections, the first textbook on this subject. He has developed his own unique strategies towards the treatment of both acute and chronic pain.

The interest that Dr. Spinner has in this field continues beyond his professional practice. He is a supporter of various pain and musculoskeletal charities, including the Facial Pain Association, a resource for information and guidance for those suffering from neuropathic facial pain. Dr. Spinner is also an active and involved supporter the Wounded Warriors Project, whose mission it is to honour and empower war veterans who suffer from physical and mental ailments in relation to their military service.

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.